At this month’s National Aged Care Alliance (NACA) face-to-face meeting two important propositions were passed that may well be a harbinger of things to come.
The propositions were that two special interest groups be established: one with a remit to address the issues for rural and remote aged care providers and the professional disciplines working with them; the other, a group that will work at the interface of the health and aged care sectors to address issues impacting on both. The proposals were developed jointly by the Australian Association of Gerontology and the National Rural Health Alliance.
The National Rural Health Alliance has struggled to identify the best way for meaningful conversations about the issues in common across the health and aged care sectors. Although the National Rural Health Alliance has been an associate member of NACA for some time, there has not been an easy method of working on common interests with a rural and remote lens. Up until this point NACA had no structure within it for the professional disciplines working in aged care and the service providers to focus exclusively on the very real issues confronting the aged care sector in rural Australia.
What are the issues confronting the aged care sector in rural and remote areas? Well, as it turns out, not too dissimilar to those that are presenting the big dilemmas in healthcare. Consider some of these:
- Increased fragmentation of the workforce with a move away from salaried positions to mixed revenue remuneration arrangements from multiple sources, including private practice, casual employment, contractor arrangements.
- Failure of activity based funding formula to adequately reflect the full cost of service (Casemix in health; Aged Care Funding Instrument (the ACFI) in aged care).
- The importance of flexible, blended funding of services – Multi-Purpose Service funding in combined health and aged care settings, National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) in Indigenous specific aged care services.
- Workforce shortage – in rural and particularly remote aged care. There is a high reliance on recruitment of personal care staff from overseas. For professional disciplines, the problems are identical for the aged care sector as it is for health. All allied health disciplines are grossly under-represented in rural Australia. In many remote and certainly very remote areas they are absent altogether.
- A lack of incentives directed to the allied health disciplines
- The absence of a mechanism to establish integrated networks of services – not only is the workforce fragmented, so are the systems.
- The correlation of similar issues in health and aged care extends to the disability sector. Many of the allied health professional disciplines are represented in the three sectors, and for the professional themselves they necessarily have a foot in each.
- Market failure – the funding systems that have been developed to support consumer directed care in the aged and disability sectors rely upon a competitive market. Those principles don’t apply in much of rural Australia – the economies of scale have to be achieved through horizontal cross sector activity and not individual sector silos.
Even at a national level we need to be forming the inter-sectoral horizontal links to have the conversations on topics that are, perhaps unsurprisingly, so similar.
The Alliance is pleased there has been one small step to enable a focus on these common issues.
Visit the National Aged Care Alliance website: https://naca.asn.au/