The Magic Faraway Tree and other aged care bedtime stories.

In the last chapter of Enid Blyton’s classic book, The Magic Faraway Tree, the children climb up the boughs of a great old tree through the clouds and into the Land of Presents, where gifts hang from trees. Thinking they can have whatever they want, the children rush to pull the gifts from their branches. However, gifts are controlled by goblins – of the benign, somewhat friendly kind – who will only dispense them to people asking for them in order to give them to someone else. 

Earlier this year, reading the draft Australian government’s National Care and Support Economy Strategy, I was left with one prevailing thought: we are not addressing what people want and how they behave.

In fact, after a decade of ‘consumer directed care’, the epic struggle between policymakers, economists, and service providers that periodically dominates the news cycle, feels like it is happening in a misty, stormy, cloud while the people of the nation move in its shadow, below.

I found myself asking, despite all the best intentions, are we missing the point? Are we making the obvious excruciatingly complicated, top heavy and expensive. 

Aged care is not a market-based sector in which people pay for a service directly by shopping for a product, service, or experience manufactured for them. 

Australians pay for aged care indirectly through taxes, and, in so doing, relinquish control over a level of decision-making to the government. The notion is that the Government acts in our best interests, and on our behalf. And it does, to a degree.

However, the Government balances investment in aged care against thousands of other needs and priorities. Departments rarely get the funding they want; money is allocated on a range of factors, of which customer outcomes is one; the process is time consuming.

Trade-offs happen at the outset. The results of early decisions cascade down to service providers with a relatively fixed income and then to case managers and facility managers who negotiate with families acting on behalf of, and with, the customer – an elderly Australian facing the ultimate reality of old age. 

“Via the service provider, the customer learns there are significant constraints on choice and many influencing forces, some immediate and others distant. The path presented is not clear or smooth, dense with many more decisions and requirements.

Is this consumer directed care? Or is it a modernised version of a legacy system which began post war to care for older people? 

Over the past two decades, the aged care system has been in an uncomfortable state of flux (or contortion). Government in its role as regulator, and baby boomers in their active role as consumer, have demanded higher standards of care and accommodation. That sounds like a win. 

However, the removal of low (residential) care and the pivot to home care has been a rough ride. People have been told that care is available, that it is consumer directed. They arrive with nervous and unprepared family members, often stumbling from a hospital discharge process, not always clear about the support they can get and confused or disappointed when the support available doesn’t always meet their needs (or isn’t available). 

So, are we addressing what the people want, and how they behave?

A motivated, capable, and resilient workforce

Ask any customer receiving care what is the most important and rewarding aspect of the experience and they will almost always say the relationship with the carer or support worker. Having a consistent team of carers who are experienced, responsive, and informed matters above all else. 

Unfortunately, distances to and between shifts, service time length, limited commitment to any one employer, and other factors act as barriers to home care worker recruitment and retention.

A 15 per cent wage increase was an important start. But it was already very low, and the Australian unemployment rate is at near record lows of 3.6%.

On Friday 4 August, the Aged Care Workforce Industry Council (ACWIC) announced it was shutting its doors, leaving the large and ever-present question of, how are we going to attract the right people to the sector, and how are we going to keep them? 

Behavioural science dictates we need to raise awareness and understanding, as well as opportunity, capability, and motivation. We need a national communication campaign, to attract workers to aged care, one that acknowledges Australia’s diversity and diverse use of media to seek and assess information and a campaign that stretches over multiple years, informed by behaviour change principles to achieve scale.

 It must be easier to learn about, train for and find a job. Worker mobility needs to be built into economic and other incentives. Affordable housing needs to be built where the work is delivered.

Think differently about services

The recent ACCPA Financial Sustainability Summit Issues Paper has created space for the Government to address that once politically toxic notion of user pays in aged care, offering different pathways to higher aged care funding. In the mix is superannuation. However, it frames the issue as one of financial sustainability instead of independence and choice, and one of intergenerational balance (or conflict). 

We need to acknowledge that this and future generations of older people have higher expectations for accommodation and care than those that came before them. They are also, on average, wealthier and can exercise that wealth in the most important investment we can all make – in our health, wellbeing and longevity.

Service and product innovation will accelerate in an increasingly competitive aged care system. We shouldn’t be scared if these innovations push the boundaries of what we currently consider ‘aged care’, or who delivers that care. In fact, that should be the primary focus of policy that is human-centred. 

That might mean less restrictive definitions of residential care and home care, bringing back ‘low care’ under another name to support people who can’t age in place at home, don’t want to commit to buying into a retirement village, but want the confidence of care nearby.

It should also take costs of the government’s balance sheet: not by policy edict, but because of customer choice.

Design services with employees, individuals, and their families

Opportunities to create individual and family wellness start long before someone receives care or enters a home. Along the aged care journey, there are critical points that affect health and wellbeing; among them, initial referral, assessment, financial arrangements, transition of health professional support, entering a home, navigating services and palliative arrangements. 

What if we viewed every one of these as an opportunity to create value rather than mitigate concern? Not only in the moment, but central to the aged care promise.

Naive? Let’s try it and then make that call. 

We should be confident because at the foundation of the aged care value proposition is the creation of shared value: a balance of financial investment and social impact. That makes sense to every Australian who has ever worked a job, and earned a dollar to invest in the life they want. It should make sense to governments, in a capitalist democracy, in 2023.

Enid Blyton felt she had a responsibility to provide readers with a moral framework and built it into her narratives. Morals are standards of behaviour defined by people of influence and adopted by the general community. They change with time. 

We need to ask Australians in 2023 what they want and design to achieve it. 

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This article appeared on Page 7 of the September edition of Hello Leaders magazine.  Read it here.

Find out more about Ellis Jones’ work in aged care strategy.