Professor Yun-Hee Jeon
While not denying Australia's aged care system needs reform, new research comparing two Australian Government-funded programs suggests we may already have some of the cost-saving answers to keeping older people well and living safely in the community for as long as they wish.
Led by the University of Sydney, a retrospective analysis published in the journal Age and Ageing late last year compared the outcomes and related cost consequences of over 65s taking up Home Care Packages (HCPs) versus those accessing Veterans' Affairs Community Nursing (VCN).
The analysis of over 40,000 participants found that within five years of accessing services 58 percent of HCP clients had been admitted to an aged-care home, compared with only 27 percent of VCN clients.
The economic analyses found that, for VCN compared to HCP clients, the estimated cost-saving for relevant government providers over five years was over $1 billion. Importantly the research also showed significant cost savings would be made even if the VCN program cost was increased in line with the HCP.
The VCN program is funded by the Department of Veterans' Affairs and is currently available to Veterans Gold Card holders and some Veteran White Card holders. HCP is available to all older people living in the community who are referred and meet eligibility criteria.
Existing research shows the longer older people live in the community, the higher their quality of life and the lower the cost to government. As such, delaying or preventing care home admission by providing the right support has long been an important policy goal, as emphasised again in the recent report from the Aged Care Taskforce.
Lead author Professor Yun-Hee Jeon from the University of Sydney said two of the key differences in the delivery of the Veterans' Affairs program were a short time to referral and the role of registered nurses.
"The major difference is that the veterans' program is led and mostly delivered by registered nurses, based on a care plan directly from the registered nurse's comprehensive assessment, with a very short wait time from a referral."
The cost savings largely resulted from preventing or delaying aged care home admission which equates to over $90k per person per year.
The other key difference is that the veterans' program is set up to be accessed periodically as needed, whereas HCP clients tend to retain their service until they die or go into care.
"Numerous conversations with service providers and clinicians suggest that participants in the veterans' program had a mindset of 'letting it go' because they were confident, they would be able to access the service again next time they needed it, for example after a fall or bad health spell. By comparison home care clients do not let services go even if their needs decrease, as they are well aware of the 6- to-18 month wait period on service," said Professor Jeon.
The final report of the Aged Care Taskforce released in March and the new Support at Home Program is planned to be introduced from 2025.
Professor Yun Hee Jeon agreed with recommendations that more emphasis needed to be placed on 'health related care' in aged care services and delivery in a timely manner to enable people to remain at home longer. However, she said all reform initiatives proposed to date gloss over the importance of skilled professionals such as registered nurses and allied health professionals for optimising outcomes.
"Using the broad term 'aged care workforce' rather than differentiating the skill sets, roles and responsibilities under this umbrella term is not always helpful and can easily dismiss profession-specific issues that need addressing to ensure quality aged care. It also overlooks challenges with attracting and retaining health professionals which are often significantly different from those of other care workers in the sector," commented Professor Jeon.
"Older persons' care requires comprehensive assessment by skilled clinicians and planned care based on individual needs, considering available resources and circumstances. The current model forces health care professionals to focus on 'tasks' and 'tick boxes', rather than using critical thinking and clinical judgement.
"Furthermore, the current HCP assessment is for determining eligibility and levels of care for an allocation of funds. By the time the allocated care is available six months later, that person's care needs have likely changed."
She said by comparing two existing models of community care, this research highlights the importance of timely care and support from a skilled nursing workforce.
While the paper suggests further economic analysis is needed, Professor Jeon said the research team have confidence in the findings due to the large sample size of this first-of-its-kind study and analyses that considered the cost of the VCN program, the length of stay in residential care and the distribution of HCP types.
Declaration: The authors have no conflicts of interest to declare. This paper draws on analysis done for a research project commissioned by the Australian Government Department of Veterans' Affairs (DVA) (Reference ID: DVA-GEN 2019-20/736) titled Investigating Protective Factors of the DVA Community Nursing Program (available at https://www.dva.gov.au/documents-and-publications/protective-factors-dvas-community-nursing-program-2023); however, the subsequent cost analysis study was not part of the project funded by DVA. The opinions expressed therein are those of the author/s and do not necessarily reflect those of DVA. The Commonwealth does not give any warranty nor accept any liability in relation to the contents of this work.
