COTA ACT Submission to the ACT Government Budget. Submission 13/02 October 2013

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1 COTA ACT Submission to the ACT Government Budget Submission 13/02 October

2 Contents About COTA ACT... 3 Background... 3 Transport... 5 Housing... 7 Palliative care... 8 Conclusion

3 About COTA ACT The Council on the Ageing ACT (COTA ACT) is the peak body representing the needs and interests of older Canberrans. It is a non-profit organisation committed to human rights, social justice and the elimination of age discrimination and ageism in all its forms. Its mission is to empower older people and those who work with them to age well in a just society. Background Firstly, COTA ACT would like to congratulate the government on some excellent recent initiatives which benefit seniors (among others), in particular the implementation of a Mobile Dental Clinic, the commitment to fund the development of Common Ground, and the Age Friendly Cities and Communities Conference, which we believe was a great start to making Canberra a more age-friendly city over the coming years. In relation to Canberra s status as a WHO age-friendly city, we support and encourage the formation of a network across Australia, led by the ACT government, which would promulgate age-friendly approaches and ideas around the country. The ACT, with its small, relatively compact community and status as Australia s capital, would be an ideal city to lead and implement an age friendly model. However, we believe it is critical that the ACT not only talks the talk but walks the walk, with visible, real improvements for older people over the next year. Our members tell us that they do not want more glossy brochures and plans: they want to see real change. To achieve this, the government will need to support its commitment with funding, which could be used to encourage age-friendly innovation, to build in bottom-up community participation, and to regularly assess progress. 3

4 This year we have focused on transport, housing and palliative care, issues of key concern to older people in the ACT. Not only do these issues have a considerable impact on people s lives, but action in these areas has the potential to save ACT government and community resources in the medium to longer term. People who can access transport for both social and health purposes become more socially connected and are able to engage more in healthy living activities, so we can expect the burden on the health and hospital system to be lower. People who have secure, supportive and affordable housing will not slip into primary or secondary homelessness with all the attendant health and social problems. Lastly, people who can access adequate palliative care in their home or residential aged care facility are much less likely to end up in expensive hospital wards and acute care settings. 4

5 Transport COTA s recent research into the transport needs of older Canberrans, Transport for Older Canberrans 1, reinforces the need for better access to transport, especially among older, more frail and mobility-constrained people. With ACTION s increasing focus on servicing commuters, older people will find it increasingly difficult to get out and about if they don t have access to a car (and are not able to walk far or cycle). To maintain its status as an agefriendly city, the ACT government should ensure that affordable alternative transport options are available and able to meet the needs including social participation - of older residents. This is not currently the case. COTA s research (completed in 2013) found that almost half the research sample of over- 50s, and three quarters of those with health/mobility conditions, had difficulty travelling within the ACT, especially for social or entertainment-related purposes. It is particularly hard for older people to access social needs because social/entertainment events often take place at night and weekends (when bus & community transport services are least available) and because social needs are a low priority for community transport providers and even for relatives and friends who provide car transport (at least, as perceived by older people who have to ask for lifts). The effects of this are illustrated by comments such as (I attend social/lifestyle activities) only thanks to kind friends, and I NEVER go out at night. However, people s capacity to continue to engage in the social and civic life of Canberra is very important. Accordingly, COTA believes that flexible transport options should be expanded, both to offer alternatives to the ACTION bus system, and to enable older people to continue to use the bus system where possible. We strongly support: improving the efficiency of the Community Transport system by enabling (and encouraging) providers to share resources, including a centralised booking system for clients. Eventually, it may be possible to expand some kind of resource-sharing 1 Final Report on Transport for Older Canberrans, at 5

6 model to include other providers who want to participate, such as retirement villages with minibuses, hospital minibuses, and operators such as Keirs; reviewing funding policy with the aim of facilitating a focus on social as well as medical needs. Where community transport providers have limited funding to provide social and medical transport, they will necessarily prioritise medical travel, and this currently means that some providers cannot offer social transport at all. We suggest that specific funding needs to be set aside for addressing social transport needs, or that funding is administered through different agencies. We would like to congratulate TAMS for trialling flexible transport options in partnership with community transport organisations, and strongly encourage the continuation of this collaborative approach. COTA s recent research shows that almost three quarters of respondents to our survey would be prepared to pay something for more flexible transport (around half would pay from $3-5 per trip, and around a quarter, from $6-10. This may indicate there is some scope to charge at least some people a small amount for flexible transport services (although there are many clients who cannot afford to pay). It is our view that in the longer term, the ACT will conserve resources currently spent on health by prioritising social connectedness (through transport and other means) as well as the medical transport needs of our older population. The link between social isolation and poor health is well established and needs no reiteration here. Most respondents to COTA s survey, in addition to using buses where possible, also drive or are driven by a partner, relative or friend. To those with mobility or health conditions, distance from parking to venue (shops, medical facility, etc) is critical. The situation in Canberra Hospital is particularly dire, with one COTA member reporting how she had to drop her frail husband (with Alzheimers) outside the hospital door while she went to park (taking the risk that he would wander off), and others recounting having to walk a long distance to the facility after parking, with various serious health conditions. Therefore we would urge the ACT government to: 6

7 continue to explore ways of preventing and discouraging people from fraudulently using current disability spaces ask the management of Canberra Hospital to look into trialling a wheelchair/scooter hire system at the carpark, similar to those in place in shopping malls. Housing Through its housing advice service, COTA ACT assists many older people each year who are in rental stress, which the ABS defines as rent comprising more than 30% of income. Unlike younger people, older renters have no future earning potential, and are faced with rising costs and often dwindling incomes. However many of our clients fall marginally outside the criteria which would qualify them for public housing. In any case, waiting lists are long and older people are understandably a lower priority than, for instance, young families. Recent research shows that older women 2 are particularly vulnerable, as they are likely to have less (if any) superannuation, are less likely to own a home, and have lower disposable incomes than older men. Feedback from our clients and membership indicates that many (not all) older people would like to live in some kind of community, where they can access services and connect with others in a similar position. However, private retirement villages are unaffordable to people who don t have a home to sell and are on a low income. Therefore COTA suggests that the ACT government: take steps to develop more affordable and flexible retirement living options for financially disadvantaged older people. For instance, the government could consider the feasibility of either retro-fitting existing property to provide apartments for retired older people close to facilities (as has been done on a commercial basis with several 2 For example, Darab & Hartman, Understanding Single Older Women s Invisibility in Housing Issues in Australia, 2012, Sharam, Getting in Front of Homelessness: Housing Single Older Women Now, 2012, and as reported in the press, eg ) 7

8 ex-office buildings), or allocating land and building affordable and supportive retirement community housing. look into providing more community facilities and/or support in public housing developments with significant concentrations of older people; We believe there may be potential, if the government decides to develop affordable retirement communities on community-zoned land, to seek some level of contribution from potential residents. For instance, financially disadvantaged potential residents may be able to contribute some capital (even if they don t have enough to move into a privately operated retirement village) or to pay rent at some level. There may also be potential to work in partnership with other organisations and the Commonwealth Government in Canberra, in a similar way to the Common Ground model. We are aware of the challenges facing the housing budget. However, action to prevent homelessness and to address the need for social connectedness through housing among older people, in particular single women, will help to prevent more costly intervention and related social problems further down the track. Palliative care There is an urgent need for more palliative care in the community. Research 3 shows that most people prefer to die in their own homes with their family around them: however, an aged person looking after their dying spouse can find it very difficult to provide day to day care (turning, cleaning, etc), let alone cope with medication and other palliative care needs. COTA s consultation with the community and relevant organisations indicates that there are not enough palliative home-care packages available to meet demand. Carers at home (especially older carers who are less physically able to meet continuous, onerous care needs) also need to be supported by adequate respite. Access to respite may mean the difference between being able to care for someone at home and having to transfer them to a hospital or aged care facility. The respite facilities run by Palliative Care Australia seem to operate very successfully, so this might be a useful model to build on (although they 3 For example Palliative Care Australia, We Need to Talk about Dying,

9 only offer day respite, and overnight respite enabling the carer to get a good night s sleep is very important). The ACT also urgently needs more out-of-home palliative care beds appropriate for older people. Clare Holland House is not geared to provide palliative care to people dying of a range of diseases associated with old age, such as dementia, Parkinsons and the like. It provides short term care, mainly for diseases with a fairly predictable end-stage trajectory, whereas people dying with dementia or other issues can have a much longer and less predictable end stage. In addition, Clare Holland s resources are already stretched. Access to qualified medical staff is an issue, with COTA s discussions with palliative care providers indicating that it is difficult to arrange visits by doctors or nurse practitioners to people s homes or aged care facilities to provide palliative care services (such as prescribing appropriate medication). The ACT government needs to take action to address this issue, either through recruitment, offering incentives, or some other means. Studies have established that the most expensive mode to provide end-of-life care is in an acute care hospital setting, followed by a residential care setting, and that it is most cost effective (as well as, usually, the preference of the individual) to provide it in the person s home. From a purely financial perspective, therefore, it makes sense to provide as much support as possible for people to die at home if they wish to and it is medically appropriate. Increasing the funding available to support people to receive in-home palliative care would therefore be the most efficient use of resources. 9

10 Conclusion In conclusion, COTA ACT urges the ACT government to re-direct its efforts into more efficient and effective service delivery, by: Increasing the availability of flexible community transport for older people; Providing more affordable, flexible and supportive housing options for older people within the ACT, including those who are marginally excluded from the criteria for public housing; and Increasing the provision of palliative care at home and in other facilities rather than in hospitals, as well as providing more funding for respite. COTA shares the government s vision of Canberra as it continues to develop as an agefriendly community that actively supports and values the continued participation of people of all ages, including seniors, in community life. We believe that the proceedings of the Age Friendly Cities and Communities Conference provide a useful evidence base to inform the deliberations of the 2014 ACT Seniors Assembly. A key need emerging from the Conference was the importance of engaging with seniors in order to achieve the goals of the WHO Active Ageing Policy Framework and the Global Movement for Age Friendly Cities. COTA encourages the government to support its commitment to making Canberra a more age-friendly city by: making funding available to community organisations to trial or implement agefriendly projects, establishing a mechanism for ongoing engagement and participation in the process by seniors, and regularly (eg annually) assessing progress through a survey or similar means. Thank you for the opportunity to make this submission. 10

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