Shift in ageing services as numbers and demands grow

ANNIVERSARY SPECIAL: Aged-care businesses are adapting to changing market trends that have arisen in the past 25 years, including a booming in-home care sector driven by Australia’s ageing society. This article is part of a special series to mark Business News' 25-year anniversary.

The profile of Australia’s ageing population has altered dramatically during the past 40 years, leading to cost and service pressures for providers, and challenging governments to adjust policy.

In 1977, one in 10 people was over 65 years of age; that number is now one in six.

Braemar Presbyterian Care chief executive Wayne Belcher told Business News his organisation, which primarily operates nursing home facilities, had transformed during the past 25 years as a result of this demographic shift.

He said the structure of the aged care system had changed significantly as people lived longer, with residents’ increased frailty a major challenge for providers.

“I can remember when I started working in aged care; even in nursing homes you might have the occasional person who would drive their car out every day,” Mr Belcher said.

“These days, residential aged care is not a lifestyle choice.

“People are incredibly dependent on the service they have, and they have multiple morbidities.”

Mr Belcher said there were three levels of care during the 1990s – retirement living, low-care hostels, and high-care nursing homes.

“The part of the sector that has gone is the aged care hostel,” he said.

“These were low-level care facilities that provided an accommodation service for people who couldn‘t live at home for social reasons, but certainly were still able to mostly care for themselves.”

One of Braemar’s sites was built as a hostel, but no longer houses any residents classed as low-care.

While the building was expected to last 40 years, Mr Belcher said it had lost its original purpose despite having only reached half its lifespan.

Braemar had invested heavily in these buildings to make them more appropriate design-wise for residents who needed far more advanced care than initially intended.

“There’s been a real cost to providers,” Mr Belcher said.

“Some of these buildings are very well designed for people who can still walk around, but now it’s a different level [of care required].”

Some organisations had taken the decision to knock down hostel buildings, he said, but most providers had chosen to convert them into higher-care facilities.

“All of those sorts of things to enhance care add cost, and it’s difficult to retrofit a building that’s only seen half of its lifetime,” Mr Belcher said.

“There’s no funding for organisations to replace those buildings, so we just have to make do with a half-life building that really wasn’t designed for the purpose it’s fulfilling.”

The space left by hostel care is now being filled by in-home service providers, a move that Brightwater Care Group chief executive Jennifer Lawrence said was driven by government and reflected demand.

“The government policy is to try and encourage people to stay at home, with support, for as long as possible,” Ms Lawrence told Business News.

“It’s what people want, and it’s probably best from a wellbeing perspective.

“They only come to us at the very end of their life into residential aged care.”

Ms Lawrence said the wave of baby boomers had caused a tangible shift in the number of older Australians, noting that this generation generally wanted to stay at home for as long as possible.

She said Brightwater was expanding into this area with the expectation it would continue to grow, as younger generations proved more willing to pay for in-home care and maintenance services.

“Once future generations need help at home, there will be more appetite to pay for services,” Ms Lawrence said.

“Generations now and previously liked to do it themselves; they’ve come through the depression and are a lot more mindful about how they spend their money.”

Mr Belcher said he had also seen a significant rise in people wanting to stay at home for as long as possible.

“Our expectation now is that many more people can be cared for at home, that includes living at home in a retirement village,” he said.

“It’s simply what we want as community-minded Australians.”

One company that has operated long term in the in-home care space is Silver Chain.

Interim chief executive Lyn Jones told Business News the service had grown strongly since it started providing in-home services, from employing a single nurse in the early 1960s to now being the state’s primary provider of care.

With annual revenue of $270.9 million, Silver Chain is the eighth largest not for profit in Western Australia according to the BNiQ Search Engine, and the second largest ranked by number of employees, with 4,371 staff.

“We currently have operations in five different states across the country,” Ms Jones said.

“WA is our largest footprint, followed by South Australia.”

Silver Chain chief adviser public policy, Keith Evans, told Business News that other states were picking up on the WA government’s lead in policy terms.

“If we go back 25 to 30 years, there was a decision taken with regard to the care of people who were approaching the end of life,” Mr Evans said.

“There were a couple of choices that needed to be made.

“They were, do you put the resources into the community or do you put the resources into hospitals?

“The government decided it was going to do both, but that it was going to put significant emphasis on keeping people out of hospital if that was their choice, and if there was a good quality service.

“In terms of palliative care, there’s no doubt WA leads the country in providing that opportunity for people to be cared for at home.”

Mr Belcher said the demand for in-home care in combination with an older population was resulting in funding issues for government.

“The [federal] government certainly doesn’t have its head around how it’s going to fund for the care needs of older people who need them,” he said.

“At the moment we have 121,000 older Australians who have been assessed by the Commonwealth assessment program for community-based aged care.

“About 57,000 of them have no allocated places, and the rest are on a package that’s under the assessed level of need.

“So we have a problem; it’s not working.

“As our population continues to age, there will be more and more demands on the public purse, and we’ve just got to think of better ways to provide for that into the future.”