Attachment 1 - FINAL Research Report Support Accommodation ... · Research Report - Page 6 Profile...
Transcript of Attachment 1 - FINAL Research Report Support Accommodation ... · Research Report - Page 6 Profile...
The support and accommodation needs of older residents and the anticipated impacts of aged care reform
RESEARCH REPORT
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ContentsExecutiveSummary................................................................................................................................................................4
Introduction...........................................................................................................................................................................5
Profile-OlderPeopleinWaverley.........................................................................................................................................6
Disability............................................................................................................................................................................7
Dementia...........................................................................................................................................................................7
Carers.................................................................................................................................................................................8
OlderRenters.....................................................................................................................................................................8
ResidentialAgedCareinAustralia.........................................................................................................................................8
NationalAgedCareReforms..................................................................................................................................................9
HomeandCommunityCareHACC-Whatischanging?........................................................................................................10
HomeCarePackages-Whatischanging?...........................................................................................................................10
NewHomeCarePackagesProgramme...........................................................................................................................10
ConsumerDirectedCare(CDC)........................................................................................................................................11
ConsumerContributionsforaHomeCarePackage.........................................................................................................11
ABasicDailyFee..............................................................................................................................................................11
AnIncomeTestedCareFee.............................................................................................................................................11
NewSupplements–DementiaandCognitionandVeteranswithacceptedmentalhealthconditions..........................12
ASingularHomeSupportProgram..................................................................................................................................12
ResidentialAgedCare-whatischanging?..........................................................................................................................12
RemovaloftheHighCareandLowCareDistinction.......................................................................................................12
MeansTestinginResidentialCare...................................................................................................................................12
AccommodationPaymentsforResidentialAccommodation..........................................................................................12
Means-testedCareFee....................................................................................................................................................13
FeesAccordingtoAbilitytoPay.......................................................................................................................................13
TreatmentoftheFamilyHomeinMeansTesting...........................................................................................................13
AnnualandLifetimeCaps................................................................................................................................................13
PublicationofAccommodationPrices.............................................................................................................................14
IncentivetobuildmoreandupgradeResidentialCareFacilities.....................................................................................14
ServiceProvisioninWaverley..............................................................................................................................................14
HomesupportinWaverley..............................................................................................................................................14
ReviewofCouncil’sHACCservices..................................................................................................................................15
HomeCarePackages........................................................................................................................................................15
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AgedCarePlacesinWaverley..........................................................................................................................................16
ResidentialAgedCareinWaverley..................................................................................................................................16
VacancyRates..................................................................................................................................................................17
AgedCareSupplyinWaverley.........................................................................................................................................17
Analysis................................................................................................................................................................................18
AgeingPopulation............................................................................................................................................................18
Disability..........................................................................................................................................................................18
Carers...............................................................................................................................................................................19
SupportingAgeinginPlace..............................................................................................................................................19
Affordablehousing..........................................................................................................................................................19
Independentlivingoptions..............................................................................................................................................20
Ageinginplace-awayforward.......................................................................................................................................21
Conclusion............................................................................................................................................................................21
Recommendations...........................................................................................................................................................22
References...........................................................................................................................................................................23
Appendix1...........................................................................................................................................................................24
Governmentresponsibilitiesinagedcareservices......................................................................................................24
Developmentandoperationofagedcarefacilities.....................................................................................................24
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ExecutiveSummaryWaverley'spopulationisageing,peoplearelivinglongerandwantingtoremainlivingintheirhomesandlocalcommunitiesforaslongastheycan.Whilstmanypeopleremainwellandhealthyastheyage,atsomestagemanywillexperienceadisabilityorillnessandrequireaccesstoagedcaresupportservices.Withintheolderpopulationtherearealsovulnerablegroupsthatmayrequireextrasupportandconsiderationoftheirneedsincluding:
• Peoplefromculturallydiversebackgrounds;• AboriginalandTorresStraitIslanderpeople;• Peoplerequiringassistancewithcoreactivitiesofdailylivingandpeopleprovidingunpaidassistancetoafamily
member;• Peopleintheworkforceearningbelowtheminimumwage;• Peopleexperiencingrentalstress;and• Peoplelivingalone.
Peoplewantgreaterchoiceandflexibilityfromagedcareservicestomeettheirindividualneeds,culturalneedsandpreferences.Whilstinrecentyears,therehasbeenanincreaseddemandforandavailabilityofin-homecareservices,theretentionofresidentialcareremainsimportanttosupportolderresidentswhoneedbothcareandaccommodationtoremainlivinginornearWaverley.
InAustralia,theaverageageofentryintoresidentialagedcareis80yearsandover,andtheaveragelengthofstayisbetween1-5years.Thismeansthatturnoverisrelativelyhigh.TheregionthatcoversWaverleycurrentlyhas85.9operationalagedcareplacesper1000peopleover70yearsofageand27.7allocatedhomecarepackageswhichgivesanoverallallocationratioof113.6placesper1000peopleovertheageof70.ThisisinlinewiththenationalstandardsetbytheAustralianGovernmentof113places(DSSStocktakeofAustralianGovernmentSubsidisedAgedCarePlacesandRatiosasat30June2014).AccordingtotheMyAgedCarewebsitetheregionhasapproximately30organisationsprovidingawiderangeofin-homecareservicestoresidentsinthearea.DuringthelastAgedCareApprovalACARfundinground(2014),thegovernmentallocatedafurther252packagestoin-homeagedcareservicestotheregionthatcoversWaverley.Aspeoplearechoosingtoremainintheirhomesformuchlongerthanwaspreviouslythecase,supplyofin-homecare
TheAustralianGovernmenthasbegunmajorreformoftheagedcareservicesystem.Themainchangesofthereforminclude:
• emphasisonconsumerchoiceandpreferences,includingenablement,consumerdirectedcare,careplanningandgoalsettingonanindividuallevel;
• phasingoutblockprogramfundingofcommunitycareservicesonalocallevel,andtenderingtosupportservicesataregionallevel;
• movingtowardsauserpayssystemwhichentailassetandincomemeanstestedcarefeeswithcapsforbothin-homecareandresidentialcare;and
• movingtowardsindividualisedfundingarrangementsforinhomeagedcare.
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packagesiswherethegreatestdemandwilloccur.Supplyofagedcareplacesintheareaislikelytobesufficientforthemediumterm.Itisimportanttonotethatnotallthedetailofthereformsareyetfullyknownorunderstood.FurtherupdateswillbeprovidedtoinformthecommunityandCouncilasnewdevelopmentsoccur.Recommendationsaredetailedintheconclusionofthereportandincludestrategiestoassistolderpeopletoremainconnectedtotheircommunityandsupportnetworksandstrategiestoimprovethedesignandaccessibilityofaccommodationandthebuiltenvironment.
IntroductionThisreportprovidesanupdateontheprovisionofagedcareandaccommodationforWaverley'solderpeopleinthecontextofthecurrentnationalagedcarereforms.Thereportincludes;
• AprofileofolderpeopleintheWaverleyLGA• Anupdateonthenationalagedcarereforms• AnoverviewofserviceprovisionforolderpeopleinWaverleyinrelationtoin-homecareandresidentialaged
care• Anoverviewofindependenthousing/livingoptionsforolderpeopleinWaverley• Apreliminaryanalysisidentifyingareasofneedasweplanforourageingpopulation
TheAustralianDepartmentofSocialServicesisresponsiblefortheregulationandallocationoffundingforagedcareprogramsandservicesacrossAustralia.Theagedcaresystemisdividedintoregions.Resourcesaregenerallyplannedandallocatedacrosstheseregions,andinformationiscollectedandreportedonaregionalbasis.WaverleyformspartoftheSouthEastSydneyRegionwhichcomprisesBotanyBay,Hurstville,Kogarah,Randwick,Rockdale,Sutherland,CityofSydney,andWoollahra.Wherepossible,informationsourcedforthisreporthasbeenbrokendowntotheLocalGovernmentlevel,howeverthishasnotbeenpossibleinallinstances.AlthoughlocalgovernmenthaslimitedinfluenceovertheallocationofAustralianGovernmentfundingtoagecareservices,theyarewellplacedtoconsultwithlocalcommunities,monitorcommunityneedandifnecessaryadvocatetootherlevelsofgovernmenttoaddressgapsinserviceprovision.Localgovernmentalsoplaysamajorroleinprovidingcommunityinformation,co-ordinatingandsupportinglocalcommunityservicesandaddressingbarrierstoaccesswithinthebuiltenvironmentthatcanpreventolderpeoplefromparticipatingincommunitylife.Thesupplyofservicestomeetlocaldemandwillneedtobemonitoredintothefutureasthereformsarefinalised,servicestransitiontothenewsystemsandpeopleseekaccesstoservices.
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Profile-OlderPeopleinWaverleyIn2011,theproportionofWaverleyresidentsaged65yearsandoverwas12%,whichwassimilartoGreaterSydneyat12.7%.Theproportionagedover85yearswas2.2%comparedwith1.9%inGreaterSydney.OverallpopulationgrowthforWaverleybetween2011and2025ispredictedtobe12.6%,whichisslightlylowerthantheEasternSydneyRegion(12.9%)andacrossNSW(13.6%).Correspondingwithpredictionsofanageingpopulation,growthofthepopulationover65isforecasttobemuchhigherat30%forWaverleyand37%fortheEasternSydneyRegion.ThehighestgrowthinWaverley'spopulationisexpectedtobeamongstthoseagedbetween75and79yearsatjustover60%.The2011Censusalsoshowedthat;
• 64.2%ofresidentsovertheageof65werebornoverseas,makingWaverley’solderpopulationmoreculturallydiversethantheoverallpopulation,andGreaterSydneyat50.7%.
• 3.7%ofWaverley'sIndigenouspopulationwereagedover65years,whereasjust0.04%oftheIndigenouspopulationofGreaterSydneywereagedover65.
• Workforceparticipationamongthe65+agegrouphassignificantlyincreased,from11.3%in2001and11.9%in2006,to16.56%in2011.Morethantwofifths(41.8%)ofWaverley’solderpopulationhadcompletedyear12,amuchlargerpercentagethanforGreaterSydneyat28.3%.
• 53.33%ofolderpeopleinWaverleyearned<$600perweekcomparedto68.86%inGreaterSydney.16.24%ofolderpeopleinWaverleyearned>$1,000perweekcomparedto9.49%inGreaterSydney.
• OlderrentersareavulnerablegroupinWaverley,affectedbyincreasingrentalcostsinthearea.12.2%ofallrentersinWaverleywereagedover50yearsold.
• 8.1%ofresidentsover65occupiedlonepersonhouseholds,whichissimilartoGreaterSydney(8%).
• Overathird(36.2%)ofWaverley’spopulationover65yearsprovidedunpaidassistanceorsupportofsomekind.13.4%ofthisgroupreportedvolunteering,12.3%providedchildcare,and10.5%providedassistancetoapersonwithadisability.
• Only16.5%ofWaverley'spopulationover65yearsreportedaneedforassistancewithself-care,communicationormobility,comparedto19.2%inGreaterSydney.However,theneedforassistanceincreasedsignificantlywithage,withonly3.9%of60-65yearoldsreportinganeedforassistance,comparedto42.8%ofpeopleagedover85years.
ThesestatisticsshowthatWaverleyhasarangeofvulnerablegroupswithinitsolderpopulation.Waverleyhasalargeculturallydiverseolderpopulation.Challengesfacingresidentsfromculturallydiversebackgroundsinclude:communicationbarriers,differentculturalpracticesanddifficultyinaccessingappropriateservices.ForAboriginalandTorresStraitIslanderpeopletherecanbemuchhigherlevelsofdisabilityatamuchearlierageandlowerlifeexpectancy.Halfofourolderpopulationintheworkforceareearninglessthanthemedianwage.Wehaveapocketofolderrenterswhoarebeingaffectedbyrisingrentalcostsinthearea.Asignificantpercentageofourolderpeoplearelivingalone,potentiallyleadingtoriskofsocialisolationifthereisanabsenceoffamilytosupportthemastheyage.Almosthalfofourolderpopulationover85yearsrequireassistancewithself-care,communicationormobility,andoverathirdofourolderpeopleareprovidingsomeformofunpaidassistance.
53.33%ofouroldercitizensearnlessthan
$600perweek
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DISABILITY
Atsomestageduringtheirlifetime,mostpeoplewillexperiencemobilityloss,sensoryorcognitivedisability.Theprevalenceofdisabilityisstronglylinkedtoageing.AroundhalfofAustralia'solderpopulation(1.7millionor7.5%ofAustralians)haveadisability.Assuch,olderpeoplewithdisabilitynowformalargerpartoftheAustralianpopulationthanpreviouslymeasured,havingrepresentedonly7.1%and7.0%ofthepopulationintheprevioustwosurveysin2009and2003. The2012SurveyofDisability,AgeingandCarersSDACfoundthatforpeopleagedover65years:
• Around42%neededassistancewithatleastoneactivitybecauseofdisabilityorage.• 87%reportedhavingalong-termhealthcondition.Thelong-termhealthconditionsmostfrequentlyreportedas
causingolderpeoplethemostproblemswerearthritis(16%),hypertension(11%)andbackproblems(9.4%).• Onethirdofolderpeoplereportedneedingassistancewithpersonalactivities(29%),mostcommonlyhealthcare
(25%)andmobilitytasks(18%).Propertymaintenance(23%)andhouseholdchores(18%)wereotheractivitiesthatolderpeopleneededassistancewith.
Accordingtothe2011Census,16.5%ofWaverley’spopulationover65yearsreportedaneedforassistancewithself-care,communicationormobility,comparedto19.2%inGreaterSydney.Theneedforassistanceincreasedsignificantlywithage,withonly3.9%of60-65yearoldsreportinganeedforassistance,comparedto42.8%ofpeopleagedover85years.TheSouthEasternSydneyLocalHealthService,intheirFallsInjuryPreventionPlan2013-2018,reportedthatatleast1in4peopleaged65yearsandoverfallatleastonceperyear,andmanyhavemultiplefalls.Whilstmanyfallsdonotresultinaninjury,fallsarewidelyacknowledgedtobealeadingcauseofprematureadmissiontoresidentialagedcarefortheolderagegroup.Justover10%offallsinacommunitysettingoccuronfootpaths,highlightingtheimportanceofensuringaccessibilityinthedesign,constructionandmaintenanceofCouncil'spublicinfrastructure.DatafromtheEasternSydneyMedicareLocalpopulationhealthprofilestatesthattherateoffallsrelatedhospitalisationinWaverleyandacrosstheeasternsuburbsforthoseaged65yearsandoverishigherthantheNSWaverage.TherateinWaverleyis34.18per1000populationcomparedtotheNSWaverageof31.29per1000.
DEMENTIA
WiththecontinuedgrowthandageingofAustralia’spopulation,thenumberofpeoplewithdementiaisanticipatedtoincreasesignificantly.DementiaisoneofthefastestgrowingsourcesofmajordiseaseinAustraliaanditisnowthethirdleadingcauseofdeath,afterheartdiseaseandstroke.AccordingtoAlzheimer'sAustralia,dementiaisthesinglegreatestcauseofdisabilityinolderAustralians(aged65yearsorolder)andthethirdleadingcauseofdisabilityoverall.By2036,thenumberofpeoplewithdementiainNSWisexpectedtoincreasefourfoldfrom84,000in2009to341,000in2050andcorrespondswiththediagnosisofalmost26,000newcasesannuallyinNSW(onepersonevery6minutes)increasingto116,000newcasesin2050.Itshouldalsobenotedthatover70%ofpeoplewithdementiaremainlivinginthecommunity.Theestimateddementiaprevalenceto2018fortheSouthEasternSydneyregionispredictedtobe14,193peoplecomprisingof:Sutherland:3729,Hurstville:1347,Kogarah:999,Rockdale:1725BotanyBay:638CityofSydney:1717,Waverley:982,andWoollahra:1136.
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CARERS
Overathird(36.2%)ofWaverley’spopulationover65yearsreportedprovidingunpaidassistanceorsupportofsomekindand10.5%reportedprovidingassistancetoapersonwithdisability
OLDERRENTERS
In2011therewere2,837peopleover50livinginrentalaccommodation.Rentersinthisagerangewere12.2%ofallrentersinWaverley,and17.7%ofthewholepopulationintheiragerange.Malesandfemaleswereaboutequallyrepresentedinallagegroupsexceptforpeopleaged85yearsandoverwherefemalesweretwothirdsofrenters.Thevastmajority,76.5%,wererentingfromaprivatelandlorddirectly,orthrougharealestateagent.TheproportionrentingfromapublicagencyincludingDepartmentofHousing,achurchorcharity,orcommunityhousingproviderwasstartlinglysmall,at17.8%.Maleswere50%ofallrenters,but53%ofrentersinprivaterental,and38%ofrentersinpublicrental.Morethanhalfofrenters54.1%,over50years,livedinfamilyhouseholds,comparedwith63%ofrentersinallagegroups.Aboutonethird,36.1%,ofolderrenterslivedalone,comparedwith29%ofrentersinallagegroups.Asmallproportionofolderrenterslivedingrouphouseholds,7.7%,comparedwith21%forallrenters.
Morethanhalfofolderrenterswereworking,52%,3.7%wereunemployedandlookingforworkand41.6%werenotintheworkforce.Themajorityofolderrenters,68.1%,earnedlessthanthemedianincomeforWaverleywhichin2011was$973perweekor$50,596perannum.Morethanaquarterofolderrenters,28.0%,earnedmorethanthemedian,somesubstantiallymore.Themajorityofthesewere50-59andlikelytobestillworking.
ResidentialAgedCareinAustraliaAlthoughthefollowinginformationisnotavailableforWaverley,itprovidesanideaoftheaverageagepeopleinAustraliaareenteringresidentialagedcarefacilitiesandtheaveragelengthofstay.InGovernment-fundedagedcarefacilitiesinAustralia,between2010and2011:
• Mostpeoplelivinginresidentialagedcarefacilitieswerewomen,themajoritywereaged80andoverandmanywerewidowed.
• Aboutthree-quarters(77%)wereaged80andoverand57%wereaged85andover.Thedifferenceinlifeexpectancybetweenmenandwomenisevidentwith70%ofpermanentresidentsbeingfemaleandmorewomenwidowed(64%)thantheirmalecounterparts(26%).
• Theaveragelengthofstayisincreasing.Forpermanentresidentswholeftresidentialagedcarebetween1July2010to30June2011,overone-third(38%)wereinresidentialcareforlessthan1year(27%forlessthan6months).Two-fifths(44%)hadalengthofstaybetween1and5years.Womentendedtostaylongerthanmenatanaverageof168.1weekscomparedwith109.5weeks,andmostresidentsleftduetodeath(91%).
41.6%ofourover50yearsresidentsarenot
intheworkforce
Theaveragelengthofstayisincreasing
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Theaveragecompletedlengthofstayforpermanentresidentsin2010-11was145.7weeks,anincreaseof11%since1998-99,whenitwas131.3weeks.
• TheageprofileforAboriginalandTorresStraitIslanderpeoplewasdifferent.At30June2011,therewere1,127residents(0.7%)inpermanentresidentialagedcareidentifyingasAboriginalandTorresStraitIslander.Theseresidentshadayoungerageprofile,with24%underage65comparedwith4%forallpermanentresidentsinthisagegroup,reflectingatendencytowardspoorerhealthandeligibilityforresidentialagedcareatage50.
(Agedcarepackagesinthecommunity2010-11:astatisticaloverviewAustraliaInstituteofHealthandWelfare).
NationalAgedCareReformsInAugust2011,theAustralianGovernmentreleasedthefindingsofaProductivityCommissioninquiryintoagedcareinareportcalledCaringforolderAustralians.TheinquirywasgiventhetaskofdevelopingdetailedoptionsforredesigningAustralia’sagedcaresystemtoensurethatitcanmeettheemergingchallengesofsupportingolderAustralians.Thereportfoundthat,whiletheagedcaresystemhadimprovedoverthepastdecade,therewerestillkeyproblems,includingdifficultiesencounteredbyclientsinnavigatingtherangeofservicesavailable,limitedconsumerchoice,variablequality,gapsincoverage,inconsistentpricingandworkforceshortages.
By2022,theAustralianGovernment'svisionisthatAustralia’sagedcaresystemwill:
• Besustainableandaffordable,longintothefuture.• Providediverseandrewardingcareeroptions.• Encourageagedcarebusinessestoinvestandgrow.• Offergreaterchoice,withcontrolinthehandsofconsumers.• Supportpeopletostayathome,andpartoftheircommunities,foraslongaspossible.Inachievingthisvision,theproposedchangesinclude;• Emphasisonconsumerchoiceandpreferences.Introducingconsumerdirectedcare,careplanningandgoal
settingonanindividuallevel.• Phasingoutblockprogramfundingofcommunitycareservicesonalocallevel,andtenderingtosupportservices
ataregionallevel.• Movingtowardsauserpayssystem,entailingassetandincomemeanstestingwithcapsforbothin-homecare
andresidentialcare.• Movetowardsindividualisedfundingarrangementsforcommunitycare-individualswillbeallocatedabudget
basedontheirassessedneedswhichismanagedbytheindividualorbytheirchosenprovider.Thereformsarestillbeingimplementedandnotallthedetailsareyetknown.Thereishoweverastrongpossibilitythatblockfundingforhomesupportserviceswillbephasedoutandindividualisedfundingintroducedwhenasingularhome
TheagedcarereformsannouncedbytheAustralianGovernmenton20April2012,aimtobuildamorenationallyconsistentandsustainablesystemandwaslargelyinformedbytheProductivityCommission’sreport.Thereformsgiveprioritytoprovidingmoresupportandcareinthehome,improvingaccesstoresidentialcare,givinggreatersupporttopeoplewithdementia,andstrengtheningtheagedcareworkforce(DoHA2012).
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supportprogramisformedin2018.Manysmallerserviceswillneedtolookatamalgamatingorriskbeingpushedoutbylargerorganisations.Councilwillalsoneedtocontinuetosupportlocalin-homesupportservicestosuccessfullytransitiontothenewconsumerbasedcaremodels.
HomeandCommunityCareHACC-Whatischanging?FromNovember2015,theAustralianGovernmentwillintroducetheCommonwealthHomeSupportProgram(CHSP)thatcombinestheexistingCommonwealthHACCProgram,theNationalRespiteforCarersProgramandDayTherapyCentresProgram.TheaimofthenewCommonwealthHomeSupportProgramistoprovideentrylevelin-homeandcommunitysupportservicesforpeopleovertheageof65yearsand50yearsforAboriginalandTorresStraitIslandersandtheircarerssothattheycancontinuelivingintheirownhomesandcommunity.Thisprogramwillcontinuetoprovidebasicsupportservicessuchaspersonalcare,domestichelp,transport,meals,socialsupportandrespiteservices.KeyfeaturesoftheproposedCommonwealthHomeSupportProgram(CHSP)
• AstandardisednationalassessmentthroughMyAgedCaretoassistthedevelopmentofgoalorientated,person-centredsupportplansforpeoplereceivingservices
• Wellnessandenablementapproachtoservicedeliverythatrequiresserviceproviderstoidentifyeachperson'sgoalsandstrengths,andtoworkwiththemtooptimisetheirfunctionalcapabilityandindependence
• Deliveringtimelimitedserviceswhenappropriate• SupportingthetransitionofpeoplewithmorecomplexorhighersupportneedstoanappropriatelevelHome
CarePackage• Afeesframeworkwhichoutlinesprinciplesproviderscanadoptinsettingandimplementingtheirfees,leadingto
greaterconsistencyandfairness• Reviewoftheplanningandfundingallocationmechanisms,includingensuringgreatercontestabilityforfunding
HomeCarePackages-Whatischanging?TheAustralianGovernmentisexpandinghomecarepackagessignificantlytoassistpeoplewhohavehigherormorecomplexneedstoremainlivingathomeandtointroducemorechoiceandflexibilitybyensuringthatcarepackagesaredeliveredthroughconsumerdirectedcare(CDC).TheGovernmentwillincreasethetotalnumberofHomeCarePackagesfromaround60,000to100,000by2016-17.Morethan40,000additionalpackagesareexpectedtobeavailableoverthefollowingfiveyearperiod,from2017-18to2021-22.
NEWHOMECAREPACKAGESPROGRAMME
Since2013,anewHomeCarePackagesProgramreplacedtheformercommunitypackagedcareprogrammes-CommunityAgedCarePackages(CACPs),ExtendedAgedCareatHome(EACH)packages,andExtendedAgedCareandHomeDementia(EACHD)packages.
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AHomeCarePackageisacoordinatedpackageofservicestailoredtomeettheindividual'sspecificcareneeds.Thepackageiscoordinatedbyahomecareprovider,withfundingprovidedbytheAustralianGovernment.TherearefourlevelsofHomeCarePackages:
• HomeCareLevel1–tosupportpeoplewithbasiccareneeds.• HomeCareLevel2–tosupportpeoplewithlowlevelcareneeds.• HomeCareLevel3–tosupportpeoplewithintermediatecareneeds.• HomeCareLevel4–tosupportpeoplewithhighcareneeds.
ArangeofservicescanbeprovidedunderaHomeCarePackage,includingcareservices,supportservices,clinicalservicesandotherservicestosupportapersonlivingathome.
CONSUMERDIRECTEDCARE(CDC)
FromJuly2015,serviceprovidersmustofferallHomeCarePackagestoconsumersonaconsumerdirectedcare(CDC)basis—CDCprovidescarerecipientsandtheircarerswithgreatercontroloverthetypesofcaretheyaccessandthedeliveryofthoseservices.Individualisedfundingwillbeintroducedfrom2017.Thismeansthefundingforapackagewillbedirectlyallocatedtoclients,ratherthantoservices.Clientscanthendecideiftheywanttoengageaservicetomanagetheirfundsforthem.Whileconsumerswillhavegreaterchoiceandflexibilitytodirecttheirpackagetotheirpreferredapprovedprovider,planningratioswillcontinue,cappingtheoverallsupplyofpackagesavailable.
CONSUMERCONTRIBUTIONSFORAHOMECAREPACKAGE
PeoplewhostartreceivingaHomeCarePackagefrom1July2014canbeaskedtopayabasicdailyfeeandanincometestedcarefee.Theincometestedcarefeeisdependentuponaperson’sassessableincome.
ABASICDAILYFEE
Thisisafeewhichallpeoplereceivingcareareaskedtopay.Themaximumfeethatcanbechargedis17.5percentofthesinglebasicagepension,whichiscurrently$136.78perfortnight.
ANINCOMETESTEDCAREFEE
Thisisanextracontributiontowardsthecostofcarethatsomepeoplemayneedtopay.Theincometestedcarefeeispayabledependingontheamountofincomesomeonehas.Itiscalculatedattherateof50percentofincomeabovecertainincomethresholdswithannualcapslimitingthemaximumthatcanbecharged.TheDepartmentofHumanServiceswillassesswhethersomeoneneedstopaythisfeeandhowmuch.Fullpensionerswillnotneedtopayanincometestedcarefee.Youcanonlybeaskedtopayanincome-testedcarefeeifyouhaveayearlyincomeabovethefollowingapproximatethresholds:
• individualperson–$25,316• memberofacouplebutnowseparatedduetoillness(individualincome)–$24,848• memberofacouplelivingtogether(combinedincome)–$39,306.
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NEWSUPPLEMENTS–DEMENTIAANDCOGNITIONANDVETERANSWITHACCEPTEDMENTALHEALTH
CONDITIONS
Additionalgovernmentfundingisalsoavailabletohelppeoplewithamentalhealthcondition.AdementiaandcognitionsupplementandaVeterans’supplementispaidtoahomecareproviderforpeoplewhoareeligible.ThesesupplementsapplyacrossallfourpackagelevelsofHomeCarePackagesandarepaidat10%ofthegovernmentsubsidyfortherelevantlevelofHomeCarePackage.
ASINGULARHOMESUPPORTPROGRAM
FromJuly2018,theHomeCarePackagesProgramandtheCommonwealthHomeSupportProgramwillbeconsolidatedintoasinglehomecaresystem.Detailsofthenewprogramhavenotyetbeenreleased.TheGovernmenthaspromisedconsultationwithstakeholdersonpotentialprogramandfundingoptions,aswellasoptionsforimplementationandtransition.Currently,theCHSPisblockfunded,whilehomecarepackagesarefundedthroughindividualbudgets.
ResidentialAgedCare-whatischanging?TheagedcarereformsrecognisethatwhileolderAustraliansprefertoreceivecareathomeforaslongaspossible,therewillalsobeanincreasingdemandforresidentialcare.
REMOVALOFTHEHIGHCAREANDLOWCAREDISTINCTION
From1July2014,thedistinctionbetweenlowcareandhighcarehasbeenremovedinpermanentresidentialagedcare.Thiswillresultinflexible,simpleandmoretransparentarrangementsinpermanentresidentialagedcare,reducingredtapeforconsumersandproviderswithoutcompromisingthelevelsofcareprovidedtoresidents.
MEANSTESTINGINRESIDENTIALCARE
Incomeandassettestshavebeencombinedsince2014toensureaconsistentfeespolicy.Thechangesareintendedtoimprovethefairnessandsustainabilityoftheagedcarefinancingarrangements,withstrongsafeguardstoensureaccesstocareforthosewhocannotaffordtocontributetothecostoftheircareandaccommodation.
ACCOMMODATIONPAYMENTSFORRESIDENTIALACCOMMODATION
From1July2014,allresidentswhocanaffordtodosohavethechoiceofpayingfortheiraccommodationthroughadailyaccommodationpayment(DAP)orarefundableaccommodationdeposit(RAD),oracombinationofboth.Agedcareprovidersarenotabletochoosebetweenagedcarerecipientsonthebasisofhowtheyelecttopayfortheiraccommodation.Residentshave28daysfromwhentheyentercaretodecidehowtopayfortheiraccommodation.
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MEANS-TESTEDCAREFEE
Dependingonaresident'sincomeandassetstheymaybeaskedtopayameans-testedcarefee.Thisisanadditionalcontributiontowardsthecostofcarethatsomepeoplemayberequiredtopay.Itcontributestoday-to-daycarecostssuchasnursingandpersonalcare.
FEESACCORDINGTOABILITYTOPAY
Aresidentialagedcarefacilitymayaskresidentstopayoneormoreofthefollowingfees:• Abasicdailyfee:thiscoverslivingcostssuchasmeals,powerandlaundry.Forsomepeoplethisistheonlyfee
theyarerequiredtopay.• Anaccommodationpayment:thisisforaccommodationintheresidentialcarefacility.Somepeoplewillhave
theiraccommodationcostsmetinfullorinpartbytheAustralianGovernment,whileotherswillneedtopaytheaccommodationpriceagreedwiththeresidentialagedcareprovider.TheDepartmentofHumanServiceswilladvisewhichappliesbasedonanassessmentofeachresident'sincomeandassets.
• Feesforextraoradditionaloptionalservices:additionalfeesmayapplyifahigherstandardofaccommodationischosenoradditionalservicesrequested.Thesevaryfromfacilitytofacility.
Theamountaresidentwillberequiredtopaywilldependontheirincomeandassets;however,therearelimitsinplace.Furthermore,accommodationprovidersareexpectedtomeettargetsforconcessionalplacesassetbytheAustralianGovernmenttoensurethatresidentswhocannotaffordtopayhaveequitableaccesstocare.
TREATMENTOFTHEFAMILYHOMEINMEANSTESTING
Itisimportanttonotethatthetreatmentofthefamilyhomehaschanged.Forcouples,halfoftheircombinedincomeandassetsareconsideredintheincomeandassetsassessment,regardlessofwhichpartnerearnstheincomeorownstheasset. Partofthevalueofthehomemaybecountedinanassetsassessment,buttherearesomeexceptionstothis.Itwon’tbecountedasanassetif:
• apartnerordependentchildislivingthere,or• acarereligibleforanAustralianGovernmentincomesupport
paymenthasbeenlivingthereforatleasttwoyears,or• acloserelativewhoiseligibleforanAustralianGovernmentincome
supportpaymenthasbeenlivingthereforatleastfiveyears.Thefullvalueofyourhomewillnotbeincludedintheassessmentofyourassets.Insteadacappedamountof$157,051.20(asat20March2015)willbeincludedorthenetmarketvalueofyourhouse,iflower.Wherethehomeisincludedasanasset,andthepersonisamemberofacouple,50percentofthenetmarketvalueofthehomewillbeattributedtoeachmemberofthecouple,andeachmember’sproportionwillbesubjecttothefullvalueofthecapthatappliesatthattime.Itwillbetheloweramountofeitherthecaporthenetvalueofeachmember’spartofthehomethatwillbeincludedasanasset.
ANNUALANDLIFETIMECAPS
Thereareannualandlifetimecapsthatapplytothemeans-testedcarefeeforagedcare.Oncethesecapsarereached,aresidentcannotbeaskedbytheirserviceprovidertopayanymoreofameans-testedcarefee.Anyincome-tested
Incomeandassetsassessmentcriteriaare
changing
ResearchReport-Page14
carefeepaidinaHomeCarePackagewillalsocounttowardsaresident'sannualandlifetimecapsinresidentialagedcare.TheAustralianGovernmentwillpaythemeans-testedcarefeeforaresidentaftertheyhavereachedthesecaps.
• Annualcap-Themaximummeans-testedcarefeearesidentcanbeaskedtopayeachyearis$25,000.• Lifetimecap-Themaximummeans-testedcarefeearesidentmaybeaskedtopayis$60,000intheirlifetime.
PUBLICATIONOFACCOMMODATIONPRICES
Since2014,allagedcarehomeshavebeenrequiredtopublishtheirmaximumaccommodationpricesanddescriptiveinformationontheMyAgedCarewebsite,theirownwebsiteandinotherrelevantmaterialstheyprovidetoprospectiveresidentsandtheirfamilies.Thisinformationisforresidentswhohaveenteredanagedcarehomeonorafter1July2014,andmeansthatprospectiveresidentsandtheirfamiliesarenowabletocompareaccommodationpricesanddescriptiveinformationfordifferentagedcarefacilities.
INCENTIVETOBUILDMOREANDUPGRADERESIDENTIALCAREFACILITIES
TheGovernmentisreformingagedcarefinancingarrangementstogiveagedcareprovidersthecertaintytheyneedsothatmoreagedcarefacilitiescanbebuilt,andexistingfacilitiescanbesignificantlyrefurbished.From1July2014,facilitiesthatarenewlybuiltorsignificantlyrefurbishedonorafter20April2012qualifyforahigherlevelofGovernmentaccommodationsupplementpaidforresidentswithlowmeans.Themaximumleveloftheaccommodationsupplementintheseresidentialagedcarefacilitieswillincreaseto$52.49(1July2014rate).
ServiceProvisioninWaverleyHOMESUPPORTINWAVERLEY
Therearecurrentlyover30organisationsdeliveringentrylevelhomesupportservices.TheservicesfundedtocoverWaverleymayalsoprovideservicestopeopleacrosstheEasternSydneyregion.Furthermore,someservicesarefundedtoprovidespecialistservicesforspecifictargetgroupssuchas:
• Peoplewithdementia• Carers• Veterans• Peoplefromaculturalorlinguisticallydiversebackgrounds• AboriginalandTorresStraitIslanders
ThehomesupportserviceslocatedinorontheborderofWaverleyare:WaverleyCommunityandSeniorsCentre,TheJunctionNeighbourhoodCentre-ECHO,RandwickWaverleyCommunityTransport,SydneyCOAandJewishCare.ThemajorityoforganisationsintheregionfundedthroughtheHACCprogramhavetakenstepsoverthelastyeartopreparefortheintroductionofthenewCommonwealthHomeSupportProgramfrom1November2015andhavebuiltcapacitytoexpandtheirservicestomeetfuturedemandifneeded.UnderthenewCHSParrangements,themajorityofserviceswillhavetheirfundinglevelsextendeduntil30June2018.
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REVIEWOFCOUNCIL’SHACCSERVICES
Inresponsetothereforms,CouncilreviewedwhatthechangeswouldmeanforitsHACCfundedservices.Aftercarefulconsideration,CouncildecideditwouldnotcontinuetheWaverleyMealsonWheelsserviceafter30June2015.Council’sdecisiontookintoconsiderationanumberoffactors.Firstly,WaverleyCouncilwasoperatingarelativelysmall-scaleMealsonWheelsservice,meaningthatthecostofrunningtheservicesignificantlyexceededthegrantmadeavailablebytheAustralianGovernment.Secondly,anumberoflargenot-for-profitorganisationsalsooperateaMealsonWheelsserviceinWaverley,andtheseorganisationsintendtoexpandandfurtherimprovetheirserviceintheyearstocome.CompetitionwiththeseserviceproviderswasnotinthebestinterestsofourMealsonWheelsclients.Thirdly,thelargerMealsonWheelsservicesoperatinginWaverleyprovidetheoptionofothertypesoflowcostserviceswhichwerenotbeingprovidedbyCouncil.Theseincludeinhomesupportandcareservices,socialactivitiesandmealsinacommunitysetting.Allclientsweresuccessfullytransitionedtootherlocalsubsidisedprovidersbythesetdate.Atthistime,CouncilalsodeterminedtocontinueactivitiesforactiveandfrailagedpeopleattheWaverleyCommunityandSeniorsCentre.TheserviceispreparingtotransitiontothenewCommonwealthHomeSupportProgram(CHSP)inNovember15withathreeyearfundingagreementandastrongfocuson‘enablement’.AllCHSPserviceswillneedtopreparefortheintroductionofconsumerdirectedcareby2018.Formanyservices,theywillneedtodeveloparobustbusinessmodel,requiringreviewofstaffingandfinancialstrategies,andtailoringofservicestoindividuals.ManyofthesmallercommunityserviceswillcontinuetorequireCouncilsupportwithsocialplanningandservicedevelopment.
HOMECAREPACKAGES
AllpackageproviderswhoarefundedtocoverWaverleyalsocoveratleasttwoormoreoflocalgovernmentareasintheregion.Somepackagesarealsorestrictedtoveteransortopeoplefromspecificculturalandlanguagebackgrounds.ThenumberofagedcarepackagesfundedthroughtheAustralianGovernment'sAgedCareApprovalsRound(ACAR)intheSouthEastSydneyRegionhasgrownsignificantlysince2005from463packagesdeliveredby6serviceprovidersto1107packagestobedeliveredby10providersin2013/14fundinground.TheAustralianGovernmenthasindicatedthattheyintendtocontinuethegrowthoftheHomeCarePackageprogramtomeetincreasingcommunitydemandforin-homesupport.AccordingtotheMyAgedCarewebsite,thereare30organisationsprovidingHomeCarePackagestoresidentsintheWaverleyLGA.Theseservicesrangefromhomemaintenanceandmodificationservicestohomedeliveredmeals,alliedhealthcare,personalcareandcasemanagementservices.Asolderpeoplearechoosingtoremainintheirhomesforaslongaspossible,inhomecommunitysupportservicesiswherethegreatestdemandwillbeasthepopulationages.ThesupplyofHomeSupportservicesinWaverleywillneedtobemonitoredintothefuture.
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AGEDCAREPLACESINWAVERLEY
AgedCareplacesareplanned,approvedandallocatedonaregionalbasis.WaverleyislocatedintheSouthEastSydneyRegionwhichcomprisesBotanyBay,Hurstville,Kogarah,Randwick,Rockdale,Sutherland,CityofSydney,Waverley,WoollahraandLordHoweIsland.ThefundingratiosetbytheAustralianGovernmentiscurrently113placesper1000peopleagedover70years.ThisratioincludesthenumberofHomeCarePackagesdeliveredinpeople'shomesandthenumberofcareplacesdeliveredwithinresidentialfacilities.Anewtargetratioof125agedcareplaceshasbeenreleasedbytheAustralianGovernmentanditistobeachievedby2021-22.Theratiocomprises80residentialplacesand45HomeCarePackagesper1000residentsaged70yearsandover.
RESIDENTIALAGEDCAREINWAVERLEY
BelowisatableofresidentialagedcarefacilitiesintheWaverleyLGA.Therearecurrently16facilitiesprovidingresidentialagedcareinWaverley,RandwickandWoollahra,offering1,087beds.Twofacilitiesareunderconstruction,andanotherfacilityispendingapprovaltoprovideanadditional11beds. FACILITY&TYPE ADDRESS CURRENTBEDSAltonaNursingHome 40HenriettaStreet,Waverley 26BUPAatQueensPark(formerAmity) 142CarringtonRoad,Waverley 71EdinaNursingHome,UnitingCare 150BronteRoad,Waverley 40SummitCareWaverley-previouslyPhillipHouse 321BronteRoad,Waverley 67VaucluseAgedCare,HallandPrior 13YoungStreet,Vaucluse 63BondiWatersAdvantagedCare 47-51O'BrienStreet,Bondi 56CharingfieldHostel 282aBronteRoad,Waverley 55EdinaHostel,UnitingCare 150BronteRoad,Waverley 41IllowraHostel,UnitingCare 195BirrellStreet,Waverley 42WoollahraMontefioreHome 23NelsonStreet,Woollahra 50RonaldColemanLodge 88WallisStreet,Woollahra 63TheLittleSistersofthePoorMountStJoseph'sHome 70MarketStreet,Randwick 62SummitCareRandwick 15FrenchmansRoad,Randwick 94RandwickMontefioreHome 36DangarStreet,Randwick 276MilfordHouseNursingHome 2MilfordStreet,Randwick 51BrigidineHouse 7CoogeeBayRoad,Randwick 30TotalProviders:9 TotalBeds:1,087RESIDENTIALFACILITYPENDING
ADDRESS STATUS BEDS
Loreto-StVincent's
363BronteRoad,Bronte DAapprovedincludesdementiaplaces.UnderConstruction.
106
VaucluseAgedCareHallandPrior
13YoungStreetVaucluse DAunderconsiderationfor11extrabeds
11extra
MarkMoranVaucluse 46NewSouthHeadRoad,Vaucluse
Underconstruction
Total:117
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CouncilisawarethatthereareplansunderwaytoexplorethefeasibilityofanAboriginalandTorresStraitIslanderfacility.TheLaPerouseLocalAboriginalLandCouncilinconjunctionwiththefederalgovernmentandinconsultationwithAboriginalserviceprovidersiscurrentlyexploringwaysofmakingthishappen.
VACANCYRATES
Thestatusofresidentialbedvacanciesvariesfromdaytoday.InformationaboutvacanciesinaregionismonitoredbyhospitalsandcannowbefoundontheMyAgedCarewebsitewhichisupdatedonadailybasis.On17August2015,therewere6vacanciesin4facilitiesintheWaverleyLGA.
AGEDCARESUPPLYINWAVERLEY
Anacceptedmeasureofthesupplyofagedcareplacesacrossthecountryisthenumberofavailableagedcareplacesrelativetothesizeofthepopulationmostlikelytorequiretheseservices.ThenationaltargetforagedcareplacesissetbytheAustralianGovernmentata113placesper1,000populationovertheageof70years.
ThedifferencebetweenallocatedandoperationalplacesusuallyresultsfromthetimelagbetweentheGovernmentallocatingplacesandtheconstructionofresidentialfacilitiesintheregion.WiththeredevelopmentoftheLoretositeandtwofacilitiesontheborderofWaverleyinthenearfuture,thesupplyofresidentialagedcareintheareaislikelytobesufficientinthemediumterm.TheallocatednumberofresidentialagedcareplacesintheSouthEastSydneyRegionis105.1placesand27.7homecareplacesper1000peopleaged70yearsformingcombinedsupplyratioof132.8whichiswellovertheforecasttargetof125by2021/22.Ananalysisofagedcareplacesin2014byEasterSydneyMedicareLocalfoundthatWaverleyhas72%morecommunityagedcarepackagesper1000persons,20%morehighcareplacesand15%fewerlowcareplacescomparedtoEasternSydney.Thisdataappearstosupportthetrendtowardspeoplestayingintheirhomesforaslongaspossibleandenteringresidentialcareonlywheninneedofhighlevelsofcare.
Itshouldbenotedthatmanyintheindustrycontinuetoadvocatefortheremovalofservicerationingforallagedcareservices.Theimplementationofconsumerdirectedcarewillrequirecarefulmonitoring,especiallywiththetrendtowardsolderpeoplehavingtomeetmoreofthecoststhemselves.
At30June2014,intheSouthEastSydneyRegion,therewere7,649operationalresidentialagedcareplacesand2,473homecareplaces,equatingto85.9residentialagedcareplacesand27.7homecareplacesper1000people70yearsandoverandanoverallsupplyratioof113.6.Thisisin-linewiththenationaltarget.
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AnalysisAGEINGPOPULATION
Thepopulationisageingandpeoplearelivinglonger,therefore,theprevalenceofdisability,includingthenumberofpeopleexperiencingdementiaislikelytoincrease.Waverleywillrequireanadequatesupplyofagedcareservicesandaccommodationoptionsthatareaffordabletomeetthisgrowingdemand.Atthispointintime,thesupplyofagedcareservicesinWaverleyappearstobereasonablysufficienttomeettheneedsofthecommunity.Although,localgovernmenthaslimitedinfluenceovertheallocationofAustralianGovernmentfundingtotheagecaresector,itiswellplacedtoconsultwithandmonitorlocalcommunityneedandifrequiredadvocatetootherlevelsofgovernmenttoaddressgapsinservices.Throughahostofplansandpolicies,Councilsalsoimplementlegislativerequirementstoensureaccess,equitableshareofresources,andtargetedsupporttothosemostinneed.Localgovernmentalsoplayamajorroleinprovidingcommunityinformation,co-ordinatingandsupportinglocalcommunityservicesandaddressingbarrierswithinthebuiltenvironmentthatcanpreventolderpeoplefromparticipatingincommunitylife.Theadequatesupplyofserviceswillneedtobemonitoredintothefutureasthereformsarefinalised,servicestransitiontothenewsystemsandpeopleseekaccesstoservices.
DISABILITY
Theprevalenceofdisabilitywithinthecommunitywillgrowasthepopulationages,itisimportanttoanalysethepotentialimplicationsofthenewconsumerdirectedcaresystemonlocalservicesandconsumers.Whilethereformswillgivetheindividualmorechoiceandflexibilityintailoringpackagestobestsuittheirneeds,thecostsassociatedcouldbemuchhigherthanbefore,particularlyforthosewithcomplexorhighcareneeds.Thisissomethingthatwillneedtobemonitoredasservicestransitiontothenewmodel.WhileCouncil’sfocusonaccessandinclusioniscurrentlychannelledthroughtheAccessandMobilityPlan,newmandatoryrequirementswillsooncomeintoforceundertheDisabilityInclusionAct.By1July2017,andinconsultationwithkeystakeholders,CouncilswillneedtohavedevelopedanewDisabilityInclusionActionPlan.Councilwillcontinue
toplaceimportanceonensuringthatdisabilityaccessstandardsanduniversaldesignfeaturesareintegratedinallplanning,developmentandmaintenanceofpublicinfrastructure.Priorityshouldbegiventoensuringeaseofaccesstopublicandcommunitytransport,parking,residentialdevelopments,shoppingcentres,medicalhubs,parksandbeaches.Underthenewplan,thereshouldalsobeafocusonsupportingsocial,employment,recreationalandeducationalopportunities.TheBondiJunctionCivicHeartprojectisan
exampleofwhereCouncilhasanopportunitytosignificantlyimprovetheaccessibilityofthepublicdomainanddevelopinitiativesthatsupportolderpeopletoremainconnectedandengagedincommunitylife.
NewDisabilityInclusionActionPlans
in2017
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CARERS
AsignificantpercentageofolderpeopleinWaverleyprovideunpaidsupportorassistanceofsomekind.Whileforsomeolderresidentsthisinavolunteeringcapacity,manyareprovidingchildcaresupportorsupporttoapersonwithadisability.Grandparentsmaybetakingontheresponsibilityofcaringfortheirgrandchildrenasparentsoftenfeelpressuredtoreturntoworkandthecostofchildcarecanbeaburden.Someolderpeoplearealsotakingontheroleofcaringfortheirspousesastheyageintheirhomes.Carersoftenrequiresupportandrespitethemselves,haveadditionalexpensesattributedtotakingonthisrole,andtheirabilitytoworkcanbeimpededbytheircaringresponsibilities.Considerationsforthisgroupincludeaccesstoaffordablechildcare,accesstoservicesthatcansupportthemintheircaringrole,accesstoflexibleworkopportunitiesandaccesstoaffordablehousing.
SUPPORTINGAGEINGINPLACE
Asolderpeoplearechoosingtostayathomelonger,therewillbeincreaseddemandforin-homecareservices.Blockfundingofhomesupportserviceswillbephased,willbephasedoutandthereisastrongpossibilitythatserviceswilleventuallydeliveredthroughconsumerdirectedcareandindividualisedbudgetsallocatedtotheclient.Smallerserviceswillneedtolookatamalgamatingorriskbeingpushedoutbylargerorganisations.Councilwillneedtocontinuetosupportlocalin-homesupportservicestosuccessfullytransitiontoconsumerbasedcare.Withtheintroductionofmeans-testedcarefeesbasedonincomeandassets,olderresidentscouldenduppayingmoreforthecaretheyneedandsomemayberequiredtoselltheirhomeiftheyneedahighlevelofcareinaresidentialcaresetting.Thenewsystemwillmeanthatpeoplewhocanaffordtopaywillbecontributingmoretotheircare,butthosewhoarelesswell-offwillcontinuetobenefitfromGovernmentsubsidiesandwillnotbeexcludedfromreceivingalevelofcare.Somepeople,however,maybereluctanttopayforservicesthattheyperceiveasnotnecessarysuchassocialoutingsorhomemaintenance,especiallyiftheyneedtopayforhighlevelsofpersonalcareordomestichelp.Thiscouldalsopotentiallyincreasethesocialisolationofpeopleinthissituation.
AFFORDABLEHOUSING
Accordingtothe2011Census,thereisashortageoflowcostrentalhousingandsocialhousingintheeasternsuburbs.Considerationwillneedtobegiventoimprovingthissupplyasolderpeoplearechoosingtoremainathomelonger;onethirdofourolderrenterslivealone;onlyhalfareemployedandthemajorityofthoseemployedearnlessthanthemedianwage.Council'ssocialandaffordablehousingportfoliocurrentlyprovidesover100unitsofhousingforresidentsinWaverley.RecentchangestoCouncil'ssocialhousingpolicyhasloweredtheeligibilityageandallowedcarerstolivewithfamilymembersinthishousingwhichhasbeenapositivemove.Ongoingcommitmenttothisprogramwillbeimportantinmeetingtheneedsofpeoplewhodonotowntheirownhomeandareonalowincome.ThesituationintheWaverleyareareflectsnationaldemographictrends.WaverleyCouncilhasidentifiedtheageingofthepopulationandhousingaffordabilityastwoofitsmostsignificantcommunityissuesinitscurrentSocialPlan(WaverleyTogether3).AsinmanyotherpartsofAustralia,thereisashortageofhousingthatissuitableforolderpeople’schangingcircumstances.ThiscancreatemajordifficultiesforlongtermolderresidentsofWaverleywhen
Councilprovidesover100unitsofsocialand
affordablehousingstock
ResearchReport-Page20
healthproblemsmaketheirhousingunsuitable,especiallyforthoseonlowincomeswhohavemodestornoassets.Forlowincomehomeowners,theirhomerepresentsasignificantpotentialassetbutonethatmayonlybeabletoberealisediftheyarepreparedtomoveoutofthearea.Gentrificationoftheareaoverthelast20-30yearshasresultedinmajorincreasesinpricesandolderpeoplewhoownahousecertainlyhavemoreoptionsthandothosewhoownapartments.However,manyarereluctantorcannotaffordtomaintaintheirhomes,insomeinstancesputtingtheirsafetyatrisk.AlmosthalfofWaverley’slowerincomeolderhomeownerhouseholdsliveinapartments,manyinolderstyleblockswithoutlifts.Lowincomeolderrentersareunderveryintensepressureandarerapidlybeingforcedoutoftheareaaltogether.Councilcouldconsideradvocatingforgreatersupplyofsocialhousingacrosstheeasternsuburbs.
INDEPENDENTLIVINGOPTIONS
ThereareanumberofRetirementVillagesintheEasternSuburbs,butlargelythemodelhasbecomeoutdated andcanfosterseparationand‘otherness’ifthelocationanddesignisolatespeoplefromtheirfamily,friendsandinterests.Retirementvillagesaretypicallyamoreexpensivelivingoptionwithhighertransactionandlivingcosts.Theyoftenfeaturesmallerproperties,thereisalimitedchoiceoflocationsaswellasaccommodationproductsandthereisgenerallyapoorfinancialoutcomeforresidentsuponexit.Contemporarydesignfeaturesarebeingincorporatedwithinnewhousingdevelopmentssuchas,ahome-likeenvironmentandonsitecafesandshops.Agrouphomemodel,designedforpeoplewithdementia,operatedbyGroupHomesAustraliaandtheMarkMorandevelopmentcurrentlyunderconstructionareexamples,inthearea,thatfeatureahome-likeenvironment.Arguably,however,housingdevelopmentforseniorsisstilllargelydrivenbycompliancewithbuildingstandards,ratherthaninnovationindesigntoassistpeopletoageinplaceandremainengagedincommunitylife.Manyoftheoptionsintheareaarealsohighendandbeyondthereachofalargepercentageofpeopleonmiddletolowincome.Theareaislikelytocontinuetoattracthighenddevelopmentsastheareaislargelyviewedashometoanaffluentcommunity.ThelossoftheBenevolentSociety’sApartmentsforLifedevelopmenthasreducedavailableoptionsforlocalresidentswithmoderatemeanstoageinplace.AkeyfeatureoftheApartmentsforLifemodelisthatitofferspeopleachancetoremainintheirownhomeastheyagetoavoidhavingtomoveiftheirhealthdeclinesandtheyrequireincreasedlevelsofcareandsupport.Themodelalsoprovidedaffordableandsocialhousingunitsforthoseonlowtomoderateincomes.
Ashortageofsuitablydesignedhousingislikelytobeagrowingissue,especiallyforpeoplewhowishtodownsizeandremaininthelocalarea.Strategiestosupportandpromotethedevelopmentofinnovativehousingdesignwithaccessibleandadaptablefeaturestodevelopers,architectsanddesignerscouldbeexploredtoimprovehousingoptionsforolderpeopleinthearea,movingtowardsindividualisedfundingarrangementsforinhomeagedcare.
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AGEINGINPLACE-AWAYFORWARD
TheNewArchitectureforaNewAge(NANA)projectoffersanewwayofthinkingaboutthedesignofaccommodation,exploringhowarchitectscandesignbetterenvironmentsforpeopleastheyagethatimprovetheirenjoymentoflife.GuyLuscomb,anawardwinningarchitect,specialisingintheagedsector,studied13residentialdevelopmentsacrossEuropeaspartoftheNANAproject.Hearguesthat’creatingplacesthatareappropriatelydesigned,thataidhealthandwellbeing,promoteparticipationbyanincreasinglyelderlyworkforceandmakecitiesandneighbourhoodsmore‘agefriendly’,willnotonlybenefitindividualsbutwouldhavebottomlinebenefitsfortheeconomy,potentiallydecreasingtheprojecteddemandonhealthservicesandprovidingawholenewgroupofactivecitizens.’Keyrecommendationsfromtheprojectinclude:societyshouldviewolderageasthenormnottheexceptionandarchitectsshouldbetrainedonhowtoincludetheneedsofpeopleatallstagesoflife;designshouldembraceinclusivenessandequalopportunityandmoveawayfromacompliancedrivenapproach;theLiveableHousingGuidelinesshouldbeappliedtoallnewbuildings;andmultigenerationalhousinganddesignthatpromotecommunityshouldbeencouragedwithmorehousingandfacilitiesforseniorsincludedinurbancentres,connectedtofacilitiesandpublictransport.
ConclusionWaverley'spopulationisageingand,correspondinglyitcanbeexpectedtherewillbeanincreaseintheprevalenceofdisabilityandanincreasingneedforbothin-homesupportandresidentialagedcare.WithinWaverley'solderpopulationtherearevulnerablegroupswhichwillrequireadequateplanningandsupport,including:
• peoplefromculturallyandlinguisticallydiversebackgrounds;• peoplerequiringassistancewithcoreactivitiesorprovidingunpaidassistancetoafamilymember;• peopleintheworkforceearningbelowtheminimumwage;• peopleexperiencingrentalstress;and• peoplelivingalone.
Themainchangesasaresultoftheagedcarereformsforhomecareandresidentialagedcareincludeanemphasisonwellness,consumerdirectedcareandtheimplementationofmeans-testedcarefeesforpeopleaccessingtheseservices.Aspeoplearechoosingtoremainlivingintheirhomesformuchlonger,anaccessiblebuiltenvironmentandaccesstoanadequatesupplyofin-homecareservicesandpackageswillbeneeded.Thesupplyofagedcareplaces,bothresidentialplacesandhomecarepackages,intheareaisconsideredreasonablysufficientatthistimebutasthefulldetailofthereformsarenotyetknown,thelongertermimpactwillneedtobemonitoredandCouncilandthecommunitykeptinformedofdevelopments.Council’sCommunityandSeniorsCentreandassistedbywelltargetedpartnershiparrangementswillplayanimportantpartintheprovisionofbestpracticeinformation,referralandsupportservicesundertheConsumerDirectedCaremodel.Councilwillneedtocontinueitseffortstoensureuniversaldesignfeaturesareintegratedinallplanning,developmentandmaintenanceofpublicinfrastructuretoprovideeaseofaccessforolderpeoplewithinthepublicdomain,andstrategiestosupportsocialinclusionandcommunityengagementopportunities.Theconceptofhealthyageingis
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encapsulatedinanumberofdifferentways.Itincludesastrongfocusonmakingourpublicspaces,openandinviting.Italsoreferstoahostofsupportsthatenablepeopletostayactiveandwellastheyagethroughsocial,recreationalandculturalprograms.ThenewrequirementsunderthenewDisabilityInclusionActionPlanwillprovideaframeworkandfocustoplanandmonitortheprogressforCouncil’sworkinthisarea.Thereisashortageof,anddemandfor,innovative,affordableandwell-designedhousingoptionsforolderpeople.Although,localgovernmenthaslimitedinfluenceovertheallocationofagedcare,Councilcouldtakeaproactiveroleinpromotinggoodpracticeandbringingarchitects,urbanplannersanddeveloperstogethertoexploreideasonhowbesttoimprovethesupply,designandpromotionofinnovativedesigninhousingthatbettermeettheneedsofolderpeopleinthearea.
RECOMMENDATIONS
• Holdaforumtostimulateregionaldiscussionstofacilitatepartnershipsaroundinnovativehousingdesignoptionsforpeopleastheyage.Theforumwouldattractarchitects,urbandesigners,developers,governmentagenciesandplannerstoexploreaffordableoptionsandmultigenerationaldevelopmentsthatsupportcommunityengagementandageinginplace.
• Continuetomonitorthesupplyofresidentialcareandseniorshousingoptions• EndorsedevelopmentofaDisabilityInclusionActionPlantoidentifyactionsCouncilcantaketosupportpeople
toremainhealthy,activeandwell,andengagedincommunitylife.• ContinueserviceimprovementsattheWaverleyCommunity&SeniorsCentretobecomeacentreofexcellence
fortheregionundertheConsumerDirectedCaremodel.
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References• Agedcarepackagesinthecommunity2010-11:astatisticaloverview-AustralianInstituteofHealthandWelfare• AgeingandAgedCareDepartmentofSocialServicesonline-www.dss.gov.au• KeyFactsandStatistics:March2014–Alzheimer'sAustralia• Australia'sWelfareReport2013-AustralianInstituteofHealthandWelfare• CommonwealthHomeSupportProgrammeDiscussionPaperSubmission-HACCDevelopmentOfficersSouth
EastSydney• DementiaServicesFramework2010-2015-NSWHealth• DemographicSnapshotMetroSouthRegion-NSWDepartmentofFamily&CommunityServices• FallsInjuryPreventionPlan2013-2018-SouthEastSydneyLocalHealthDistrict• GuidetoAgeCareNSW&ACT-DPSPublishingonline-www.agedcareguide.com.au• HomeandCommunityCareCityofSydneyandEasternSuburbs-InnerSydneyRegionalCouncilforSocial
Development• MyAgedCareonline-www.myagedcare.gov.au• NewSouthWalesStateandLocalGovernmentAreaPopulation,HouseholdandDwellingProjections:2014Final
-2014AustralianBureauofStatistics• PopulationHealthSub-RegionalProfile2014WaverleyLocalGovernmentArea-EasternSydneyMedicareLocal• ReportonGovernmentServices2013-SteeringCommitteefortheReviewofGovernmentServiceProvision-
AustralianGovernmentProductivityCommission• ReportontheOperationoftheAgedCareAct1997,2013-2014-2012AustralianGovernmentDepartmentof
SocialServices• Residentialagedcareandagedcarepackagesinthecommunity2011–12-AustralianInstituteofHealthand
Welfareonlinewww.aihw.gov.au/home• TechnicalPaperonthechangingdynamicsofresidentialagedcarepreparedtoassisttheProductivity
CommissionInquiryCaringforOlderAustralians-2011DepartmentofHealthandAgeing• TheNANAProject-GuyLudscombe-ByeraHadleyTravellingScholarshipsJournalSeries,NSWArchitects
RegistrationBoard2015• 30June2014StocktakeTotalPlacesandRatiosbyAgedCarePlanning-TheDepartmentofHealth
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Appendix1
Governmentresponsibilitiesinagedcareservices
LEVELOFINFLUENCEINAGEDCARE
KEYFUNCTIONS
FederalGovernment
Primaryresponsibilityforagedcare
NationalRegulationandfundingofresidentialcareandhomesupportservices.Setsnationaltargetforallocatedplacesforresidentialcareandhomesupport.
StateGovernment
Limitedinfluenceoveragedcare.RegulationandfundingfordisabilityinclusionuntilNDISrolloutiscomplete.
NSWAgeingStrategysetsoutactionsthatstategovernmentagencieswilltaketosupportanagingpopulationeg:SeniorsCardNSWDisabilityInclusionAct2014requiresStategovernmentagenciesandCouncilstodevelopaplantosupportandpromotetheinclusionofpeoplewithdisabilityincommunitylife.
LocalGovernment
Limitedinfluenceoveragedcare
Urbanplanningandimplementationofaccessimprovementstothebuiltenvironment.MaydirectlyprovideservicesandsupportsforolderpeopleUndertakessocialplanning,communityconsultationandadvocacytoaddressneedsandinformCouncil’sstrategicplanning
Developmentandoperationofagedcarefacilities
Agedcarefacilitiescanbedevelopedandoperatedbygovernment,privatebusinessandnotforprofitagencies.
ThedevelopmentofagedcarefacilitiesrequirecompliancewithbasicbuiltenvironmentstandardsAgedCareprovidersmustcomplywithagedcarequalitystandardsandstringentfundingrequirements.