Innovative models of housing that integrate person-centred care could provide a ‘third sector’ in aged care, a royal commission research paper says.
The aged care royal commisssion’s Research paper 7 exploring integrated care says it’s time to consider service-integrated housing as a solution to the growing challenges of providing aged care.
“There is scope for government to recommit to supporting service integrated housing for older people, potentially by promoting or sponsoring co-housing developments and/or housing colocated with home care services,” it says.
The report examines integrated models of care relating to health, social care and housing, arguing this approach offers a way of overcoming fragmentation between services and sectors.
“Rising acuity and medical complexity of aged care users both in residential care and the community warrants examination of innovative models of care that can better integrate aged care with healthcare, social care, community services, and accommodation options,” it says.
Service integrated housing
Integrated sits between community care and residential care, the paper says. It can encompass retirement villages, independent living, assisted living, and extra care housing.
“What these models have in common is that the housing service, either directly or through external arrangements, supplies some form of support and care to residents in addition to providing housing,” it says.
The report says it’s a model that’s been largely ignored in favour of a competitive home care marketplace.
However, the paper says, this is based on the assumption that home care clients have stable and sustainable housing and can make informed decisions, which is not always the case.
The report says co-housing models, where older people can live in communities designed to meet age-specific needs, mutual care and support, can encourage social connectedness, reciprocal care, and engagement in community life.
The model can help older people remain financially and socially independent, and foster friendships and connections.
“We suggest there is scope for Government to promote and support the development of these facilities, through co-design with older people, and consider how integrated person-centred care services could be co- located on-site,” the paper says.
Co-housing remains more common in Europe than in Australia, the report says, and would probably need to introduced in partnership with developers to succeed locally.
Partnerships with PHNS
Care providers are well positioned to play a key role in integrating community health and aged care, the paper says.
For example, home and disability care provider Integrated Living is moving towards a model that would see it enter into regional partnerships with primary health networks.
Under the model, the provider would be able to use PHN resources to screen the community to identify and engage with potential clients.
The system would digitally managed using telehealth and e-health records and the provider would employ a personal care manager to co-ordinate a multidisciplinary team.
However, according to Integrated Living’s Chief Health Transformation Officer Kylie Houlihan, says the current consumer-directed model makes it difficult for providers to enter partnerships with PHNS or other government entities.
Current home care system falls short
The paper says the main justification for the current policy emphasis on home care is that older people want to live at home, close to their family and friends, and with control over their environment.
“Unfortunately, current home care policy does not fully align with living, ageing, and dying in place,” it says.
The paper says the combining housing communities with integrated care could offer a “more appealing” alternative to residential care, as well as overcoming some of the logistical problems and costs of visiting people in their homes.
“Most people prefer to remain living in their homes rather than residential aged care, and the expansion of the Commonwealth’s home care provision supports this,” the paper says.
“However, some older people’s needs fall somewhere between these two alternatives. Allowing flexibility for home care to be integrated into housing options is a logical and simple way of offering personal care in these contexts.”
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