PUBH1382 Australian Health Care System - 2015

Learning objectives

Week 8
The aged care sector
1. What are the implications of an ageing population for health and social care systems
(including the growing prevalence of dementia).
2. Explain the wide range of programs in aged care, its major intentions and its
relationship with dependency.
3. Describe recent trends in residential care.
4. Describe recent trends in community care.
5. Discuss the complexity/balance of aged health care in terms of:
a. Young versus old
b. Residential versus community
c. Illness versus wellness
d. Age as a crisis versus an opportunity
e. Medical versus social model
f. Protecting the vulnerable versus domination by bureaucratic regulation

Disability professionals: Assisting people living with a disability to navigate the health
system
6. Discuss how an individuals impairment interplays with and impacts on their health.
7. What specific skills/knowledge can be useful for health professionals working in the
disability area?
8. Who are disability professionals?
9. Where do Developmental Educators and other disability professionals work?
10. What are the employment opportunities and responsibilities for disability health care?

The aged care sector

Philosophically, care in the early 21st century reflects cultural concern with human rights,
dignity and empowerment. Still, in many respects, ageing and aged care remain a social
problem in Australia and many Western countries. The ageing of populations, the increasing
dependency profile of older people in care, and tensions between regulatory and consumer
demands on one hand, and workforce shortages and the low remuneration for their labour on
the other, are key elements of this problem.

The aged care sector

1. What are the implications of an ageing population for health and social care
systems (including the growing prevalence of dementia).

Due to increasing life expectancy and improved health care services, Australias
population is ageing, which means that overall the population is older than it was
in the past. This is also due to lower infant mortality and improvements in public
health systems, health promotion, education, housing, medicine, nutrition and
workplace safety. Between 1901 and 2010, life expectancy for non-indigenous
women in Australia increased from 58 to 84 and 55 to 80 for non-indigenous
Australian men. Between 1990 and 2010, the population in Australia over 65
went from 11.1% to 13.6% while the population under 15 decreased from 22% to
18.9%. Overall, there was a decrease of Australians under the age of 35 and an
increase of Australians over the age of 50.

http://www.aifs.gov.au/institute/pubs/briefing10.html

An aging population has many implications for a country. One issue that arises
from an ageing population is that much of the population is retired and no longer
help fund the health care they require. As people age, their needs for services
increase. These services include home help, community services and residential
care services. The expectations of quality of health services are high.
One of the most major concerns of the ageing population is the vast increase of
Australian citizens with dementia. There is a strong positive correlation between
dementia and age. The most common form of dementia in Australia is
Alzheimers disease. The increased need for aged care that preserves the dignity
of these individuals has therefore arisen in recent years.

http://www.ginkgogroup.or
g/eng/?action-viewnews-itemid-4

The aged care sector

2. Explain the wide range of programs in aged care, its major intentions and its
relationship with dependency.
There are many services available for older Australians.
These include the traditional residential services for long term care of elderly
residents who can no longer look after themselves. Then there is respite care
where the elderly can be temporarily located while their carers [primarily family]
can have a holiday or short rest from caring for their loved ones. Finally there are
community based programs such as personal caring, home nursing, home help
(also known as domestic assistance), meals (such as Meals on Wheels), home
maintenance and care management. These services are provided to enable the
elderly to remain in their communities for most of their remaining years. Many of
these services are provided through the local council of the older adult. The
services aim to keep the aged person as independent as possible and keep them
in their own home safely for as long as possible.

http://www.seniorliving.org/healthcare/respite/
However, with age come physical limitations as the body systems age. Age
related conditions can reduce stamina, everyday functioning and independence.
Many conditions can be managed to ensure that they have less or no impact on
self-care. Many chronic conditions increase the dependence of an older person
such as cardiovascular problems, diabetes, sensory loss and cognitive conditions
such as dementia. Many older age conditions are accompanied by co-morbidities
such as the physical effects of a stroke on a person. These conditions are

normally managed through a multidisciplinary team. Rates of poor health and

disability increase with age; however they are not evenly spread across the aged
population.

http://www.kurz
weilai.net/how-to-prevent-a-global-aging-crisis

Due to the increased number of residents over the age of 80 years, there has
also been an increase of the population being frail and becoming more
dependent on family, friends and services. Due to the nature of dementia, those
with the disease become heavily dependent on those around them. Initially,
memory declines but this is followed by a decline in comprehension, reasoning
and then physical declines such as loss of bladder and bowel control.

http://www.milbank.org/uploads/documents/0008stone/

Key points associated with age care services

The aged care sector

3. Describe recent trends in residential care.
Over the last few years, aged care services have been reformed significantly.
Previously care for the elderly was combined with people who were of low socioeconomic status, people that were homeless and intellectually disabled people.
In 1954, the federal government created a policy called the Aged Persons Homes
Act which saw the creation of nursing homes. Over the next 20 years, nursing
home beds doubled to 51286. At this stage, community care services were not
effective, and most elderly people that had become frail or could not live in their
homes independently anymore, would move to the aged care facilities.
In the 1980s, reviews of aged care facilities were taking place to improve the
standard of care. An Aged Care Reform Strategy was devised to ensure quality of
service was being managed. This strategy also saw the involvement of
multidisciplinary teams for assessment and referral of the appropriate services
and an increase in community services. To ensure quality, a charter of residents
rights was developed along with systems for monitoring outcomes of health care
processes in aged care facilities. All these reforms enabled the expansion of
current aged care services and other residential care programs.
In recent times, the terms hostels describing low level care and nursing homes
describing high level care are now all referred to as residential aged care
facilities. When a resident changes from needing low level care to high level
care, it is referred to as aging in place.
Many issues still lay within the aged health care system, especially those in
regional areas. Retaining and recruiting staff in aged care has been found to be
extremely difficult. Many graduate nurses, doctors and allied health professionals
do not initially go into aged care practice. Many residents also have complex care
needs that are seen as overwhelming for staff. A focus on person-centred care is
not seen in many residential aged care facilities, and residents have reported the
feeling of a medicalised environment instead of a home like environment.
There has been a push for increased numbers of beds in residential aged care
facilities due to the increasing number of high care needs patients in the aging
population.

The balance between residential and

community aged care

The aged care sector

4. Describe recent trends in community care.
There are a wide variety of community based services for the elderly, the frail
and older people with chronic illnesses. These include formal and informal
services. Informal services make up the majority of community care and include
family, friends and older people themselves caring for an older person in the
community. The majority of these informal carers are partners caring for their
spouse and all informal carers are unpaid. Often these carers have their own
health burdens.
Formal support includes things like council services, personal carers and meals
on wheels. The federal government funds formal community programs such as
Home and Community Care (HACC) programs, which supplements informal care.
A person can receive HACC services after being assessed and approved by the
Aged Care Assessment Team (ACAT). Some examples of programs that can be
accessed after an ACAT assessment include HACC programs, Extended Aged
Care at Home (EACH) programs, respite care, permanent residential care,
Veterans Home Care (VHC) programs and Department of Veterans Affairs (DVA)
community nursing programs.
All informal and formal community services and programs are designed to enable
the older person to live in their home independently and safely for as long as
possible. HACC programs include personal care, home maintenance, cleaning
and other domestic help, transport, home nursing, and varied allied health
services. HACC programs are the largest provider of services and the most
widely accessed by Australians.
Another funding body for community services is the DVA and provides programs
to veterans and war widows/widowers. DVA community services are the second
largest provider of services and the second most accessed services by
Australians. DVA also provide transition care and respite services.
Community service quality is monitored through Quality reporting, ensuring
services are held to a certain standard and that the health and wellbeing of older
people in the community is maintained.

The aged care sector

5. Discuss the complexity/balance of aged health care in terms of:
a. Young versus old
b. Residential versus community
c. Illness versus wellness
d. Age as a crisis versus an opportunity
e. Medical versus social model
f. Protecting the vulnerable versus domination by bureaucratic regulation
Many debates and discussions have arisen over the best balance for aged health
care. An appropriate mix of services needs to be provided to ensure the highest
quality of care. Many issues impact on this balance.

5. Discuss the complexity/balance of aged health care in terms of:

a. Young versus old
One issue is the imbalance of young and old people in the Australian population.
With the aging population, it is difficult to maintain a balance to ensure that
funding is distributed evenly and a range of services are available for all.
Creating opportunities for people at all stages of their life is important to ensure
everyone has equal access to health care and services when required.

5. Discuss the complexity/balance of aged health care in terms of:

b. Residential versus community
A balance between residential and community care is vital to ensure residential
services are not put under immense pressure and that older people can live in
their homes if safe and able to do so. To ensure that this occurs, governments
need to balance services with the growing trend for community based care

5. Discuss the complexity/balance of aged health care in terms of:

c. Illness versus wellness
There are two ways to approach ageing the illness approach and the wellness
approach. That is, should ageing be conceptualized as people becoming sick and
requiring more and more primary care, or should ageing be seen as an
opportunity for people to retire from work and spend time maintaining their
health for the next couple of decades

5. Discuss the complexity/balance of aged health care in terms of:

d. Age as a crisis versus an opportunity
A significant number of people view aging as a crisis, and see it as a negative
portion of their life, whereas, many people view aging as an opportunity to retire
and do things they enjoy. Recent medical advances have enabled many older
people to enjoy 20-30 years of healthy retirement time.

http://www.aihw.
gov.au/WorkArea/DownloadAsset.aspx?id=60129542184

5. Discuss the complexity/balance of aged health care in terms of:

e. Medical versus social model
One of the most important balances in the health care system is the model of
care used. A medical model focussing on older people with complex care needs
and co-morbidities they may have, must be balanced with a social model that
recognises people individually, focussing on the diversities and values of each
person. Combining models of care ensures a more holistic approach to health
care.

5. Discuss the complexity/balance of aged health care in terms of:

f. Protecting the vulnerable versus domination by bureaucratic regulation
Finally, a balance must be created between a system that cares for the
vulnerable citizens [quality of services] and one that focuses on bureaucratic
regulation [quality of care]. Client centred care is vital to ensure the individual
needs of the people are being met in both residential and community care, but
rules and regulations must be in place to support workers and ensure quality of
work is kept to a high standard.

One of the major challenges is the availability of informal carers, both in aged
care and in disability services.

ht
tp://www.aihw.gov.au/australias-health/2014/how-healthy/

Top graph http://www.aihw.gov.au/australias-health/2014/health-system/

Secong pie chart

http://informaaustralia.wordpress.com/2013/08/26/wherewould-you-allocate-the-federal-governments-healthcare-funds/

http://arc
hive.treasury.gov.au/igr/igr2010/report/html/02_Chapter_1_Economic_and_demog
raphic.asp

http://
natsem.edu.au/storage/Lymer%20IMA%20paper%20final%20version.pdf

http://www.macrobusiness.com.au/2011/02/the-baby-boomer-bust/

Disability professionals: Assisting people living with a disability to navigate the health
system
According to Keane (1996), the concept of health can be a difficult construct to define. In
research conducted by Ellison et al. (2009), participants living with disability most often
described health as being free from the negative impacts of illness or disease. In addition,
participants comments reflect the perception that having health was linked to being mobile,
able to engage in activities of daily living to their satisfaction, having activities to keep busy,
as well as having the opportunity and ability to form and maintain relationships
.
Global chart

http://en.wikipedia.org/wiki/Disability-adjusted_life_year
DALYs scale

http://en.wikipedia.org/wiki/Disability-adjusted_life_year

6. Discuss how an individuals impairment interplays with and impacts on their

health.
The World Health Organisation (WHO) describes health as having a total state of
physical, social and emotional wellbeing, not just being free from illness, disease
or injury. Under the WHO definition, those with a disability will never be able to
obtain health
Each individual person has a different definition of health for themselves. People
living with a disability often describe health as being free from negative side
effects of illness or disease. Health is also often viewed as being able to be
mobile, being able to participate in activities of daily living (ADLs) and creating
and sustaining relationships with others [a social rather than a bio-medical
definition].

http://www.scotland.gov.uk/Publications/2013/06/1123/7
Disability itself has varying effects on the individual. Depending on the person,
disability may have an effect on their health, their engagement in activities, their
independence or their community participation. Disability can be invisible or
visible, lifelong since birth or onset later in life and symptoms may be episodic or
constant. The amount of care will vary for people with a disability from low level,
occasional care to high level, constant care.
Currently, the support systems in place for people with a disability have been
deemed inadequate and fragmented. Systems have been created to improve the
access to funding and services for people with a disability such as the National
Disability Insurance Scheme, which allows long-term support for people with a

disability for ADLs and the National Injury Insurance Scheme, which allows those
who have had a traumatic injury to be supported through medical services,
rehabilitation services and returning home with domestic services.

7. What specific skills/knowledge can be useful for health professionals working in

the disability area?
Due to the variability of effects a disability can have on a person, there is a wide
variety of skills and knowledge required from health care professionals who work
in the disability field. There are specific skills and knowledge that is useful for all
disability health care workers.
Knowledge on what health issues impact the person with a disabilitys ability in
to manage their condition, be educated on their condition and support
themselves. This information is also vital for carers and other individuals who
support the person with the disability.
Health care professionals in the disability field should know a variety of impacts
that conditions have on bodily functions and bodily systems. These impacts in
turn can affect a persons ability to perform their activities of daily living (ADLs)
and participate in the community.
It is also advised that health care professionals become familiar with the specific
needs of some syndromes and impairments such as personal care needs and
communication difficulties. A client centred approach is necessary to ensure that
these issues are identified early and managed so they do not impact on the
quality of care being received.
There are also specific health care issues that impact on people living with a
disability such as medications, incontinence, epilepsy, aging, and psychological
and mental health issues. Knowledge of these aspects will improve individual
care.
A health care professional also must be informed on the vulnerability to lifestyle
factors such as housing, nutrition, relationships (both physical and emotional),
grief, loss and sexuality. It is also noted that people with a disability are
vulnerable to abusive relationships (both physical and verbal).
Finally, a health professional must ensure that a duty of care is maintained for
their patient, but allowing them to be involved in their health care decisions,
giving them the freedom of choice. This sometimes may be hard for health
professionals to allow people with a disability to make decisions, but it is their
human right to choose what they do and do not want, as long as duty of care is
not breached.

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422169

8. Who are disability professionals?

Disability professionals are a mix of health care professionals, volunteers and
carers that provide services to people with a disability. The disability sector is
made up of multi-skilled professionals who work under what is known as a
transdisciplinary framework. A transdisciplinary approach means that allied
health professionals forego traditional boundaries and share knowledge and skills
further than their discipline. Disability professionals can work alongside
occupational therapists, physiotherapists, speech pathologists, psychologists and
social workers. Disability professionals work collaboratively with these allied
health professionals to provide holistic care for people with a disability and help
support daily living within the community.
The main direct support for people with a disability is from health care
professionals called Disability Support Workers. They have previously been
referred to as Care Attendants, Disability Care workers and Carers, however, the
title Disability Support Worker is now becoming the most common title, as carer
can imply a family member/friend.
In the 1980s and 90s, workers that supported people with a disability, helping
them with everyday tasks and communication, were mostly untrained and
worked with people with various disabilities. This resulted in poor health
outcomes for the clients and poor outcomes in general for the families.
Nowadays, a person needs at least a Certificate III level of training to work in
disability and disability related areas.
Previously, people with a disability were viewed as society as people that needs
to be pitied and that workers caring for them were simply minding them, as
opposed to supporting them. A disability professional is still not seen as a
specific allied health profession.
Disability professionals may also be referred to as Developmental Educators
(DEs) and may possess skills in program development, addressing and managing
difficult behaviour, creating and manipulating alternate communication methods,
supporting community and leisure development and ethical practice techniques.
In the disability area, there is a strong focus on advocacy, community
development, case management, and group and interpersonal skills.
Many universities offer training and education for disability professionals.
Undergraduate and post-graduate training is available. Undergraduate courses
range from two to four years while post graduate training range from six months
to two years.

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454098

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454098

http://www.aifs.gov
.au/institute/pubs/resreport16/chapter9.html
For both graphs

9. Where do Developmental Educators and other disability professionals work?

Developmental Educators (DEs) and disability professionals can work across
many different disability areas and services such as disability employment,
accommodation support, local government, community services and disability
education services. Often within these services, clients can also be from
marginalised groups such as people who are homeless and people from other
cultured and countries.
The majority of DEs and disability professionals work in government and nongovernment not-for-profit organisations. Some are in acute settings; however
there could be more valuable and increased roles for them to play in the acute
health care system. One thing DEs could be responsible for in the acute system
is the creation of personalised support plans for people with a disability to ensure
key factors of their health are managed consistently, such as dietary needs.
Disability professionals can work one on one, in group settings, through private
organisations or in community settings. DEs and disability professionals are also
involved in policy development, including managing and assisting in local, state
and national disability campaigns.

Go to the following website and view the video, discuss how

current employers can play an active role in the employment of
people with a disability

10. What are the employment opportunities and responsibilities for disability health
care?
There is great opportunity for disability professionals to work as consultants in
non-disability specific settings such as family support, while working with other
disadvantaged groups, research and education. Specific areas of employment for
disability professionals include non-government organisations that are disability
specific, non-government organisations that can encounter people with a
disability but are not disability specific, government departments, health
departments, education settings, government, private health care centres,
community centres and some acute settings. Very few disability professionals
work in private practice.
Debate continues over whether people with a disability should receive health
care services through the main stream system or whether they should have
segregated specialised care. There are many costs associated with living with a
disability such as specialised health foods, specialised therapies, medications
and support. These services are difficult to afford on a disability support pension.
On many occasions, people with a disability also face co-morbidities such as
diabetes; however, people with a disability are rarely targeted in health
campaigns.
Due to the complexity of many disabilities, people who have a disability will see
many different allied health professionals for services, each with different sets of
recommendations and strategies. Sometimes these different strategies can be
cost inefficient such as expensive equipment prescription, and often the allied
health professionals are unaware of this. The Australian health care system is
also very focussed on curing illness and health promotion through changing
lifestyle factors. It focussed on the individual being empowered to make the
change for themselves; and this can be challenging for people with a disability
who have limited resources and support.
The disability profession as a whole can shape health care to suit the needs of
people in Australia with a disability. Providing client centred practice and
enabling people with a disability to contribute to disability research and practice
will improve health care services for Australians with a disability.

An excellent advancement in the social determinants approach is the National Disability

Scheme [see below for more details]

http://www.lifeinsurancefinder.com.au/post/insurance-types/total-and-permanent-disabilityinsurance/national-disability-insurance-scheme-ndis-australia/