Review of subsidies and services in. Australian Government funded. community aged care programs

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1 Review of subsidies and services in Australian Government funded community aged care programs January 2007

2 This submission was prepared by: Gill Pierce, Senior Policy Advisor Carers Victoria Colleen Sheen, Senior Policy Advisor Carers Australia Date: January 2007 On behalf of: Carers Australia Unit 1, 16 Napier Close DEAKIN ACT 2600 Telephone: Facsimile: Website: Carers Australia 2007 This work is copyright and may not be reproduced either in whole or part without the prior written approval of Carers Australia.

3 Table of Contents 1. Introduction About Carers Australia Who cares in Australia Carer acknowledgement Carer capacity and wellbeing Carer workforce participation Carers and their health Ageing and disability in Australia Ageing in place Household make-up Ageing and transport Disability, ageing and carer support services coordination Recommendations Services needs of frail older Australians, particularly those with complex needs, and their carers Dual targeting Early intervention and an active services model throughout the basic care and packaged care services Future services systems to support community care Gaps and overlaps in services for frail aged and their carers Proposed development of a tiered system of basic care and packaged care Development of common reporting data across Commonwealth programs National Respite for Carers Program (NRCP) Reforms of community care in relation to Commonwealth funded aged care programs Ageing carers of people with disabilities and ageing people with disabilities Culturally sensitive aged care services The structure of subsidy and fee arrangements with regard to equity and choice Services needs into the future References... 15

4 1. Introduction Senator the Hon Santo Santoro, the Minister for Ageing, has invited submissions from consumers, industry and other stakeholders on the Review of Subsidies and Services in Australian Government Funded Community Aged Care Programs. Key focus areas of the review were outlined in the Minister s invitation, and Carers Australia has chosen to focus on: how to improve the types of community care services required by frail older Australians with complex care needs and their carers, now and into the future how the Australian Government can facilitate building greater capacity and sustainability into the community care sector why the Australian Government needs to consider the changing demographics of an ageing Australia and the availability of carers. Carers Australia also supports the recommendations in the submission to this review by the Continence Foundation of Australia and Alzheimer s Australia. Incontinence is a complex and widespread health issue and is a comorbidity for many recipients under the programs being reviewed, and is a key issue for the individuals and their carers. Carers often have increasing responsibility and stress in trying to manage incontinence. The incidence of dementia in Australia is well-documented. As Alzheimer s Australia indicated in its submission, the majority of people with dementia prefer to remain in their homes with appropriate care where possible, and that this is reflected in the falling occupancy rates particularly in low care residential facilities. Without the support of carers many people with dementia could not remain in their homes. Carers Australia has also participated in the review of the National Respite for Carers Program by the Australian Government Department of Health and Ageing (DoHA) and provided input into the proposed framework. 2. About Carers Australia Carers Australia is the national peak organisation dedicated to improving the lives of the 2.6 million carers in Australia who are providing care for people with a disability, mental illness, chronic condition or who are frail aged. Our members are the eight state and territory Carers Associations (the Network ), which directly provide services to carers in their communities. Carers Australia delivers in partnership with the Network a range of carer services as well as identifying gaps in services. It also provides advice to the Australian Government on carer support. Australian Government-funded carer services delivered through the Network include specialist information, referrals, counselling and some education and training designed 1

5 to meet the support needs of carers. These services are funded by DoHA, which also provides core funding to Carers Australia. 3. Who cares in Australia Carers can be parents, partners, brothers, sisters, friends or children. In some cases, a neighbour may take on the role of carer. According to the Australian Bureau of Statistics (ABS) 2003 Survey of Disability, Ageing and Carers1 there are 2.6 million carers in Australia (ABS 2004). Nearly 500,000 are primary carers the people who provide the most care to people with a disability or who are frail aged. The majority of primary carers are women and aged between years. ABS 2004 data indicated there were 245,800 people aged 60 and over with a profound or severe disability living in the community and needing assistance with self care. The ABS 2006 Census included for the first time questions about unpaid work, and we anticipate that the Census data will indicate an increase in the number of Australians who identify as a carer. It will also provide information about whom the carer is caring for. 4. Carer acknowledgement The significant impact of carers to the Australian society and its economy was acknowledged in the Federal Parliament on 16 October 2006 during Carers Week 2006 with the unanimous support of a motion which recognised the enormous contribution of Australia s 2.6 million carers. The motion noted the approximately 1.2 billion hours of informal care provide by family carers. It called on all levels of government, businesses and schools to consider adopting carer-friendly work practices and learning environments. 5. Carer capacity and wellbeing Carers are diverse and each carer has individual support requirements to improve their care situation and quality of life. The majority of carers do not receive government income support, while it is the main source of household income for others. However, there are common factors that support all carers in their choice to continue their caring role and to provide a better quality of life. These should be considered in any national review that affects carers and the people for whom they care. They include workforce participation in a carer-friendly workplace, support to look after their own health, access to affordable carer education and training, an improved long-term financial future and adequate and appropriate community care and health services. 5.1 Carer workforce participation An important trend in workforce participation is the continuing rise in the number of women working and an increase in the hours they work. As women are the largest component of family carers in the community, strategies need to be put in place to make it easier for family carers to remain in, or enter the workforce. Paid employment 2

6 is reported to have protective effects for carers by offering respite from the caring role and helping to maintain social networks. The ability of carers to maintain or return to paid employment will be an increasingly important factor in women s predisposition to provide ongoing paid care. Physical, psychological and time demands of caring place paid employment out of reach for many family carers of working age. Difficulties associated with employment include a lack of suitable, affordable alternative care arrangements and inflexible work hours, disruption to the care recipient and loss of carer opportunities while caring. In its Federal Budget Submission Carers Australia recommended several strategies to assist carers workforce participation (Carers Australia 2006). Of relevance to this review are: the conduct of research into the best way to provide appropriate care models and facilities for employed carers the funding of sufficient and flexible respite and care models to allow all carers to remain in, or to re-enter the workforce if they choose the introduction of legislation to provide carers with the right to flexible working hours the implementation of the 50 per cent reimbursement of disability and aged care costs of up to $10,000 each year outlined in the Taskforce on Care Costs report Where to now? TOCC 2006 Final Report recommendations the establishment of a national carer workforce participation gateway similar to the Working Carer s Support Gateway established by the Disability and Aged Information Service in New South Wales to provide information for carers and for employers about carer-friendly workplaces and available support for employed carers the funding of a Supporting Working Carers guide for carers and employers produced in conjunction with carers, Carers Australia and business and government organisations. The National Aged Care Alliance (NACA) also supported strategies to increase carer workforce participation in its Federal Budget Submission (see: Carers and their health Caring is a health hazard. This is well-documented by Carers Australia s own research, and Australian and international research. Recent research by the Independent Living Centre of WA (2006) to measure the physical impact of caring on carers indicated that for many carers providing care was demanding and had a significant impact on their health. Research findings from 1,619 carers indicate: 43% of carers said they had been physically hurt or injured as a result of providing care 63% reported that caring had a medium to very large impact on their physical health 40% described their current health as only fair to poor carers were much more likely to say they had a health condition now than before becoming a carer 3

7 carers reported a higher level of orthopaedic or spinal problems, cardiovascular problems and emotional or mental problems now than before becoming a carer. The most recent research on chronic diseases in Australia identifies the influence of social economic disadvantage as one of the major risk factor for chronic diseases (AIHW 2006a). As ABS (2004) data identifies, carers are over represented in the lower income quintiles and under represented in the higher income quintiles in Australia. This is a contributing factor in the poor health of many carers. AIHW (2006) indicated that 70 per cent of allocated health expenditure in was accounted for by the top disease groupings cardiovascular disease, nervous system disorders, musculoskeletal conditions, injuries, respiratory diseases, mental disorders, oral health, neoplasms and diabetes. The majority of these diseases are long-term conditions. In these diseases cost $10.9 billion, or 22 per cent of the total allocated health expenditure. Reducing risk factors will reduce the incidence of these diseases in Australia. It is an economic advantage for the Australian Government to implement strategies that reduce the high risk for carers of chronic diseases and injuries. It is also good social policy. In November 2006, DoHA funded Carers Australia to investigate options for a sharedcare model to assist carers self-manage their own health and wellbeing with the support of general practitioners and other health professionals. The project is funded through the department s Sharing Health Care Program to 30 June 2007, and will include the participation of Carers Associations. Carers Australia believes that initiatives to improve carer health should include carer inclusive and sensitive education for general practice to supplement the role of the general practitioner in treating the person for whom the carer looks after. DoHA has completed reviews of services funded through the National Respite for Carers Program (NRCP), including Carelink Centres, Commonwealth Carer Resource and Respite Centres, and the National Carer Counselling Program. Specialist carer services are provided through the NCRP, and Carers Australia believes that an additional 50 per cent of funding is required to allow carers to access specialist information and support, including carer counselling when they require it. For some services there is a waiting list and this increases carer stress. Carers Australia believes respite services should be carer-focussed, carer-responsive and support carers in their caring role. All carers should have access to respite services relevant to their individual caring situation, including short-term residential care. 6. Ageing and disability in Australia The ageing of the Australian population presents a significant challenge to the Australian Government and to the nation. Ageing issues are emerging as a national policy priority. These include the funding of aged health services, the availability of an 4

8 aged care workforce, the availability of carers to support the delivery of community care, and succession planning for aged carers. According to the Productivity Commission (2005) the effects over the next 40 years will be pronounced. One quarter of the population will be aged 65 years or more by , roughly double the present proportion of the population in that age group. The proportion of those 85 years and over will increase from 1.5 per cent to five per cent over this period. One of the implications of an ageing population is that many more Australians will require assistance because of age-related disability. According to the ABS (2004) the rate of disability increases with age. Only four per cent of children 0-4 years have a disability, but 41 per cent of people aged and 92 per cent of people aged 90 and over have a disability. The ABS estimates that the number of Australians with disabilities will increase over the next 50 years as the population ages. This is influenced by people living longer and acquiring disabilities as they age, as well as people with existing disabilities living longer. According to the AIHW (2000) this means carers will need to care for a longer period, and patterns of service use in health and community care will be affected. Similarly, the National Centre for Social and Economic Modelling (NATSEM, 2004) estimates large increases in the ageing disabled population over the next 25 years. It indicates: a 160% projected increase in the number of people aged over 65 needing care from 539,000 people in 2001 to 1,390,000 in 2031, and only a 25% projected increase in the number of people with disabilities under 65 years. AMP NATSEM (2006) projects that the number of potential carers will increase but not at a rate that will meet the increased demand over the next 25 to 50 years. Projections include: a steady fall in Australia's caretaker ratio the ratio of the number of people most likely to provide care to the number of people most likely to need care in 2000 the caretaker ratio was around 2.5 over the next 50 years the caretaker ratio is projected to fall to below one. The projections on ageing and disability and the availability of carers have obvious implications for the future of community, hospital and residential care. 6.1 Ageing in place The majority of people prefer to live independently in their own homes as they age, rather than in health and residential aged care facilities. Ageing in place means people should be cared for with minimal disruption to their situation in the place of their choice where they live permanently. Most people are able to do this and rely on their own resources for their day-to-day living requirements with care from their family 5

9 members and assistance from formal services when needed. The type and intensity of care needed is likely to rise as the level of disability, illness or frailty increases. Our system of maintaining people who need care in their home environment and community care relies heavily on family and friends to provide that care. ABS (2004) data indicated that of the 245,800 people aged 60 and over, with a profound or severe disability living in the community: 25% received formal assistance 84% received informal care from family members and friends 10% received no assistance from either source despite their need. (There is some overlap in these figures as some people may be receiving both formal and informal assistance.) DoHA estimated that the number of people across all age groups who rely on community care services will increase from approximately 650,000 people in 2002 to nearly 970,000 in 2019, using a benchmark of 30 per cent of people over 85 years currently receiving services (Carers Australia 2005). 6.2 Household make-up Often, when people who live alone require nursing home or hospital care when their disability, illness or frailty reaches an advanced stage they have no carer to provide a high level of daily personal care. The ABS 2003 survey indicated that of people aged between 60 and 79 years with a profound, severe or moderate disability and living in a private dwelling, 75 per cent lived with others while only 25 per cent lived alone (ABS 2004). According to AIHW (2003), aged people living alone are more likely to move to residential care and it is more likely to be low level residential care than high level care. This is believed to reflect psychosocial factors as well as physical care needs for people living alone. AIHW (2006b) data also found that in aged care, people who use both community care services (such as personal care, help around the house and transport assistance) and short-term residential care, remain in the community longer than those who use residential respite care only. When there is no primary carer or informal care available, formal community care is very important. AIHW (2004) data about the use of Community Aged Care Packages indicated that clients without a family carer used social support, domestic assistance, food services, transport, home maintenance and rehabilitation support more than those with a carer. The biggest difference (75%) in usage was for social support services. The ABS projects that in the future many more old old people, and very old women in particular, will live alone. Effective community care in this demographic climate implies an increased demand for formal assistance to compensate for a lack of informal care when a primary carer is not available, and to supplement informal care provided by older primary carers and other carers. 6

10 NATSEM (2004) projected that by 2031 the population aged 65 years and over living in private dwellings and needing care without a primary carer will grow by about 65 per cent. This will affect the need for community care services. The challenge for governments is to ensure that people without a primary carer and needing care have adequate alternative sources of care. This is likely to be a growing issue over the next thirty years as the NATSEM projections indicated, and as the number of older people living in single person households increases. The success of national policy objectives in aged and community care depend on the extent to which the relationship between the carer and the person cared for can be sustained without unacceptable costs to either (DHFS 1996). This means that the challenge for governments will be to implement a framework for community care that facilitates early intervention for aged people and carers who need formal support, and one that continues to develop support mechanisms that are responsive to the needs of individuals. Submissions to this review will be important to develop this framework. 6.3 Ageing and transport The recent Australian Government House of Representatives Standing Committee on Health reported that appropriate transport systems for older people were not optional but essential (House of Representatives 2005). Nearly one-third of older people identified assistance with personal activities, with health care and transport as two of the top three areas where they required help. AIHW (20005) data indicated that unmet need for transport assistance was reported by the highest proportion of older people. Access to affordable transport services is important for older people (with or without a carer) and their carers to access health and other community services and facilities, as well as participate in social, recreational and community events. This is more so, in rural and remote areas and for Indigenous older people and their carers. The National Aged Care Alliance (NACA) is developing an issue paper on transport to discuss the impact of transport on access to health care services for older Australians. Carers Australia is a NACA member and asked these questions to inform the discussion paper: What are the implications of the preferences of older people to age in place? Will treatment and management of conditions and illnesses be undertaken in several different sites in the community? How will older Australians need for transport assistance to access health care be met? What will this mean for independent or other travel? How can the needs of isolated and vulnerable older people who lack access to the support of family and friends be addressed? To what extent do difficulties GPs have providing home visiting services relate to GP shortages in particular areas? 7

11 As recent research and data indicated that general practitioners now and in the future are less likely to provide home visits, transport to health services becomes more cricital. Medicare statistics indicated in the first quarter of 2006 that almost 22,000 general practitioners (GPs) provided a Medicare service, but only 46 per cent provided a standard home visit. The number of home visits provided by GPs (for which most are for elderly females) fell from 1.76 million in , to 1.05 million in A study found that the next generation of GPs may be even less able to provide home and aged care services. It found GPs over 65 were about six-times more likely to do home visits and five-times more likely to do residential aged care facilities visits than those under 35 (Charles 2006). Any national review on aged care community services needs to consider the important issue of available, affordable transport for older Australians and their carers to access health care and community services. 6.4 Disability, ageing and carer support services coordination Many carers have dual caring roles. They may care for a child with a disability and care for a frail aged parent or a partner with a disability at the same time. Many carers who have cared for a child with a disability for a long time now require their own agde care services. People over 65 years with disabilities are also accessing Commonwealth State Territory Disability Agreement (CSTDA) funded services. Consequently, many carers in these situations interact with service providers from CSTDA, Home and Community Care (HACC) and NRCP funded services. A common eligibility assessment tool would remove the need for many carers and the people for whom they care to undergo multiple assessments to achieve the mix of services required. Often assessment is required by different service areas within the same agency or provider. The respective responsibilities of disability and aged care service providers to the needs of the group must be determined. Very elderly carers of a son or daughter with a disability who are 65 years and over will not be well supported if their son or daughter becomes ineligible for disability services and if alternative support options are unavailable in the aged and community care systems. Ongoing care by family members should not be assumed, and the new CSTDA should address the longer term care planning issues. This is a key issue for ageing carers. 7. Recommendations Carers Australia recommends the following actions to improve the availability and appropriateness of community care services to enable older people remain in their own homes as long as possible, either independently or supported by a carer. These recommendations also aim to encourage Australian governments to provide community services to better support carers caring for an older person. 8

12 7.1 Services needs of frail older Australians, particularly those with complex needs, and their carers The improvement of community care support for older people with complex needs and their carers requires: Dual targeting The focus of all services interventions should aim to support community care and address the support needs of the care situation. This implies: that the HACC program, Community Aged Care Package (CACP) program and Extended Aged Care at Home (EACH) programs need to: o focus their interventions on the needs of the care situation o develop inclusive (of the carer and older person) priority of access criteria for community care services o ensure that both direct care staff, care coordinators and case managers have access to training or capacity building concerning the needs of carers the need to ensure policy and program guidelines to govern HACC, CACPs and EACH are carer inclusive the need to ensure that, given the need for services substitution, support for family carers is a component of post acute care programs Early intervention and an active services model throughout the basic care and packaged care services This requires: active intervention to maximise and restore the independence of older people where possible carer and community capacity building which requires: o the education of general practitioners in - the need for early identification of disabilities and illnesses in older people - he development of accredited GP training programs re the needs of carers, and the identification of risk of breakdown in the care situation - knowledge of where to refer for assistance o the raising of community awareness of - the need to promote intergenerational planning for the care of older people within families, as far as possible - the impending need for friends and families to share the care Future services systems to support community care This requires: Commonwealth, state and territory government agreement on: o desirable planning ratios for community care support o consistent planning arrangements between the Commonwealth, the states and the territories o minimising restrictions, for carers and older people, associated with multiple program boundaries. 9

13 Improved information services to ensure carers and older people with complex needs access appropriate information about available community care services, regardless of where they enter the services system. 7.2 Gaps and overlaps in services for frail aged and their carers Fragmentation of the services system in most states and territories, together with complexity of targeting, eligibility requirements and the services that can be delivered within different programs makes the services system difficult both to understand and to access for most carers and consumers Proposed development of a tiered system of basic care and packaged care This requires: A more generously funded packaged care tier for people with complex needs and their families to ensure: o people accessing package level care, by default, through the HACC program can receive a more appropriate funding allocation for packaged care and free up about 10 per cent of HACC funding for basic care o older people who choose community care have access to a level of resources appropriate to their needs. This requires: - increasing the per capita level of CACPs packages to acknowledge that older people with higher intensity needs are remaining in the community - ensuring that CACPs programs can purchase, according to need, nursing care and day activity programs - introducing a further band of packaged care at a level between CACPs and EACH o defining the proportion of funding which needs to be directed to the basic and packaged care tiers. Consideration of means for consolidating the services system beyond the common arrangements. This requires progressive reductions in the development of separately targeted small funding programs and in the distribution of small amounts of program funding to a wide variety of agencies. Consolidation of eligibility and needs assessment for the packaged care tier, currently underway. Improved continuity of care between basic CACPs and HACC, as o some carers may be reluctant to transfer from HACC to CACPs because of loss of trusted care workers o some carers are reluctant to transfer to CACPs due to possible reduced services and higher fees than those being received under the HACC program. Better management of CACPs programs waiting lists to ensure equity of access. For example, coordinated regional management of CACPs waiting lists in some regions in Victoria has ensured greater fairness and equity of access for clients and carers. 10

14 7.2.2 Development of common reporting data across Commonwealth programs The development of common reporting data across Commonwealth programs and the increasing comparison of data systems across programs using common client identifiers are essential to future planning National Respite for Carers Program (NRCP) The specialised NRCP program has achieved a great deal in terms of raising awareness of the needs of carers within general community care services. It has progressively developed protocols and procedures with other community care providers to govern work at the interface between services and minimise duplication in assessments for clients and carers. However: better integration within the program and other community care programs progressive increases in program funding will enable more carers to benefit from respite work is required to coordinate the fragmented components of NRCP funding which are external to the Commonwealth Carer Respite and Carelink Centres, such as Commonwealth Respite for Carers funding, cottage respite funding and employed carers funding there is a need to reduce the number of separately funded and targeted programs within NRCP Reforms of community care in relation to Commonwealth funded aged care programs This includes: the need to protect the support services available to younger people with disabilities and their carers currently being delivered within the HACC program the need to ensure that sufficient funds are available to state and territory disability administrations to deliver care packages (usually required for longer periods) to younger people with disabilities and their carers Ageing carers of people with disabilities and ageing people with disabilities The emerging issues of increasing numbers of ageing people with disabilities and increasing numbers of ageing carers of people with disabilities need to be addressed. Sustaining and supporting care relationships, which involve the need to provide support to both ageing carers and people with disabilities, will challenge community care, as a consequence of issues at the interface between aged care, disability, mental health and health care services. Problem solving processes around the barriers that arise at the interface between services are required. These include: How can we develop responsive and appropriate policies that govern arrangements for combining packages of care and support which are received respectively by an ageing carer (such as CACPs and EACH), and a person with a disability (with a disability support package) so that support to the care situation is coordinated and the least intrusive arrangement possible is made? 11

15 Policies to govern arrangements for combining and delivering support packages from different funding sources are required to ensure streamlined support to care situations involving ageing carers. How do we ensure that people with disabilities can receive appropriate community support services when they are over 65 and living with very elderly carers? How do we reduce the risks to ageing carers that may result from poor access to appropriate community aged care programs for their sons or daughters? How do we sustain caring relationships, and address the barriers for people with disabilities to access aged care facilities with their parent when there is interdependence between the carer and the person with a disability? How do we develop appropriate responses to acute health episodes for an ageing carer who needs hospitalisation? Note that some Victorian Emergency Departments automatically ask about caring responsibilities for each admission. What is needed to ensure that ageing carers (who may be frail or ill) can continue to have regular meaningful contact with and provide emotional support and nurturing for their sons or daughters who live in supported accommodation? How do we develop substitute services to support people with disabilities who may live separately from their elderly parents but still receive considerable care and support, while reassuring ageing carers about ongoing support to their sons or daughters? How can we replace the crisis intervention and emotional support services that have always been available for many people with psychiatric disabilities who live independently? Their elderly parents have continued to assist and encourage them to access appropriate treatment, seen them through periods of acute illness, and assisted them with financial aid, searching for accommodation or employment and dealing with Centrelink Culturally sensitive aged care services The need for culturally sensitive aged care services is another important issue. AIHW (2003) data indicated that 20 per cent of people aged over 65 were originally from non-english speaking countries. In addition, the older population born in non English speaking countries is projected to increase more rapidly than the older Australian born population. It is expected to increase by 66 per cent between 1996 and 2011, compared with a 23 per cent increase in the older Australian born population. The projected increase in older people aged 80 and over from non English speaking countries will increase from 13 per cent to 22 per cent. This will pose challenges on services provision because older people from non English backgrounds prefer different types of services, may need culturally sensitive services provision and may revert to their first language in later years. Culturally sensitive aged care services are also required to provide appropriate services for older Indigenous Australians and their carers. 12

16 7.3 The structure of subsidy and fee arrangements with regard to equity and choice Carers Australia has identified several issues that need to be considered in providing equity and choice in aged care services for older Australians and their carers. There is a dilemma, where there are multiple providers (eg a person receiving CACPs, Home Nursing and a day activity program) of establishing equitable fees. There is a need to avoid shifting too great a cost on to carers and consumers. Half the primary carers in Australia are in the lowest two income quintiles but they pay fees for community care and residential care. Although, the CACP program requires service providers to allocate a proportion of their services to people in financial hardship (defined as not having owned their own home within the past two years or before the reference time, and at the reference time being in receipt of the maximum basic rate of pension or benefit), the majority (78%) only provided between 11 and 30 per cent of their total packages to people in financial hardship. Ninety nine percent provided 10 per cent of their total packages (AIHW 2006c). Family carers provide the major part of the care. Those of workforce age who care long term (eg dementia) can be severely disadvantaged in terms of their capacity to save for their own retirement particularly when required to meet community care fees. Future services systems need to allow the capacity for consumer managed care packages as well as case managed care. Funding for packaged care programs need to be supported by guidelines concerning the extent of funding directed to case management and administration versus direct care for consumers. 7.4 Services needs into the future Demographic change and the projected increases in numbers of older people with disabilities and illnesses will be accompanied by an increasing preference of older people for care at home. This trend will occur at the same time as there are changes in the dependency ratio and Australian governments need to maximise workforce participation to sustain the economy. However, at the same time there is a projected gap between the demand for and supply of unpaid family carers. Governments need to consider: incentives for intergenerational planning in advance incentives for sharing informal care within families to maximise workforce participation at least part time and reduce disadvantage supports and services required to maximise workforce participation including increased day care options for older people, and carer friendly workplace practices incentives and compensation for long-term carers of workforce age who are shut out of the workforce because of caring responsibilities (eg Government sponsored superannuation and workers compensation for long term carers). NACA released a discussion paper on long term financing of long term care community and residential care systems in 2006 (see as a 13

17 response to the Hogan Report on aged care, and to provide funding options for consideration. Carers Australia contributed to this paper. NACA recommended that the increasing cost of aged care in Australia can be met by a range of options, either singly or in combination. These included: increased government spending either from general revenue or a special levy increased consumer contributions, financed through long term care insurance or home equity release schemes increased financial efficiency in the industry through deregulation, increased competition, and increased choice for some consumers. Affordable, appropriate and available transport will be a significant factor in the future for older Australians (either with or without a carer) and their carers in maintaining their health and wellbeing, particularly in rural and remote areas. As our population ages many carers of older people are also ageing and may develop age-related disabilities or health problems which prevents them driving. Strategies to deliver community transport become more essential. 14

18 References AMP NATSEM (2006). Income and Wealth Report 13 - Who Cares? The Cost of Caring in Australia 2002 to 2005, May 2006 Australian Bureau of Statistics (2004). Australian Bureau of Statistics Disability, Ageing and Carers: Summary of Findings, Australia. Canberra, 2003 Australian Institute of Health and Welfare (2000). Disability and Ageing Australian Population Patterns and Implications. AIHW Cat No DIS19, Canberra Australian Institute of Health and Welfare (2005). Australia s Welfare 2005, AIHW Cat No AUS65, Canberra Australian Institute of Health and Welfare (2006a). Chronic Disease and Associated Risk Factors in Australia, AIHW Cat No PHE81, Canberra Australian Institute of Health and Welfare (2006b). AIHW Bulletin No 43. The ins and outs of residential respite care. AIHW Cat No AUS80, Canberra Australian Institute of Health and Welfare (2006c). Community Aged Care Packages in Australia , AIHW Cat No AGE47, Canberra Carers Australia (2005., Ageing Population Discussion Paper see n%20paper.pdf Carers Australia (2006). Federal Budget Submission Building choices for carers, Canberra see Charles J, et al. The independent effect of age of general practitioner on clinical practice, MJA, MJA 2006; 185 (2): House of Representatives Standing Committee on Health and Ageing (2005). Inquiry into long-term strategies to address the ageing of the Australian population over the next 40 years, tabled March 2005, Canberra Independent Living Centre of WA (2006). Family Carers and the Physical Impact of Caring Injury and Prevention Research Report, Perth see Medicare Australia (2006). Medicare statistics at accessed 9 August 2006 National Aged Care Alliance, various publications see NATSEM (2004). Who s going to care? Informal care and the ageing population, Report prepared for Carers Australia, Canberra Productivity Commission (2005). Economic Implications of an Ageing Australia. Australian Government, Canberra 15

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