Australia is a unique mixture of modern culture and old traditions.

The country has its roots of the modern culture from the British who established as settlers here. The original population, Aboriginals and the Torres Strait Islanders, have been one of the oldest known civilizations known to mankind. They have been living on this island continent approximately for around 60000 years. The rest of the people are migrants and their descendants who came in here from more than 200 countries since Great Britain did the first settlement in Sydney Cove in 1788. After the Second World War, the Federal Department of Immigration was established and several schemes launched as the country was in need of immediate rise in population for the army.

After the Second World War, there was a sudden upsurge in the local population as well. It has been well documented that a total population of 6.5 million people has migrated in the country since 1945. Since the famous population burst 55 years ago the country now faces a problem of the aging population.

Australia offers one of the best healthcares around the world. Even though the GDP spending are less than other OECD countries the standards of the healthcare in the country are high and well maintained. However the ageing population, sedentary lifestyle, rises in the people affected with chronic diseases creates concern in the minds of the government. Sadly, a little can be done now to change or alter the population dynamics. Hence the only alternative is to bring about a change in the present healthcare approach. A change needs to be made to suit the needs of the population requirements in the future. After taking in confidence the State Government, the central government started taking into considerations various perspective about addressing this problems. On August 2nd 2011 the National Health Reform Agreement was announced in coordination with the state and the territory

government. The main aim of these reforms is to provide a better healthcare to the Australian population and to get it equipped for the future changes and requirements. The health reforms has decided to focus on 8 different streams Hospitals Primary care Age care Mental health Standards and performances Workforce Prevention Ehealth

However out of the 8 streams one of the major concerns for the Australian government is the constantly ageing population. Twenty years post the Second World War, there were a significant rise in the birth rate owing to the prosperity .this was known as the baby-boomers. These baby boomers are now ageing.

Other than that, the reduced fertility and the increased life expectancy also have played a significant role in the rising of the ageing population. According to Department of Healthcare and Ageing, 7.2 million people will be over the age of 65years by 2051 from the current 2.5 million. This would comprise of the 26.1 % of the total population. The proportion of the people aged over 85 years will go as high as 6% from the current 1.4% by the year 2051. Despite the population of Australia as a whole ageing, there is wide variation seen as far as the individual territories are concerned. Tasmania is proposed to grow the state with the most aged

population surpassing the South Australia by the year 2021. By 2051, as compared to the rest of the country, the province of Tasmania and South Australia will have 30% of population over 65 years of age. The northern territory will be having the least of the aged population whereas the province of Queensland and Western Australia will have a moderate variance in the age of the people.

Ageing will bring about a significant effect on the economy of the country. The increase population of the aged over the employable population bounds to create a significant load on the budget making it necessary to increase the tax burden on the working population. The ability to support the aged will be also compromised due to labour shortage and increased population going for the early retirement. Significant low labour class will be working to support an evidently large aged population as the size of the dependable population rises. According to the 13th biennial report, 44% of those aged 65-74 have disability of which 11% have a severe activity performing issues that is to say they always require assistance in performing the day to day activities including mobility and personal care.81% of people who are aged above 85 years have disability issues with severe activity difficulties.49% of the Australian people between the age of 65-74 are affected by the long term chronic diseases such as hypertension, diabetes, arthritis,

musculoskeletal

issues

etc.

It is in the best interest of the government that it starts taking steps to reform the strategies to deal with age care issues

Since 1962 the older Australians have lived in the Commonwealth funded Aged care after an amendment to the National Health Act 1953 was passed allowing the per-day nursing benefit for all the residents in the government approved nursing home. Nursing homes were the main form of the residential care until the Hostel sector took over which highlighted the need for the greater social support along with the personal care requirements. The nursing and the hostel sector were two different sectors in which the nursing sector was funded by a complex system of payment linked to staffing for the care (Care Aggregated Module, Standard Aggregated Module and Other Cost Reimbursed Expenditure). The residents in the nursing care paid capped daily fees of 87.5 percent of combined pension and rent assistance with no entry contributions regardless of his income and assets. The residents in the hostel paid daily fees of 85 percent based on the providers initial assessment. They also paid the negotiated capital entry contributions based on the assessment unlike the nursing home. This system was incapable as far as the efficiency and the effectiveness was concerned. The sustainability of the funding system, lack in quality and the rising demand were the major factors that questioned the credentials of the system. This brought in the major reforms were brought about by the Coalition Government in the year 1997.

The major reforms included unifying nursing homes and hostel under one system, single funding tool, greater flexibility, greater care fees, and income tested fees, accommodation payments (accommodation bonds, accommodation charges), extra service schemes, quality assurance, certification etc In the year 2008, considering the fact that a large no of people lived in their own home and then moving towards residential care was a clear signal in the rising demand of the aged care. A total population of 1.9 million people aged 70 and above which was expected to double in a couple of decades. Also, around 200000 people were known to suffer from the dreadful disease of dementia, making it necessary for the government to take revolutionary steps. The sources tell that dementia is the single greatest contributor to the burden of the disease and disability at the older ages. It solely contributed the rise in the residential aged care. It was estimated that in 200 4, 171000 were over 65 years with dementia and by 2050 this would be around 730000 that is around 2.8% of the total population. Perhaps the rate of dementia in the people of Western Australia was higher than the people in the other part of the country. Important changes in the age care system came about on 20th March 2008. There was change in the accommodation fee and the government subsidies for the people who entered in the residential aged care. Other than that, the inequities with respect to the income tested fees were also addressed. These changes were passed in the parliament with bi-partisan support. The resultant was that people who could afford more for their accommodation and caring were asked to pay more. The people who couldnt afford to pay were given subsidy provided by the government. However no changes were made in the accommodation fees and age care fees for the existing aged care residents. The income test for aged care residents became fairer, with self-funded retired were considered as same as pensioner with respect to their income. The maximum level of the residents income did not depend on the whether the resident is a pensioner on the self paid retiree. The existing aged didnt have to pay more at all and 45% of the self paid retirees paid less for the age care under the new system. An asset test was carried out on all the high care residents to decide how much accommodation charge the individual will pay and how much will be subsidized by the government. The changes brought about a significant revolution in the field of aged care. Nearly $1 billion was raised as the additional funds with $860 million coming from the government and rest from the residents. These huge funds gave them certainty, better future, investments in better property better amenities and facilities for the needful. According to the report of the National Health and Hospital Reform Commission released in June 2009, the reforms brought around included the provisions for the extensions of the aged care subsidies by around $838 million, an increase in the flexibility of the community aged care by $437 million, medical arrangements with the residential aged care services and training the workforce for delivering the advanced care. The accessibility of the people to the hospitals and the aged care centers improved by the achievements of the National Access Targets. Rising number of the aged care people led to the development of more responsive services. A few reforms were also made for improving the allocative efficiency. The three reforms comprising of the increased sub-acute services, improved access to age care and advance care planning made a large number of bed

available in the hospital. There was also an increase in the number of the age care places looking towards the rising demand predicted by the Australian Institute of Health and Welfare (AIHW)

The year 2010 was evident in own sense. The Commonwealth took over the full policy and funding responsibility for the aged care services. The complete resourcing was transferred from the Home and Community Care (HACC) program to the Commonwealth. Developments of the consistent program took place including the basic aged care at home to the high level care in the aged home care. The Commonwealth became the lead funder in the Australian health and the hospital system and brought about an increased collaboration between the acute care, hospitals, GPs, primary health care and essentially the aged care. Coming to the monetary point of view, the Commonwealth invested $813 million in the dedicated aged care with an additional funding of $533 million. Another $280 million was driven to the states for aged people in the public hospital sector. It was also decided that the Common wealth would invest more in the Zero Real Interest Loans for the development of 2500 additional Aged care places. The Commonwealth also decided to provide aged care in the 286 bed equivalent Multi Disciplinary services to provide integrated health and the

aged care service. It also decided to team up with the state government to release more land and accelerate the process of planning approvals so that an increased number of aged care could be built and made operational rapidly. The Common wealth made an allocation of around $99 million for the increased accessibility of the primary Healthcare services for people in the aged care homes and $10 million for upsurge in the viability of the community aged care providers. For the patients who had a prolonged stay in the hospital, 2000 flexible aged care places were started in the various states and territories. Other small things taken care by the Common wealth included strengthen consumer rights for the aged people, controlling the costs of the tax payers, sub acute beds to help the transition phase between the acute and the aged care. More than $390 million were allotted for comprehensive and professional workforce to bring in greater support.

In the year 2011, Aged and Community Service Australia acting CEO said the funding for the critical age care service in the Federal Budget remained undisturbed in spite of the rising cost. A claim of $330 million inclusive of 1.75 % subsidy for community aged care and a 10$ rise in the accommodation charges for high care individuals was not considered in the Federal Budget. The resultant was that that the service providers failed to provide an optimum service to the aged

people. Furthermore, the July decision of Fair Work Australia resulted into the increased salary of the aged care workers, which undermined the workforce till an extent. However there were a few positive outcomes also. There was an increase in availability of the important components for age care until an amount of $16 million, the matter of age care being identified as high priority under the Fair Work Australia initiatives to satisfy the rising demands In April 2012, the government launched a complete package for a better, fairer, sustainable and nationwide concentrated package for the aged care. The Living Longer Living Better as it was called provided a huge amount of $3.7 billion over a time of next 5 years for a comprehensive age care. A 10 year plan was commenced that looked forward to provide the people with more choice, sense of control and improved quality of care. It was launched with aim of dealing with the economic backlog the ageing population will create. The purpose of providing a quality care right at the home was taken care of in this package. Special care was taken to strengthen the work force and better care for the people suffering from geriatric diseases such as dementia. Recently it has been also decide that from July 201 the government will provide additional funding through an AGED CARE FUNDING SUPPLEMENT for all the aged care providers to increase the funding to the workforce, improvise the quality of the services, reduce the staff turnover, deliver better work practices, boost the outcomes and better planning. A package of 268.4million had been announced over the next 5 years to deal with the dreadful dementia. Government made it easy for the assessment of the aged care by starting the Aged Care Assessment Services which assist the aged people about the services that will best deal with their requirements. They also help referral to the appropriate residential or community care options. The ACAT team can also help provide subsidy from the government. The service has been funded by the Australian Commonwealth and so free of cost to the aged.

A critical analysis of the reforms and the changes brought around in the last 5 years tells that the government has taken the aged care and its implications quite seriously. However, the age care system is underfunded, complex, and inconsistent. It lacks choices and the consumer feels trapped. There is a little choice and one cannot quit once in the system one cannot quit. The age care system is focused significantly on the aspect of maintenance rather than rehabilitation. Its more dependent on what the government can or cannot do rather than on what the people need.

The government needs to also look for the aboriginals and the people of the Torres Strait Island with significant aged people and depleting health. Care must be taken to ensure the various funds allocated are indeed reaching the targeted population at the peak time. Apart from that, government needs to act on the rise in the geriatric diseases among the aged. This includes dementia, Alzheimers, arthritis, impaired vision and hearing. The number of people living with dementia is expected to rise to one million by 2050 from 257000 in the year 2010. The government should also focus on the aspect of increasing the workforce. The pays should be increased to lure more people towards the lucrative jobs. A significant amount of time is spent on the paperwork by the staff rather than on the care. In the best interest of the citizen a new aged care system with strong safety net with no limit on the type and the quantity of the service must be designed. It should also be taken into consideration that the need of the low-income Australians and the ones in the remote part be addressed. Care and accommodation are two separate entities to be taken care of. New innovative ways should be figured out to address the aged care. The Productivity Commissions recommendation should also be taken into consideration. The recommendation includes a single entry point for the aged care which will simplify the complex process. It also recommends a government run equity scheme that enables people to borrow against their houses that will allow the wealth tied to private houses being unleashed without selling them. Flexibility should be allowed in the payment methods.

Aged care is a vital concern for the government in the current scenario. If properly taken care of, the knowledge, experience and foresight from the aged people can be harnessed for the progress of the nations.

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