Understanding the Aged Care system is like wandering down in Alice Wonderland’s rabbit hole.
Exactly what is aged care and the fuss about THE aged care system, and why do so many Chinese think there is a lack of Chinese aged care services.
Who is Aging?
The world, not just Melbourne, is on the brink of a demographic challenge. Driven by falling fertility rates and increases in life expectancy, people aged 65 and over are outnumbering children under 5, with most aging population occurring in developing countries. This is evidence provided by United Nations, which estimated the aging population will grow to 1.5 billion in 2050 (WHO,2011).
More and more people are living beyond 80. So who can you call an older person or the senior citizen. Surprisingly, there is no standard definition of who is an older person. However most developed, often western countries agree that the older person is aged 65 & over.
“The ageing process is of course a biological reality which has its own dynamic, largely beyond human control. However, it is also subject to the constructions by which each society makes sense of old age. In the developed world, chronological time plays a paramount role. The age of 60 or 65, roughly equivalent to retirement ages in most developed countries, is said to be the beginning of old age. In many parts of the developing world, chronological time has little or no importance in the meaning of old age. Other socially constructed meanings of age are more significant such as the roles assigned to older people; in some cases it is the loss of roles accompanying physical decline which is significant in defining old age. Thus, in contrast to the chronological milestones which mark life stages in the developed world, old age in many developing countries is seen to begin at the point when active contribution is no longer possible.” (Gorman, 2000 in WHO, 2014)
It is no wonder that the definition of the older person varies country from country, and this affects when people can access aged care services.
What is Aged Care?
Aged care refer to the broad spectrum of care services provided to senior citizens to fulfill their special needs and requirements. Examples of these services as assisted living, adult day care, long term care, nursing homes, hospice care, and home care. These services are provided by governments and the private sector.
In Australia, the range of aged care services is summarized in the diagram below. More information can be obtained on the Australia Institute of Health and Welfare page. The three key service lines are:
- Community Aged Care Packages (CACP)
- Extended Aged Care at Home Packages (EACH)
- Extended Aged Care at Home Packages Dementia (EACHD).
In each package, there are a number of services that help aging consumers deal with everyday practical support, emotional and socialization needs, advocacy support, carers’ support and complex specialized care, such as dementia.
Possible Aged Care pathways
- Often the cycle of care begins with low-level community care in the home.
- The care at home may progress into higher levels of care. The person may decide to move into a residential care environment, either choosing low or high level care home, or continues to remain at home till the end.
- Respite care in a residential aged care facility may be a step along the way to permanent care.
One can be referred to the appropriate aged care by a GP or a hospital staff (if one is a hospital patient). The Aged Care Assistant Team (ACAT) team member can be a doctor, nurse (what they call clinicians) or non medical professionals who are part of the health or aged care system (what they called allied health workers).
They will interview and screen you and your family carers, or friends, to identify your aged care needs. When the ACATS assessor identifies your care needs, they will refer you to the appropriate residential or community care services, and provide contact details of service providers if available. If you are in hospital because of a terminal chronic disease complication (eg cancer), the hospital clinician/s may refer you to palliative care, which is a different pathway in the health system.
Is there a lack of Chinese Aged Care Services?
Aged care services are lacking for everyone, Chinese or no Chinese, in both the areas of:
- Residential aged care facilities, which include independent living and nursing care homes
- Community aged care services for Chinese preferring to stay at home.
Because of social and government policy trends, and community care is more affordable for most people, there will be more gaps in community care services addressing the high care needs of older Chinese and partially catering for their Chinese cultural preferences.
Aged care service provisioning is not about increasing the “Chinese-ness” in aged care, but more importantly is about closing the gaps in providing more complex care required by anyone with dementia and complex chronic health issues.
Healthy and older Chinese, who there are many, can continue to live well at home and be effectively supported with community care services. The issue is the CALD orientation (including integrating the “Chinese-ness”) in community care service provisioning is only developing.
In a cultural and linguistic diverse society, we need to be mindful that we do not promote mono-culture aged care services, because Chinese culture, like any other migrant equivalents, is continuously changing from one generation to another. Furthermore, the Chinese community has so many sub cultures – where one group of Chinese have different preferences from another Chinese group.
When the Chinese community gets affixed in building Chinese only aged care facilities and services, these amenities are short lived because the next generation of Chinese older consumers will have different and more cross cultural expectations. What works for the current generation of Chinese senior citizens will incrementally fade out with future waves of Chinese aging consumers. As aged care provisioning is expensive, no provider can afford to lock in service provisioning capacity to just cater for today’s needs and wants, and ignore having the ongoing capacity to change service mix and facility standards to suit future consumers.
Age Friendly Cities
Governments are also doing things to enable people age in their homes. They are making their cities age friendly. The World Health Organisation (WHO) has developed guidelines for developing Global Aged Friendly Cities in specific contexts of:
respect and social inclusion
civic participation and employment
communication and information
community support and health services
outdoor spaces and buildings
The concepts are still in infancy stages, and articulation of how technology enables integration of and delivery of value add services into these city redevelopment components is still unclear, however evolving. The WHO guidelines do not assume governments to lead in this new social and environment trend direction, it also empowers individuals and communities to innovate their own creative service oriented solution versions in their own backyards and community networks. The Gen X,Y and Zs will be the ones spearheading further developments of age friendly cities and reshaping today’s aged care amenities that tend to cater for the silent and baby boomer generations, which may last for another 10 to 20 odd years before new models of digitally enabled aged care dominate the playing field.