Ageing population requires new model of care, say nurses

In the wake of the findings of the intergenerational report, a coalition of peak nursing organisations is calling for Australia to adopt innovative models of care to support a healthier ageing population.

Released last week, the Intergenerational Report 2023 predicts in 40 years’ time Australians will remain healthier to an older age. Indeed, the number of people 85-plus is set to triple by 2063, while the number of people 65-plus is expected to double. 

“This,” say the IGR’s authors, “will exert considerable pressure on aged care spending.” While the growth in spending on residential aged care will be the main contributor to the increase, the authors say spending on community care is also projected “to rise significantly”.

In order to minimise people’s reliance on government-funded services for longer, the coalition – which represents 400,000 nurses across the country – is calling for models of care that support people to age well in place.

“It’s about providing the infrastructure to enable people to remain in their home, in their community, with their family and with, hopefully, their friends,” Mary Chiarella – a professor of nursing at Sydney Nursing School – told Community Care Review.

There is strong evidence internationally that demonstrates the benefits of nurses working in partnership with consumers, said Professor Chiarella.

She points to a model of care adopted in The Netherlands. Running for 17 years, the Buurtzorg model of care involves small teams of nurses providing a range of personal, social and clinical care to people in their own homes in particular neighbourhoods.

“We tend to divide patient care – in terms of what we would call clinical care that nurses give – and then social care that is given by others,” said Professor Chiarella.

However, nurses, argue the coalition – which includes the Australian Primary Health Care Nurses Association, the Australian College of Nurse Practitioners, the Australian College of Mental Health Nurses, the Australian Nursing & Midwifery Federation, Drug & Alcohol Nurses of Australia, and CRANAplus – are currently under-utilised and under-funded to cross that divide.

She told CCR that, in contrast to the Australian approach, the Buurtzorg model is a non-hierarchical system of personal and social care sitting together.

“They go to the patient, and they say to the patient, ‘Okay, what do you need?’ The patient is then able to work through what they need, what they can do for themselves, what the nurses can do for them, what their informal networks can do, what the actual clinical team can do, and you move forward from there. And what has been shown in Europe is it’s an incredibly efficient model.”

But for such a model to succeed in Australia, primary health care funding would need to undergo a restructuring, said Professor Chiarella. She told CCR she would like to see Australia adopt a capitation funding model for nurses.

“If you had a capitation model, whereby the funding went to the individual, then a team could take on a group of individuals and they would be funded for caring for those individuals rather than simply providing a widget on a particular day.”   

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