aged care in_australia_introduction_feb_08

Aged Care in Australia

History of aged care 1890 to 1900

• Destitute elderly were incarcerated in ‘protective’ asylums and given basic support (food and water)

• NSW records show that from 1890 to 1900 some of the number of inmates doubled. Due to relatives disowning their family older members some changed their name!

• These places were called asylums.• The Melbourne Benevolent asylum which

was dependent upon charity for finances inmate numbers tripled from 1891 to 1897 and those that couldn’t be accommodated we incarcerated in Pentridge prison

How aged care was provided in 1900’s

• In the early 1900’s many of the inmates of the old people’s asylum in NSW were older men.

• Many had been labourers without property or relatives to care for them

• In Australia at this time older women were more likely to be taken into families as unpaid help doing housework and child minding.

Before World War II• Before World War II and up

until about the 1950’aged care services developed through voluntary organisations with various religious and social philosophies.

• In Australia the Uniting Church, Red Cross and the Country Women's Association were heavily involved in caring for and advocating for the needs of elderly people.

After World War II• During World War II

taxation powers were handed over to the Commonwealth (previously collected by the states.

• Approximately 80% of all taxes are still collected by the Commonwealth because of this a large amount of financial power still rests largely with the commonwealth government.

The Aged Person’s Homes Act 1954

• The Federal Government entered the aged care field in 1954 with the Aged Persons Homes Act which provided capital subsidies to approved charitable organisations to provide essentially self contained and hostel type accommodation.

History of aged care 1962 - 1969

• The introduction in 1962 of a Commonwealth nursing home benefit heralded an explosion in the provision of nursing home care provided principally by the for-profit sector.

• With recurrent subsidies being extended to hostels in 1969 this resulted in a significant increase in the number of hostels constructed by the Church and charitable sector.

History of aged care1963 -1971

• This period saw a rapid growth in nursing homes when the number of nursing home beds increased from a national average of 29 beds per thousand people aged 65+ to 46.5 per thousand.

• However this growth was scattered and unevenly distributed and funded and led to very unequal access in different states.

1980’s Reforms

• During the early 1980 s there were four major reviews and inquiries into aged care services:– 1980 by the House of Representatives Standing

Committee on Expenditure Sub Committee on– Accommodation and Home Care for the Aged;– 1981 the establishment of a Senate Select

Committee on Private Hospitals and Nursing Homes;

– 1984 the establishment of a Joint Review of Hostel Care Subsidy Arrangements; and

– 1985 the Joint Review of Nursing Homes and Hostels.

What the Reforms of the 1980’s did

• The changes implemented from 1985 by the Labor Government came to be referred to with increasing frequency as the aged care reform strategy. The major objectives of this first wave of aged care reform were the reform of both home based care and residential care, the implementation of appropriate assessment strategies, an emphasis on improved access, equity and participation across a wide range of policy areas.

The Aged Care Act 1997 introduced the following

– Aged Care standards & Accreditation– Principles to guide assessment, eligibility and approval (ACAT)– An appeals process – The complaints resolution scheme and

funding of Advocacy services– The current funding targets – Community Aged Care Packages and Extended Aged Care

Packages– Accommodation Charges and Means Testing – Concessional Beds– Building Certification – Residential Classification Scale (RCS) – Ageing in Place

Aged Care Planning

• Since the 1980’s, the federal government has

planned and developed extensive strategies to

manage the increasing future demand for aged

care services

• Community care places and residential beds

allocated according to population changes

Aged Care Planning

• Places/beds allocated as 100:1000 persons over 70

• Broken up this wayLow Care

High Care

CommunityPackages

Aged Care Assessment TeamsACAT’s

• Assess older people who believe they need assistance with care to identify their needs and choose the available service that most suits their needs

• Assessment teams are comprised of people from a range of health professionals

Monitoring

• The Aged Care Act 1997 sets down what providers have to do for people in their care

• It also sets down what will happen if they fail to meet their responsibilities

• Gives the Department and its officers power to enter premises, conduct investigations, seize documents etc

Resident Classification Scale (RCS)

• Both Nursing Homes & Hostels use the same funding instrument to determine the RCS level

• The level is used by the Department to determine funding

RCS Scale

• 1 Highest level of care• 2• 3• 4• 5• 6• 7• 8 lowest level of care

Aged Care Funding Instrument

• Under the new changes to the aged care system in the strategy statement from the Department of Health and Ageing “Securing the future of Aged Care in Australia”

• ACFI will replace the RCS in 2008

Aged Care in Australia• Consists of 3 different

types of services and care available to older people and their carers

• Informal care provided by family carers

• Formal care– Community Care– Residential Care

• Flexible Care eg. Rehabilitation programs

• Accommodation and Housing

Aged Care Informal Care

• There are 2.6 million unpaid carers in Australia

• The need for the important role of carers in maintaining frail older people in the community is set to increase as Australia's population continues to age and more older people choose to stay in their own homes.

• Many carers are ageing them selves

Aged Care Informal Care

• To support these carers and the older people they are caring for there are a number of services available in the community.

Aged Care Informal Care• Some of the services that

help older people remain living independently at home include

• Meals on wheels• RDNS• Local councils• Day Therapy centers• Social clubs• Respite centers• Can you name any others?

Aged Care – Community Care

• Community care is provided formally to older people and their carers so that they can remain living at home for as long as it is safe for them to do so. The programs provided include

What do home care workers do?

• Home care workers are involved in going into older peoples homes and providing support to the older person and their carer to remain living independently in the community.

• Home care workers daily tasks will vary depending upon the type of program they are employed by.

What do home care workers do?

As a guideline they may be involved with supporting the older person with -

• personal care, • meal preparation, • shopping, • paying bills,

• cleaning, • laundry, • respite, • outings, • Social support• rehabilitation

programs (eg. Exercises).

Aged Care –Community Care• These programs are

provided to older people nationally:

• Home and Community Care (HACC)

• Community Aged Care Packages (CACP)

• Extended Aged Care at Home (EACH)

• Extended Aged Care at Home Dementia (EACH Dementia)

• Day therapy and respite service

Aged Care –Community Care

• Community Aged Care Packages


• Extended Aged Care at Home (EACH)


• Extended Aged Care at Home Dementia (EACH)


• Day therapy • Respite services


• Other providers of community care are state funded programs such as Metropolitan Dom Care

• And Private providers and agencies

Aged Care – Residential Care

• Residential care (accommodation and care support) is provided at two levels– Low Level Care

(formerly Hostel care)

– High Level Care (formerly Nursing Home Care

What do care workers do in residential care?

• A care workers role in residential care will vary depending upon whether they work primarily in Low level care or High level care.

What do care workers do in residential care?

• Generally they are involved with supporting and assisting the older person to

• Get in or out of bed (using lifters or manual handling techniques)

• Attend to their personal care and grooming needs• Eat their meals• Attend and participate in activities• Attend religious ceremonies• Communicate effectively


• Low Level Care (formerly Hostel care)


• High Level Care (formerly Nursing Home Care)


• Residential Respite Care – Low level care

– High level care

Aged Care - Flexible care

Aged Care Accommodation and Housing

• Retirement Villages• The South Australian

Housing Trust• Local Council housing

estates

Aged Care in Rural Areas

• Aged care in rural areas consists of community care and residential care. Often these services are provided by what is known as a Multi-purpose Service (MPS), Often based from a hospital setting.

How is aged care funded?

• There are three level of government involved in the funding and provision of aged care in Australia.– Australian Government (also known at Federal

or Commonwealth Government)– South Australian Government– Local Government

Australian Government• The Department of Health and

Ageing• Provides funds and regulations for

– Commonwealth Care link– Aged Care Assessment Teams– Community Aged Care Packages– Extended Aged Care at Home

Packages– 80% of the Home and Community

Care programs– Multi-Purpose Services

Australian Government• The Australian Government advertises an

aged care funding round and then organisation (providers apply for funding).

• (ACFR)• The Australian Government decides

which organisation receives the funding based on the merit of their application

Aged Care Providers

• Can you think of any more?

Australian Government

Australian Government

• Provides pensions, health care benefits and Veterans Home Care to war veterans, returned service men and their wives/widows.

South Australian Government

• The Department of Families and Communities

• Contributes to 20% of HACC funding• Administers HACC funding• Administers funding to state run hospital

services.• Funds and administers Metropolitan

Domiciliary Care• Funds and administers other related

services.

Local Government (Councils)• Administer many Home and

Community Care programs for older council residents and their carers

• Some provide home maintenance programs for older council residents

• Run social and recreational programs for older council residents.

• May collaborate with other service providers and funding bodies to provide service to older council residents.

References• www.health.gov.au• Bereson, I. (1989) Decades of change: Australia in the twentieth century. Heinemann Educational Australia, Victoria,

Australia. TAFESA Library 994.04 B491• Bereson, I. (2000) Decades of change: Australia in the 1900’s. Echidna Books, Victoria, Australia. 994.041 BER Burnside

Library.• Bereson, I. (2000) Decades of change: Australia in the 1910’s. Echidna Books, Victoria, Australia. 994.041 BER Burnside

Library.• Bereson, I. (2000) Decades of change: Australia in the 1920’s. Echidna Books, Victoria, Australia. 994.041 BER Burnside

Library.• Bereson, I. (2000) Decades of change: Australia in the 1930’s. Echidna Books, Victoria, Australia. Pg 7, 20. 994.041 BER

Burnside Library• Bereson, I. (2000) Decades of. change: Australia in the 1940’s. Echidna Books, Victoria, Australia. 994.041 BER Burnside

Library.• Bereson, I. (2000) Decades of change: Australia in the 1950’s. Echidna Books, Victoria, Australia. Pg 19. 994.041 BER

Burnside Library.• Bereson, I. (2000) Decades of change: Australia in the 1960’s. Echidna Books, Victoria, Australia. 994.041 BER Burnside

Library.• Dugan, M. (1997) Australia’s Children: The population boom 1946-1970. Macmillan Education Pty Ltd. Victoria

Australia. 994.0083 Burnside Library.• Gibson, Dianne (1998) Aged Care: old policies, New Problems. Cambridge Press University Press, U.K. • Guile, M. (2005) Children in Australian History. Baby Boomers. Growing up after World War II 1945-1975.

Heinemann Library, Victoria, Australia. 994 GUI Burnside Library• Guile, M. (2005) Culture in Australia.Heinemann Library. Victoria Australia. 994 GUI Burnside Library• Sheppard, B. (2005) Timeline Australia Book 1 58 000 BCE - 1854. Echidna Books. Victoria Australia. 994 SHE Burnside

Library • Sheppard, B. (2005) Timeline Australia Book 2 1855-1911. Echidna Books. Victoria Australia. 994 SHE Burnside Library • Sheppard, B. (2005) Timeline Australia Book 3 1912 - 1964. Echidna Books. Victoria Australia. 994 SHE Burnside Library

• Sheppard, B. (2005) Timeline Australia Book 4 1965-2005. Echidna Books. Victoria Australia. 994 SHE Burnside Library

http://www.health.gov.au/