Aged Care Insite Issue 92 | December 2015 - January 2016 | Page 18

industry & policy

It’s just not that simple

The transition to consumer
directed care brings up complex
problems; and some of the
ideas for so-called easy answers
don’t stand up to scrutiny.
By Michael Fine

A

s Australian governments have
sought to promote the move of
aged care from a social welfare
model to a consumer-controlled service,
there have been a number of simple,
attractive and seemingly sensible solutions
proposed for what have long been
entrenched, highly complex problems.
One of the most intractable problems is
the widespread lack of knowledge about
aged-care services. Such knowledge is
a prerequisite if consumers are to make
informed choices. Otherwise, the system
needs well-developed safeguards – as
is the case for medical care, in which
advertising, for example, is tightly regulated
to prevent market abuse.
The failure to understand what agedcare services are available for whom and at
what cost is especially evident amongst the
older age groups, those most likely to need
care themselves. But it is shared by their
younger family members and, perhaps more
surprisingly, by many hospital discharge
services, general practitioners and other
health professionals. Indeed, with so many
changes happening at the moment, does
anyone really understand how the Australian
aged-care system works?
The My Aged Care website has been
promoted as the gateway – the one-stop
shop – that will solve these and many
other problems, including organising how
people will gain access to care if and when
they need it. And here’s a simple, sensible
sounding suggestion!
18 agedcareinsite.com.au

On several occasions we heard from the
minister responsible that government’s
intention is to make the gateway operate
like TripAdvisor, the popular travel website
that presents millions of individual
consumer reviews about different hotels
and other travel options. Sussan Ley, the
new minister for aged care in the Australian
Government, most recently repeated the
previous minister’s call at an aged-care
conference at the end of November 2015.
TripAdvisor? Really?
As a researcher in the field of aged care,
if I were to investigate the feasibility of such
a proposition, the first thing I would do
is test the approach out with a small but
representative group of potential consumers.
So before I go on much further, I’d like
you to ask the next older person or family
member you meet who needs aged care, to
sit down at the computer and plan a holiday
using TripAdvisor. Say, a week long, with a
fixed and known budget, to somewhere like
Switzerland, Bali or central Australia, staying
a night or two at a few different locations.
It is not easy. Before you know it, you
have been transferred from one website to
another, making comparisons difficult. Do
you get all the options, or just a select few?
And can you believe all the reviews you see?
If you are competent with the computer
and internet, you can save money that way
and make reasonably informed choices
about travel, although you may miss many
of the best local secrets. If you have the
time and the ability, there are plenty of

competing websites available, too. When
there are problems, there are also lots of
official travel agents who will do the work
for you. And if you don’t have the money,
you can simply stay at home.
Is this the model we need for aged care?
Here, the extent of choice is not so simple.
How will the gateway site list the cost of
accommodation bonds for residential
care, or explain the option of paying a
daily, income-tested care fee? And what
about other options? We need a system
that caters for those who can’t afford to
pay, but nonetheless need assistance. We
need a system that gives valid information
on legal issues such as means tests, fees
and entitlements. We need a system that
works for carers as well as government and
commercial service providers.
And what about the issues that are not
just about consumer choice? To function
as a gateway, one of the key roles of My
Aged Care is to link applicants to assessors,
and to do so in a way that cuts out the
need for duplicate assessments by different
providers. Yet it seems there are massive
delays in the referral system in a number
of regions across the country, at great cost
to consumers, to some of the RAS service
providers, and to government.
The web is already often confusing. Try
searching for My Aged Care on your favourite
website. When I searched for it while writing
this column, the first site I was presented with
was a provider site from Queensland, not the
official government site.
As we seek to shift aged care to a more
responsive consumer model, let’s not
forget that it is a key area of Australian social
policy. Access to aged care needs to be
underpinned by a system of entitlements,
rights and safeguards and cannot be simply
remade as a self-regulating competitive
market or reduced to a system of optional
purchases based on the principle of caveat
emptor – let the buyer beware.
If consumers were all well informed,
cashed up and able to choose whether
to use services or not, we wouldn’t need
a national program for aged care. But
until those days arrive, we should be
careful about confusing aged care with
planning a holiday. If government wants
a TripAdvisor approach, let it legislate to
allow independent operators to provide
competing independent reviews. In the
meantime, there are plenty more pressing
problems with My Aged Care that demand
urgent attention. ■
Michael Fine is an adjunct professor,
sociology, at Macquarie University.