National Ex-Service Round Table on Aged Care
Final Report : The Future Provision of Residential and Community Services.
SECTION 1: LITERATURE REVIEW
The literature review was undertaken to synthesise existing research material pertaining to Ex-service Organisations (ESO’s) into a succinct summary of the findings from these studies. Whilst it is recognised that unique situations and differences prevail in the veteran community amongst ESO’s, the review focussed on the key issues relating to each of the following areas:
- The likely demand for aged care services for the Ex-service Community in the next 5-10 years.
- The capability of Ex-service Organisations to provide accommodation and community care to the Ex-service Community.
- The financial practices of ESO aged care service providers and their utilisation of available Information Technology.
- The ability of ESO residential and community service providers to remain viable without jeopardising service quality.
- The ability of ESO service providers to meet the challenges posed by the Federal Government’s Aged Care Reform Agenda.
Likely demand for Aged Care
The indications are there will be significant change in the characteristics of the Ex-service Population over the next ten years. The population is ageing at a faster rate than the general population.The demographic projections indicate that many ESO’s may need to reposition themselves as aged care providers.The key characteristics of the Ex-service Community over the coming decade indicate it will:
- Comprise an increasing proportion of people aged 80 years and over
- Have an increased proportion of female constituents
- Have a higher proportion of its number who live alone
- Have an increasing need for community based and residential careHave an incidence of dementia approximately double the current incidence 4
- Likely increase in the incidence of psycho-social needs 6
The highest concentrations of the Ex-service community will continue to be in metropolitan regions with numbers in rural areas remaining relatively small and more widely distributed.The literature confirms that the majority of the Ex-service Community will want to "age in place 11 and will require services to support them when they can no longer manage independently. They will need access to services which maintain their health, prevent illness, and help to manage their health needs.There will be a high need for personal care in the community (showering, dressing, home care and related supports) in the near future and this demand will increase over the next 20 years. 1Requirements relating to home modifications will become more prevalent (such as hand rails and special showers), and people in remote locations are more likely to have unmet needs in relation to these. 6Carers have also cited the need for assistance to enable them to care for people in their own homes longer. Some members of the Ex-service Community are caring for spouses, children, and others whose needs are equal to or greater than their own. This places an added burden on their personal resources and physical health.A proportion of veterans require support and assistance to reduce the impact of social isolation. A variety of actions are needed to raise awareness and draw resources to bear on addressing this issue. 13The research indicates the majority of carers are partners, which raises the issue that as Ex-service clients age, partners are likely to become frailer themselves, posing implications for future service needs 6 in the community. For residential care providers, veterans and their partners are likely to require different levels of care and the opportunity to remain together.Whilst most demand will be for support for people living at home. There will also be a high demand for residential care, particularly high dependency support, including dementia care. ESO’s have expressed a critical need for dementia specific secure hostel facilities. 5
The capability of ESO’s and community based organisations to provide community care
ESO’s have considered the key issues affecting the type and level of service they provide. These range from issues of organisational and financial management, organisational size and service range to the development of clear strategic directions. Closely related to this ESO’s need to consider whether they become home care providers as well as residential accommodation providers.Scope for joint ventures with other residential and community providers is being examined by ESO’s in relation to accommodation and community care projects 5.Strategies which address a major demand for personal care to support people in their own home (peak demand 2003 – 2010), are constrained by limited financial and funding resources. Organisations will need to consider ways of meeting this need with minimal additional administrative cost and/or combining with others to provide the required services.Service providers will need to rigorously prioritise their efforts in the development of new community-based programs particularly where they are to be the service provider.ESO’s have sought to respond to the provision of community services through advocacy, co-operative, auspice or supportive arrangements with other suitable service delivery agencies. Opportunities to add on to existing services, particularly in country regions are being explored 7.
Service levels differ between ESO’s, and it is apparent from the literature, that not all are well placed to provide the appropriate range of services and level of care in the future. Where organisations are not well placed to provide the appropriate level and range of care, they should consider the need of investing in core business such as hostel/nursing home development, or seek opportunities to develop community based aged care as part of their business. 4
The financial practices of ESO aged care service providers and their utilisation of available information technology
The literature suggests that many ESO facilities need to review or redefine their financial management practices. The challenge for many lies in redefining financial management systems without betraying their basic charter or commitment to their target group.
Many facilities are struggling with outdated infrastructure. Some facilities are unable to attract sufficient entry contributions to finance a refurbishment or upgrade. A number of facilities intend to redefine their approach to fee and accommodation bonds in order to provide a stable financial base upon which to operate in the future. Rationalisation of existing properties to raise funds for capital upgrades is one option. 3 Establishing closer links with the wider community will enable other facilities to achieve economies of scale in service provision. Opportunities exist for some to re-develop existing facilities by way of selling off surplus/non producing assets.
Changes need to be made to accounting systems to enable easier comparison and analysis of regular financial results without the need to re-work information. In some cases the financial accounting system does not reflect the true operating position, nor does it allow for provision for replacement or upgrade.
It is suggested that a lack of resources, both administrative and financial, competing demands and low levels of information technology justify a thorough review of financial practices. It is not evident in the literature that ESO’s are benchmarking with other providers in the industry, or have developed internal benchmarks related to key performance indicators. One major service provider has expressed the need to bench-mark the operating efficiency of all its facilities in view of increasing financial pressure. 3 Others seek to be exposed to industry "best practice". 5
The ability of ESO residential and community service providers to remain viable without jeopardising service quality
ESO’s aim to provide the highest and most cost effective individual service to meet the physical, social, emotional and spiritual needs of every client. 8 It is the intention of ESO’s to operate a wide range of services that touch all areas of aged care service. This may not necessarily occur through direct service provision, but through a variety of service models.Residential strategies for funding upgrade and maintenance include:
- Taking reasonable steps to benchmark, monitor and improve operating efficiencies of all facilities.3
- Creating capital resources by way of borrowings or access to limited Commonwealth funding. 5
- Borrowings, entry contributions, subsidies for financially disadvantaged, donations, special government grants & cross subsidisation. 10
ESO’s acknowledge the need to achieve meaningful outcomes with clients through quality improvement. This will be achieved by providing tailored services in line with regulatory standards.1 ESO’s will need to operate as part of the community and build on community structures that exists and enhances their operation or the level of access that the elderly veteran community needs. Whilst ESO’s have not always capitalised on opportunities to participate in some innovative service delivery models,2 the literature suggests that they are now committed to responding to changes in aged care and fostering innovation.1 There is a willingness to examine a range of different funding and service arrangements in the provision of accommodation and services for the veteran community. ESO’s need to review their range and quality of service provision, facilities and infrastructure in order to achieve financial viability and better ways of meeting client needs.
The ability of the ESO service providers to meet the challenges posed by the Government’s Aged Care Reform Agenda
From the literature, the following challenges of the Aged Care Reform Agenda are anticipated to be:
- Equity between pensioners and self funded retirees
- Viable choices as to how to pay for the accommodation contribution
- Hardship protection for carers
- Aged care facilities must meet health and fire regulations
- More residential care places will be needed every year at least over the next decade.
- The number of people over 80 will grow three times as fast as the general aged populationCost of providing care is growing
- Equal access to care 9
The challenge for aged care facilities is to meet the new Accreditation Standards without exceeding funding limits, operating with financial efficiency, and meeting the changing needs and expectations of clients.It is expected that the general standard of facilities will lag behind general community expectations and legislative requirements within the next few years. 3
The major points to emerge from the literature review are as follows
- Ex-service Community preference to age at home
- Increases in the very frail, aged population suggests the need for a major initiative to support the Ex-service Community in their homes as well as provide higher level residential care.
- A review of financial management practices of ESO’s is needed
- ESO’s need to make best use of professional expertise, to join together in planning for their members and to concentrate on delivering high levels of care in innovative ways.
- ESO’s need to look at benchmarking with other organisations and to strengthen links with other aged care providers in the industry.
- ESO’s acknowledge the need to review infrastructure, not be all things to all people, establish links with the wider community, and examine the implications of the Structural Aged Care Reform Agenda.
- ESO’s need to further develop personal care services to frail older members of the Ex-service Community or assist them to access personal care support provided by other organisations.
- Infrastructure investment for residential care projects for the Ex-service Community with a 10 year life span are justified. After that there may be a need to include an increasing number of non-veterans in these facilities.
The findings in the literature review largely reflect the key outcomes sought in the National Healthy Ageing Strategy 12, in particular:
- Working towards improved health and well-being for all older Australians.
- Facilitating appropriate living environments and local communities for older people.
- Providing appropriate and affordable support so that older people can continue to live in the community rather than in residential care.