Health of the elderly

1. Health of the elderly To discuss the policy aims, services and management of healthy ageing

2. Life expectancy in Australia • For those born at the turn of the century it was 55 years for men and 59 for women • Currently it is 76 for men and 81 for women • Aboriginal life expectancy remains 15-20 years lower

3. Changes in life expectancy • Mainly due to rapid decline in infant and maternal mortality and infectious diseases up until the 1960s • Since then the gains have been partly due to dramatic decline in cardiovascular disease • Women currently comprise 70% of the population aged 85 or more

4. Happy old age may depend upon • General health, wealth, housing, transport, retail opportunities, personal interests and safety at home and in the community • Risk of social isolation means policy should also focus on supporting paid employment, voluntary work, recreation and further education

5. Policy focus • Lower socio-economic status positively correlated with poorer health and greater levels of disability. • National Strategy for an Ageing Australia focuses on health, physical activity, preventing falls and injury, nutrition, detecting sensory loss early, managing incontinence and drug use

6. Policy focus • Remain independent in one’s own home as long as possible (good superannuation policy which assists this goal is vital) • Provide services which help people make easier transitions from full-time work to part-time work, community service, recreation, education, etc. so they keep fit

7. Disability, hospitalization and death • 65-69: 7.8% of men and 9.2% of women have a profound or severe core activity restriction. After 75 the proportions rise to about 20% of men and 25% of women • Problems are arthritis, circulatory system and other musculoskeletal conditions • Conditions of the eye and ear, and behavioural problems

8. Reasons for hospitalization and death for those over 65 • Dialysis, cataract problems and heart disease main reasons for hospitalization • Diseases of the circulatory system, cancers and respiratory diseases major causes of death • Medication may increase problems related to failing eyesight, osteoporosis and Parkinson’s disease - falls

9. Focus on • Enhanced preventative care through all stages of life (focus on hazards of diet, work, drug use and lack of exercise)

10. Historical development of services • After WW2, Commonwealth service provision limited to a small pension available to less than 1/3 of the elderly, and some state hospital based services • Accommodation systems provided by churches. National Health Act (1963) provided nursing home subsidies to private, voluntary and govt. care providers

11. Historical development of services • 1969: Commonwealth provision of limited home care, paramedical, and meals services • 1970s: Establishment of Medibank (later disbanded) and community health centres • 1987: Disability Services Act brought increased home and community care programs, Aged Care Assessment Teams and carer’s pension

12. Superannuation and aged care management • 1986 award based superannuation • 1992 Commonwealth legislation for a superannuation guarantee from all employers • Early 1990s Council of Aust. Govts (COAG) called for national policy, pooling of Cwth/State funding and devolution of service delivery in regard to aged care

13. Aims of govt. policy • To promote relative decline in nursing home beds and relative increase in hostel or own home accommodation • 1997: Commonwealth integrated nursing homes and hostels and a means tested accommodation bond was required • This was withdrawn in favour of a daily fee from residents who could afford it

14. Aged care standards and accreditation agency (1997) • All residential aged care services required to meet standards by 2001. Standards relate to: • Management systems, staffing and organizational development • Health and personal care and residential lifestyle • Physical environment and safe systems

15. 1995/96 $22 billion spent on health and welfare of the aged • This was 5.1% of gross domestic product • Almost two thirds for aged pensions • 15% for services in hospital • 10% residential care • 3% non-residential care • Expenditure on pharmaceuticals growing at 13% per annum; medical growing at 8.5%

16. Home and Community care(HACC) • 12% of those aged 70 and over get HACC support • 60% from Commonwealth with the rest from States and user charges • Around 4000 organizations receive HACC funding and 60% employ fewer than 3 staff • Need for better coordinated management

17. Major HACC programs • Community nursing 23% • Home help 20% • Other 22% (what?) • Community respite care 13% • Program support 12% (high?) • Community options (high level care) 7% • Delivered food and meal services 3%

18. Residential care • Average length of stay between 1 and 2 years (1/6 of residents return to community) • Resident need for care measured by an eight-point classification scale which provides the basis for daily payment to the residential care facility

19. Value scale of 20 questions measures • Communication, mobility, personal hygiene, toileting, bowel management, whether the person is aggressive and their medication requirements • Resident pays a daily charge depending on their wealth level • ACAT approves residents for entry

20. Carers benefit and service planning • 1999: Over 40,000 Australians received the carer payment • 33% of these were for carers of aged persons • Current govt. planning framework aims to provide 100 residential aged care places and community care packages for every 1000 people over 70 in each planning region

21. Kendig and Duckett on pooled regional funding • Commonwealth and State funds pooled and managed at regional level. The funds would incorporate residential, home and community care, community aged care packages and relevant State funded community health activities • Separate funding streams for accommodation costs and care needs

22. The right to die • Not addressed in the National Strategy for an Ageing Australia yet the power to automatically prolong life irrespective of its quality is great and extremely costly • Why should the elderly person not have the right and assistance to end their own life when they choose to do so? I personally demand this.