Transcript Of Press Conference,NACA Panel Discussion At The Conclusion Of The National Aged Care Summit, AMA President, Dr Bill Glasson, Melbourne

           I'd like to begin by introducing my panel.  To my right Mr Rod Young from the Australian Nursing Home and Extended Care Association.  To his left Professor Tony Broe, Australian Association of Gerontology.  To my right Jill Iliffe, Australian Nursing Federation.  To my left Dr Mukesh  Haikerwal, who is the AMA Vice President and also chairs the AMA Working Party on Aged Care.  And Mr Greg Mundy to his left, from the Aged Community Care Services Association.  And to his left again Mr Glen Rees from the Alzheimer's Association.  I welcome you on this panel.

           To put it very briefly, over the last 24 hours the issues have been to try and develop strategies, particularly in relation to the forthcoming election that identifies areas in aged care that are of concern to this group or this alliance. This meeting has been hosted by the AMA, but is in partnership with the National Aged Care Alliance, leaders of which sit on this panel and around this room. And various strategies, as I say, have been drawn together that we can take back to the Government and the Opposition in relation to the forthcoming election.

           As you know basically, aged care is really part of the health care debate.  And we have a nation that is ageing and that should not be considered as a threat but considered as an opportunity which each and every one of you sitting in this room, in fact the solution we're trying to develop here is a solution for you because essentially it's when you get to this age that the problem may arise.  But hopefully by the time you get to that stage we'll have the solution before you.

           So I'd like now just to hand over to Dr Mukesh Haikerwal, to summarise some of the key points and then I'll open the forum up for questions.

HAIKERWAL:   The National Aged Care Alliance is a very diverse group of people that provide services in the aged care sector.  The 23 Alliance members, over 30 representatives of organisations here at this summit.  What's very clear from the summit is that aged care is a theme that we all want to pursue to ensure people have access to care when they need it of a high quality without problems in terms of funding and access.

           Key themes over these past few days have been around the manpower issue, we have a major problem with recruitment and retention of people into the sector.  The main reason for that is people who work in the sector do not feel valued.  And that's partly as a result of society's valuing of our older people. 

           Our older people are the memory and they form an enormous resource for the community.  We need to respect what they've done for us in the past and look after them into the future. If we can look after them well it also paves the way for our care will be looked after in the future too.

GLASSON:        Jill, would you comment on the nursing workforce related issue particularly in relation to our aged care facilities?

ILIFFE:              I'd prefer to talk about the workforce more broadly than nursing because we have quite a diverse workforce.  Those who are employed as well as those who come to visit, general practitioners, medical specialists, allied health people.  So it's a very broad workforce, it's not just nursing.

           One of the really interesting things that we heard today from Sue Richardson, who's from the Labour Policy Unit at Flinders University is that we have an increasing number of seriously old people over the next 30 years, but a very significant decrease in the number of workers, particularly women, who do most of the caring in this industry and most of the caring in the community.  For example at the moment, we've got one woman for every seven people needing care.  In 30 year's time we're going to have one woman for every 42 people needing care.  Quite a significant difference.

           The good news from Sue was that we've got time to do something about it.  And also this industry attracts older workers so we won't have to compete for the declining numbers of young people.  However if we want to keep people in the workforce we've got to pay them the same and give them the same conditions as those that are employed in the public sector, in the acute care sector.  So we've got some challenges ahead of us but I don't think they're unresolvable if we have the will to do so.

GLASSON:        On the medical side what do you foresee needs to be done or could be done or should be done?

BROE:                Thanks Bill.  Yes.  I echo what Jill Iliffe said, that we run a multi-disciplinary workforce and that's been a key item that's come out of the conference, that it's not about doctors and nurses and other professionals, it's about the ability to work together.  And some are ... there is some difficulty in achieving that in the aged care home industry and in the community health industry big providers of aged care are general practitioners. 

           Obviously the announcement yesterday by the Salvation Army southern division that they're about to substantially exit the residential aged care sector, really brings home and emphasises what we ... this sector's been saying to government for quite some time. And that is that if you want to provide residential care, of quality both as to the quality of buildings and services and hotel services we provide, and more particularly, the quality of care services and nursing services that we provide, then it's absolutely essential that we recognise the cost of providing that care.

           And the Salvation Army message yesterday clearly said that they'd been reviewing its services, that they could not see themselves continuing in this environment because they were not able to survive financially. They're a large provider and with over 1500 residential care beds, many of the efficiencies of size and administrative overheads that are endeavoured to be achieved in this sector, and which is part of the underlying policy they have, should operate in that operator's administrative environment.

           But what we're looking at is the need for government to really review the financial viability of the sector. There is a report, the Hogan Report due at the end of last year, still to be delivered to the Minister, and we certainly are seriously requesting that the government receive that report and adopt its urgent short term solutions and that they be incorporated within the May budgetary process.

GLASSON:        Thanks Rod.

           One of the major issues raised at this summit is the issue of dementia and this summit has made a move to try and make this a national health priority. And I'd like Glen to comment on this issue as far as dementia and particularly of Alzheimer's.

            Glenn, what we should be doing?

REES:                From the point of view of Alzheimer's Australia, it's immensely important to have the support of the National Aged Care Alliance for dementia as a national health priority. Because it's a recognition that dementia is not simply an aged care problem, it's an issue that has to be tackled across the health care system. It has to be tackled in hospitals. It has to be tackled in the mental health system, it has to be tackled in residential care, it has to be tackled in community services.

           We also need a forward looking strategy through dementia being a national health priority, that actually makes the Commonwealth and the States work together. We see in all aspects of aged care the Commonwealth/State divide is a real problem towards getting better outcomes, and that is nowhere truer than in the area of dementia which can fall between the aged care system on the one hand and the mental health care system on the other.

           So I would like to say again from the point of view of Alzheimer's Australia that we're immensely grateful to a peak body, which has 23 bodies as part of it, to have their support for dementia as a national health priority.

GLASSON:        Thanks, thanks very much. And finally to Greg, could you comment from the perspective of your Aged and Community (sic) Care Association, from the point of view of, I suppose, the outcomes of this summit and the perspective you've gained.

YOUNG:            Certainly, Bill, I'm happy to do that. One of the key themes of this summit has been the linking of services, of not looking at aged care as something separate from health services, the GPs unconnected with hospitals and residential care services.  And I'd like to link that to the point about the need for the government to invest in these services if we're going to meet the needs of our ageing population.

           Because a failure to invest in one part of the system is going to make the whole system less effective in terms of caring for older people and less efficient. If we don't have enough aged care services, we're going to have people spending inappropriately long periods of time in public hospitals, for example.

           I think the real strength of a summit like this is that the aged and medical sectors can get together, identify the issues, and identify some practical ways forward. I think one of the take home messages from the summit is it's now time for perhaps our politicians to do the same thing, to put an end to the squabbling between the Commonwealth and the States, to saying it's your problem, no it's your problem.  Duckshoving won't solve the problem. If the sector can get together to do it, then government should be able to do the same.

GLASSON:        Now it's over to you for questions.

QUESTION:       Dr Glasson, following the decision yesterday by the Salvation Army, what's the AMA's perspective on that first, and second, non government agencies to go

GLASSON:        The reality is, as you know, the Medicare system has been underfunded for the last decade or more.  It probably reflects less than 50 per cent of what it costs to provide a general practice service, and a specialist service.  And so, unless we are going to increase the funding across the board, and I keep saying if they increase the funding appropriately the issue of the needy, or those that people feel need to be bulk billed or rebated, the doctors will sort it out. 

           But don't come in with the stick because what you'll do with the stick is you'll drive the workforce out, you'll drive the participation rate lower than it is at the moment, which is about 67 per cent. So come in with the carrot and say to the doctors, we're going to give increased rebates to this group or patients, or increased rebates to all patients, whatever the Government decides is appropriate, but I'd like to think that those who are most in need get the most help.  And that's obviously, particularly our children, which is the future generation of this country, and our elderly people who basically have paid their dues and we owe it to them to make sure they get the best quality care that this country can offer.

REPORTER:      Just on another topic, the elderly, the elderly getting heavier, in weight obviously.  Can I just get you to make a comment about that?

ILIFFE:              Yes, certainly it's a real issue I suppose.  It's a real issue for those caring, when you look at the fact that we are getting bigger, heavier.  And of course if we're all getting heavier then those who are doing the caring are also getting heavier, which means that you compound the problem, because you've got heavier people lifting heavier people. Which doesn't sound like very good formula. 

           The aged care industry already has a very high injury rate.  We don't use technology as well as we should, it's not available.  So there is a number of things we have to do.

           First of all we have to make sure that we are healthier, that's a focus on preventative care, which is something again, that not much money is put into.

           And then secondly, we have to make sure that the sector is resourced well enough so that we use the technology that's readily available, readily available in the acute sector, in the aged care sector so that we don't maintain the same injury rates. That has flow on effects, as far as workers compensation premiums is concerned, as far as sick leave is concerned; there's real cost savings if you do it right. 

           So it's very interesting, this very interesting study that showed how heavy we're all getting.

REPORTER:      What can they do to avoid it? Obviously they can sustain injury more easily, they can't exercise as easily.  What's your advice for them?

ILIFFE:              Well there's an enormous amount that can be done.  We have, we have really good evidence from physiotherapy, from occupational therapy, from medicine, from nursing that there are things that you can do to bring the level of obesity down, not just with diet but with exercise as well.  There are programs available, we're just not putting the resources into it. We need to look to the future and plan properly.  At the moment all we get are ad hoc responses to everything.

           The question that was directed before about nursing.  The workforce isn't just nursing.  It's a global workforce.  The funding isn't just for aged care, or hospitals here, or Medicare there, or doctors there.  We need to look at it globally. And this is something that this Government isn't doing.

           If we want to look into the future where we've got an increasing aging population, and a decreasing workforce, we've got to start looking at things globally.  And the answers are there, we've got the answers, we just have to be prepared to put them together and pay for them.

ends