Australia's aged care system plays a crucial role in supporting the well-being and quality of life for our ageing population. However, recent challenges and shortcomings - including COVID-19, and the impact of the Royal Commission, to name a couple - have highlighted the need for significant improvements within Australia’s aged care system. One potential solution may lie in examining New Zealand's continuum of care model, which has shown promising outcomes in providing integrated and seamless care for older adults. 

In a conversation between Elise Hartevelt, Health Editor of Aged Care Insite, and Cameron Holland, CEO of Ryman Healthcare Australia, held on the Aged Care Insite Podcast in late 2022, the benefits of implementing a similar care model in Australia were discussed. This article delves deeper into the insights shared during their conversation, examining the potential advantages and considerations of adopting New Zealand's care model in Australia's aged care system.

Key Takeaways:

• The continuum of care model implemented in New Zealand integrates retirement villages, residential aged care, service departments, and home care on the same site, offering residents seamless access to different levels of care as they age.

• Challenges faced by the Australian aged care industry include the impact of the Royal Commission, the COVID-19 pandemic, staff shortages, and complexities in legislation and regulatory requirements.

• The continuum of care model addresses these challenges by integrating care options, improving efficiencies, and providing residents with more choice and control over their aging journey.

• Deregulating fees and accommodation options in Australia could allow residents to contribute more and access higher-quality services.

• Aligning incentives for quality care, as seen in the retirement village model in New Zealand, is crucial for improving the Australian aged care system.

• Staff shortages can be addressed by increasing pay parity with the health system to attract and retain qualified nurses and care workers.

• The continuum of care model can help reduce stigma associated with aged care by allowing individuals to choose retirement village living earlier and ensuring appropriate care if needed.

• Changes in the aged care system are needed to provide better support and remove barriers for individuals seeking residential care.

Challenges in the Australian Aged Care Industry

The Australian aged care industry has been confronted with numerous challenges that have necessitated significant improvements. Firstly, the impact of the Royal Commission on Aged Care Quality and Safety has shed light on systemic issues and shortcomings within the industry. The findings and recommendations of the [Royal Commission](https://agedcare.royalcommission.gov.au/) have called for substantial reforms to enhance the quality of care and ensure the well-being of older Australians.

Additionally, the COVID-19 pandemic has presented unprecedented challenges for the aged care sector. Outbreaks in aged care facilities have exposed vulnerabilities in infection control, staffing, and overall preparedness. The [Australian Government Department of Health](https://www.health.gov.au/resources/publications/aged-care-covid-19-readiness-toolkit) has provided a comprehensive Aged Care COVID-19 Readiness Toolkit to help address these challenges and protect the health and safety of residents and staff.

Another significant challenge faced by the Australian aged care industry is staff shortages. A shortage of highly qualified nurses and care workers has strained the capacity to deliver quality care and meet the increasing demand for services. The scarcity of skilled personnel has implications for the well-being and experiences of residents, as well as the overall sustainability of the aged care workforce. The [Aged Care Workforce Strategy Taskforce Report 2018](https://www.health.gov.au/sites/default/files/documents/2019/03/aged-care-workforce-strategy-taskforce-report-2018.pdf) by the Australian Government Department of Health highlights the need for strategies to address this workforce shortage.

Moreover, the complexities of the regulatory framework have posed challenges for operators in the retirement village sector. Many operators have been hesitant to provide care services due to the intricate and separate nature of the aged care system compared to retirement village legislation. This has resulted in a gap between retirement village offerings and the comprehensive care needs of residents, limiting their options and potentially compromising their well-being (Productivity Commission, 2021).

Furthermore, aged care providers in Australia have often focused primarily on the provision of care, with limited attention to the lifestyle and accommodation aspects that contribute to the overall quality of life for residents. This lack of integration has hindered the development of holistic and person-centred approaches to aged care.

The Continuum of Care Model: Lessons from New Zealand

In the Aged Care Insight podcast, Mr Holland, of Ryman Healthcare, explained various aspects of the continuum of care model successfully implemented in New Zealand. This model integrates various levels of care, including retirement villages, residential aged care, service departments, and home care, all operating within the same site.

The continuum of care model offers several advantages for older adults and the aged care system as a whole. One key benefit is the seamless access to different levels of care as individuals age and their needs change. With this model, residents can transition smoothly between independent living in retirement villages to more supported care in residential aged care or home care services, depending on their evolving requirements. This integrated approach ensures that residents' needs are consistently met and provides them with a sense of continuity and familiarity as they move through different stages of aging.

Moreover, the continuum of care model promotes improved efficiencies in terms of capital and operating costs. By consolidating multiple care options within the same site, resources can be shared, and economies of scale can be achieved. This integrated approach reduces the need for duplicative infrastructure and staffing, optimising the allocation of resources and potentially leading to cost savings. Additionally, the continuum of care model facilitates better coordination and communication among care providers, enabling a more streamlined and holistic approach to care delivery.

Another advantage of the continuum of care model is its increased choice for residents; older adults can select the level of care and accommodation that best suits their preferences and needs. Whether they prefer the independence and social engagement of a retirement village or require more comprehensive support in a residential aged care setting, the continuum of care model ensures that appropriate options are available, empowering individuals to make decisions that align with their lifestyle and aging journey.

The success of the continuum of care model in New Zealand serves as a valuable lesson for Australia's aged care system. By embracing this model, Australia can address the challenges and shortcomings it currently faces, such as fragmented care experiences, limited choice for residents, and inefficiencies in resource allocation. Implementing a similar continuum of care approach can foster a more integrated, person-centred, and sustainable aged care system that meets the evolving needs and preferences of older Australians.

Challenges of Implementation

Government Funding and Regulation: Comparing New Zealand and Australia

A comparison between the government funding and regulation systems in New Zealand and Australia reveals significant differences with implications for aged care service quality and resident experience.

In New Zealand, operators have the flexibility to charge a premium fee in addition to the standard care funding base. This allows for higher-quality accommodation and lifestyle services, with operators setting fees based on what they believe customers can afford and are willing to pay. The focus is on the daily accommodation and lifestyle needs of residents.

In contrast, Australia's aged care system follows a regulated fee structure with fixed fees across the industry. While this ensures affordability and protects residents from excessive costs, it limits the ability of operators to provide varying levels of service and accommodation options based on individual preferences and financial capacities.

To enhance service quality and resident experience in Australia, suggestions have been made to deregulate fees and expand accommodation options. Deregulating fees would enable operators to set fees based on residents' preferences and financial capabilities, allowing for more personalised and tailored aged care. Expanding accommodation options would provide residents with a wider range of choices and facilitate a seamless transition from independent living to higher levels of care.

Note: Any changes to government funding and regulation systems should consider safeguards to protect vulnerable individuals and maintain affordability for those with limited financial resources.

Staff Shortages and Pay Parity

Staff shortages in the aged care industry are a common challenge faced by both New Zealand and Australia. To address this issue, Ryman Healthcare in New Zealand successfully increased nurse salaries to match the local health network, leading to industry-wide improvements in recruitment and retention.

In Australia, establishing pay parity with the health system is crucial to attract and retain qualified nurses and care workers. Currently, there is a wage disparity between the aged care sector and the health system, making it difficult to compete for skilled professionals. By ensuring pay parity, the industry can create a stable and competent workforce, providing quality care and job satisfaction.

Prioritising pay parity as part of workforce development strategies is essential for the aged care sector. Equitable compensation not only addresses staff shortages but also fosters job satisfaction and career development opportunities. It is a crucial step in building a sustainable workforce dedicated to providing excellent care to older adults.

Reducing Stigma and Improving Residential Care

The continuum of care model can play a significant role in reducing the stigma associated with aged care. By offering individuals the opportunity to move into retirement villages earlier in life with the assurance of accessible care if needed, the model promotes proactive planning and diminishes negative perceptions of aged care transitions.

To further address stigma, the aged care system must provide better support and remove barriers for those seeking residential care. This involves improving information availability, streamlining admission processes, and enhancing the overall living experience in aged care facilities.

Collaboration between aged care providers, government agencies, and community organizations is essential to create a supportive and person-centred environment. By implementing policies that emphasise emotional well-being, social engagement, and community connections, the system can dispel stigma and foster a sense of value, respect, and quality care.

Reducing stigma and improving residential care requires a comprehensive approach that considers both physical and emotional needs. Through collective efforts, the aged care system can evolve to prioritise dignity, choice, and a sense of belonging for all individuals in need of residential care.

Related reading: Modern Ageing: Here's Why It's an Opportunity, Not a Threat

Additional Challenges in Implementing the Continuum of Care Model in Australia

For all its potential benefits, implementing the continuum of care model in Australia may face several challenges. These challenges include:

1. Financial Considerations: Implementing the continuum of care model requires significant investment in infrastructure, resources, and staffing. Funding these changes and ensuring sustainability can be a major challenge, especially considering the existing financial pressures on the aged care sector.

2. Infrastructure and Capacity: Developing and expanding the necessary infrastructure to support the continuum of care model, including retirement villages, residential aged care facilities, and home care services, requires careful planning and coordination. Ensuring sufficient capacity and availability of services in different locations can be a logistical challenge.

3. Regulatory Framework: Adapting the regulatory framework to accommodate the continuum of care model can be complex. Aligning regulations, standards, and accreditation processes across different care settings and ensuring compliance with quality and safety standards throughout the continuum of care can present challenges.

4. Workforce Development: The continuum of care model requires a skilled and diverse workforce capable of providing care at different levels and settings. Ensuring an adequate supply of trained professionals, addressing workforce shortages, and promoting ongoing professional development and support are crucial challenges to overcome.

5. Change Management: Implementing a new care model involves significant change for organisations, staff, and residents. Managing and navigating this change, addressing resistance, and ensuring smooth transitions can be challenging, requiring effective change management strategies and clear communication.

6. Integration and Collaboration: Effective coordination and collaboration among various stakeholders, including government agencies, aged care providers, health professionals, and community organisations, are essential for the success of the continuum of care model. Establishing effective partnerships and communication channels can be a challenge, particularly when different sectors and organisations have different priorities and operational structures.

Addressing these challenges requires careful planning, stakeholder engagement, and ongoing evaluation to ensure the successful implementation and sustainability of the continuum of care model in Australia's aged care system.

Embracing a New Era of Aged Care: Lessons from New Zealand

In conclusion, the discussion highlights several key takeaways regarding the potential benefits of adopting a care model similar to that of New Zealand in Australia's aged care system.

First, the continuum of care model, successfully implemented in New Zealand, offers seamless access to different levels of care, improved efficiencies, and increased choice for residents. Integrating retirement villages, residential aged care, service departments, and home care on the same site provides a comprehensive and flexible approach to meeting the evolving needs of individuals as they age.

Second, the challenges faced by the Australian aged care industry, including the impact of the Royal Commission, the COVID-19 pandemic, staff shortages, and regulatory complexities, can be addressed through the continuum of care model. By integrating care options and improving efficiencies, the model tackles these challenges head-on and promotes a more holistic and person-centred approach to aged care.

Third, the comparison between government funding and regulation systems in New Zealand and Australia highlights the importance of flexibility in fees and accommodation options. Deregulating fees and expanding accommodation choices in Australia can enhance service quality, resident experience, and personalisation of care.

Furthermore, addressing staff shortages by ensuring pay parity with the health system is crucial in attracting and retaining qualified nurses and care workers, improving the overall quality of care provided.

Lastly, the continuum of care model and the necessary changes in the aged care system have the potential to reduce the stigma associated with aged care, offer better support, and remove barriers for individuals seeking residential care.

By embracing these key takeaways and implementing a care model inspired by New Zealand's success, Australia's aged care system can strive towards providing higher-quality, person-centred care, enhancing the well-being and quality of life for its aging population.

Listen to the full podcast here: Adopting NZ’s aged care blueprint could be Australia’s salvation: podcast
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