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In-home aged care should be a support, not a burden

A guest post from Ben Martin Hobbs at Consumer Policy Research Centre (CPRC).

Until recently I hadn’t given a lot of thought to aged care.

Though my own grandparents have encountered a number of health issues over the last few years, they appear to be living pretty happily in their own home of more than 50 years close to Cottesloe Beach in Perth. I can’t imagine them living elsewhere. While they don’t receive any in-home care, they’re well supported by an extensive network of family and friends. Grab rails have been battle planned and installed by architecturally inclined uncles, the garden is maintained by a small army of green-thumbed friends, and outings to the shops, the pool or the theatre are easily managed.

Recent reforms to aged care in Australia are geared to help older people achieve just this kind of independence and quality of life. Part of an increasing move towards Consumer Directed Care (CDC), the reforms aim to provide more choice and agency through the introduction of in-home care to help older Australians live in their own homes for longer.

At first glance this reform direction seems sensible—a way of giving older Australians more quality of life and a clever use of public funding compared with accumulating isolated individuals in sterile hospital wards or aged care facilities.

But when I started learning about the serious issues that people have encountered trying to use the home care system—the burgeoning waitlist to secure what is known as a ‘Home Care Package’ (HCP) and the complexity involved in the ‘consumer directed’ aspect of care—I came to realise that my grandparents’ experience of independence and agency would probably be unattainable for anyone without a sturdy support network of family and friends.

In other words, the system is likely to fail the people it’s meant to empower—those most in need of help.

The issue of choice in complex markets is one that preoccupies us here at CPRC, particularly around questions of market stewardship—that is, how regulators or policymakers design and steer the functioning of markets to ensure they work for people.

Though there is talk in the literature about how “we are all behavioural economists now”, we continue to see governance of programs, policy interventions and bureaucracy that fails to account for how people actually make decisions, designed instead around assumptions about how they ought to make decisions.

The current in-home care system, sadly, turns out to be a prime example of this kind of problem. Our research found a complex market where consumers are notionally given choice and control over their care, but at a time when engaging in a market might be particularly difficult. The very issues that prompt the need for care can create barriers to making informed decisions, especially in a regulatory context where information disclosure has been the default for consumer protection—despite evidence that it doesn’t necessarily work in people’s interests.

Everything from reduced cognitive capacity and limited hearing to health issues and long-term illness can change the context in which people make decisions. Throw in a healthy dose of complex bureaucracy and you’ve got a recipe for trouble.

Almost everyone has someone in their life—a parent, an aunt or uncle, or grandparent—who needs some kind of care or will likely need it sooner rather than later. But in talking to people about in-home care, we found a stark lack of awareness about the care and support available. Family members are often just as confused as their older relatives, and can be heavily burdened by the responsibility and cost of providing informal support.

And for older Australians who don’t have people around to help navigate the bewildering system, the kind of choice and control that home-based care is meant to provide can be simply unattainable.

We’ve made a range of recommendations that go to the heart of better designing markets for the people they are intended to serve. Home Care Packages themselves can be simplified and standardised. Information can be designed in a way that older people and their carers can simply access and understand. Enforcement agencies can do a better job of holding service providers to account, and they can collect and publish better information about the quality of care being provided. And particularly important is independent support and guidance to navigate the system for those who need it. We have a responsibility to ensure older members of our community gain access to the support they need.

The stories of people waiting months for care, sometimes dying before a package became available, are heartbreaking. If the treatment of its older citizens is a reflection of a society, the number of Australians waiting months and months for care, sometimes isolated and alone, is a genuine embarrassment and an indictment on our cultural values. Older Australians deserve the ‘fair go’ that access to a good, accessible in-home care system will provide.

 

Ben Martin Hobbs is a Senior Research and Policy Officer at Consumer Policy Research Centre, leading CPRC’s research on consumer choice and decision making. Ben co-authored CPRC’s Five Preconditions of Effective Consumer Engagement, developing a conceptual framework to build consumer confidence and trust in markets and facilitate effective demand-side engagement. This innovative framework has informed subsequent work, including “But are they any good?”, a report considering Akerlof’s “lemon problem” in the context of consumer services and the latest report from CPRC – Choosing care: the difficulties in navigating the Home Care Package market. Ben holds a Master of Public Policy and Management and a Bachelor of Arts (Hons) from the University of Melbourne.