Royal commission background papers: dry reading but it's all there in black and white

The paper looks at aged care now, and what we will be looking at in the future.
The paper looks at aged care now, and what we will be looking at in the future.

OH DEAR. Background papers, to anything, are generally dry documents and make for tough reading: but sometimes it worth your while to wade through the words to glean an understanding of what is going on.

Such is the case with Background Paper 2 from the Royal Commission into Aged Care Quality and Safety.

With the title Medium- and long-term pressures on the system: the changing demographics and dynamics of aged care, you could be forgiven for consigning it immediately to the round file.

But no: take the time to look at some of the statistics and points raised. They'll make you really sit down and consider what you want for your life as you pass 70 and 80 and 90...

For starters, there's the bleeding obvious ... like "older people needing help rarely require one form".

Now that's a no-brainer. But when you look at how aged care was traditionally delivered, it is obvious it took quite a while for the message to get through.

Another revelation? Older people's needs change over time. You don't say. But thankfully this is something that has been embraced by the ageing-in-place model. Tick.

So what is aged care?

The report cites the Organisation for Economic Co-operation and Development's definition of long-term care: "Care for people needing support in many facets of living over a prolonged period of time".

In Australia, the report says, "Much of aged care is about social functioning. It is providing help needed to cope when physical and mental disabilities impair the capacity to perform everyday activities such as eating, bathing, dressing, shopping and managing money."

That said, the report continues that while these disabilities can be the result of chronic illness or disease, aged care is principally about managing and reducing functional impairments rather than managing disease processes.

So, rather than involve highly technical medical services, aged care services are in the main provided by "relatively low-level trained staff who account for the majority of paid carers".

It's no secret Australians are living longer - and that's not expected to change. In 1980-82, life expectancy at age 65 was 13.8 years for men and 18 years for women. By 2015-17 this had increased to 19.7 for men and 22.3 years for women.

In 2018 there were 503,685 (or 2 per cent of the population) aged 85 and over. It is projected that will increase to more than 1.5 million (3.7 per cent of the population) by 2058.

Proof that if we don't begin planning now, there will be a lot of people - perhaps your grandchildren - going without proper care as they age.

What does it all mean?

At present public spending per person is highest for those aged 65 and over; and substantially higher again for those 80 and over.

How do we pay for this?

"Currently, there are 4.2 working age Australians for every Australian aged 65 years or over," the report says.

By 2058, that will have decreased to 3.1.

The ratio of working people to people 85 and over was 32.5 in 2018; this is estimated to fall to 14.6 by 2058.

No prizes for guessing this means funds - and a huge workforce. The report says recent projections indicate that the social assistance workforce (excluding child care) will grow from 542,000 to 638,100 in the next five years - 96,200 extra workers.

Where older people were born will play an increasingly important role in how and by whom care is delivered in the future.

The 2016 Census showed that more than a fifth (21 per cent) of Australians spoke a language other than English at home, so the demand for culturally appropriate services is likely to considerably increase, as is the need for a workforce appropriate for their needs.

What about you?

"Most of the people who will require aged care services in the next 20 years are already in the retirement phase of their life and their future level of wealth and income is already relatively fixed," the report says.

As time passes, more Australians will retire as fully or partly self-funded retirees, so will be expected to pay fully, or in part, for their care.

However, there will still be a "significant group of older people with low incomes and little wealth" because of unemployment or disability and "because aged care needs normally arise 20 to 30 years after retirement, many ... will have already consumed much of their accumulated wealth during their retirement".

So the report notes that taxpayers will remain the main contributors to the cost of aged care.

Australians will still expect aged care to be accessible to those who need it; and service providers will be expected to deliver high quality services and value for money.

Now for the bad news...

Because we're living longer we can expect to have more health problems - and not just thanks to ageing. Add in increasing obesity, depression, the threat of influenza epidemics and neurological disorders (memory, behaviour, motor and sensory function) and dependency becomes a major possibility.

Whether longer life spans are because we're keeping sick people alive for longer or "whether illness and disability have been compressed towards the end of life" is debatable.

Argue all you like: it's still happening and we're living it right now.

In 2014, it was estimated that more than a third of all men and more than half of all women would be admitted to permanent residential aged care at some time in their life.

Many would beg to argue this point. The majority of people would prefer to age at home by accessing appropriate care.

Does anyone really factor residential aged care into their ageing well plan?

Home care, where possible and practical, makes sense: not just for the recipient, but for the coffers (public and private).

The report estimates that home care at a level equivalent to residential aged care costs $26,539 per client per year. In 2016-17 this was delivered by 702 organisations.

A further 239,379 people received subsidised permanent residential aged care at some stage during 2016-17 and 59,228 received subsidised respite residential aged care. This was delivered by 902 organisations at an estimated average annual cost (public and private) of $98,386 per person.

So home care makes sense, personally and financially; but sometimes a person's circumstances and needs mean no option other than residential care.

Sounds heartless, but basically it's the end of the road ... a person's final home ... God's waiting room.

As the report puts it: "Home support, home care packages and residential care define a notional continuum in which care recipients move as their ability to cope with the activities of daily living diminishes, from limited domiciliary care to more extensive community care and then to residential care, though often for very short periods of time."

However, it notes that "demand for care is likely to shift from being a continuum that moves from home into low-level residential care and then, often for only a short time, into high-level residential care, towards a pattern concentrated at the two ends of the spectrum".

That means choosing the care needed at home for longer and to a greater degree, with residential aged care only accessed when the client has higher levels of frailty than currently occurs.

In 2016-17, the average stay in residential aged care was about two years and six months; for respite care it was a month. People who died in residential care had an average stay of two years and eight months.

Thanks largely to ageing-in-place, most people remained in the same facility until their death.

And here's something for the girls: there'll be more blokes around to share those golden years in the future.

In 1978 there were 40 males per 100 females aged 85 and over. By 2018 that had increased to 70 males per 100 females. It is predicted to increase to 89 males per 100 females by 2031.

Let's hope they're all good-mannered types who always remember to put the seat down!

So there you have it - aged care now and into the future.

As this article was being written came news that two more background papers were now also available.

Can't wait to digest those with a good lie down.

Yes, dry reading, but if you want to get a handle on Australian aged care, it's worth the time.

Find out more about the royal commission HERE

This story Aged care: just when you thought we'd come a long way... first appeared on The Senior.