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THE AGED CARE SERVICES INDUSTRY IN REGIONAL AUSTRALIA:
Will it cope with the tsunami to come?
Dr Jennifer Sappey
Institute for Land, Water and Society, CharlesSturtUniversity, Bathurst, Australia
Email:
Zelma Bone
Institute for Land, Water and Society, CharlesSturtUniversity, Orange, Australia
Email:
Dr Roderick Duncan
Institute for Land, Water and Society, CharlesSturtUniversity, Bathurst, Australia
Email:
Preferred Stream:Public Sector and Not-for-Profit
Profile:Zelma Bone (Presenter)
Zelma Bone is a Lecturer in Communication at Charles Sturt University, Orange. Zelma specialises in community development and community based landcare programmes.(Zel, max. 100 words from you)
THE AGED CARE SERVICES INDUSTRY IN REGIONAL AUSTRALIA:
Will it cope with the tsunami to come?
ABSTRACT
This paper reports on a pilot project (still in progress at the time of ANZAM submission) to map out the aged care services industry in the Bathurst regional area of Central West New South Wales. The purpose of the project is to inform the future efforts of government, community based providers (CBPs) and private agencies in the sustainable development of the aged care industry. Early data suggest that the fragmented industry structure of community based providerCBPs, funded through asynchronous, disjointed state and federal funding programs, will be unable to respond to the increased demand for aged care services over the next decade. Initial findings also suggest that market tensions between community based providerCBPs and commercial providersprivate agencies will increase as they engage in competitive tendering for state and federal funding, and directly compete for scarce labour in a very tight regional labour market. This paper explores these issues through a case study of a regional city (Bathurst), a nearby regional town (Blayney) and a rurallocal village (Wattle Flat). The study draws on: interviews with community based service providers, commercial providers, seniors’ organisations, and local, state and federal government agencies; and, focus groups with seniors (aged 60+ years) in each of the localities.
Keywords: not-for-profits, social services, social capital, social services, governance
AGEING IN RURAL AND REGIONAL AUSTRALIA
DEMOGRAPHIC CHANGE
Amongst the foreseeable social, environmental and economic challenges faced by Australia, the ageing of our population is the only phenomenon which can be predicted with any degree of accuracy (McIntosh 1998; Productivity Commission 2005; McIntosh 1998).
The ageing of the population has emerged as a result of a sustained lower fertility rate since 1965[1], longer life expectancies [2] and the large cohort of 'baby boomers' [3] who are beginning to reach retirement age.[4] It is forecast that by 2021 the percentagenumber of Australians aged 65 years and over will increase to 18% (4.2 million) (ABS 2006b; AIHW 2002; ABS 2006)).Based on these projections, iIn forty years time, one quarter of the population (or 6.6 million people) is projected to could be aged 65 years and over. It is also projected that the number of people aged 80 years and over - the ageing of the aged - - will almost double in size over the next twenty years and triple in size over the next fifty years (AIHW 2002). [5] The use of formal aged care increases rapidly after 80 years of age, therefore, population ageing will exert substantial pressure on aged care expenditure and aged care service delivery (Productivity Commission 2005, p 34; DoHA 2005) over the next twenty years (DoHA 2005; Productivity Commission 2005:34). Inspite of access to residential care facilities, the majority of older Australians will remain in their own homes, with meals programs, home support, respite and allied health services, and social support services substituting for institutionalised care (ALGA 2005; Brown, Lymer, Yap, Singh & Harding 2005; DoHA 2005,; 2007 (a), 2007 (b), 2007 (c), 2007 (d)) (Brown et al 2004, p. 2) [6] substituting for institutionalised care.
A lesser known feature of population ageing is occurring at the regional level where non-metropolitan areas have, on average, older age profiles and more rapid rates of growth in numbers of over 65 year olds than metropolitan areas (ABS 2006b; Productivity Commission 2005:, p 15; ABS 2006(b)). It is predicted that, with the exception of Western Australia, the populations based outside metropolitan areas will age more rapidly than the city populations (ABS 2006a, 2006b; Intergenerational Report 2002; ABS 2006 (a), (b)3). In Central West NSW- an area which encompasses the pilot study- the region has seen a 23% increase in its population aged 60 and over in the decade between the 1996 and the 2006 Australian Census[7], while the overall population for the region has remained relatively unchanged. Currently over 20% of the population of the Central West or 35,520 people out of a population of 170,900 are aged 60 and over. As is predicted to happen in the general population, the increase in the population aged 80 and above is even faster. The Central West has experienced a 42% increase in numbers of people aged 80 and above over the same decade. To date, there is little detailed empirical understanding about ageing in rural and regional Australia and its implications for the community based provision of services..
FERTILITY AND MORTALITY: (Budget No 5 p 4)
“the total fertility rate (TFR) of Australian women has declined since 1961 when it peaked at 3.5 births per woman during the post-World War 11 ‘baby boom’. Since the mide-1970s the TFR has been well below the rate needed for population replacement. At the same time, high standards of public health have contributed to increased longevity. The ageing of Australia’s ‘baby boom’ cohort, with lower mortality rates than previous generations and smaller cohorts following as fertility declined, accentuates the impact of an ageing population. In the past century, the proportion of the population aged over 65 has risen from just 4% to nearly 12.5%. By 2042, around 24.5% of Australia’s population is expected to be aged over 65……
“At the same time as fertility rates have fallen, mortality rates have also fallen. Declining mortaility rates add to population growth rates and the proportion of aged people in the population. Australia’s death rate gell from 8.5 per thousand in 1971 to 6.9 per thousand in 1991 and around 6.7 per thousand in 2001…..Mortality rates have fallen across all age groups, and this is expected to continue for the next four decades. The male proportion in older age groups is increasing slowly. Although women have a higher life expectancy than men, men’s mortality rates have fallen faster than those of women…..
(p2) Australian’s life expectancies are mongs the highest of OECD countries and this is expected to continue. In the past 40 years, Australians’ life expectancies have increased by more than 8.3 years for men and 7.6 years for women. Based on recent trends, men born in 2042 are projected to live to 82.5 years, an average of 5.3 years longer than those born in 2002. Women born in 2042 are projected to live to 87.5, 4.9 years longer on average.”
THE NEEDS AND EXPECTATIONS OF ‘BABY BOOMERS’SENIORS
The ageing of the population profile will put significant pressure on our regional communitiesy, andnot just for the provision of aged care services (ALGA 2004, 2005) including:
- in-home medical and nursing,
- home care including personal care, cleaning and shopping,
- meal production and delivery,
- respite care and temporary accommodation and
- community transport.
. With higher superannuation savings in the near term and with increasing expectations and needs, the consumption potential of our older residents will drive an increased demand for goods and services that accommodate their income and lifestyle preferences (DoHA 2005; Gittins 2004; Kelly, Harding & Percival 2002; DoHA 2005). We are witnessing this already in the Central Westour region with the ‘tree-change’ migration of older Australians to the inland cities of Bathurst, Mudgee and Orange and Mudgee. Changing expectations are also evident in the data collected in this study fromby community based providers (community based service providers (not-for-profits NFPs) CBPs) whicho identify an increasing expectation of the quality, speed and of service and the range of their services. irFor example, managers of hostels have identified resident demands for internet access in their rooms and customised air conditioning. Managers of nursing homes t-60 Managers of nursing homes and hostels have also identified the expectations of their residents' families, for single room/private facility accommodation for their over 80s family member. These expectations cannot be met in older style residential facilities designed around 4-bed wards, irrespective of the resident's capacity to pay. Consistent with a consumer society, consumption patterns and expectations of service, aged care services are changing in rural and regional Australia. It is not just a matter of finding a statistical match between the demographics of ageing and service availability, but understanding the changing clientelle and their different expectations of consumption and lifestyle in the context of the capacity of current service providers to meet those expectations.Transdisciplinary, long term research is needed to identify holistic solutions to the challenges which our Central West communities will face over the next decade.
PENSIONS (Budget paper no 5)
“Between 1980 and 2001, the total number of Age Pensioners increased from 1.3 million to 1.8 million. This was mainly due to growth in the eligible population, partly offset by a decline in the proportion of the population in the eligible age group receiving a pension (the coverage rate). The number of Service Pension and War Widows Pensioners has been stable around 300,000 for some time and is expected to decline as veterans from the Second World War age. …. In the future, the key driver of Age Pension spending is likely to continue to be the increase in the population in the eligible age range, which, expressed as a proportion of the total population, is projected to about double by 2041-42. This rise is expected to be partly offset by a projected further decline in the coverage rate. In addition, the proportion of pensioners receiving a full Age Pension is also projected to decline, while the proportion with a part Age Pension will increase significantly. These restraining factors reflect the impact of the maturing superannuation system, which both encourages and requires greater self provision for retirement.
METHODOLOGY
This paper reports on the pilot project, which is the first step in gaining a foundational understanding of the larger economic, social and environmental problems associated with an ageing population and the problems of maintaining sustainable communities in rural and regional AustraliaAs a first step, the pilot project is a mapping exercise of the aged care services industry in the Bathurst region of Central West New South Wales. [8]. It will also seek to identify a foundational understanding of the larger economic, social and environmental problems associated with an ageing population and the problems of maintaining sustainable communities in rural and regional Australia. This should identify the dimensions of the ageing issue for future research projects to be conducted by the ERD group of ILWS. Arising from the pilot project will be an ARC competitive grant application, to be lodged in 2008. If successful, the ERD group will undertake a major project from 2009-2012 which will focus in depth one of the key issues identified in the pilot project.
The pilot study has undertakens to begin, for the first time, to provide detailed evidence of the relationship between population, infrastructure and socio-economic issues in the Bathurst regional community of Central West New South Wales. It will maps the ways in which the federal and state governments , through CBPs community based service providers (NFPs) public and private agencies are responding, through a range of policiesy and programmes responses, to provide age-friendly infrastructure and services for older age groups in the Bathurst regionarea. It will provide a starting point for future longitudinal studies of the area by the ILWS.
The range of organisations and individuals encompassed by this descriptor is extremely broad, with groups and individuals planned for investigation to include (but not exclusively) the following organisations:
Bathurst Regional Council; Orange City Council; Blayney Shire Council and other local government agencies;
State Department of Ageing, Disability and Home Care
Federal Department of Health and Ageing; Centrelink; JobNetwork providers.
NSW Farmers Association (Bathurst Branch); Country Women’s Association (Bathurst Branch)
NSW Pensioners and Superannuants Association (Bathurst Branch)
Western Research Institute
Centre for Rural Social Research, ILWS
Other teams with an interest in the ageing project which are emerging in the ERD group. For example, Prof John Hicks, Dr PK Basu and Dr Richard Sappey are undertaking a preliminary study of the participation rates of older workers in the Central West labour market.
Providers of aged care such as the Bathurst Aged Care Assessment Team, Bathurst Rehabilitation Centre, Freemasons, Bathurst Hospital, St Vincent’s Hospital, Home Help Service and Day Care Centres.
NFP community groups and stakeholders such as the Bathurst Ageing Issues Group, Bathurst Health Issues Group, Bathurst Community Transport Group, Meals on Wheels, the Red Cross, Cancare, Volunteering Australia, Bathurst Information and Neighbourhood Centre, Home Help Service, St Vincent de Paul Society, church groups, and the local branch of COTA (Connecting Over 50s Throughout Australia).
Four focus groups will be conducted with seniors in our community (two at Bathurst, one at Blayney and one at Wattle Flat).
It will be important for the pilot project to capture three “voices”: public and private agencies providing aged care services; older people in our regional city, town and village; and older rural landholders/rural workers and their families.
4METHODOLOGY
Preliminary analysis of demographic data for the Central West region suggesteds that there are marked variations in composition and migration between its regional cities, towns and rural villages. For example, the population of Bathurst CityRegionalCity Council (BCC)[9] peaks between the ages of 15-19 whilst the population of the former Evans Shire Council (which surrounded the BCC) peaks between the ages of 10-24 and 40-60 (2001 Census cited in Bathurst Regional CouncilThe Bathurst Region Statistical Profile 2005).
Accordingly, the project has selected Bathurst (a regional city approx. 200 kms west of Sydney with a population of 37,000 (2005)), Blayney (a regional town approximately 30 kms south-west of Bathurst with a population of 3,000 (2005)) and Wattle Flat (a rural village approx. 30 kms north-east of Bathurst with a population of 275 (Bathurst Regional Council (2001 Census cited in The Bathurst Region Statistical Profile 2005)) as the foci of the pilot. The fieldwork locations were selected to target issues of spatial inequity.
The pilot project involved secondary analysis of ABS 1996, 2001 and 2006 census data [10]; 30 interviews with community based service providers (NFPs) CBPs and private agencies in Bathurst, Blayney and Wattle Flat [11]; and four focus groups with seniors (60+ years) in the three localities. Given that the notion of '“working age'” is now redundant consequent on anti-discrimination legislation, the age cut-off of 60 years was chosen because it reflected the lower retirement age of 60 for most superannuation schemes (Brown et al 2004:, p6). The 60+ cut-off also captures the changing employment patterns and lifestyles of older citizens in the region. [12] At the time of submission of this paper twenty interviews with service providers had been completedis ongoingis ongoing, with the remaining interviews and seniors' focus groups still to be completed. Complete data and the analysis of results will be included in the revised conference paper for submission in OctoberAugust, with the project finalised for the ANZAM 2007 presentation in December.
The pilot will include the following research methods:
Face-to-face interviews with government (local and state)
Telephone interviews with government (federal)
Secondary analysis of ABS 1996, 2001 and 2006 census data
Face-to-face interviews with service providers in Bathurst, Blayney and Wattle Flat, having been referred to said providers through snowballing referral.
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2 AGENDA
Population ageing and its associated impact on the sustainability of our towns, villages and rural areas in the Central West is relevant to a broad range of topics including:
Economic Growth
development within the expanding services sector and new industries generated to service the ageing population;
the labour market: employment rates; implications for labour demand and supply and retirement age;
Population Migration and Development Patterns
‘Aged’ migration patterns (tree-changers and the migration of 60+ year olds into the area; migration of older residents 80+ from outer rural villages to their nearest regional city);
implications of ageing for regional planning and maintaining sustainable towns, villages and rural communities.
Infrastructure
health (with a focus on the greatest need in the region for specialist medical and dental services);
housing (considering the full range of housing needs of older Australians in the region from private home ownership through to nursing home care);
transport (public and private), particularly for older people in rural villages and outlying rural areas;
telecommunications;
education (U3A, Central West Community College and other regional providers).
Social Capital and Civic Engagement
Social capital as a resource which older individuals can invest in and draw upon to be actively engaged in their local communities through civic engagement, volunteering and social networks, with the beneficial consequence of productive ageing;
Social capital as a resource which can facilitate rural and regional communities addressing specific environmental, economic and social problems in their immediate communities, such as: