Budget focus on primary health care; a missed opportunity for ageing Australia

By  Patricia Edgar  and  Don Edgar

May 13, 2023

We need a radical rethink of the way we structure a 100-year life.

Stephen Duckett  welcomes the shift in focus of health care policy from the extreme end of hospitalisation to making primary care a priority - improvements to Medicare, cheaper access to medications, bulk-billing incentives for GPs. These measures will help many older people, as they will those younger, but there is a need to look at reforms that could be made for our burgeoning group aged 65 and over who by 2025 will outnumber those under 14 years. The issues involving the ageing of our population are far wider than aged care.

Fewer than 4 per cent of Australians over the age of 65 are actively using age care services. Yet the major policy focus is on costly late-life care rather than on support and prevention at the time when a little help is needed, which could mitigate intrusive costly aged care.

Opportunities to remain in the workforce with flexible hours, community engagement, shared housing, improved public transport, paths where one can walk without fear of potholes, dogs and scooters, accessible care support and health information, building a truly age-friendly community could help ensure that primary care is given priority - a fence at the top of the cliff instead of an ambulance at the bottom.

Ironically, predictions suggest fewer aged people will want to enter aged care accommodation in future years than has been predicted in previous doomsday scenarios. Doubtless a result of the Royal Commission's revelations about widespread neglect and abuse in aged care homes. The Budget cuts that funding by $2.2 billion over 3 years, providing for just 60 residential places per 1000 people over the age of 70 compared with the previous provision for 70 in 1000.

Over 90 per cent of older Australians live, as they prefer, in households in their own community.

The Budget sensibly responded by increasing the number of home care packages by 9500, still not enough, but a recognition of people's preferences. That $166.8 million is supplemented by $112 million for getting more GPs into aged care and $59.5 million for better training of support workers yet shrinks in comparison with the extra (and much needed) $515 million for the recommended workers' pay increase and the overall $338 million for aged care accommodation.

New provisions to strengthen regulation and compliance to improve food and nursing care quality are important and will, we hope, help bring change. A relative in aged care resides in a home where the quality of food was rated, after Government enquiry, the second worst in the State of Victoria. This was after aged care providers were receiving an additional $10.00 a day per resident from July 1, 2021. Enquiries we made were met with bureaucratic responses amounting to, we are doing the best we can in difficult circumstances.

Access to the system needs overhaul. Try navigating online or through phone calls, any part of the cumbersome system and you understand why many older people stay struggling on alone. Log in to the so-called ‘Carer Gateway' for unpaid carers (mostly spouses and family members) and you meet a solid wall of assessment queries, steering you into an approved ‘Package' provider and the complicated four-tiered package system. There is no way to avoid an inspection of your living and financial circumstances, and no way of guaranteeing any of the promised respite care. The carer's own health comes under scrutiny, time spent at work and with friends queried, and eligibility is restricted to informal carers over age 65. There is nothing for middle-aged daughters or grandkids who may be sandwiched between childcare and aged care.

There is no thought given in the budget to alternatives such as  HomeShare  which could ease both the rental burden and ensure better use of existing housing stock, and a scant $59.5 million for training care workers across the system. The Gateway offers unspecified coaching and online courses for unpaid carers which may or may not be appropriate for their varied experience and just $11.9 million to expand the Quality Indicators Program. Means testing is set to be tightened, and some $487 million is set aside for Disabled Support for older Australians, doubtless needed, but ignoring most older Australians who need only casual home help and support with chores like shopping, cooking, cleaning, odd job repairs, gardening, getting to medical appointments.

There are thousands of young people, single mothers and retired nurses with diverse skills who could help in exchange for some form of rent assistance. Such measures could help reduce isolation, stress, illness, falls and early hospitalisations - primary support, not costly secondary aged care provisions.

The Budget is still framed to attempt to help redress pressures brought by ageing.

Perhaps it's too early in the life of this Government to reshape the ageing debate. But they need to think about the 30 years of extended life span medical science has given us across less than a century, as a bonus and a resource and develop the potential those years have, to contribute socially, economically, and culturally. The approach need not be that of a looming burden. We need a radical rethink of the way we structure a 100-year life. By 2060, 25 per cent of Australia's population will be over 65 years of age.

Both Treasurer Jim Chalmers and Minister Mark Butler speak of capitalism with values.

A new approach will be one based on lifelong engagement in family, community, and leisure activities, in active work and ongoing education - learning and retraining as our interests and circumstances change. Better health outcomes will follow.