Driving excellence in aged care and healthy ageing

It is really refreshing to read journal articles, policy documents, and social media posts about people and organisations who are wanting to drive excellence in aged care and healthy ageing through experimenting with new ideas and incorporating digital technologies instead of reading about the different ways and means to meet the strengthened aged care quality standards, minimum nursing care hours, and requirements for accreditation in aged care.

The problem with the reactive medical model is that we spend disproportionately more time on meeting multiple hurdles for a relatively small group of older persons receiving care and less and less time focusing on how we can improve the lives of the majority of older persons, albeit living in a variety of settings. With 4.2 million (16%) people aged 65 years and over in Australia, most are living alone or with a partner or family member in a home environment.¹ The care economy includes both paid and unpaid carers. And yet the focus with the Department of Health and Aged Care, aged and home care providers, peak bodies, professional associations, trade unions, and advocacy groups is on the paid economy of the 193,000 persons using permanent or respite residential care and the 258,000 persons receiving home care services.²

Yes, I get it – if the federal government is allocating tax-payer funds to aged and home care, then it is not unreasonable to expect these government-funded services to come under increased scrutiny. A preventive social model would also be looking at healthy ageing per se and the factors that contribute to healthy ageing. The United Nations’ Decade of Healthy Ageing (2021–2030)³ embodies this view by seeking to reduce health inequities and improve the lives of older persons, their families and communities through collective action in four areas: tackling ageism, developing communities to foster abilities of older persons, delivering responsive primary health services, and providing access to quality long-term care.⁴

At the recent federal election, numerous stakeholder groups tried to gain traction for a Senior Dental Benefits Scheme. Good oral health is fundamental to overall health and wellbeing.⁵ Without it, a person’s general quality of life and the ability to eat, speak and socialise is compromised, resulting in pain, discomfort and embarrassment.⁶ People with poor oral health are at higher risk of illness, hospitalisation and death from infection,⁷ aspiration pneumonia^8–11 and infective endocarditis.¹²

In Australia, Medicare covers the whole body except the mouth. Sadly, poor oral health is one of the strongest indicators of inequality in Australia, with unemployed and low-income people more likely to suffer dental problems.¹³ For this reason, some older people have not been able to access dental treatment for decades.

A Senior Dental Benefits Scheme was a recommendation from the Royal Commission into Aged Care Quality and Safety¹⁴ and noted as ‘yet to be agreed by the Australian Government’ in the Royal Commission’s Progress Report 3 years later.¹⁵ The lobbying for the Scheme included the Australian Dental Association, the Council on the Ageing, the Australian Association of Gerontology, Ageing Australia, the Public Health Association of Australia, Consumers Health Forum of Australia, National Seniors Australia, as well as researchers, journalists and media outlets. The establishment of a Senior Dental Benefits Scheme is consistent with the UN Decade of Healthy Ageing’s aim to reduce health inequities and improve the lives of older persons through responsive primary health services but, apart from being a key policy announcement from the Greens, it failed to find any support with the two major parties.

Really? Why? Three reasons. First, this health policy failure is a good example of Australia’s focus on aged care being firmly fixed on a reactive medical model dominated by privatised dentistry, instead of a preventive social model looking at excellence in aged care and the factors that contribute to healthy ageing. Second, our health system incentivises ‘fast medicine’ through Medicare Urgent Care Clinics and bulk-billing of short GP consultations to the disadvantage of older persons with chronic illnesses and complex healthcare needs such as dental diseases.¹⁶ Third, there is still much work to do during the UN Decade of Healthy Ageing (2021–2030) to change how we think, feel and act towards age, ageing and ageism. Older persons matter and we can do better.