industry & reform
Sharp relief
Coronavirus
highlights the
strengths and
weaknesses
of aged care.
By Mike Rungie
The coronavirus has highlighted the
strengths and weaknesses of our
aged care system. In the past few
months, we have really appreciated that
aged care is substantially resourced for all
citizens, has globally recognised infection
control, stands by vulnerable people in
tough times, has unbelievably dedicated
staff, and will make extraordinary efforts in a
crisis. That’s pretty impressive. But the virus
has also exposed three weaknesses:
1) Occupancy is dropping in residential
and home care, suggesting some older
people don’t think it’s safe.
2) Visits and outings in residential care
have stopped as part of the successful
infection control, but this further
reduces quality of life in a service model
that’s already not very good at it.
3) Some of the sector have become too
rigid or too leveraged to be able to
respond to this pandemic event.
It appears that consumers may be pivoting
faster than providers. They have been
unnervingly quick to social distance from
residential and home care. We’ve seen
a rapid uptake of alternative generic and
specialist technologies that buy them bigger
networks, communication, information,
home deliveries, security, monitoring,
socialisation, games, care and healthcare,
combined with a renewed energy from the
community to pitch in.
Growing our understanding of why some
consumers have stopped buying and what
they would prefer is the ‘coronavirus bonus’.
We need this information quickly so we can
pivot the substantial aged care capacity to
what consumers want. We are not starting
from scratch here. Existing research (that
we have largely ignored) tells us it’s likely
to be more flexibility, more at home, more
technology, more of how they’ve always
lived, more joy, and less of the aged care that
was designed for their grandparents.
Not surprisingly, providers aren’t seeing
much bonus in the current situation. They’ve
always valued quality of care over quality
of life, and they aren’t in the mood to hear
that quality of life just got a whole lot worse.
If there is a bonus, they say, it will be more
funding to ensure survival of financially
stressed providers.
Provider financial stress is caused
by more than the increasing cost of
coronavirus management. There is a cost
in containing infection: staffing, cleaning,
PPE, new technology, inefficiencies of
isolated operations. We are told about
$10/resident/day in both residential and
home care. And this exceptional cost needs
to be found in a sector with thin margins.
But the big financial stress is being caused
by more consumers deciding not to buy, and
that’s not the virus’s fault. Many consumers
simply don’t want what the providers are
offering. That is a tough lesson for providers,
because changing the current monolith
is no nimble exercise, and some transition
support will be needed.
What we don’t want is to use this time just
to weed out the financially weak providers;
we also want to weed out the inefficiencies
of approach: over-servicing, inflexibility,
low life-quality, non-inclusive care, no
re-enablement, and the lack of imagination
of what a maximised frail life could look like.
These inefficiencies far outweigh those of
lack of scale. We will lose the biggest ‘virus
opportunity’ if we think we have to choose
between backing consumers’ pivoting
preferences or backing provider financial
strength as a way forward. We clearly need
both, and the potent combination of the two
is the only option we should settle for.
So, we need to be wary of the financially
stronger providers who see the ‘virus
opportunity’ as a way to achieve the
consolidation they have always wanted.
The argument goes like this: larger providers
have economies of scale, stronger balance
sheets and better access to capital. This
financial strength means they can better
sustain in downturns and invest in strong
governance and systems. This resource
means they are better able to provide
affordable care that older people want.
This is all fine, but not if it favours providers
to survive without changing their service
models, and that’s what we’re seeing. We’re
landing the efficiencies of scale, but not the
holy grail: the efficiencies of approach. And
maybe we shouldn’t rush to euthanise the
small providers until we know how much
they embody these approach efficiencies.
The pivoting consumers don’t stand much
chance without strong intervention from
government – first understanding modern
elders, then procuring from the sector what
these modern elders want.
This is an exercise in disrupting the service
models that providers are so attached to. We
had pinned our hopes on the consumers
demanding this, empowered through
individualised budgets. More of a nudge than
a disruption. Then the virus arrived…
Responding to disruption is not an
exercise in consolidation. It’s an exercise in
cooperation between consumers, providers,
suppliers, universities and governments
to design, build and test community and
service prototypes that can imagine a
maximised frail life. And that the consumers
think are safer and less restrictive when
the next pandemic arrives or this one
hangs around.
We have never seen so much cooperation
to care for customers, staff and suppliers in
other sectors, so why wouldn’t we also see
this in aged care? Well, mostly because, as
competitive as we are, we have all aligned
with an ageist view of the world: that care
quality matters, life quality doesn’t. This
bond is strong, deep and resistant to change.
But the virus is inviting us to align with
what consumers want, what staff want to
be empowered to do, what suppliers have
in their kit bags, like we have never done
before. Can providers pivot on this one as
quickly as consumers have?
What we do next will set the scene for the
decade ahead. ■
Mike Rungie specialises in the intersection
between good lives and aged care. He
is a member of a number of boards and
committees including ACFA, EveryAGE
Counts, Global Centre for Modern Ageing
and GAP Productive Ageing Committee.
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