Author: Alice Mantel

Gilbert + Tobin

On 31 October 2019 the Royal Commission into Aged Care Quality and Safety  released its interim report after 10 months of public inquiries on the aged care industry.

The interim report provides a narrative of the aged care landscape in Australia, structured into three volumes. Volume 1 – which contains the bulk of the report – is set out in three parts:

• Part 1 provides a historical overview of the aged care system and previous inquiries and reforms, and considers demographic, social and economic pressures on the system.
• Part 2 sets out persons’ experiences of the aged care system through direct evidence records and submissions.
• Part 3 highlights several issues in the aged care system, such as the availability of information on aged care services, access to aged care, use of restraints in residential aged care, and recruitment of trained staff.

Volume 2 contains an overview of public hearings conducted by the Commission to-date, and Volume 3 contains appendices and summaries of community forums held by the Commission.

The Commission has not included specific recommendations pending its final report.

Overarching theme

The theme recurring through the Commission’s interim report is that of a system not meeting the needs of the aged population and in need of reform.

The report describes the problems that older persons and their families face in accessing aged care. It also details service shortfalls, the use of restrictive practices in aged care, the experience of the workforce, and highlights the issue of young people living in residential aged care.

What recommendations are likely to be proposed in the final report?

While it is still early days and the Commission’s recommendations will only be published in its final report, the Commission has set out its observations and early conclusions on a number of issues. These are:

1. Improving people’s experience in navigating the aged care system and helping them to access the right service. Specifically, the Commission has indicated it will look into improving access to information to enable comparisons of available aged care services, and into improving the availability of information as to the length and progress on home care waiting lists.
2. Considering options to address the current waiting times for Home Care Packages, which may include more localised approaches to service planning and allocation; greater transparency of the waiting list; increased flexibility in Home Care Packages; ‘uncapping supply’ of home care; combining home care with home support; and allocation of unspent funds. The Commission has also stated additional funding should be provided for Home Care Packages immediately and into the future, to ensure that supply meets community expectation.
3. Improving the provision of aged care for Aboriginal and Torres Strait Islander people so it is delivered in ways that are flexible, adaptable and culturally safe. The Commission will also explore ways to support aged care services to be staffed and managed by Aboriginal and Torres Strait Islander people.
4. Making recommendations on changes in the medical and operational practices utilised in residential aged care, to address the prevalence of restrictive practices (particularly the use of chemical restraints).
5. Addressing workforce issues, including attracting and retaining staff; education and training; choosing the right staff; remuneration and careers; continuity of care; and staffing levels and staff mix.
6. Considering solutions for younger people currently accessing aged care. The Commission has proposed that, subject to very limited exceptions, by 2022 no younger people should be entering residential aged care, and by 2025 no younger people should be living in residential aged care except for those who choose to be there.

Areas for more immediate attention

The Commission also identified three areas for more immediate attention:

• providing more Home Care Packages to reduce the waiting list for higher level care at home;
• responding to the over-reliance on chemical restraints in aged care; and
• stopping the flow of younger people with disability going into aged care and speeding up the process of getting out younger people already in aged care.

Government’s response

The Government has on 25 November 2019 responded to the Commission’s report by pledging a $537 million funding package across the three priority areas identified, which will be used to:

• increase the number of Home Care Packages;
• improve medication management programs to reduce the use of medication as a chemical restraint on aged care residents;
• provide training and support for aged care workers and providers; and
• invest to help meet new targets to remove younger people from aged care.

The Government’s response can be found here: https://www.pm.gov.au/media/response-aged-care-royal-commission-interim-report

What is next?

The Commission’s comments make clear that reforms to all aspects of the aged care industry, and not just the practices of aged care providers, will be proposed in its final report. Indeed, the Commission has flagged that it will ‘recommend comprehensive reform and major transformation of the aged care system in Australia’.

This will be welcome news to applicants facing issues accessing aged care or funding, although details as to how the changes impact them will only be clear when final specific recommendations are published. For aged care service providers, the likelihood of increased regulation and tougher accreditation and service standards following from the inquiry, may result in providers facing increased capital and operating cost requirements. We could potentially see consolidation in the sector and investment opportunities could present themselves for potential investors, as the impact of the Commission becomes clearer over time.

However, the Commission is still midway through its inquiry and implications arising from its inquiry will only be clear when its final report is issued (the final report is due in November 2020). In the meantime, the interim report sends a clear signal that the aged care sector will likely see comprehensive and significant changes over the next few years.

More information about the Aged Care Royal Commission can be found here: https://agedcare.royalcommission.gov.au

The combination of climate change and an ageing population is interacting to create “a perfect storm”, according to a research paper written for the Actuaries Institute.

Heatwaves are killing more Australians than any other natural disaster and are expected to become more frequent and last for longer with over-65s particularly at risk.

The paper, The Impact of Climate Change on Mortality and Retirement Incomes in Australia, was written by Ramona Meyricke, a senior actuary and associate investigator, and Rafal Chomik, a senior fellow at the Centre for Excellence in Population Ageing Research at the University of NSW.

These researchers say that deaths from heatwaves could rise by 12 per cent among over 65-year-olds, with heatwaves expected to triple in some regions.

“More frequent, longer and hotter days will drive a significant increase in mortality, with Australia’s ageing population amplifying the number of people who will die as a result of climate change,” the paper says.

It also canvases the financial implications of climate change for investors, warning of long-term negative returns.

The paper examines how climate change will affect Australians in broad ways, including the impact on economic growth, health and mortality, government spending and investment returns. It explores the consequences for individuals and businesses, including health, general and life insurers, pension providers, investors and emergency services and governments.

It states that climate change and ageing populations are interacting to create “a perfect storm”.

“Without proper risk management, these megatrends have the potential to overwhelm individuals, private companies and government balance sheets over the course of this century,” the authors state.

“In terms of public policy, the wide-ranging consequences of climate change on mortality, public health and the economy mean that system-wide policy responses are necessary to mitigate the risks posed.”

Heatwaves have killed more Australians than bushfires, cyclones, earthquakes, floods and severe storms combined, and are the main threat to Australians’ mortality from climate change, the authors say, warning that population ageing is a major contributor to the numbers.

The Australian Bureau of Statistics (ABS) projects that by 2050, the population of over-65s and over-85s will nearly double and triple respectively.

“Population ageing will amplify the burden of heat related mortality and health risks in a warming climate – an interaction that policymakers and insurers have not yet fully taken into account,” the report states.

It says that the potential impact of climate change could also extend to lower superannuation contributions and investment returns due to negative long-term returns for investors whose portfolios are not diversified. This, in turn, could lead to lower superannuation balances.

The predictions also have major implications for pension providers, including the Federal Government. The authors say there may be a greater reliance on the Age Pension if climate change seriously diminishes superannuation balances, and a higher cost of provisioning for future Age Pension liabilities if investment returns are lower.

Have you considered the implications of climate change on your income?

Carers’ advocates are urging a rethink of the way we support middle-aged Australians caring for ageing parents.

Sydney-based organisation Your Side, which supports older people and their carers, has called for a new type of leave – similar to paid parental leave – to ease the burden on carers and help them stay in the workforce.

While the details are yet to be fleshed out, the idea has merit and could alleviate some of the problems with our current system, which relies on informal carers, many of whom are stressed and struggling financially.

Who are the carers?

Australia has 2.65 million informal carers who provide unpaid help or supervision to people with a chronic condition, disability, or those aged 65 or older. About 57% of informal carers are women and more than two-thirds are 45 or older. In 2015, almost half a million informal carers in Australia were of working age.

While caring can be fulfilling, it can significantly impact workforce engagement and career trajectories. The most common impacts are reduced working hours and leaving employment altogether. This can reduce the carer’s income, assets and superannuation, placing them at risk of financial hardship and poverty.

Impacts are felt most severely by people from lower socioeconomic backgrounds, young people and women, especially if they’ve already taken time time out of the workforce to raise children, as recently demonstrated by Annabel Crabb.

Lost income and taxes

When otherwise productive Australians drop out of the workforce, this costs the government through lost taxes and increases in welfare payments.

A recent study by GenIMPACT at Macquarie University estimated that nationally, the income lost to informal carers leaving the workforce was A$3.58 billion in 2015. This is projected to grow by 49%, to A$5.33 billion, in 2030.

The difference in income between those working full-time and those out of the workforce due to informal caring was estimated at A$936 per week in 2015 (A$48,000 a year), rising to A$1,137 (or A$59,000 a year) in 2030.

And carers who leave their jobs are unlikely to return after their care-giving period ends.

Carers’ leave would enable longer workforce participation, increasing both income and taxes paid, one of the federal treasurer’s goals.

What are the psychological impacts on carers?

Many informal carers, particularly those out of the workforce, experience isolation, increased mental stress and high levels of psychological distress.

A study from Carers Queensland found 30% of carers felt socially isolated and 39% have chronic anxiety.

Government-subsidised aged care services are available to older Australians, but these services don’t necessarily enable carers to work. In many cases they’re not available when and where a carer needs them.

Carers’ leave could improve not only carers’ financial stability, but also their mental health, reducing isolation.

Isn’t carers’ leave already available?

Employed carers are already entitled to some carers’ leave. This allows them to take time off work to care for a family or household member. But this often comes out of an employee’s sick leave, which is taken a day at a time.

While informal carers have the right to request flexible working arrangements, employers can still say no on reasonable business grounds.

Some large organisations, including universities, already have carers’ leave, in addition to sick leave. This allows staff to take time off (days or weeks) to care for family members and then return to work, without needing to leave the workforce. This is the model an expanded carers’ leave scheme should emulate.

What are the solutions?

Multiple strategies are needed to solve problems of workforce participation for informal carers. These include:

1) increasing carers’ awareness of their existing entitlements to carers’ leave and flexible work

2) expanding these provisions to accommodate longer periods of leave, either with government or employer support, using the parental leave model. The details of such a scheme, including eligibility and the amount of leave, would need to be developed

3) improving funding and access to aged care services, including home care packages and

4) encouraging innovation in the workplace through flexible working arrangements and a culture supportive to carers. This can boost productivity of care-giving employees and reduce staff turnover.

Introducing longer periods of carers’ leave, similar to parental leave, could better support people with ongoing caring responsibilities to stay in the workforce in the longer term.

This could allow informal carers to support the older person to transition into residential aged care, to recover from a hospital admission due to an age-related illness or fall, or to set up longer-term caring arrangements within the family.

Caring for an ageing parent could therefore result in a relatively short break from a long and productive career, rather than being a trigger for leaving the workforce.

The Conversation: https://theconversation.com/more-carers-leave-may-help-australians-look-after-elderly-parents-and-stay-in-work-127496 

This article was written by Tony Walker who writes on politics, North America and the Middle East. He was formerly the Australian Financial Review’s international editor.

“OK Boomer!” Let me rise on behalf of my own baby boomer generation, not in disapproval of our X, Y and Z children but in their support.

The “OK Boomer!” meme, popularised in the United States on social media and amplified across the Tasman by a young New Zealand MP to ridicule an entitled cohort, has sliced through generations to expose a widening disconnect between age brackets.

NZ Greens Chloe Swarbrick deployed the phrase “OK Boomer” in Parliament to put down a conservative MP who had been heckling her on climate change.

In Australia, the “OK Boomer” meme might just as easily be applied to growing tax-advantaged wealth disparities. My own Gen Y daughter has been going on about this for years, to which my response has been to accuse her, in jest, of “generational envy”.

After all, didn’t we Baby Boomers have our own generation gap in the 1960s, more pronounced than the one now, as we fought our battles with our “silent generation” parents? Didn’t we shift the country on its axis – and for the better – in the Vietnam era? And, by the way, didn’t Baby Boomers such as Bill Gates and Steve Jobs create the software and hardware for the communications revolution to which Millennials are addicted?

All of this is true, but as the most privileged generation – with the caveat that many, many Baby Boomers born between 1946-1964 have fallen through the cracks – we have to admit that Millennials and their successor generation (known as Gen Z) have a point.

A lucky generation in a lucky country in danger of scorching its dumb luck has had bestowed on itself the sort of once-in-a-hundred-year windfall that is unlikely to be repeated in all our lifetimes, Millennials included.

The housing boom is the Baby Boomer Klondike. I’m talking about a period of supercharged wealth accumulation that has produced the sort of intergenerational-riches bulge that has distorted the benefits of a record-setting economic expansion to the advantage of one generation and the disadvantage of others. You would be hard put to argue that, if not intergenerational theft, this was not an intergenerational provocation driven by the most favourable giveaway tax regime for an entitled generation in the Western world.

In other words: Generation X, born between 1965-1980; Y, 1981-1996; the so-called Millennials; and Z, 1997 onwards, have a rather large point in their criticisms of a protected Baby Boomer species.

A joint UNSW Sydney, Macquarie University and RMIT study has found that aged care workers are so rushed and pressured to provide basic physical care for older people, they have no time to meet their clients’ basic social and emotional needs.

The report was prepared for the Health Services Union and United Voice, unions which represent aged care workers.

Care workers overwhelmingly say they have insufficient time to either talk to their clients or get to know their uniqueness, or to support their decision making and independence.

Evidence has long shown that older people value the relationships they have in aged care services, aspire to feel at home and valued, and define quality services as those where staff have time and flexibility to get to know them and attend to their needs. These aspirations are also a feature of Australia’s quality standards.

“Yet it has become structurally difficult to provide care in this way,” lead author Professor Gabrielle Meagher from Macquarie University’s Department of Sociology says. “The Australian aged care system has to meet increasing levels of demand, and to respond to the increasing complexity of need among older people related to daily living, behavioural issues or complex health care. But our research shows this has not been matched with appropriate funding, staffing levels or a mix of staff skills.”

The Meeting the social and emotional support needs of older people using aged care services report comes a week before the Royal Commission into Aged Care Quality and Safety is due to hand down its interim report on Thursday, 31 October.

The universities’ report found:

·         Numbers of aged care places have outstripped workforce growth, with no increase in the ratio of fulltime equivalent care workers to residential care places since 2003.

·         In the same period, residential care workers’ skill profiles have significantly deteriorated.

·         Personal care workers perform an increased proportion of direct care work in residential settings, up from 57% (2003) to 72% (2016). Correspondingly, the share of nurses and allied health professionals has declined.

·         Across residential and home care services, 90% of care workers agreed they had no time to respond to unexpected needs, or to spend time with an older person they found to be in low spirits.

·         More than three-quarters (78%) said they had insufficient time to support older people to do things for themselves, such as use a walker instead of a wheelchair.

·         Only 37% felt their managers understood the importance of workers’ relationships with older people, with many reporting they were seen to be “slacking off” if they attended to a client’s social and emotional needs.

“Care workers routinely observe that older people’s emotional needs are left unmet in the system designed to support them,” Wendy Taylor from RMIT’s School of Management says. “In the aged care system today, overlooking older people’s basic social and emotional needs has become part of accepted business practices.”

Dr Natasha Cortis, from UNSW’s Social Policy Research Centre, says the research shows that organisational supports for quality care are too thin: “We found that less than a quarter (22%) of aged care workers were receiving one-on-one support from a supervisor, and less than half (45%) were able to participate in team meetings to discuss the way they provide care. ”

“Insufficient time and support for relationship building and care makes it difficult to realise principles of dignity, respect and person-centredness in aged care,” Professor Meagher says. “This partly explains the very high rates of social isolation and mental distress experienced by older people.”

“Employment conditions and pay rates in aged care also fail to recognise the specific skills and demands of the work, leaving care workers and older people vulnerable,” says Professor Sara Charlesworth of RMIT’s School of Management.

The report recommends:

·         The psychosocial needs of older people be at the forefront of the design of aged care services.

·         Aged care funding be increased to sufficient levels to enable services to be provided to all older people who need support, and this funding be care-centred.

·         The aged care system’s human resources be regulated to ensure that rostering and daily work arrangements allow workers enough time to care and to offer continuity of care relationships.

·         Workers have relevant practice and relational skills to deliver high-quality care, and be supported by managers so that they develop meaningful relationships with older people.

Former Australian of the Year Rosie Batty has partnered with women’s legal services across Australia to urge the federal government to enact reforms to keep women and children safe in the family law system.

Ms Batty, who was driven to campaign to end family violence after her 11-year-old son was murdered by her former partner, yesterday endorsed the new Safety First in Family Law plan, launched by Women’s Legal Services Australia.

Safety First comprises a five-point plan, advocating that the federal government: strengthen family violence response in the family law system, provide effective legal help for the most disadvantaged, ensure family law professionals have real understanding of family violence, increase access to safe dispute resolution models and overcome the gaps between the family law, family violence and child protection systems.

The plan “can be implemented right now, and is based on research, evidence and key recommendations from previous family law inquiries”, the partnership noted in a statement.

Ms Batty said it was critical for the government to act now to reform the family law system.

“Nearly 70 percent of matters lodged in the family courts involve allegations of family violence, but the system is not set up to deal with this – and neither are the many professionals who work within the system,” she said.

“The family courts don’t have case management processes specifically designed for family violence cases, so safety risks are not being managed. This is putting women and children at grave risk.”

WLSA spokesperson Helen Matthews added that the government needed to show its commitment to ending violence against women, and that one step that could be taken in achieving this would be to implement the reform plan developed by specialist women’s legal services around Australia.

“Women’s legal services across Australia work on the frontline to represent family violence victim survivors – we know just how urgent these reforms are, and how the current family law system is failing women and children,” she said.

“These reforms can and should be implemented now. If the government is serious about making the family law system safe for women and children, it must act and implement our recommendations”.

By Jerome Doraisamy|23 October 2019