One of the main findings in the interim report from the Aged Care Royal Commission was that most older Australians want to stay in their homes as they age, or in a place of their own choice. The Royal Commission also heard there are many barriers to downsizing for a lot of older Australians.
With COVID-19 sweeping the world and impacting aged care homes globally (and 683 deaths from COVID-19 in Australian residential aged care), there is also an increased preference for older Australians to stay at home.
In 2020, there is an estimated 3.9 million older Australians (aged 65 or over), with 95.3 per cent living in households, and 4.6 per cent in aged care accommodation. From this group, 1.3 million older Australians living at home needed some assistance with everyday activities, and 152,000 receive help via a Home Care Package. However, with our aging population there is increasing demand for Home Care Packages. In fact, there are around 100,000 people on a waiting list for a Home Care Package to be allocated.
What can Australia do better to help ensure older Australians can stay in their homes and communities for longer? As a start, we can reinvigorate our cities to make them more age-friendly.
Ensuring a city is age-friendly isn't just more inclusive for older Australians – it'll also support the more vulnerable members of our community including children, and people living with a disability.
The World Health Organisation has published a guide to Global Age-Friendly Cities, which enables town planners and community development professionals to assess how age friendly local neighbourhoods are using the eight domains of the Age-Friendly Cities framework. They include good walkability, open spaces, access to public transport, housing affordability, local services, cafes, doctors, technology access and in-home aged care services.
Some of these indicators may be more difficult for regional or rural communities to achieve, but they still provide an important starting point for discussion.
The Royal Commission was also interested in the pioneering work of Jos Schols, a professor of aged medicine from the Netherlands. Similarly to older Australians, older Dutch citizens also have a preference for staying in the home as they get older.
By improving the quality of in-home care and making it difficult to get into a nursing home, Doctor Schols advised the Netherlands were able to decrease the percentage of older people in residential aged care from 7.5 per cent to 3 per cent.
One study cited to the Aged Care Royal Commission has suggested that every additional hour of in-home care provided also lowers the chance of going into residential care by 6 per cent.
The overseas evidence is clear – by enabling older Australians to live at home for longer, they enjoy better quality of life and independence. There is both an economic and social impact argument to increase the number of Home Care Packages for the 100,000 older Australians on the waiting list.
However, even if Australia was to decrease the number of older Australians to 3 per cent in residential aged care, as a society we still need to ensure that aged care is improved so residents can enjoy quality of life in their final years.
Lawyers assisting the Royal Commission into Aged Care Quality and Safety have outlined 124 recommendations, including mandated staffing ratios, compulsory registration of workers and a new independent watchdog, in a major shake-up for the aged-care sector.
A combination of improved community liveability, increased Home Care Package funding, and Residential Aged Care reform is needed to ensure our all older Australians can enjoy quality of life in their preferred setting.
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