Dr Karen Thurecht
|Day Presenting||Tuesday 30 October|
|Session||Concurrent C2- Research|
|Presentation Title||What does it take for an older person to live at home until death|
Older Australians prefer to age in place, and the majority of people want that place to be their long-term home in the community; only 1% report a preference for residential aged care (RAC) . Over 40% of people will require some level of assistance as they age ; while formal community-based care and services are delivered into individual’s homes by the subsidised Home Care Packages (HCP) programme, these are not consistently successful in enabling someone to remain at home until death. Little is known about the care and services that will most effectively support older people to remain living confidently in the community, until death if this is their preference.
To address this evidence gap, ECH commenced the EnRICH (Enabling Responsive and Individual Care at Home) pilot in September 2017. Supported by a high level Advisory Panel, the study rigorously examines the type, quantity, construction and cost of care and services that could support a person at risk of permanent RAC admission to remain living at home within the maximum needs-based Government subsidy currently available – in effect developing a Level 5 HCP.
Meeting the primary selection criteria of elevated risk of admission to RAC, 12 randomly selected HCP clients consented to participate, with four provided with funds above their HCP subsidy after Aged Care Funding Instrument equivalence assessment. Aged from 71-91 years with widely variable clinical and social care presentations, participants are managed by an EnRICH Care Manager, who has enacted broadened care management activity and an extended, flexible service suite under a consumer-directed care framework.
With participants completing active trialling between April – October 2018, emerging evidence supports flexible distribution of funding (including ‘frontloading’ of care), an increase in the depth and breadth of care management activities and slight increases in service volume as central to increasing client quality of life and preventing premature RAC admission within the current subsidy limit.
These findings begin to evidence the need for an adequately subsidised higher level HCP or sophisticated needs-based funding agnostic to setting with flexible funds distribution in order to fully realise the ambitions of Government, service providers and older people themselves for successful ageing in place.
David has worked in health and social care in the UK and Australia for almost 40 years, over half as a CE. In the UK he has worked in the NHS and local government. In 2004 he was recruited to the SA public health system where for over 10 years he led reforms including the development of the new Royal Adelaide Hospital. Currently the CE of profit-for-purpose ECH, SA’s biggest provider of affordable housing and support services for older people. David is committed to services responding to the diversity of Australian communities and passionate about enabling all older people to live well until death in their own home if that is their wish. David is a past President of the AHHA, holds academic appointments with Adelaide University and the University of South Australia, is currently the Chair of SACOSS, a Director of ACOSS and a Director of LASA.