With so many factors and unfolding changes influencing Australia’s community care sector, organisations are struggling to predict their future. Dr Keith Suter puts forward four possible scenarios.
What might support in the home look like in 2035? That’s the big question that Meals on Wheels NSW put forward in a new report it commissioned into the possible future of community aged care in Australia.
Given the unprecedented changes underway in the sector, the organisation is keen to explore the wider environment in which it may have to operate in two decades’ time and how it can best prepare for that new era.
This is a time of great change. Among the key factors driving the current transformation of the sector are: client-directed care (funding going to clients to buy services, rather than going to providers to supply them), competitive price tendering, increased competition, population changes impacting both client expectations and the capacity of volunteers, and new technologies that are reshaping how services can be provided.
Three ways of thinking about the future
One way of thinking about the future is prediction. This means extending out into the future some of the current trends we’re seeing. This is the most common form of thinking about the future. A treasurer, for example, will predict how much money an organisation may receive and spend in the coming year.
However, the further out the prediction, the less reliable it may become. For example, government long-range forecasts for the economy are usually wrong. That’s because there are too many variables, or things that can influence the outcome, to include and calculate.
A second way of thinking about the future is having a preferred future, which is where a person or an organisation has a vision which they work towards. Meals on Wheels began in this way in 1943, when aged and infirm people in the UK received meals on wheels from volunteers to replace the previous assistance from carers who had been recruited for the war effort. Those pioneers had a vision of a service that could look after aged and infirm persons in an innovative way.
With a preferred future we move from what is currently being suggested by prevailing trends, a prediction, to what we would like to see happen. Prediction and preferred future are equally valid, but different, ways of thinking about the future.
A third way of considering the future is examining what could happen – this is known as scenario planning. This is a future that is not necessarily being currently suggested (via prediction) and it may not be one we would like to see happen (via preferred futures). Scenario planning is not so much about getting the future right as much as it is about trying to avoid getting it wrong. Done properly, scenario planning reduces the risk of being taken by surprise.
The technique we used in our report for Meals on Wheels NSW is scenario planning. Four possible futures are outlined.
If we have done our job properly as authors of the report, one of the four scenarios will turn out to be a warning of what the future will be like.
The two main drivers of change that helped us explore what support in the home could look like in 2035 were: the level of government expenditure, and the level of social cohesion.
Government expenditure referred to the extent there would be government funding for community care in the home, while social cohesion referred to the extent there would be some form of community spirit – or would people prefer to live individualistic lives? Would people want to work together to solve common problems or would they try to cope on their own?
1. Leave it to the bureaucrats: This scenario is characterised by high government funding and low social cohesion. The individualistic experiments such as consumer directed care have failed and there has been a decline in NFP organisations such as Meals on Wheels, and so government is back providing welfare direct.
Some of the indicators of this scenario emerging might include failed experiments in client-directed care, particularly for older people, meaning government moves back into the direct provision of care in the home; and media scandals over clients who have exhausted their funding prematurely, thereby being reduced to poverty or having to place greater reliance on family, where it exists.
Other indicators of this scenario emerging might include continuing pressure on attracting and retaining volunteers; people being unwilling or unable to serve on boards; and small, local NFP services continuing to close or amalgamate with other services to use some economies of scale to survive.
Further, some other indicators might include larger NFP service providers and peak bodies becoming more entrepreneurial in an attempt to survive (but some don’t and so they disappear); and an increase of for-profit service providers in the community care space for affluent clients.
2. Golden era: This scenario is defined by high government funding and high social cohesion. The economy is going well and so there is adequate money for social welfare, and there is a flourishing non-government sector.
Some of the indicators of this scenario emerging might include an appetite for innovation, a greater willingness to give things a go and less fear of change; changes in Australia’s national economic structure leading to economic expansion; and increased numbers of volunteers available to local community services, both for service provision and governance.
Other indicators might be the flourishing economy resulting in an increased feel-good mood within the community and a greater optimism about the future; government receiving electoral approval to increase taxes to fund community services and other welfare programs; and less “politics of anger” and resentment coupled with a greater sense of community and wanting to assist others.
3. Each person is an island: This future is characterised by low government expenditure and low social cohesion. This foreshadows the end of organisations like Meals on Wheels, despite the country’s increasing financial and social problems.
Some of the indicators of this scenario emerging might include continued national economic problems; increased difficulty for NFP boards in finding and retaining board members; significant reductions in volunteers; and the loss of many local services such as Meals on Wheels.
Other indicators might be the amalgamation of some services in an attempt to survive through economies of scale and effort; increased elder abuse and depression across the community; increased number of working poor; increased erosion of the tax base; and increased law and order issues.
Further, other indicators of this scenario might include increased development of so-called gated suburbs; an increased push for the legalisation of voluntary euthanasia and the dilemma for caring organisations in how they handle the requests of people who wish to die with dignity.
4. Local self-reliance: This scenario is defined by low government expenditure and high social cohesion:>>> As was the case in wartime Britain, where Meals on Wheels began, there is not much government expenditure available but there is a grim determination among people of all ages to carry on assisting fellow members of their community.
Some of the indicators of this scenario emerging might include an increased number of service providers, particularly small, local organisations; increased numbers of volunteers; increased resources available for NFP governance (e.g. websites, training) and growth in bartering and local employment and trading services.
Other indicators might be increased mainstream support for “alternative” lifestyles; increased local community activities such as community gardens and organic farmers’ markets; and government programs to encourage volunteering.
Our report has now been published and is being publicised to encourage public discussion. We look forward to hearing your thoughts on these four possible futures for the community aged care sector in Australia.
Keith Suter is a futurist, consultant, lecturer and media commentator with a long-standing involvement in the aged and community services sector including 17 years consulting with Wesley Mission in NSW. His report The Future of Community Care in the Home in 2035: Four Scenarios with Steve England is available from nswmealsonwheels.org.au
This article appears in the current edition of Community Care Review magazine.
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