What will aged care look like for the next generation? More of the same but higher out-of-pocket costs
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Aged care financing is a vexed problem for the Australian government. It is already underfunded for the quality the community expects, and costs will increase dramatically. There are also significant concerns about the complexity of the system.
In 2021–22 the federal government spent A$25 billion on aged services for around 1.2 million people aged 65 and over. Around 60% went to residential care (190,000 people) and one-third to home care (one million people).
The final report from the government’s Aged Care Taskforce, which has been reviewing funding options, estimates the number of people who will need services is likely to grow to more than two million over the next 20 years. Costs are therefore likely to more than double.
The taskforce has considered what aged care services are reasonable and necessary and made recommendations to the government about how they can be paid for. This includes getting aged care users to pay for more of their care.
But rather than recommending an alternative financing arrangement that will safeguard Australians’ aged care services into the future, the taskforce largely recommends tidying up existing arrangements and keeping the status quo.
No Medicare-style levy
The taskforce rejected the aged care royal commission’s recommendation to introduce a levy to meet aged care cost increases. A 1% levy, similar to the Medicare levy, could have raised around $8 billion a year.
The taskforce failed to consider the mix of taxation, personal contributions and social insurance which are commonly used to fund aged care systems internationally. The Japanese system, for example, is financed by long-term insurance paid by those aged 40 and over, plus general taxation and a small copayment.
Instead, the taskforce puts forward a simple, pragmatic argument that older people are becoming wealthier through superannuation, there is a cost of living crisis for younger people and therefore older people should be required to pay more of their aged care costs.
Separating care from other services
In deciding what older people should pay more for, the taskforce divided services into care, everyday living and accommodation.
The taskforce thought the most important services were clinical services (including nursing and allied health) and these should be the main responsibility of government funding. Personal care, including showering and dressing were seen as a middle tier that is likely to attract some co-payment, despite these services often being necessary to maintain independence.
The task force recommended the costs for everyday living (such as food and utilities) and accommodation expenses (such as rent) should increasingly be a personal responsibility.
Lizelle Lotter/Shutterstock
Making the system fairer
The taskforce thought it was unfair people in residential care were making substantial contributions for their everyday living expenses (about 25%) and those receiving home care weren’t (about 5%). This is, in part, because home care has always had a muddled set of rules about user co-payments.
But the taskforce provided no analysis of accommodation costs (such as utilities and maintenance) people meet at home compared with residential care.
To address the inefficiencies of upfront daily fees for packages, the taskforce recommends means testing co-payments for home care packages and basing them on the actual level of service users receive for everyday support (for food, cleaning, and so on) and to a lesser extent for support to maintain independence.
It is unclear whether clinical and personal care costs and user contributions will be treated the same for residential and home care.
Making residential aged care sustainable
The taskforce was concerned residential care operators were losing $4 per resident day on “hotel” (accommodation services) and everyday living costs.
The taskforce recommends means tested user contributions for room services and everyday living costs be increased.
It also recommends that wealthier older people be given more choice by allowing them to pay more (per resident day) for better amenities. This would allow providers to fully meet the cost of these services.
Effectively, this means daily living charges for residents are too low and inflexible and that fees would go up, although the taskforce was clear that low-income residents should be protected.
Moving from buying to renting rooms
Currently older people who need residential care have a choice of making a refundable up-front payment for their room or to pay rent to offset the loans providers take out to build facilities. Providers raise capital to build aged care facilities through equity or loan financing.
However, the taskforce did not consider the overall efficiency of the private capital market for financing aged care or alternative solutions.
Instead, it recommended capital contributions be streamlined and simplified by phasing out up-front payments and focusing on rental contributions. This echoes the royal commission, which found rent to be a more efficient and less risky method of financing capital for aged care in private capital markets.
It’s likely that in a decade or so, once the new home care arrangements are in place, there will be proportionally fewer older people in residential aged care. Those who do go are likely to be more disabled and have greater care needs. And those with more money will pay more for their accommodation and everyday living arrangements. But they may have more choice too.
Although the federal government has ruled out an aged care levy and changes to assets test on the family home, it has yet to respond to the majority of the recommendations. But given the aged care minister chaired the taskforce, it’s likely to provide a good indication of current thinking.
Hal Swerissen, Emeritus Professor, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Scarcity Brain – by Michael Easter
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After a brief overview of theevolutionary psychology underpinnings of the scarcity brain, the author grounds the rest of this book firmly in the present. He explains how the scarcity loop hooks us and why we crave more, and what factors can increase or lessen its hold over us.
As for what things we are wired to consider “potentially scarce any time now” no matter how saturated we are in them, he looks at an array of categories, each with their nuances. From the obvious such as “food” and “stuff“, to understandable “information” and “happiness“, to abstractions like “influence“, he goes to many sources—experts of various kinds from around the world—to explore how we can know “how much is enough”, and—which can be harder—act accordingly.
The key, he argues, is not in simply wanting less, but in understanding why we crave more in the first place, get rid of our worst habits, and use what we already have, better.
Bottom line: if you feel a gnawing sense of needing more “to be on the safe side”, this book can help you to be a little more strategic (and at the same time, less stressed!) about that.
Click here to check out Scarcity Brain, and manage yours more mindfully!
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The Minimum Method – by Joey Thurman
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Trying to squeeze out an extra 0.5% from every effort in life can be exhausting, especially with diminishing marginal returns when it comes to linear increases in effort.
Surely there must be a sweet spot of getting the best returns on the least effort and call it a day?
That’s what this book is about. Thurman examines and explains how to get “the most for least” in various important areas of health, including diet, exercise, sleep, breathwork, recovery, and a chapter specifically on brain health, though of course all the aforementioned things do affect brain health too.
An interesting feature of the book is that at the end of each chapter, he’ll give different advice for different levels of experience/commitment, so that essentially there’s an easy/medium/hard way to proceed each time.
The style is light and personal, without much hard science. The advice given is nonetheless consistent with prevailing scientific consensus, and there are still occasional scientific references throughout, with links to appropriate studies. Mostly though, the focus is on being practical.
Bottom line: if you’ve been looking for a “most for least” way of going about health, this is a fine option.
Click here to check out The Minimum Method, and enjoy benefits disproportionate to your effort!
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Discipline is Destiny – by Ryan Holiday
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We’ve previously reviewed another of Holiday’s books, The Daily Stoic, and here is another excellent work from the same author.
We’re not a philosophy newsletter, but there are some things that make a big difference to physical and mental health, the habits we build, and the path we take in life for better or for worse.
Self-discipline is one of those things. A lot of the time, we know what we need to do, but knowing isn’t the problem. We need to actually do it! This applies to diet, exercise, sleep, and more.
Holiday gives us, in a casual easy-reading style, timeless principles to lock in strong discipline and good habits for life.
The book’s many small chapters, by the way, are excellent for reading a chapter-per-day as a healthy dose of motivation each morning, if you’re so inclined.
Bottom line: if you’ve noticed that one of the biggest barriers between you and your goals is actually doing the necessary things in a disciplined fashion, then this book will help you become more efficient, and actually get there.
Click here to check out Discipline is Destiny, and upgrade yours!
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Brain Benefits in 3 Months…through walking?
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Keeping it Simple
Today’s video (below) is another Big Think production (can you tell that we love their work?). Wendy Suzuki does a wonderful job of breaking down the brain benefits of exercise into three categories, within three minutes.
The first question to ask yourself is: what is your current level of fitness?
Low Fitness
Exercising, even if it’s just going on a walk, 2-3 times a week improves baseline mood state, as well as enhances prefrontal and hippocampal function. These areas of the brain are crucial for complex behaviors like planning and personality development, as well as memory and learning.
Mid Fitness
The suggested regimen is, without surprise, to slightly increase your regular workouts over three months. Whilst you’re already getting the benefits from the low-fitness routine, there is a likelihood that you’ll increase your baseline dopamine and serotonin levels–which, of course, we love! Read more on dopamine here, here, or here.
High Fitness
If you consider yourself in the high fitness bracket then well done, you’re doing an amazing job! Wendy Suzuki doesn’t make many suggestions for you; all she mentions is that there is the possibility of “too much” exercise actually having negative effects on the brain. However, if you’re not competing at an Olympic level, you should be fine.
Fitness and Exercise in General
Of course, fitness and exercise are both very broad terms. We would suggest that you find an exercise routine that you genuinely enjoy–something that is easy to continue over the long term. Try browsing different areas of exercise to see what resonates with you. For instance, Total Fitness After 40 is a great book on all things fitness in the second half of your life. Alternatively, search through our archive for fitness-related material.
Anyway, without further ado, here is today’s video:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Planning Festivities Your Body Won’t Regret
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The Festive Dilemma
For many, Christmas is approaching. Other holidays abound too, and even for the non-observant, it’d be hard to escape seasonal jollities entirely.
So, what’s the plan?
- Eat, drink, and be merry, and have New Year’s Resolutions for the first few days of January before collapsing in a heap?
- Approach the Yuletide with Spartan abstemiousness and miss all the fun while simultaneously annoying your relatives?
Let’s try to find a third approach instead…
What’s festive and healthy?
We’re doing this article this week, because many people will be shopping already, making plans, and so forth. So here are some things to bear in mind:
Make your own mindful choices
Coca-Cola company really did a number on Christmas, but it doesn’t mean their product is truly integral to the season. Same goes for many other things that flood the stores around this time of year. So much sugary confectionary! But remember, they’re not the boss of you. If you wouldn’t buy it ordinarily, why are you buying it now? Do you actually even want it?
If you really do, then you do you, but mindful choices will invariably be healthier than “because there were three additional aisles of confectionary now so I stopped and looked and picked some things”.
Pick your battles
If you’re having a big family gathering, likely there will be occasions with few healthy options available. But you can decide what’s most important for you to avoid, perhaps picking a theme, e.g:
- No alcohol this year, or
- No processed sugary foods, or
- Eat/drink whatever, but practice intermittent fasting
Some resources:
Fight inflammation
This is a big one so it deserves its own category. In the season of sugar and alcohol and fatty meat, inflammation can be a big problem to come around and bite us in the behind. We’ve written on this previously:
Positive dieting
In other words, less of a focus on what to exclude, and more of a focus on what to include in your diet. Fruity drinks and sweets are common at this time of year, but you know what’s also fruity? Fruit!
And it can be festive, too! Berries are great, and those tiny orange-like fruits that may be called clementines or tangerines or satsumas or, as Aldi would have it, “easy peelers”. Apple and cinnamon are also a great combination that both bring sweetness without needing added sugar.
And as for mains? Make your salads that bit fancier, get plenty of greens with your main, have hearty soups and strews with lentils and beams!
See also: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Your gut will thank us later!
Get moving!
That doesn’t mean you have to beat the New Year rush to the gym (unless you want to!). But it could mean, for example, more time in your walking shoes (or dancing shoes! With a nod to today’s sponsor) and less time in the armchair.
See also: The doctor who wants us to exercise less; move more
Lastly…
Remember it’s supposed to be fun! And being healthy can be a lot more fun than suffering because of unfortunate choices that we come to regret.
Take care!
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With all this bird flu around, how safe are eggs, chicken or milk?
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Enzo Palombo, Swinburne University of Technology
Recent outbreaks of bird flu – in US dairy herds, poultry farms in Australia and elsewhere, and isolated cases in humans – have raised the issue of food safety.
So can the virus transfer from infected farm animals to contaminate milk, meat or eggs? How likely is this?
And what do we need to think about to minimise our risk when shopping for or preparing food?
AS Foodstudio/Shutterstock How safe is milk?
Bird flu (or avian influenza) is a bird disease caused by specific types of influenza virus. But the virus can also infect cows. In the US, for instance, to date more than 80 dairy herds in at least nine states have been infected with the H5N1 version of the virus.
Investigations are under way to confirm how this happened. But we do know infected birds can shed the virus in their saliva, nasal secretions and faeces. So bird flu can potentially contaminate animal-derived food products during processing and manufacturing.
Indeed, fragments of bird flu genetic material (RNA) were found in cow’s milk from the dairy herds associated with infected US farmers.
However, the spread of bird flu among cattle, and possibly to humans, is likely to have been caused through contact with contaminated milking equipment, not the milk itself.
The test used to detect the virus in milk – which uses similar PCR technology to lab-based COVID tests – is also highly sensitive. This means it can detect very low levels of the bird flu RNA. But the test does not distinguish between live or inactivated virus, just that the RNA is present. So from this test alone, we cannot tell if the virus found in milk is infectious (and capable of infecting humans).
It’s best to stick with pasteurised milk. Amnixia/Shutterstock Does that mean milk is safe to drink and won’t transmit bird flu? Yes and no.
In Australia, where bird flu has not been reported in dairy cattle, the answer is yes. It is safe to drink milk and milk products made from Australian milk.
In the US, the answer depends on whether the milk is pasteurised. We know pasteurisation is a common and reliable method of destroying concerning microbes, including influenza virus. Like most viruses, influenza virus (including bird flu virus) is inactivated by heat.
Although there is little direct research on whether pasteurisation inactivates H5N1 in milk, we can extrapolate from what we know about heat inactivation of H5N1 in chicken and eggs.
So we can be confident there is no risk of bird flu transmission via pasteurised milk or milk products.
However, it’s another matter for unpasteurised or “raw” US milk or milk products. A recent study showed mice fed raw milk contaminated with bird flu developed signs of illness. So to be on the safe side, it would be advisable to avoid raw milk products.
How about chicken?
Bird flu has caused sporadic outbreaks in wild birds and domestic poultry worldwide, including in Australia. In recent weeks, there have been three reported outbreaks in Victorian poultry farms (two with H7N3 bird flu, one with H7N9). There has been one reported outbreak in Western Australia (H9N2).
The strains of bird flu identified in the Victorian and Western Australia outbreaks can cause human infection, although these are rare and typically result from close contact with infected live birds or contaminated environments.
Therefore, the chance of bird flu transmission in chicken meat is remote.
Nonetheless, it is timely to remind people to handle chicken meat with caution as many dangerous pathogens, such as Salmonella and Campylobacter, can be found on chicken carcasses.
Always handle chicken meat carefully when shopping, transporting it home and storing it in the kitchen. For instance, make sure no meat juices cross-contaminate other items, consider using a cool bag when transporting meat, and refrigerate or freeze the meat within two hours.
Avoid washing your chicken before cooking to prevent the spread of disease-causing microbes around the kitchen.
Finally, cook chicken thoroughly as viruses (including bird flu) cannot survive cooking temperatures.
Are eggs safe?
The recent Australian outbreaks have occurred in egg-laying or mixed poultry flocks, so concerns have been raised about bird flu transmission via contaminated chicken eggs.
Can flu viruses contaminate chicken eggs and potentially spread bird flu? It appears so. A report from 2007 said it was feasible for influenza viruses to enter through the eggshell. This is because influenza virus particles are smaller (100 nanometres) than the pores in eggshells (at least 200 nm).
So viruses could enter eggs and be protected from cleaning procedures designed to remove microbes from the egg surface.
Therefore, like the advice about milk and meat, cooking eggs is best.
The US Food and Drug Administration recommends cooking poultry, eggs and other animal products to the proper temperature and preventing cross-contamination between raw and cooked food.
In a nutshell
If you consume pasteurised milk products and thoroughly cook your chicken and eggs, there is nothing to worry about as bird flu is inactivated by heat.
The real fear is that the virus will evolve into highly pathogenic versions that can be transmitted from human to human.
That scenario is much more frightening than any potential spread though food.
Enzo Palombo, Professor of Microbiology, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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