A new Aged Care Act cannot fix a broken system

Aug 30, 2023
Shot of a senior couple standing close together.

Age 65 is no longer relevant to define older people in a new Aged Care Act. It was introduced by Bismarck in Prussia in the 19th century at a time when life expectancy was less than 50 and few people lived past 65. It was reinforced by the US Social Security Act under Roosevelt in 1935 when life expectancy was 58.

Most people in their late 60s now are relatively fit and active and many wish to continue working. Defining these people as old contributes to ageism and denies them access to jobs. More significantly, it denies these people access to the NDIS which emphasises reablement as against the care emphasis of the Aged Care system

Age 70 is a reasonable compromise.

Aged care

Conflating Community Aged Care programs and Residential Aged Care (RAC) into one Aged Care Services no longer makes sense or helps to provide quality services.

Community Aged Care aims to maintain people at home in a state of independence and has similar goals and principles to the NDIS.

Residential Aged Care is a health care system trying to manage some of the most difficult problems in our health service. It is denied the resources it needs to do this work because it is not part of the mainstream health system.

It also allows the health system to deny any responsibility for the assessment of delirium; the assessment and management of severe behavioural problems in dementia; and other problems experience by RAC residents that are beyond the expertise and resources of the RAC system.

Residential aged care

This is a broken system that needs to be rebuilt from the ground up. Tinkering with it by a new Act will do nothing to provide quality care for older people.

When I started in Geriatric Medicine 40 years ago, we had nursing homes (high care) and hostels (low care). Nursing homes looked after people requiring high levels of nursing care and people with dementia with no significant behavioural problems.

Hostels looked after ambulant people who didn’t wish to live at home because of ill-health, anxiety or lack of suitable accommodation. Hostels were closed in the 1980s and nursing homes now had high and low care with ageing in place, mainly for people with cognitive impairment.

Older people with chronic mental illness; older people with intellectual disability; people with dementia and severe behavioural problems; and younger people with traumatic brain injury or quadriplegia were all in purpose-built long stay hospitals.

All these long-stay hospitals have been closed as cost-saving measures and ideological imperatives. Some of these people moved into community homes but many were forced into residential aged care due to the lack of alternatives, often because of the failure of States to make the required expenditure.

Residential Aged Care Facilities (RACFs) now look after:

  •  people with high levels of nursing care requirements
  •  people with dementia and a wide range of behavioural and psychological problems
  •  older people with chronic mental illness
  •  older people with intellectual disability, many of whom now have dementia
  •  people with slowly resolving delirium following acute illness preventing their return home
  •  young people with traumatic brain injury with frontal dysfunction.

This range of people and problems is managed in one environment with a single staffing mix, many of whom are poorly paid, inadequately trained and from a different cultural background to the residents.

Decisions to be made before a new Aged Care Act can be introduced

Before any new Aged Care Act is introduced which increases the administrative demands on staff, the Commonwealth Government needs to determine:

  • how the RACF system can be restructured to provide appropriate care to the range of older people now receiving care.
  • how an appropriate staffing mix can be funded and trained.
  • how primary care will be provided to supplement the dwindling number of GPs willing to attend RACFs.
  • the integration of the RACF system into the mainstream health care system so that appropriate resources are available for good medical care.
  • the feasibility of including people up to 70 in the NDIS.

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