Navigating the marketisation of community aged care services in rural Australia

Abstract

The aged care policies of many Organisation for Economic Co-operation and Development countries reflect free-market principles. In Australia, the recently introduced Consumer Directed Care programme centres on markets in which a range of organisations compete to provide services to community-living elders. As consumers, older people are allocated government funding with which they select and purchase items from their chosen service organisation. This article presents findings from a case study that explored the impacts of this programme on a group of rurally based, not-for-profit providers and consumers. The findings portray the challenges and advantages associated with providing and accessing services in limited rural markets.

Australian rural community aged care services: Precarity and capacity

“…In September 2019, some 120,000 approved consumers were on the waiting list (National Seniors Australia, 2019a). This staggering number, including consumers in our study, re‐frames the notion of consumer choice as a matter of chance rather than certainty, and underscores the precarity of those assessed as needing high levels of supportive care (Fine, 2019; Hodgkin et al., 2020). Queued applicants awaiting approved, high‐level HCP packages may receive interim funding to purchase a level of care below their assessed need.…”

Revisiting rural healthcare access through Held’s ethics of care

“…Such strategies would support healthcare user needs to be identified and facilitate their access to required services without enduring financial hardship. This approach might be difficult to implement while marketised approaches are becoming more dominant internationally, for example in Sweden (Kullberg et al 2018), United States of America (Barker et al 2019) and Australia (Hodgkin et al 2020) because these approaches engage a for-profit mentality that could counteract the equitable provision of healthcare for rural people (Quilliam and Bourke 2020;Kullberg et al 2018). Adopting ethics of care-informed concepts around affordability in the Australian context would require policymakers to relax Medicare and other government health service funding eligibility and criteria constraints and/or provide flexible funding arrangements and service models that allow rural health professionals to deliver care in a place-based manner, as recently suggested by the National Rural Health Alliance (2022).…”

Tailored and Seamless: Individualised Budgets and the Dual Forces of Personalisation and Collaboration

“…In the last decade, Australia's predominantly block-funded approaches for disabled and older people have been progressively replaced by individualised funding to provide more user choice and control and create a competitive assemblage of diverse markets. This includes the National Disability Insurance Scheme (NDIS) for children and working age disabled people (Olney and Dickinson, 2019) and the Consumer Directed Care (CDC) initiative for older Australians (Hodgkin et al, 2020). As in the UK, these reforms have sought to address inadequacies in social services and supports for disabled and older people.…”

“…Consumer Directed Care (CDC) has its origins in The Aged Care (Living Longer Living Better) Act 2013, and Home Care Packages Program created in 2013, which aimed to support older people to live at home and have choice of services and supports through a sustainable market-based system (Jorgensen and Haddock, 2018). Further legislative amendments in 2016 transferred financial control from providers to consumers, ensuring that by 2018 all home care packages were consumer-directed (for further information see Hodgkin et al, 2020;Moore, 2021). Described as a 'tiered system that provides greater levels of support according to an individual's assessed care needs' (Hodgkin et al, 2020: 378), home care is means tested (unlike the NDIS), and sometimes may require co-contributions (My Aged Care, n.d.).…”