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Former teacher and nurse Maureen Smith knows where she wants to spend the rest of her life – with husband Tom in their home of 20 years by the Aldinga scrub, just a short walk to the beach.

Mrs Smith, now 79 but most days feeling 18, plans to be around for a long time yet with her husband, a former merchant marine engineer, 81.

They’ve been together 58 years, but when their final breaths do come, the Smiths want them to carry the scent of the bush and sea.

“I would walk into the ocean, if I was still capable of it, before they would put me in a nursing home,” she says.

“Tom is definitely the same. Who would want to go into a nursing home? Too many of my friends go into nursing homes and, to be perfectly honest, don’t last very long.”

The Royal Commission into Aged Care Quality and Safety’s final report this week was a mixed bag of missed opportunities and important changes, experts say.

But if the Federal Government accepts the thrust of the proposals, it could be good news for most Australians such as the Smiths, who want to live out their lives at home.

Dr David Panter, chief executive of aged-care provider ECH, says while surveys show 70 per cent of Australians want to die at home, only 10 per cent of people over 70 do.

He says this is the lowest rate in the developed world because “we’ve got a set of policies and a system at the moment which essentially leads to more residential care and to hospital”.

ECH divested itself of nursing homes to focus on care at home six years ago, recognising that was where people want to be. Dr Panter says proposed changes by the royal commission could “absolutely” help them achieve that.

One key change, broadly supported this week by Prime Minister Scott Morrison, would be a move to individualised care packages.

Now, people wanting home care may be funded from the Commonwealth Home Support Scheme for low-level help, or from Home Care with four packages ranging between about $9000 for level one to $52,000 for level four.

There are an estimated 170,000 people with home packages – but a waiting list of another 100,000 which the government says it is clearing by 1200 a week.

The royal commission has recommended combining those programs, scrapping the four levels, and replacing that with a unique package for each individual in need.

The upshot would be more targeted, precise funding that would mean less for some but more for the most needy.

The royal commission found that even on a level four package people received an average of just eight hours and 45 minutes of service a week – nowhere near enough, and down from 18 hours in 2001. How much is enough? The royal commission says nobody has done the sums.

“Certainly, if we had access to more dollars for somebody in their own home, there’s even more we could do,” Dr Panter says.

Australia’s thinking must change from the idea the elderly progressed from low care, to higher home care and then to nursing home and maybe hospital. “It’s just not the case,” he says. “Our oldest homecare client is 106. He’s still living independently at home. We’ve got a dozen who are over 100.”

Mark McBriarty, who runs home-care provider My Care Solution, agrees the call for individualised packages makes sense. The current split into four categories is simplistic.

“There are people who are socially isolated, who have profound dementia, who would need a lot more support than a level four package could offer if (they were to receive) a truly viable option to stay at home,” he says.

But he cautions against an expectation that waiting lists will be cleared quickly, as the royal commission has urged. It would require 10,000 more care givers to do so by the end of the year – but it takes 10 months to train someone from well-intentioned to competent, Mr McBriarty says.

Mrs Smith, who followed the royal commission’s work closely, says whether aged care improves depends on factors outside the royal commission’s control.

It is not just about money but people choosing the right care provider, she says.

Mrs Smith broke her shoulder two years ago when she tripped in her garden while watering plants. Now with ECH, which she says is excellent, she is on the road to recovery. But she says her previous provider let her down several times, and farmed her out to other providers – one day someone she had never met turned up to help shower and dress her.

A keen watcher of federal parliament, Mrs Smith also worries that politics will affect the recommendations.

“I think they haven’t got a clue,” she says of the government. “I think it is just a numbers game with them.”

Mrs Smith says she has heard many horror stories of people receiving packages below what they’ve been assessed as needing.

In her case, after her shoulder injury, she was assessed for level three, worth $34,250, because she needed help in everything from housework to hair-brushing.

Yet, two years on, she is still on level two – worth $15,750 – and has been told it could be another six months to get to level three.

It’s these sort of delays, only due to the government “playing politics”, that must be fixed to encourage people to stay at home, she says.

When circumstances change, people need speedy help, including access to palliative care to allow a good death at home.

Dr Panter says entrenched ageism is preventing more people from staying at home until they die.

“A lot of the reason why people end up moving from home into residential care is because of concerns that they’re not safe, or that they can’t cope at home,” he says.

“Actually, they can if they’re allowed to. And at the end of the day, we all make decisions about what risks we are prepared to live with.”

Home is where people want to spend their last precious days and hours, but relatively few do, he says. That’s why it’s important for people to have the conversation so their family and friends know what they want.

The Smiths have made their thoughts very clear.

Click here to read the full article When home is to die for.

Posted: March 6, 2021