home care

A report by a leading public policy think tank has called for an overhaul of aged care in Australia based on a rights framework, describing the current system as a mess.

Dr Stephen Duckett

The Grattan Institute report, Rethinking aged care, says regulation of aged care hasn’t kept pace with the nation’s privatised and marketised system, with systemic problems compounded by pervasive ageism.

“We have a top-down, provider dominated system dominated by poorly regulated organisations,” the authors write.

The report says more money and regulation is needed, but that alone isn’t enough to turn around what it says has been a litany of failures in aged care.

What’s needed instead is recognition that older Australians have rights, and that these rights should shape the way a new system of providing support for older people is organised, the report argues.

It identifies principles including independence, self-fulfilment, community participation, informed choice, universal access to support,  non-discrimination and dignity in death, as well recognition of the rights of cares and staff as essential in a rights-based system.

Quality home care is key

Co-author Stephen Duckett says the service system must be explicitly designed to help older people maintain as much independence as possible, making the provision of accessible quality home care a key feature of a better system.

“If you’re serious about having a rights based system, you’ve got to have a right to home care,” Dr Duckett told Community Care Review.

“We’re saying you’ve got to have a rights-based system and the rights need to start before you enter the system – and that means you have a right to home care.”

The report says the number of for-profit home care providers has nearly tripled in the past four years, from 13 per cent in 2016 to 36 per cent in 2019.

But rather than ensuring an appropriately regulated aged care market, the government’s focus has been on controlling expenditure by constraining supply.

The report say pressure to manage costs means formal assessment of home care is about eligibility and funding, rather than meeting need.

It also notes one of home care’s biggest failures, which is the more than 100,000 people waiting for a care package at their appropriare level.

“At the moment there are 100,000 people wating for home care, so we’ve got to say this is not a rights-based system. This is a ration-based system,” Dr Duckett says.

“Some people are going into residential care because they can’t get access to home care. If we want a system where people will have a right to independence then home care has to be where you start, because inevitably if you go into residential care you lose some of your independence.

“Home care has to be about trying to protect and maintain independence and so it is a core part of a rights-based system.”

Dr Duckett said older people also need to have real choice and control in a rights-based home care system, and this doesn’t exist today despite the rhetoric about consumer driven care.

“You’ve got this rhetoric called consumer driven care but there is nothing that we do to promote that,” he said.

 The report, which provides a framework for a rights based system, is the first of two, with the second to provide practical steps to reform.

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