industry & policy the neglect of disability policy and that the current disability support system is“ underfunded, unfair, fragmented, and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports”. The rationale for NDIS was to provide reasonable long-term supports for people with a long-term disability, to minimise the impact of disability and to promote the inclusion of people in Australian society.
The Productivity Commission advocated the creation of a three-tiered system. Tier one was for all Australians; tier two was for anyone with disability or supporting a person with disability to access information and support; and tier three was for people with disability with needs for care and support. The report recommended that the NDIS should be fully funded by government with no means testing.
On the other hand, the Productivity’ s Commission report on older people, Caring for Older Australians( 2011) acknowledged“ weakness” in the aged-care system with limited choice and control for older people. The report stated the“ aged care system suffers key weaknesses. It is difficult to navigate. Services are limited, as is consumer choice. Quality is variable. Coverage of needs, pricing, subsidies and user contributions are inconsistent or inequitable.” It framed solutions in terms of reform by‘ layering’ and argued for older people to have choice and control while – in contrast to the NDIS recommendations – increasing their contributions to the costs of care and uncapping the supply of aged-care services.
The Productivity Commission’ s framing of the issues has set the policy parameters for the creation of two different types of social care systems in Australia. For older people and particularly older people with disability, the impact of these two systems poses questions about how they can access the appropriate support to allow them to age well in their communities.
BeneFits oF social insUrance scheMes The issue of social insurance and funding long-term care for older people was subject to debate in Australia during the late 1990s and early 2000s. Proponents of social insurance argued that it is universal, with no problems of adverse selection – meaning no outsized risk for the insurer – and can provide greater security of funding for older people. However, social insurance schemes for older people were not politically popular within the Australian Government during this time. Perhaps this resistance has now shifted with the funding and launch of the NDIS, which is framed as an insurance system to support the participation and inclusion in society of people with disability.
One of the strengths of the NDIS is the flexibility of the scheme for participants in how they manage their funding. People can choose to self-manage or use a budget holder model. Although the number of people who are choosing to self-manage is much lower than expected( with only 2 per cent of participants in the Hunter NSW trial site self-managing their plans) participants do have the option. This trend reflects other countries, including the UK, where the take up of self-management was initially low. Initiatives to build the skills and capabilities of people to manage their own funding are critical.
In contrast, the current funding of aged and community care does not allow the flexibility or a self-managed option for older people and their care partners. Funding is still attached to providers, reflecting the historical institutional funding of aged and community care in Australia. The implementation of consumerdirected care in community aged care has created challenges for providers and older people and their care partners. Initiatives are needed to teach older people and their allies how to make the community aged care system work for them. The introduction of a voucher type system for older people in February 2017 will provide some choice for older people and their allies; however, they will still need to know how to make the system work for them.
choice and control For older people throUgh long-terM care insUrance There is an opportunity to have a different debate about the funding of long-term support for older people and their care partners in Australia. Reflecting on the lessons from the implementation of the NDIS and insurance schemes for long-term care from other countries, it is possible that the funding mechanisms for older people to age well in their communities could be reviewed. This review must include a more rigorous discussion of the positives and negatives of a long-term insurance scheme for older people, how it can be funded( for example, through general revenue or through a Medicare-type levy) and how the funding can ensure flexibility to empower older people and their care partners to age well in their community. n
carrie hayter is managing director of carrie hayter consulting, a firm specialising in the disability, aged-care and healthcare sectors.
Dementia Training Study Centres offer a range of educational opportunities for health professionals that support the translation of current knowledge and research into practical, effective approaches to helping people living with dementia and their families. These opportunities include online courses, workshops, seminars, webinars, scholarships, and undergraduate and postgraduate curriculum.
Visit www. dtsc. com. au to:
• Register for training events / workshops near you
• Access the wide range of evidence-based eLearning training courses and lectures
• Download resources or order online
• Subscribe for automatic notification of forthcoming events and eNewsletter
All training courses and resources are free of charge.
Leaders in education and knowledge transfer in the care of people with dementia
Dementia Training Study Centres are funded by the Australian Government
agedcareinsite. com. au 17