The Prime Minister has apologised for the number of deaths in residential aged care during the COVID disaster. But he hasn’t apologised for the large number of people in residential aged care who don’t need to be there.
We are not doing all we can to keep Australians ageing with a disability or into disability out of residential care.
The gold standard for disability care is the NDIS. It is based on a rights approach recognising our obligations under the Convention for the Rights of People with a Disability and its Optional Protocol (CRPD) – both of which have been ratified by Australia.
Aged care is not based on a rights approach, but gets what politicians believe the public is (apparently grudgingly) prepared to fund. The NDIS legislation amended the Age Discrimination Act 2004 to enable the lawful exclusion of those over 65 from the “reasonable accommodation” demonstrated by the NDIS in their support of assistive technology and services.
How is this consistent with our obligations under the Convention for the Rights of People with a Disability? Well, it isn’t.
The CRPD recognises, inter alia, the equal right of all persons with disabilities to live in the community, with choices equal to others, and requires that effective and appropriate measure be taken to facilitate full enjoyment by persons with disability of this right and their full inclusion and participation in the community (Article 19). The Convention focuses on the fact of disability, not its causes, or the age of sufferers, and bans discrimination between the disabled and the broader population, and among the disabled.
The COVID pandemic has given this issue a new urgency with many elderly disabled deeply anxious about being consigned to a flawed residential aged care system if their partner/carer dies or becomes incapacitated.
A key way of avoiding residential aged care is, of course, home care – and early or continued support through assistive technology, home modifications and services would allow more Australians to maintain their independence. Assistive technology includes apparatus like prostheses, orthoses, mobility aids such as wheelchairs, bed lifts and so on. It can enable disabled people to live in the community and lead near to normal lives. Home modifications can reduce access problems and the need for supervision while showering. Support services can range from assistance with aids to physiotherapy.
These are all supported by the NDIS, but not to anything like the same extent by Home Care and parallel state programs.
When Productivity Commissioner Patricia Scott and Associate Commissioner John Walsh put together the 2011 PC report on the NDIS they envisaged that the Commonwealth/State aged care agreements would be renegotiated to provide an equivalent level of support for those who acquired a disability after the age of 65 so that they too can enjoy these rights recognised under the Convention.
This hasn’t happened.
There are many Australian, of whom I am one, who were disabled long before, and already over 65, when the NDIS was established. While a disabled person who was 64 when NDIS was introduced can elect to continue with the NDIS (and why wouldn’t they), those who were 65 were left dependent on the tightly limited Commonwealth Home Care and state schemes which are far less comprehensive than the NDIS, have unrealistic caps on the costs of aids. Both are subject to budgetary constraints, which result in significant queuing. The Commonwealth Home Care cap of $500 for assistive technology is laughable. I have personally spent $40,000 on equipment alone over the past 5 years – few others in my aged group could afford that.
For many people ageing with or into disability, if they lose their partner/carer, there is no choice but to enter residential care where the wait time is 5 months compared with nearer to two years for high-level home care – which brings me back to COVID and the extraordinary pressure on the aged care sector.
The June 2018 position paper on Assistive Technology for Older Australians by the National Aged Care Alliance makes a strong economic case for providing prompt assistive technology and related health services, to people ageing with, or into, disability. As in many other health areas early intervention seems to prolong years of healthy life and reduce total health system and aged care costs. It requires genuine client-focused multi-disciplinary teams. The Alliance suggested that:
“COAG, through the Australian Health Ministers Advisory Council, makes the establishment of a national AT program a priority to address the gap for older people between the aged care and disability programs and to leverage cross-sector opportunities between disability and aged care. It is noted that in 2009 all levels of government in Australia agreed to nationally consistent aids and equipment schemes through the National Disability Agreement”
This has not happened. It is time it did.