New directions in aged care in Australia

Comparisons with international systems and innovations in aged care has identified many opportunities for improvement in Australia, according to researchers at Flinders University.

Flinders University experts from the Rehabilitation, Aged and Extended Care research group and Caring Futures Institute with research partners produced two major reports for the Royal Commission into Aged Care Quality and Safety that examine how aged care is delivered around the world and the types of innovative approaches used.

In Research Paper 2: Review of International Systems for Long Term Care of Older People, the authors examine aged care systems in 22 countries. The report uses available data and assessment of each country’s aged care policies such as financing, accessibility and regulation. The authors note country comparisons are complex and require some judgement.

The authors point to Denmark and Sweden as countries likely to have good quality long term care systems. Both have government expenditure on long term care for older people greater than 4% of Gross Domestic Product (based on OECD data), whereas Australia spends around 1.2%. Both countries fund long term care through local authorities with federal grants and local taxes. Both focus on providing long term care in people’s homes with a moderate proportion of care recipients in residential care institutions.

Australia’s spending on long term care is among the lowest of the countries in the study. A relatively high proportion of Australia’s long term care recipients are in residential institutions (around 45%) while most other countries support a greater share of their long term care recipients through home and community care. Staffing in Australia’s residential institutions appears at the lower end of the range internationally, both for total staffing and nursing.

The level of accessibility to long term care in Australia was assessed as relatively high, along with Korea, Japan, the Netherlands, New Zealand, Sweden and Switzerland. Care recipients in these countries have an entitlement to care, are not means tested and can choose the type of provider. These countries vary in other ways, for example Australia scores less well than many for quality of coordination between long term care and other services including health care.

Professor Maria Crotty, left, and Dr Sue Dyer, right, are leading the Rehabilitation, Aged and Extended Care group at Flinders University.

Australia predominantly regulates aged care quality through a single central agency using an inspection-based approach. Many other nations have multiple levels of responsibility for regulation of quality and many have a decentralised approach. Some countries, like Japan, Germany and Switzerland have a professionalism based approach. An increasing number of countries use mandatory reporting and provide public data to empower consumer choice and drive improvements in quality.

The report notes the need to think of a care system from the social rather than just economic perspective and highlights some key areas where the authors consider that care for older Australians can be improved:

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