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The quality of Australia’s aged care system has been under scrutiny since the Royal Commission into Aged Care Quality and Safety, where it was alleged the sector needed stricter clinical governance.
But what if the focus was less clinical and more about users’ quality of life, recognising their needs as people, irrespective of their age bracket? And what if doing so helped divert older people from the health system back into aged care, where the cost to care for them was less, and public funds were better utilised?
Duncan McKimm CEO of Clarence Village believes this renewed focus on quality could be the missing ingredient in Australian aged care. He claims that when people’s holistic needs are met, clinical ones become easier to manage.
It is something he has seen firsthand watching a loved one undergo cancer treatment.
“[The treatment] has been rugged on them physically and clinically, but they have got family around them and the ability to make choices for themself. And so, their quality of life, despite their clinical situation, is pretty good,” he said, ahead of the Aged Care Reform Forum.
“It’s something we need to capture in the broader aged care system, because if we just measure clinical areas, we’re not getting anywhere near the whole picture. We won’t achieve the system-wide outcomes we have been striving for, for all these years doing that.”
Defining quality of life
When defining quality of life in an aged care context, McKimm recommends forgetting users’ age.
“When we look at people solely through an aged care lens, we can get very clinical, very quickly. Older people’s lives are much richer than their clinical ailments.”
Broadly, McKimm says quality should be considered across three contexts: mind, body and soul.
“It’s not just about whether someone has a pressure injury or is incontinent. Those things affect quality of life, of course. But equally, we should consider things like people’s connection to their faith, their community, and their ability to have agency over themselves and how they spend their time.
”When these needs are met they’re more resilient and we find clinical ailments don’t have as significant a negative impact on their quality of life.”
Balancing government books
McKimm acknowledges the high costs of healthcare are challenging. However, he says investment in aged care can be offset by the savings it will provide elsewhere in health spending.
“It’s 10 times more expensive to have a one-night stay in a hospital bed than a residential aged care bed. If we divert some funds from public hospitals into residential aged care, we’ll have a lot of buffer to work with. I don’t see it as adding to the cost of caring for older people. I see it as a redistribution of spending.
“If people are missing out on residential aged care, they don’t just disappear because there are no beds for them. They wind up in hospitals, funded by the States. So, their care just goes onto a different set of books.
“There’s tonnes of money currently being spent on older people in State hospitals that isn’t in the Federal aged care budget. If you take all of that into account, I think there’s enough money to do it.”
Aged care economics
Standing in the way of reform is, however, what McKimm refers to as a “unique economic situation”.
At present, the sector is operating in a monopsony, meaning there is only one buyer.
“The federal government are the only funders of aged care,” he said. “That is partly the reason we have some challenges from a reform perspective. It’s just how those markets work – and if we want to do a serious reform of aged care, we need to be aware of how we navigate this, so we can chart a course for better times ahead.”
Thankfully, McKimm believes political support is on the sector’s side.
“People recognise that aged care is a universal right and it’s something people in the electorate will always fight for, regardless of their financial status.
“The necessity of fairness in accessing care is a foundational thing in Australia. I don’t think there’s any doubt about that,” he said.
Further insight
Sharing more on his vision for aged care, Duncan will present at the upcoming Aged Care Reform Forum, where he will outline a nine-tiered framework for sector-wide improvement.
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