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The Changing Face of Community and Aged Care. Challenges for the future.

The Changing Face of Community and Aged Care. Challenges for the future. A/Prof Michael Fine Department of Sociology Centre for Research on Social Inclusion Macquarie University Sydney NSW michael.fine@mq.edu.au. Setting the scene. Ten Years Time?

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The Changing Face of Community and Aged Care. Challenges for the future.

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  1. The Changing Face of Community and Aged Care. Challenges for the future. A/Prof Michael Fine Department of Sociology Centre for Research on Social Inclusion Macquarie University Sydney NSW michael.fine@mq.edu.au

  2. Setting the scene Ten Years Time? • Big question - Data is missing • The future is unknown and unknowable. Generally a way of talking about today. Starting point: the foundations of today.

  3. Major challenges • Ageing: Longevity Society • Climate change - from ‘prediction’ to management • Globalised world • Social change. From - modern industrial society to - post-modern, post-industrial society? • Economic sustainability

  4. Proportion of the population in select age groups, Australia, 1901-2101 (%) Source: (ABS 2006: 114, Table 5.16, in Borowski and McDonald, 2007: 30)

  5. The demographic shift • Ageing associated with affluence, high living standards. • Australia still well behind most N. European Countries • ageing of the population, • fertility rates below replacement level. National Strategy for an Ageing Australia (2003); Intergenerational Report (2002, 2007) For every (Italian child) under five. In Italy in 1950, there were 8.5 children under five: 1 over 80 year old. In 1995 the ratio had fallen to 1.3: 1 By 2050 there may be 1: 6 over 80-year olds and 1: 18 over 60-year olds (Golini, 1997: 54)

  6. The Need for Care Epidemiology 3 scenarios: 1. Compression of Morbidity hypothesis (Fries, 1980; Fries, Green and Levine, 1989) 2. Expansion of Morbidity (Gruenberg, 1977; Kramer, 1980; Olshansky et al., 1991) 3. Postponement of Morbidity (Manton, Stallard and Corder, 1995; Manton and Land, 2000)

  7. Epidemiological Evidence 1. Very moderate or no gains in disability on the whole – Australia, the Netherlands and the United Kingdom; 2. Mixed or moderate results – Canada, Sweden; 3. Significant gains – Germany, France, Japan and the United States. (Jacobzone et al., 1998a: 16) Likelihood of better prevention etc, but continuing need for care.

  8. Dementia: 2007-2050 2007 220,000 people affected 2050 731,000 expected. Dementia numbers: increase of 327% Total population: increase less than 40%

  9. Table 1 Long-term Care Arrangements for Older People (aged 65+) Australia, 2003-04

  10. Key issues in aged care The Availability of (unpaid) Carers Future workforce planning Future models of service delivery Funding options

  11. Availability of carers • Australian projections - AIHW (1998-2013), NATSEM (2001-2031) Suggest declining availability of ‘primary carers’ in coming decades. • UK projections (Pickard et al. 2001) suggest improvement in availability of carers due to improved rates of marriage and cohabitation amongst older people.

  12. Formal Care Staff • Less projections done, less data available • NILS Study (2004) of existing residential care workforce suggests current staffing not in crisis, but increasingly under threat. • 94 pct female; • Mainly part-time (66 pct); 25 pct casual/agency staff; • Fewer nurses; more low paid personal carers; • Increased reliance on migrant staff • National Aged Care Workforce Strategy (2005)

  13. Projected Number of Direct Care Workers Needed for Aged Care Accommodation and All LTC services, Australia: 2003-2031 Source: Hugo, 2007: 177. Calculated using ABS 2005 Projections, Series B and ABS Survey of Disability, Ageing and Carers, Catalogue No. 4430.0, + authors calculations

  14. Future Care Workforce Planning • Will the shortage of care staff experienced in Europe affect Australia? • Already major concerns about lack of wage parity with comparable staff. Can we afford better pay? Can we afford not to pay better? • Concerns also about changing staffing mix. What is right? • Should existing specialised division of labour be maintained?

  15. National Aged Care Workforce Strategy 1. WORKFORCE PROFILE Strategy 1: Know the Workforce Profile Strategy 2: Link Workforce Profile to Supply and Demand 2. WORKPLACE PRACTICE MODELS Strategy 3: Identify and Develop Effective Workplace Practice Models Strategy 4: Link Workplace Practice Models and Workforce Demand 3. LEADERSHIP AND MANAGEMENT Strategy 5: Develop and Sustain Workplace Leadership Strategy 6: Develop and Sustain Effective Management

  16. National Aged Care Workforce Strategy (Cont’) 4. EDUCATION, TRAINING AND DEVELOPMENT Strategy 7: Provide Effective Training Design Strategy 8: Provide Effective Training Delivery and Opportunities Strategy 9: Ensure Specialised Training Strategy 10: Support Access to Training and Re-entry Strategy 11: Support Continuing Education and Professional Development 5. A RESPONSIVE WORKFORCE Strategy 12: Strengthen Supply of Staff and Monitoring the Client Profile Strategy 13: Attract and Recruit Staff Strategy 14: Retain Staff

  17. National Aged Care Workforce Strategy (Cont’) 6. STATUS AND IMAGE Strategy 15: Create a Preferred Image Strategy 16: Communicate the Image 7. EFFECTIVE LINKAGES Strategy 17: Maintain Linkages with Other Relevant Strategies, Policies and Plans

  18. My concerns Positive: Planning framework.. Thinking about issues. Recognition of likely problems. Issue: Assuming current system and developments provides template for the future. Fear: McDonaldized Care Casualised, underpaid staffing model extended into future, Increasing ‘flexibility’ for employers, Insecurity for staff, Uncertainty for clients, potential service users

  19. Future models of service delivery New constellations of care • Biggest users of health care services are aged people. • Health care and aged care increasingly likely to interact. Integration of different services increasingly important. New functions for residential care e.g. as sites of clinical excellence, for intermittent, short term use - complementing hospitals and home care. • Substitution principle to manage increasingly expensive care interventions. Existing emphasis on care at home will need to be continued, enhanced. • Technology Increasing use of everyday technologies to assist, monitor to Our future as cyborgs

  20. Models of service delivery (Cont’) • What can be learnt from new home based services? Hybrid care. Individualised care - case/care management. • Home-based care innovations. Further development inevitable: - Increased intensity of service - New organisational and financial technologies: eg - direct payments - enhanced access to case management/ care co-ordination

  21. 3. Funding options • Hogan’s vision of a mature industry: Corporate care, with a minimum safety net. Asset run down implied. • What are the options? Leave it to the market? Other forms of user pays - death duties; social insurance? Continuation of existing system of means and asset tested subsidies?

  22. Re-imagine the future of aged care. • Workforce planning, development and education is key. • The future is NOT pre-determined. • Challenge is to imagine the ideal future and make it happen. • ‘Think Globally; Act Locally’. • Aged care’s time has come. Must be the real ‘cutting edge’ of the future. • Challenges major, good people can make a difference on this scale.

  23. Published by Palgrave Macmillan, UK and Australia. Available from Glebe Books, Co-Op Bookshop, Amazon.com, etc.

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