Address to AFR Ageing Population Summit

Good morning

I’d particularly like to acknowledge Professor Warren Hogan, Rod Young, CEO, Aged Care Association of Australia; Greg Mundy, Chief Executive, Aged and Community Services Australia; and Kate Hammond, Chief Executive Officer, Retirement Village Association Australia.

Before the Howard Government began the series of reforms which has transformed this sector over the past 11 years, ageing was scarcely talked about at all. Nowadays, it is a key part of the government’s work and is factored into the initiatives of most ministries. 

The year 1997 marked a watershed when it comes to this country’s ageing. The Aged Care Act completely broke with the past and set us on the road to genuine improvements in the standards of care and accommodation.

Total Australian Government funding for aged and community care has surged from $3.1 billion in 1995-96 to greater than $8.6 billion this financial year. That’s an increase of nearly 177% in nominal terms. When you consider that the growth in population aged over 70 for the same period has been about 25%, you’ll see how much we have really increased our commitment to this industry.

The Prime Minister, John Howard, foresaw the importance of ageing during his first term, being the first leader to establish a Minister for Ageing. The Treasurer, Peter Costello, with his first Intergenerational Report, analysed and drew attention to the importance of ’s demographic changes.

As a result of these changes we will increasingly be devoting more resources to the care of our elderly.

We are living longer, a tribute to our success as a society and advancements in medical science. As you know, the dependency ratio – that is the number of people of working age compared to the number who are either under, or over that age – is changing.

The number of people aged 70 and over will double in the next 20 years. That’s why the provision of aged care is one of the most important long-term social issues in this country. It is one requiring a whole of government approach, which the Australian Government has been planning for since the release of the first Intergenerational Report in 2002.

At the end of the day, Aged Care is a service industry, which must be consumer demand driven. The challenge ahead will be diversifying the available services to meet demand.

I have chosen to concentrate today on one area of growing significance: community care. 

The majority of older people prefer to stay in their own homes for as long as possible. With the greatest respect to those providers present, there would be few who would disagree that the most comfortable bed in the country tends to be your own. As many older Australians have lived in the same home or same area for years and are integrated into a community, they don’t want to be uprooted from the neighbourhood that contains their friends, families, or the local community facilities they are familiar with.

Quite often, people who wish to remain independent, either staying in their own homes or with relatives, may simply need occasional help, medical visits, or someone checking in on them. Sadly, without suitable community care, people in this situation can find themselves having to enter residential care - not because they want to, but simply to receive the small amount of care they require which could have been given in their own house.

Therefore, as well as a growing demand for more aged care in general, there’s also growing demand for flexibility in the way we deliver aged care….and for people to receive good quality care while ageing in their own homes and communities.

The Government is well aware of this, and we’ve been doing something about it. But it takes time.

As a nation, we face several challenges in ageing – providing more residential care, but also more community care, increasing the awareness of age-related illness and disability among medical professionals, financing the health requirements of an older population, growing and training the aged care workforce. And providing more flexibility in the way that people can access care, so that care can be tailored to the individual requirements of the particular person. After all, we all age differently and in different circumstances.

The Howard government has dramatically developed community care and our latest package Securing the Future of Aged Care for Australians, continued to expand such services.

The Australian Government funds community care directly through services such as the Community Aged Care Packages (CACPs), Extended Aged Care at Home (EACH), and the National Respite for Carers Program.

We also jointly fund community care with the states and territories, including through the Home and Community Care (HACC) program.

Whenever it’s appropriate, we want to encourage people to stay in their own homes, as they get older, and receive care there.

We have enabled many more frail older people who wish to stay at home to do so. When we came to power in 1996, there were approximately 4500 community aged care packages in the country.

Now there are nearly 40,000, and we’re funding an additional 7200 places over the next four years. It means that many more frail older Australians who, in the past would most likely have had to enter residential care, will now receive the care they need in their own or their families’ homes.

We also have expanded community care programs by introducing EACH and EACH-Dementia packages to improve support for clients with high care needs. In 1996 there were no such packages – now there are some 3400 high care packages enabling people who previously would have gone into high level residential aged care to stay at home. I can confirm today that we will shortly announce the allocation of another 1500 EACH and EACH-Dementia places, and that we intend to continue with the growth of these packages.

We have also more than doubled our funding for the HACC program, from just over $423 million in 1995-96 to more than one billion dollars today. And we continue to work with the States and Territories to make it easier for clients to access community care services.

In 2004, we doubled the community care ratio from 10 places per 1,000 people aged 70 or over, to 20 places. This year’s new initiative will bring us up to 25 community care places per 1,000 people aged 70 or more by the year 2011. So you can see that we’re making a significant difference in this area.

In the past, people assessed as having ‘high care needs’ could not stay in their own homes, no matter what their wishes were . But now, for the first time, we are allocating places for high care at home. This is the area in which there is the fastest growth in demand.

When you build a major program to provide care at home for older Australians, you also have to respond to the needs of family members and others who give them support.

It’s important to acknowledge right now that much aged care provided in the community is from carers who are volunteers or family members. Many carers are themselves elderly. They often work tirelessly under difficult and sometimes frustrating conditions, all too often not able to look after their own needs as well as they should. They need a break. We estimate there are about 2.6 million carers in , of whom about 475, 000 have primary care responsibilities. Respite for these carers is essential. That’s why we run the National Respite for Carers Program.

We have grown this Program from approximately $19 million in 1996-97 to over $185 million this year – that’s more than a nine-fold increase. The Program provides information and counselling services for carers, as well as respite care to allow the carers to go to work or to take a break from time to time.

Community-based respite looks after frail older people or people with a disability during the day or overnight, so that carers can get a break. It’s provided in a range of settings, including the home, in aged care centres, or in overnight cottages. This gives quite a deal of flexibility for carers within local communities. In this year’s Budget, we announced extra support for this, to fund an additional 100, 000 days of respite care over four years.

At the same time, we are setting up demonstration sites for respite care in aged care homes. These centres will offer care for the elderly person who attends the facility for the day, as well as providing respite for the carers who can take a break for themselves. But the centres will also research better ways of providing day respite in residential settings. We are offering 20 grants, totalling $35.4 million over four years, for the establishment and operation of demonstration day respite services in metropolitan and rural regions across the country. There has also been a considerable expansion in respite through the Family, Community Services and Indigenous Affairs portfolio.

We have also increased support for the respite that’s provided in aged care homes. Carers and the people they care for are now able to access over 2 million days of respite in aged care homes, with some $122 million in funding from the Government last year. 

Good community care delays or prevents the entry of people into a residential facility. What it can mean is that for those people who do eventually enter a facility, their needs are likely to be much greater than they would have been before. In other words, the requirement for the high end of residential care will increase compared with low care. We are responding to this as well, and have altered the high to low care ratios to take account of it, but I will keep my focus here on our community care initiatives.

Now as you know, for residential care homes receiving Commonwealth funding, we have standards and regular assessment. In the same way, older people receiving aged care in the community, and their families and loved ones, also need to feel confident about the quality of the care they are getting. In the Budget we announced extra funding to do just that. We put aside nearly $27 million over four years for increased monitoring of community care providers by means of unannounced reviews, as well as for developing better models for care planning and delivery in the community. We already have mechanisms in place, but we want to enlarge and improve them.

This talk of ageing in your own home is all very well, you may say, but what about people out there who don’t have secure accommodation of their own, and don’t have a place in an aged care home either?

To help in those circumstances, we’ve developed the Assistance with Care and Housing for the Aged (ACHA) program. This helps homeless older people, or those who are in rather insecure housing, to receive appropriate care or accommodation if necessary.

In the latest Budget, we expanded this program by nearly $6 million so that existing providers in this area – largely charitable or religious not-for-profit organisations – can help greater numbers of disadvantaged older Australians obtain the housing and community care services to which they are entitled.

Staying at home as you get older can sometimes seem difficult because of conditions that can be hard to manage without help, such as incontinence. For older people, incontinence is one of the main reasons that cause them to be admitted into residential care. And yet it doesn’t necessarily have to be like that. If someone suffers from permanent incontinence, it should be possible to stay at home, and even go out and about, with dignity and confidence.

That’s why we have the Continence Aids Assistance Scheme to help with the cost of pads, catheters and other necessary products. We have expanded the scheme, so that more people can benefit from the financial support it offers. Until the latest Budget, the subsidy was only available to people of working age with a neurological cause of their incontinence. The scheme has been expanded now to include people aged five years and over with a neurological cause as well as to all people aged five and over who are permanently and severely incontinent – no matter the cause – who hold a Pensioner Concession card or who are the dependants of those who have one.

It will cost about $98.5 million in new funding, but will triple the number of people receiving assistance under the Scheme.

Helping people in their own homes is made much easier if we use technology appropriately. There are two main areas of interest – information technology, or IT; and assistive technology, or AT.

IT is obviously essential in all areas of society, but we can streamline how we use it to improve our service delivery and make life easier for all concerned. People require health care throughout the course of their lives, regardless of where they are. However, the ability of health care professionals to access timely and relevant information about an individual whenever and wherever necessary, is currently limited and fragmented. This is a particularly important issue when it comes to looking after older people at home, who may not be able to remember all their current medical details and past history. We’re working on electronic health information or e-health systems that should help with better and faster communication, whilst protecting privacy.

Assistive technology is perhaps even more important for community care because, in some cases, it can help with the medical management of older people without it being necessary to move them. This technology can include remote monitoring of important clinical signs; emergency-activated call alarms; systems to remind people when to take their medication and to dispense the appropriate pills; and things like mattress sensor pads which automatically activate lights at night when the person gets out of bed, so reducing the likelihood of falls. Along with continence assistance, these can all help improve the independence of frail older people and help them remain safely in their own homes for longer.

We have decided to initiate a grants program of $15.3 million, starting next year and running over three years, to fund innovation in this area. We are also establishing an industry body to promote the use of assistive technology by community care providers.

One of the challenges arising from our expansion of community care – and indeed, aged care in general – is finding enough care staff and skilled professionals.

In the 2006-07 Budget announcement, we introduced for the first time federal government funding from the Health and Ageing Portfolio for training the community care workforce. As part of our Securing the Future package this year, we included a measure to train 6,000 personal care workers who are delivering our CACPs and EACH services. We want to ensure that these people have the skills and knowledge to provide the very best home-based care to older Australians – in particular those whose needs can be complex and demanding.

In addition, we are providing up to 410 post-graduate nursing scholarships to encourage more people to enter (or return to) the community aged care sector, and to increase the skills of nurses already in the sector.

The cost of this measure is just over $32 million, and it brings our investment in the residential care workforce since 2002 to a hefty $274 million. Yes, there is still a nursing shortage in some areas – and indeed this applies to much of the developed world, so there are limits to what we can do.

However, one thing that is possible is to help free up our existing nursing and other staff, by using technology appropriately. Both assistive technology and IT, if used creatively, can save time and keep carers and nurses doing what they do best – caring for people.

Ladies and Gentlemen, as you can imagine we have spent the last ten years listening to what older people and their carers have told us that they want. We’ve taken this on board and have responded as much as possible – bearing in mind that we are spending taxpayers’ hard-earned money.

This aspect of consulting and listening is something I believe in, and something that we will continue to do. As we develop the community care system, we are asking what people actually want and researching the options – just as we did when we expanded residential care so successfully.

In September last year the Department of Health and Ageing commissioned an extensive review of Commonwealth community care programs. The Review focuses on identifying any areas in the current structure and funding arrangements for community aged care programs that could be improved. So…we are asking for criticism! And that’s because we want to improve. The Review is expected to take 18 months, but we are receiving periodic reports during that time.

So far, I have received three key messages.

First, people tell us that they would like better “end to end” care to support them to age at home. They would like the system refined so that the level of support they get changes as their care needs change, and so they do not have to move from one program to another, or from one care-giver to another. The aim here is to get a seamless transition from one type of care, or care provider, to another.

Second, consumers want to see home-based care become more consumer-directed. They want to be able to determine some of it themselves.

Third, where there are opportunities to restore the abilities of older people, to actually prevent decline, rather than just keep someone comfortable, then we need to be proactive. Wherever possible, people need to keep doing what they are capable of, to remain socially engaged, to exercise mind and body. These are now widely acknowledged as effective ways of holding back age-related decline.

Some people may only need short episodes of care, to retrain and rebuild their own capacity after a fall, for example, rather than needing ongoing assistance.

The existence of this important review process, along with the initiatives I have outlined, show that the government is genuinely committed to the future of aged care in the community. We have already achieved a lot, but there’s always more to be done. We are certainly not finished yet.

Thank you for holding this conference on these important issues, and for inviting me today. I welcome any questions.