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Aged care requires the support of our whole society - here are seven steps to achieve that

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Aged care in Australia must change if it is to meet the future needs of our aging community, industry innovator Natasha Chadwick has told the aged care royal commission. Michael Sheather reports

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One of the aged care sector’s leading chief executives, Natasha Chadwick, has given evidence at Australia’s Royal Commission into Aged Care Quality and Safety, declaring that government funding for the industry must make fundamental changes to meet the needs of our ageing community.

Chadwick has more than 25 years’ experience in the aged and dementia care industry – as a manager, consultant, business owner and operator in the sector. She has also been a member of the Ministerial Dementia Forum Working Group and the Aged Care Financing Authority advisory group, as well as the National Executive Officer of peak industry body, the National Association of Nursing Homes and Private Hospitals.

She is also the founder of NewDirection Care at Bellmere, near Caboolture, which she used as an example of how innovation can lead to better outcomes and a higher quality of life for those who live in the aged care sector. Chadwick was named as last year’s Telstra Businesswoman of the Year for developing this unique model.

New Direction Care (NDC) in Bellmere is a “microtown” community that has developed a world-leading inclusive approach to residential aged care that caters for all its residents, not just those living with dementia, including some younger residents with a variety of diagnoses, including young onset dementia and complex care needs.

The microtown model challenges the traditional approach to aged care and focuses on enabling residents to live their lives as closely as possible to the life they experienced in their own homes at the same time meeting all their care needs.

In her witness statement, Chadwick told the Commission that NDC put its focus on the individual by recognising that each resident has unique needs, values, interests, and aspirations. She said freedom of movement and access to outdoor spaces and the wider community provides opportunities for residents to socially interact.

“The microtown community consists of 17 domestic-style homes across two hectares,” she told the Commission. “Each home can accommodate up to seven residents. Each person has their own private bedroom with ensuite bathroom and partners are welcome to stay overnight. Each home has been designed and styled with different lifestyles in mind. The décor and furnishings act as reminiscent therapy that helps the residents feel comfortable at home, triggering positive memories.”

Each house also has a fenced outdoor area with a barbecue, all of which is reminiscent of a typical suburban home. The microtown also includes a fully functioning retail precinct with a café, a cinema, a beauty salon, a barber, a corner store, a music room, medical rooms for a visiting GP, a dental clinic and a wellness centre with a gym and a hydrotherapy pool. Additionally, there is a men’s shed and a chicken coop and gardens, all of which are open to residents, their families and friends, staff, and the external community.

“My commitment to this model and vision meant recognising that there was a need for change and being willing to challenge traditional thinking whilst being open to opportunities to ensure viability through the additional income available from the facilities on site, including our retail precinct and wellness centre,” Chadwick said.
Chadwick went on to make the following seven recommendations for fundamental change in the aged care industry.

1. Funding for aged care should be setting agnostic: “In my opinion there should be no distinction in the amount of Government funding based on where the care is provided. That is, care recipients should receive the same funding (reflective of their needs) irrespective of whether they choose to live in their own home, in residential care, in a retirement village in a group home or elsewhere. If funding were setting agnostic the funding could follow the individual. I believe this would increase choices for consumers and encourage providers to be more innovative.”

2. Break apart the funding of care, ‘hotel services’ and accommodation: “All members of society who are able to, should pay for their accommodation and living costs. These costs can range significantly depending on assets and income. Care on the other hand, is, in my opinion, the responsibility of a whole society.

By breaking apart care, ‘hotel services’ and accommodation, providers would be able to choose from a more diverse range of service delivery options. In doing so, they could consider consumers’ varied expectations and the capacity of consumers to pay for services themselves.

This would facilitate increased innovation and the development of offerings that are market-driven and consumer-driven rather than being restricted by a rigid funding structure.”

3. Introduce a user pays model: “Any system of funding must respond to more than just the cost of care. Funding must also address services provided to support emotional needs as well as everyday living services and accommodation for no/low means residents.

Services beyond the ‘cost of care’ may need to be funded both by the Government and the individual by way of a ‘user pays’ and means tested approach. There would be a base-line level of funding that is means tested but anything above this base level would be paid for by the consumer and not restricted by means testing.

4. Introduce ‘Admission Funding’: “I propose a 12-week fixed funding program (Admission Funding) to enable the aged care provider to undertake a thorough analysis of the new resident to ensure their needs are identified at the outset. This would include a full assessment by skilled professionals; an individual support plan; implementation of that plan with emotional support to help the individual adapt; an education program for the individual and their family/guardians about their needs and how they will be met.

5. Individualised or case mix model for ongoing funding: “After the Admission Funding phase funding would be provided on an ongoing basis (Ongoing Funding). This could be provided on either an individual basis akin to NDIS or a case-mix basis that identifies the mix of residents and their needs and then provides the skill sets to meet those needs as base, plus funding for additional individual needs.”

6. Additional funding for allied health professionals: Any future funding model needs to recognise the importance of allied health professionals such as occupational therapists, physiotherapists, dieticians, podiatrists, and speech therapists who all assist in delivering a high standard of care for older people. These professionals can also support residents and take pressure off the hospital system.

7. Additional funding for registered or enrolled nurses to facilitate communication between GPs, family, and residents. “A future funding model should facilitate the provision of a permanent registered nurse or enrolled nurse to assist in the communications between GPs, residents and families. This would result in better outcomes.

Poor communications with family members about treatment makes it difficult for the family to support their relative to make choices about health care, particularly in circumstances where a family member becomes a substitute decision-maker when a resident no longer has capacity to make their own decisions.”

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