Nearly three decades ago, the Danish parliament passed legislation which effectively banned the construction of new nursing homes. Denmark then embarked on a process of boosting home care services and developing accessible social housing so that older people did not need to move into a nursing home if they needed care. Nursing homes closed at a rate of around ten per cent per year in the early years after the reforms and by 2010, 87 per cent of older people needing care received it in their home.
By contrast, new nursing home construction in Australia shot up by 69 per cent in 2013/14 on the previous year.
Of the 314,659 people who received a coordinated package of aged care in 2013/14, only 26 per cent did so in their home. The remainder were in nursing homes.
In Australia, unless you require only an hour or two of care per week, you’ll likely need to go into a nursing home.
The newly appointed Minister for Aged Care, Sussan Ley stated that people are most comfortable when they can spend as long as possible in their own homes.
A recent survey of CPSA members found that 95 per cent would want to be cared for in their home.
Unfortunately, under current policy settings, few would be able to exercise that choice.
There are three major roadblocks to seeking aged care in the home.
The first is availability. If you have moderate to high care needs, it’s likely you’ll have to wait between six and 24 months for a home care package, which is probably not going to be feasible given the level of care you require.
The occupancy rate for a level four package is 90.1 per cent. There are only 13,679 level four packages, leaving just over 1,200 packages available, Australia-wide.
That roughly equates to less than one available package for every 1,000 people aged 75 and over.
The second roadblock is funding. Home care package funding is capped. So if your care needs exceed your package’s funding allocation, you will either need to pay the difference (which could amount to hundreds of dollars per week) or ration your care. For many, the only option is to move into a nursing home.
Finally, older people may not be able to remain in their homes because the home is not accessible or affordable. A staircase can mean the difference between staying at home and moving into a nursing home. Older renters in the private market often end up in nursing homes because they cannot afford the rent.
Unlike in Denmark, which, after banning nursing home construction, embarked on a long-term program to boost accessible social housing supply, there are few affordable and accessible housing options for older people looking at moving into a more manageable home.
Older people have little choice when it comes to aged care. Unless they’re very lucky or not that frail, a nursing home generally remains their only option.
Minister Ley’s recognition that people want home care is welcome. Now the question is how to ensure more people get it. It’s unlikely Australia will ever ban the construction of new nursing homes. However, the Minister must prioritise addressing some of the roadblocks to accessing home care so that the majority of older people can stay in their homes.
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