AustLII Home | Databases | WorldLII | Search | Feedback

Elder Law Review

School of Law, UWS
You are here:  AustLII >> Databases >> Elder Law Review >> 2002 >> [2002] ElderLawRw 2

Database Search | Name Search | Recent Articles | Noteup | LawCite | Help

Hardy, Ian --- "Aged Care" [2002] ElderLawRw 2; (2002) 1 Elder Law Review 4


AGED CARE

Ian Hardy [*]

The nature and scope of the aged care sector in Australia remains a mystery to most of those not directly touched by it.

Turning over about $6.5 billion in 2001/02, and ranging from intensive round-the-clock institutional care to occasional “daily living” support in the home, aged care in Australia is a complex and, at best, loosely coordinated web of Commonwealth and State-funded and regulated services delivered by both not-for-profit and commercial enterprises.

Residential care policy is administered by the Commonwealth through the Aged Care Act 1997 http://www.austlii.edu.au/cgi-bin/disp.pl/au/legis/cth/num%5fact/aca199757/?query=title+%28+%22aged+care%22+%29, with about 140,000 places provided nationally at around 3,000 sites. In relation to resident outcomes, care provider organisations are subject to the Act’s provisions relating to formal accreditation and monitoring processes administered by The Aged Care Standards and Accreditation Agency http://www.health.gov.au/acc/whoswho/orgs/agency.htm, which are complemented by a Complaints Resolution Scheme and a set of enforcement “teeth”, including financial and other sanctions, under the Commonwealth Department of Health and Ageing.

The relationship between a residential care provider and each resident is in many respects an onerous one; the provider accepts responsibility for the resident’s environment, nourishment, hygiene, health care (in partnership with the GP) and often recreation, whilst the resident has to adjust to communal living and the sometimes unconscious sense that to question or complain may prejudice their relationship with staff or the provider.

The 1997 Act strengthened, desirably, residents’ right of tenure and improved the transparency of the assessment process for determining the financial contribution made by residents towards their care. Notwithstanding more than one thousand pages of legislation and related documentation, many of the most difficult issues relating to the rights and protection of residents sit beyond the scope of legislation, and whilst the advent of guardianship mechanisms and advance medical directives have added significantly to the protection of residents, judgements about the mental capacity of a resident to express their wishes, and the potential for family conflict to cloud decision-making processes, are constant challenges.

Most Retirement Village operations stand outside the definition of aged care (although are often chosen for their perceived social and health-monitoring benefits), and are regulated by the states. Some villages, of course, do offer care services; those which are provided on a user-pays basis are subject to consumer law, while those which have an element of public subsidy may be subject to some external guidelines but, as we shall see, most non-institutional care is largely unregulated at the present time.

Care for people still living in their own homes is largely funded through either the Commonwealth’s Community

Aged Care Package (CACP) program http://www.health.gov.au/acc/publicat/qcoa/03info.htm or the Home and Community Care (HACC) system funded jointly by the Commonwealth and the States and administered at state level. These programs provide a range of services ranging from garden maintenance or Meals-on-Wheels through to supports which can include meal planning and preparation, cleaning, hygiene and medication assistance at a level similar to that found in the institutional setting.

A notable characteristic of community care in this country is the relative lack of formal regulation. There are articulated standards for HACC and Commonwealth-funded services, but in neither case have they been implemented. Many providers operate quality control and complaints mechanisms, but many do not, and so consumers, while in the majority of cases well supported and cared for, are exposed potentially to variable service standards, uncertainty about the background of staff they admit to their homes and few if any avenues of complaint.

Aged care in Australia probably leads the world in its relative equity of access, levels of funding and articulation of purpose. But the duplication of funding regimes is evidence that from a national perspective we continue to lack a unified policy, service planning and funding framework.

Consequently, clients’ options, rights and protections lack consistency and transparency, a state of affairs which will only be improved by Commonwealth/State agreement that older Australians deserve a nationally-driven, coordinated care system with commonly articulated outcome objectives and consistent accountabilities.


[*] Ian Hardy is the Past President of Aged and Community Services Australia and a member of the Centre for Elder Law’s Advisory Board.


AustLII: Copyright Policy | Disclaimers | Privacy Policy | Feedback
URL: http://www.austlii.edu.au/au/journals/ElderLawRw/2002/2.html