Choice, control and dignity strengthened for older Australians at home

Older Australians can celebrate today that a new Aged Care Act, as recommended by the Royal Commission, will put them first, “so that their preferences and needs drive the delivery of service.”

Mable strongly supports and welcomes the founding principle of the Report of the Royal Commission into Aged Care Quality and Safety made public today, that “older people should genuinely be at the centre of their care”.  Mable specifically applauds that the Report, entitled, “Care, Dignity and Respect”, retains the important option for people to be able to self-determine their Home Care services according to their own individual needs and preferences rather than be required to accept the menu of options and associated costs offered by the majority of Home Care providers.

As Australia’s largest, two sided online community supporting self-management in home care, Mable welcomes the agreement of both Commissioners, that individuals “should be part of the conversations about their care, and their needs and preferences should be respected and reflected in their care.”

“Care services should enable older people to live the life they want to live and to be all they can be,” the Report says.

Mable co-founder and CEO, Mr Peter Scutt, said he was pleased to hear the Prime Minister, Scott Morisson today describe this principle as the fundamental generational shift coming out of the Royal Commission; as a move away from a system that is based on funding for aged care providers to “a needs-based system that puts people at the centre”.  

Mr Scutt also welcomed the Prime Minister’s reference to the NDIS (National Disability Insurance Scheme) as evidence that putting people in control at the centre of the system is possible.  

“The Prime Minister rightly noted that there are strong parallels between the proposed highly individualised aged care system and the way the NDIS works and much that can be learned from that. Working across both Home Care and the NDIS, this is something Mable knows well,” Mr Scutt said. 

Other aspects Mable welcomes include recognition that care and support should be relational, not transactional, which is a far too common complaint about the way care and support services are delivered. 

The Commissioners acknowledge the importance of relationships in getting quality outcomes, noting that, “Older people get the best care from regular workers they know, who respect them and offer continuity of care as well as insights into their changing care needs and health requirements.” 

“This continuity of relationship is a central feature of Mable’s model, made possible because people choose and engage their support worker directly, often people from their local community, and together they determine how they will work together.   

“With strong experience and clear outcomes over time, we must reject one of the views expressed in the Report that relationships and continuity of care are best facilitated through a direct employment model on the part of an approved provider,” said Mr Scutt.  

“On the contrary, it is this predominant current model, involving frequent changes and substitution of care workers, that has led to the problem of inconsistency of relationships. Relationships cannot be directed; they are personal. They are formed between people based on mutual choice and common interests ” Mr Scutt said. 

“Mable came about because I became involved in the support needs of my own parents and saw the lack of dignity and self-determination afforded to them by the transactional nature of their care, often under the guise of ‘provider knows best’,” he said.

“Not being able to exercise control over who came into their home or the time they came and what they did and how they did it was frustrating and upsetting for them.  But it was much more than inconvenience. 

“For the first time in their lives they felt diminished as adults: they had no agency over their lives and if they complained, they were viewed as being difficult. That really impacted on their mental and physical health and it was entirely understandable,” Mr Scutt said.    

Mr Scutt said that a person’s option to self-manage their care and support was the full expression of the human rights based policy of ‘consumer directed care’,adopted on a bipartisan basis as part of the Living Longer Living Better reforms arising from the 2011 Productivity Commission inquiry, Caring for Older Australians.  

“Not all older people are or see themselves as vulnerable. Many want to continue living meaningful lives and remain connected to the things, places and people important to them.  They’ve built capacity over a lifetime to know what they need and want and the option to self manage a home care package acknowledges this.” Mr Scutt said. 

Protections are important 

Scutt said it was also right and appropriate to ensure strong safeguards are in place to protect both the older person and the workers who provide the care and support and form important relationships with them.  

“It’s critical we have those protections in place, including police and ID checks, qualification checks, good communication and governance systems, quality training and access to quality care management to support proper oversight of Government funds,” said Mr Scutt.  

“But with those proper safeguards in place, we must ensure that all Australians, whether alone or with assistance from a family member or close representative, have the choice, in line with their enduring rights as adults, to self-manage their home care.

“I commend the Commissioners for their magnificent principles and bold vision and the Government’s strenuous support today.  I hope that, as the Government works toward its detailed response, it will ensure the detail of the implementation remains true and consistent with the overarching vision and principles of putting people at the centre.”

“Self-management will never be the best option for every person who is eligible for a Home Care Package; but it is currently one of the few expressions we have of a rights based approach in aged care and therefore should remain an important choice for all older Australians who want it now and in the future,” Mr Scutt said.