There is a “mismatch” between what people in the community expect from aged care services and what the sector is actually funded to deliver, says the head of one of Australia’s leading aged care peak bodies.
Funding per person for aged care services is significantly lower than for hospitals and disability, a situation that is “discriminatory”, said Aged and Community Services Australia chief executive officer, Pat Sparrow.
The royal commission is a once-in-a-lifetime opportunity to ask what we want from our aged care system, says Ms Sparrow.
Residents older, more complex health needs
Over the last decade, there’s been a significant increase in the proportion of people coming into aged care with high-level, complex health needs, Ms Sparrow told HelloCare.
According to the Productivity Commission, in 2017/18, 53 per cent of all residents were receiving the highest level of complex health care funding, compared with 12.7 per cent in 2008/09.
“I remember a time when people used to drive their car to and from aged care, but the people coming in now, don’t do that. They come in at a later age, they’ve got more complex healthcare conditions,” Ms Sparrow said.
Aged care not funded to provide high-level healthcare
With a larger population of residents with high-care needs, the cost of caring for them has also risen, but funding has not kept pace.
Ms Sparrow said in many cases the community expects complex healthcare to be delivered in residential aged care facilities, and there is a “mismatch” between expectations and what can actually be provided.
“I think people come in (to aged care) with an expectation we will be more hospital-like than we are able to be,” she said.
“People come in and they think we’ll be staffed and funded like a hospital, but there’s a big funding differential between aged care providers and what hospitals are funded to do for people, even (for those) with similar kinds of needs,” she said.
Ms Sparrow’s concerns were echoed by dementia advocate and COTA volunteer, Val Fell, at last week’s Criterion Quality in Aged Care Conference, who said she is often asked, “If I’m paying all this money”, why aren’t I getting the care I need?
Older people should have access to the healthcare they need
“An older person needs to have access to the healthcare system, regardless of where they live,” Ms Sparrow told HelloCare.
“They should be able to get the medical services they need, and we need to make sure it (the healthcare system) works.”
Huge funding differences: aged care, hospitals and NDIS
Ms Sparrow said older Victorians who find themselves in a ‘geriatic evaluation management bed’ in hospitals are usually discharged into nursing homes.
“One day they’re in a geriatric management bed on around $800 day, and then the’re discharged into a nursing home on around $280 a day (on the top ACFI),” Ms Sparrow said.
Anecdotally, Ms Sparrow said she has heard the funding differential has made some people reluctant to leave hospital.
At the Quality in Aged Care conference, Ms Sparrow said,”I’m not saying that our (aged care) services are the same (as hospitals), but that differential is huge.”
There is also a huge difference between disability funding and aged care funding, even for people with the same care needs.
At the conference, Ms Sparrow told the audience of a friend with disabilities who received $78,000 per annum for their care while living in aged care, but received $309,000 when they moved into a disability setting.
“There’s probably less than 10 per cent of people on the NDIS who are on that amount, but the truth is, if that person needs support and they’ve come into residential aged care or they’re on the NDIS, their needs are the same and they should get the same funding wherever they’re living.”
“At the moment… if you’re under 65 and you get into the NDIS system, you might be able to get a higher level of funding than if you’re over 65 with the same conditions and living in residential aged care, and that to me seems fundamentally discriminatory.”
“Why is it okay if someone ends up in aged care, whether they’re over 65 or under 65, they only have access to $78,000,” she asked.
Royal commission: what do we want aged care to be?
“People are being treated differently for the settings they’re in, when what we really should be looking at is what are the needs of that person and, regardless of where they live, how are they supported, otherwise it’s discriminatory,” Ms Sparrow said.
These issues, and others, are being examined in the royal commission.
“We have to get serious, and the only way we can do that is to look at all the different angles, which the royal commission is doing,” Ms Sparrow told the conference.
If the community says it wants the aged care sector to operate differently, and if the royal commission recommends more health services should be able to be provided in aged care, then “a different sort of funding for aged care” is needed, Ms Sparrow said.
“The royal commission gives us an opportunity to say… there might be a mismatch now, but what do we want it to be going forward?”