Optimism in aged care

The greatest source of optimism for aged care in our nation is not reform or finance streams, regulations or accountability, but the deep desire of those providing care to truly understand the people they’re supporting.

After four years as a CEO in the sector, I know that just 'seeing' older people is not enough – it has to be personal.?

It’s carrying the wonder of who each person is at the heart of all we do. It’s marvelling at their story, being moved by their propensity to love. It’s that moment when we connect deeply as human beings – experiencing the passion to provide the care that’s deserved.

That’s grown in me day by day, through Royal Commission and pandemic, and now as we wrestle with the challenge of continued reform. I know if aged care leaders and frontline teams – in fact all of us – can hold central this beauty of care, even under pressure, then we’ll always have cause for optimism.

Fortunately, there are other reasons to be optimistic.?

The Aged Care Taskforce Report provides ways to address some of the funding issues we face. A key focus of the report is to ask those who can, to contribute more to their accommodation and daily living costs, allowing government to focus on funding increasingly complex care needs. This would be complemented by a strong safety net for those with limited means.

Measures may include increased co-contributions in home care for things like cleaning and gardening so government funding can focus on core care needs. In residential care, requiring providers to retain a small part of Refundable Accommodation Deposits (RADs) in the future will help meet the estimated $42 billion needed to build and refurbish care homes. It will also help address the under-capitalisation of aged care.

More broadly this extra capacity will allow innovation in the delivery of specialist dementia and palliative care, to seamlessly reach people where they are – at home, in residential care, in a sub-acute hospitals. And it will help us support a doubling in home care clients, from 1 million to 2 million by 2042, as the number of Australians over 85 triples, and those reaching 100 grows sixfold.?

While the pace of reform has been staggering, change has come that contributes to a sense of optimism. This includes greater emphasis on face-to-face care, and increasing transparency of government funding, but also how care is provided and resources used. The work of the Independent Health and Aged Care Pricing Authority will finally publicly determine the real cost of care, while the aged care wage increase not only speaks to the value of this work, but has helped with recruitment and retention.

On the other hand, other reforms have unknown or questionable outcomes and unintended consequences. The compliance pendulum has at times swung too far, and now regulatory requirements may put at risk the care provision they are meant to protect.

One example is the broad definition of ‘key personnel’. While banks may provide statutory information on a handful of people, aged care is obliged to manually provide this for many more – it’s hard to see what this improves.

RN minutes reform is well-intentioned, but it appears to be out of reach – we will struggle to have the available RNs to achieve this. There’s a case for a more reasonable definition of nursing minutes that includes Enrolled Nurses and Assistants in Nursing.

I’m hopeful the Government is open to a systematic review of the impact of reforms, especially to see if older people are benefitting. I’m also encouraged by signs the Government and Opposition will take a bipartisan approach to ensuring we can deliver quality care with dignity for older Australians.

With all this going on, against a backdrop of stubborn financial losses, it could be easy for our collective aged care team in Australia, to be distracted from the reason it exists – the privilege of caring for unique, diverse and precious older Australians.

It took months of challenging media reporting and the turbulence of a Royal Commission, to refocus our sector on what is truly important – the beauty of care and those we care for. We fought hard to regain and advance this, I know we will fight to keep it. That’s my main cause for optimism.

I experienced this personally when my mum was in care during her final days.

Suddenly aged care was not a thing to discuss, but a relationship to experience, a wonder of people and support.

Mum was a remarkable person with an amazing life – supporting orphans in Egypt, visiting prisoners, counselling traumatised first responders, raising a family – a unique story that became known and was woven through her care in those final weeks.?

Or Elliot and Val, who had not been apart in 71 years of marriage until the height of COVID-19, when they were separated by pandemic restrictions. As these eased, a reunion was organised, but we were unsure if they would realise how long they had been apart.

When they locked eyes, the recognition and emotion was instant. They were quickly in each other’s arms – heads together, holding hands, tears of joy. They may not have been able to say how many months they’d been separated, but their hearts told them it was too long.

It’s stories like these that remind us that old age or advancing dementia do nothing to diminish the personhood or value of people.

And as long as we find our motivation from ensuring there’s room for relationship-based care, we have every reason to be optimistic.

*Based on a speech given to the aged care Leaders Summit, 19 March 2024