Should Australia ban nursing homes?

danish flagNearly 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.

Image courtesy of the Professional Windsurfers Association: http://bit.ly/1MHstlR

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5 responses to “Should Australia ban nursing homes?

  1. Nursing homes as they currently operate in Australia should be banned. There are more than enough complaints and hard evidence to support their demise. Government funds are being exploited by
    many service providers in the aged care industry. Consequently, those for whom the funds were intended to provide optimum care fail to meet this objective.

    If Denmark was able to anticipate care needs for its elderly thirty years ago and put in place far better alternatives to address those needs, one has to question the mindset and, indeed the calibre of the Australian Govt. in relation to this issue.

    In view of the many on going horror stories which are a national disgrace, it is clear that a total overhaul of the aged care industry and, nursing homes in particular, is urgently needed.

    Minister Ley’s recognition of the malaise is one thing but to actually put in train a well considered and workable alternative is another. Unfortunately, we have all heard the concerns, tut tutting, platitudes etc. etc. all before with nil outcome. Lets see if the Minister is really prepared and willing to walk the talk!

    Equally, in the last thirty years, this country has had numerous Round Robin Inquiries, reports, complaints,calls for law reform, submissions and so on – but to what end? Is it just to keep public servants employed and to be seen to be doing something when in fact nothing of any value ever occurs? I have yet to see evidence to the contrary.

    Whether it is wilful blindness, apathy or simple incompetence, the manner in which nursing homes and aged care services operate in this country is shameful. Our elderly and disabled are and continue to be devalued and dehumanised right across the board.

    No one in Government appears to ever give any real thought to this issue. Band Aid policies are put in place from time to time but the wound still festers. The CDMs are a step forward but even then, the Govt. boffins could not get that right – yet it is not rocket science! A fair, decent and workable system for the aged and disabled is achievable. We just need a Government which is willing to put to tender and engage totally independent experts, with the views of caregivers incorporated in the mix, to make sure that a well thought out, financially viable and workable alternative is implemented. History shows that the Government is incapable to formulating any workable
    option from within its own ranks where common sense is not so common.

    Bridgette Pace

  2. Home care places enormous burdens on family members – often to the point of serious breakdown in other family relations. The current system assumes someone, usually a woman, but in some cases even a neighbour will fill in all the gaps. This cost needs to be factored in to these overly ‘moral’ conversations about nursing homes. In some cases the carer has worse health than the elderly person who is insistent that they stay at home. In almost all cases the family members have many other task that need to be attended to – including earning a living and caring for other family members, and they may have to drive long distances to provide this ‘add-on care’ because the ‘home’ people want to stay in is a long way from the caring family. In other cases they refuse the care of ‘strangers’, adding deeply to the burden – and to some extent compromising their own health. Nursing homes certainly could be better, but some people really do need twenty four hour fully professional care, and past a certain point it seems unreasonable to expect family or friends or whoever to be the default carer – however willing they maybe. Actually, good hospitals or palliative care centres are very comfortable and secure for very sick people.

    • I meant to add I say this from observation of many friends and neighbours. Sadly I lost both my parents early and quickly.

  3. The article above referred to a model of care in Denmark and the various improvements that could be made in order to allow home care to be more effective if one chose to remain in their own home .

    My comment in response to that article did not make a judgement on whether home care should or should not, morally or otherwise, be provided by family and friends. It would seem, therefore, that Ms. Rasmussen has very much missed the point.

    Having had almost a decade of experience of dealing with nursing homes, allied health care and ultimately palliative care in nursing homes, I can safely say, based on first hand experience and copious amounts of evidence, that nursing homes, in general, are pitiful places to be.

    The article, in part, stated …..

    “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”.

    Therefore, the main thrust of the article was to (a) recognise that some people do wish to remain in their own homes and there should be Govt. funding and assistance to allow them have that choice and to do so safely and securely and (b) that Denmark introduced a model of care that is far superior to that which we have here in Australia. In my opinion, and from what I have personally witnessed, our nursing facilities fall into the 80/20 rule – that is, 80% are abysmal and the remaining 20% do their best.

    Therefore, the only “moral” issue of any relevance in this matter is that which relates to the poor manner in which the elderly and infirm are largely treated in this country. Nursing homes claim to provide “twenty four hour care” which they do not in any true sense of the word. Home Care packages are few and far between, difficult to obtain and the majority of the Govt. funds provided eaten are up by service providers thus leaving many elderly people vulnerable to being removed from their homes or suffering neglect.

    Those are not the options I want to be faced with when I reach an age or level of health where I may need some care assistance. I would much prefer to see a major overhaul of our aged care system and more humane standards of care or the Danish model is implemented here rather than my having to move to Denmark to receive it!

    Bridgette Pace

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