The Changing Face of Community and
Aged Care.
Challenges for the future.
A/Prof Michael Fine
Department of Sociology
Centre for Research on Social Inclusion
Macquarie University
Sydney NSW
michael.fine@mq.edu.au
Setting the scene
Ten Years Time?

Big question - Data is missing
 The future is unknown and unknowable.
Generally a way of talking about today.
Starting point: the foundations of today.
Major challenges
Ageing: Longevity Society
Climate change - from ‘prediction’ to management
Globalised world
Social change. From
- modern industrial society
to
- post-modern, post-industrial society?
Economic sustainability
Proportion of the population in select age groups,
Australia, 1901-2101 (%)
Year/
Age group
1901
1947
1971
2002
2021
2051
2101
0-14 yrs
35.1
25.1
28.7
20.3
16.1
14.0
13.8
15-64 yrs
60.8
66.8
63.0
67.1
64.9
58.9
57.2
65+ yrs
4.0
8.1
8.3
12.6
19.0
26.1
28.9
Source: (ABS 2006: 114, Table 5.16, in Borowski and McDonald, 2007: 30)
The demographic shift

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Ageing associated with affluence, high living standards.
Australia still well behind most N. European Countries
ageing of the population,
fertility rates below replacement level.
National Strategy for an Ageing Australia (2003); Intergenerational
Report (2002, 2007)
For every (Italian child) under five.
In Italy in 1950, there were 8.5 children under five: 1 over 80 year old.
In 1995 the ratio had fallen to 1.3: 1
By 2050 there may be 1: 6 over 80-year olds and 1: 18 over 60-year
olds (Golini, 1997: 54)
The Need for Care
Epidemiology 3 scenarios:
1. Compression of Morbidity hypothesis (Fries, 1980;
Fries, Green and Levine, 1989)
2. Expansion of Morbidity (Gruenberg, 1977; Kramer,
1980; Olshansky et al., 1991)
3. Postponement of Morbidity (Manton, Stallard and
Corder, 1995; Manton and Land, 2000)
Epidemiological Evidence
1. Very moderate or no gains in disability on the whole – Australia,
the Netherlands and the United Kingdom;
2. Mixed or moderate results – Canada, Sweden;
3. Significant gains – Germany, France, Japan and the United
States. (Jacobzone et al., 1998a: 16)
Likelihood of better prevention etc, but
continuing need for care.
Dementia: 2007-2050
2007
2050
220,000 people affected
731,000 expected.
Dementia numbers: increase of 327%
Total population: increase less than 40%
Table 1
Long-term Care Arrangements for Older People (aged 65+) Australia, 2003-04
Number
Pct 65+(a)
Workforce(b)
Care arrangement
Residential Aged Care Services (High
Care) (c)
89,922
3.45
86,761
Residential Aged Care Services (Low
Care) (c)
47,785
1.83
44,469
646
0.02
Community Aged Care Packages
(CACP)(c)
25,722
0.99
At Home with HACC or VHC(c)(d)
598,737
22.99
Living at home with unpaid care only
345,500
13.26
2,604,900
100.00
Extended Aged Care at Home
(EACH) (c)
Total people aged 65+
51,792
Key issues in aged care
The Availability of (unpaid) Carers
Future workforce planning
Future models of service delivery
Funding options
Availability of carers

Australian projections AIHW (1998-2013),
NATSEM (2001-2031)
Suggest declining availability of ‘primary carers’ in coming
decades.

UK projections (Pickard et al. 2001) suggest improvement
in availability of carers due to improved rates of marriage and
cohabitation amongst older people.
Formal Care Staff


Less projections done, less data available
NILS Study (2004) of existing residential care
workforce suggests current staffing not in
crisis, but increasingly under threat.

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94 pct female;
Mainly part-time (66 pct); 25 pct casual/agency staff;
Fewer nurses; more low paid personal carers;
Increased reliance on migrant staff
National Aged Care Workforce Strategy
(2005)
Projected Number of Direct Care Workers Needed for Aged Care
Accommodation and All LTC services, Australia: 2003-2031
Year
2003
2011
2021
2031
No. of Older Persons Residential care Percent Change p.a Residential and
Needing Care No. of Direct Care
Commy Care
Accommodation Workers Needed (fte)
All LTC Staff (ft & pt)
144,000
68,400
183,022
370,848
176,153
12.6
471,343
495,315
235,275
2.9
629,539
611,292
290,364
2.1
776,944
Source: Hugo, 2007: 177. Calculated using ABS 2005 Projections, Series B and ABS Survey of Disability, Ageing and Carers, Catalogue No. 4430.0,
+ authors calculations
Future Care Workforce Planning

Will the shortage of care staff experienced in Europe
affect Australia?

Already major concerns about lack of wage parity with
comparable staff. Can we afford better pay? Can we
afford not to pay better?

Concerns also about changing staffing mix. What is right?

Should existing specialised division of labour be
maintained?
National Aged Care Workforce Strategy
1. WORKFORCE PROFILE
Strategy 1: Know the Workforce Profile
Strategy 2: Link Workforce Profile to Supply and Demand
2. WORKPLACE PRACTICE MODELS
Strategy 3: Identify and Develop Effective Workplace Practice Models
Strategy 4: Link Workplace Practice Models and Workforce Demand
3. LEADERSHIP AND MANAGEMENT
Strategy 5: Develop and Sustain Workplace Leadership
Strategy 6: Develop and Sustain Effective Management
National Aged Care Workforce Strategy (Cont’)
4. EDUCATION, TRAINING AND
DEVELOPMENT
Strategy 7: Provide Effective Training Design
Strategy 8: Provide Effective Training Delivery and Opportunities
Strategy 9: Ensure Specialised Training
Strategy 10: Support Access to Training and Re-entry
Strategy 11: Support Continuing Education and Professional
Development
5. A RESPONSIVE WORKFORCE
Strategy 12: Strengthen Supply of Staff and Monitoring the Client
Profile
Strategy 13: Attract and Recruit Staff
Strategy 14: Retain Staff
National Aged Care Workforce Strategy (Cont’)
6. STATUS AND IMAGE
Strategy 15: Create a Preferred Image
Strategy 16: Communicate the Image
7. EFFECTIVE LINKAGES
Strategy 17: Maintain Linkages with Other Relevant Strategies, Policies
and Plans
My concerns
Positive: Planning framework.. Thinking about
issues. Recognition of likely problems.
Issue: Assuming current system and developments
provides template for the future.
Fear: McDonaldized Care
Casualised, underpaid staffing model extended into
future,
Increasing ‘flexibility’ for employers,
Insecurity for staff,
Uncertainty for clients, potential service users
Future models of service delivery
New constellations of care

Biggest users of health care services are aged people.

Health care and aged care increasingly likely to interact.
Integration of different services increasingly important. New functions
for residential care e.g. as sites of clinical excellence, for intermittent,
short term use - complementing hospitals and home care.

Substitution principle to manage increasingly expensive care
interventions.
Existing emphasis on care at home will need to be continued,
enhanced.

Technology
Increasing use of everyday technologies to assist, monitor
to
Our future as cyborgs
Models of service delivery (Cont’)

What can be learnt from new home based services?
Hybrid care.
Individualised care - case/care management.

Home-based care innovations.
Further development inevitable:
- Increased intensity of service
- New organisational and financial technologies:
eg - direct payments
- enhanced access to case management/ care co-ordination
3.

Funding options
Hogan’s vision of a mature industry: Corporate care,
with a minimum safety net. Asset run down implied.

What are the options?
Leave it to the market?
Other forms of user pays death duties;
social insurance?
Continuation of existing system of means and asset
tested subsidies?
Re-imagine the future of aged care.
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Workforce planning, development and education is
key.
The future is NOT pre-determined.
Challenge is to imagine the ideal future and make it
happen.
‘Think Globally; Act Locally’.
Aged care’s time has come. Must be the real
‘cutting edge’ of the future.
Challenges major, good people can make a
difference on this scale.
Published by
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