What will aged care look like for the next generation? More of the same but higher out-of-pocket costs

10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

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.

Aged care resident eats dinner from a tray
Aged care users will pay more of their share for cooking and cleaning.
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.The Conversation

Hal Swerissen, Emeritus Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Don’t Forget…

Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

Recommended

  • Support For Long COVID & Chronic Fatigue
  • Why Diets Make Us Fat – by Dr. Sandra Aamodt
    Crash-dieting doesn’t work. Dr. Sandra Aamodt explains why and offers a better solution: building consistent healthy habits for a healthier life at any weight.

Learn to Age Gracefully

Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Do CBD Gummies Work?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝I take CBD gummies. I don’t know if they are worth buying. Can you find a study on the effectiveness of gummies❞

    If you take them, and you’re not sure whether they’re worth it, then it sounds like you’re not getting any observable benefit from them?

    If so, that would seem to answer your question, since presumably the reason that you are taking them is for relaxation and/or pain relief, so if you’re not getting the results you want, then no, they are not worth it.

    However! CBD gummies are an incredibly diverse and not-well-studied product, so far, given the relative novelty of their legality. By diverse we mean, they’re not well-standardized.

    In other words: the CBD gummies you get could be completely unlike CBD gummies from a different source.

    CBD itself (i.e. in forms other than just gummies, and mostly as oil) has been studied somewhat better, and we did a main feature on it here:

    CBD Oil’s Many Benefits

    And while we’re at it:

    Cannabis Myths vs Reality ← This one is about cannabis products in general, and includes discussion of THC content and effects, which might not be so relevant to you, but may to some readers.

    Companies selling CBD and CBD gummies may make bold claims that are not yet backed by science, so if you are buying them for those reasons, you might want to be aware:

    Selling cannabidiol products in Canada: a framing analysis of advertising claims by online retailers

    One thing that we would add is that even though CBD is generally recognized as safe, it is possible to overdose on CBD gummies, so do watch your limits:

    A Case of Toxicity from Cannabidiol Gummy Ingestion

    Take care!

    Share This Post

  • Kiwi vs Grapefruit – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing kiwi to grapefruit, we picked the kiwi.

    Why?

    In terms of macros, kiwi has nearly 2x the protein, slightly more carbs, and 2x the fiber; both fruits are low glycemic index foods, however.

    When it comes to vitamins, kiwi has more of vitamins B3, B6, B7, B9, C, E, K, and choline, while grapefruit has more of vitamins A, B1, B2, and B5. An easy win for kiwi.

    In the category of minerals, kiwi is higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while grapefruit is not higher in any minerals. So, no surprises for guessing which wins this category.

    One thing that grapefruit is a rich source of: furanocoumarin, which can inhibit cytochrome P-450 3A4 isoenzyme and P-glycoptrotein transporters in the intestine and liver—slowing down their drug metabolism capabilities, thus effectively increasing the bioavailability of many drugs manifold.

    This may sound superficially like a good thing (improving bioavailability of things we want), but in practice it means that in the case of many drugs, if you take them with (or near in time to) grapefruit or grapefruit juice, then congratulations, you just took an overdose. This happens with a lot of meds for blood pressure, cholesterol (including statins), calcium channel-blockers, anti-depressants, benzo-family drugs, beta-blockers, and more. Oh, and Viagra, too. Which latter might sound funny, but remember, Viagra’s mechanism of action is blood pressure modulation, and that is not something you want to mess around with unduly. So, do check with your pharmacist to know if you’re on any meds that would be affected by grapefruit or grapefruit juice!

    All in all, adding up the categories makes for an overwhelming total win for kiwis.

    Want to learn more?

    You might like to read:

    Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list!

    Take care!

    Share This Post

  • Mung Beans vs Black Beans – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing mung beans to black beans, we picked the black beans.

    Why?

    Both are great! But…

    In terms of macros, black beans have more protein, carbs, and fiber, as well as the lower glycemic index (although both are already low). So, a clear win for black beans here.

    In the category of vitamins, mung beans have more of vitamins A, B5, B9, and C, while black beans have more of vitamins B1, B6, E, K, and choline. Thus, a slight win for black beans this time.

    When it comes to minerals, mung beans have more selenium and zinc, while black beans have more calcium, copper, iron, magnesium, manganese, phosphorus, and potassium. An easy win for black beans.

    Of course, enjoy either or both—but if you’re going to pick one, we say black beans win the day.

    Want to learn more?

    You might like to read:

    Plant vs Animal Protein: Head-to-Head

    Take care!

    Share This Post

Related Posts

  • Support For Long COVID & Chronic Fatigue
  • Hot And Sour Shiitake Soup

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is a popular, easy, and delicious soup that nonetheless is not found in many western kitchens, despite being enjoyed in restaurants/take-out. Best of all, making it at home means that you know all the ingredients, can account for quality, and also can customize it per your preferences (i.e. how much heat/sourness you like).

    You will need

    • 3 cups shiitake mushrooms, sliced
    • 3 cups bok choy, chopped
    • 2 cups cherry tomatoes, quartered
    • 1 cup carrot, grated
    • 3 spring onions, chopped
    • 2 shallots, sliced lengthways
    • 2 serrano chilis (or similar), sliced thinly
    • 2 tbsp apple cider vinegar
    • 1 tbsp lemon juice
    • 1 tbsp fresh ginger, sliced into 1″ strips
    • 1 tsp black pepper, coarse ground
    • ½ bulb garlic, crushed
    • 6 cups low-sodium vegetable stock. Ideally you will have made it yourself from vegetable cuttings that you saved in the freezer until you had enough to make stock from, but if that’s not an option, then low-sodium vegetable stock cubes can be purchased and used.
    • Garnish: ¼ cup (or 4 tbsp) cilantro, chopped, or if you have the soap gene, then this time we recommend chopped basil as the subsitution

    Method

    (we suggest you read everything at least once before doing anything)

    1) Put the ginger in a big pot with the stock; cover and simmer for about 20 minutes (otherwise the ginger flavor will remain mostly concentrated in the ginger strips).

    2) Bring it to a boil and add the bok choy, mushrooms, shallots, chili peppers, and the carrot; simmer for another 5 minutes

    3) Add the remaining ingredients except for the garnish, and simmer for another 5 minutes

    4) Serve, adding the garnish

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Almonds vs Walnuts – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing almonds to walnuts, we picked the almonds.

    Why?

    It wasn’t just our almond bias, but it was close!

    In terms of macros, the main important differences are:

    • Almonds are higher in protein
    • Walnuts are higher in fats (they are healthy fats)

    So far, so even.

    In terms of vitamins, both are rich in many vitamins; mostly the same ones. However, walnuts have more of most of the B vitamins (except for B2 and B3, where almonds win easily), and almonds have more vitamin E by several orders of magnitude.

    So far, so balanced.

    Almonds have slightly more choline.

    Almonds have a better mineral profile, with more of most minerals that they both contain, and especially, a lot more calcium.

    Both nuts have [sometimes slightly different, but] comparable benefits against diabetes, cancer, neurodegeneration, and other diseases.

    In summary

    This one’s close. After balancing out the various “almonds have this but walnuts have that” equal-but-different benefits, we’re going to say almonds take first place by virtue of the better mineral profile, and more choline.

    But: enjoy both!

    Learn more

    You might like this previous article of ours:

    Why You Should Diversify Your Nuts

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Drug companies pay doctors over A$11 million a year for travel and education. Here’s which specialties received the most

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Drug companies are paying Australian doctors millions of dollars a year to fly to overseas conferences and meetings, give talks to other doctors, and to serve on advisory boards, our research shows.

    Our team analysed reports from major drug companies, in the first comprehensive analysis of its kind. We found drug companies paid more than A$33 million to doctors in the three years from late 2019 to late 2022 for these consultancies and expenses.

    We know this underestimates how much drug companies pay doctors as it leaves out the most common gift – food and drink – which drug companies in Australia do not declare.

    Due to COVID restrictions, the timescale we looked at included periods where doctors were likely to be travelling less and attending fewer in-person medical conferences. So we suspect current levels of drug company funding to be even higher, especially for travel.

    Monster Ztudio/Shutterstock

    What we did and what we found

    Since 2019, Medicines Australia, the trade association of the brand-name pharmaceutical industry, has published a centralised database of payments made to individual health professionals. This is the first comprehensive analysis of this database.

    We downloaded the data and matched doctors’ names with listings with the Australian Health Practitioner Regulation Agency (Ahpra). We then looked at how many doctors per medical specialty received industry payments and how much companies paid to each specialty.

    We found more than two-thirds of rheumatologists received industry payments. Rheumatologists often prescribe expensive new biologic drugs that suppress the immune system. These drugs are responsible for a substantial proportion of drug costs on the Pharmaceutical Benefits Scheme (PBS).

    The specialists who received the most funding as a group were cancer doctors (oncology/haematology specialists). They received over $6 million in payments.

    This is unsurprising given recently approved, expensive new cancer drugs. Some of these drugs are wonderful treatment advances; others offer minimal improvement in survival or quality of life.

    A 2023 study found doctors receiving industry payments were more likely to prescribe cancer treatments of low clinical value.

    Our analysis found some doctors with many small payments of a few hundred dollars. There were also instances of large individual payments.

    Why does all this matter?

    Doctors usually believe drug company promotion does not affect them. But research tells a different story. Industry payments can affect both doctors’ own prescribing decisions and those of their colleagues.

    A US study of meals provided to doctors – on average costing less than US$20 – found the more meals a doctor received, the more of the promoted drug they prescribed.

    Someone lifting a slice of pizza
    Pizza anyone? Even providing a cheap meal can influence prescribing. El Nariz/Shutterstock

    Another study found the more meals a doctor received from manufacturers of opioids (a class of strong painkillers), the more opioids they prescribed. Overprescribing played a key role in the opioid crisis in North America.

    Overall, a substantial body of research shows industry funding affects prescribing, including for drugs that are not a first choice because of poor effectiveness, safety or cost-effectiveness.

    Then there are doctors who act as “key opinion leaders” for companies. These include paid consultants who give talks to other doctors. An ex-industry employee who recruited doctors for such roles said:

    Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations […] If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.

    We know about payments to US doctors

    The best available evidence on the effects of pharmaceutical industry funding on prescribing comes from the US government-run program called Open Payments.

    Since 2013, all drug and device companies must report all payments over US$10 in value in any single year. Payment reports are linked to the promoted products, which allows researchers to compare doctors’ payments with their prescribing patterns.

    Analysis of this data, which involves hundreds of thousands of doctors, has indisputably shown promotional payments affect prescribing.

    Medical students on hospital grounds
    Medical students need to know about this. LightField Studios/Shutterstock

    US research also shows that doctors who had studied at medical schools that banned students receiving payments and gifts from drug companies were less likely to prescribe newer and more expensive drugs with limited evidence of benefit over existing drugs.

    In general, Australian medical faculties have weak or no restrictions on medical students seeing pharmaceutical sales representatives, receiving gifts, or attending industry-sponsored events during their clinical training. They also have no restrictions on academic staff holding consultancies with manufacturers whose products they feature in their teaching.

    So a first step to prevent undue pharmaceutical industry influence on prescribing decisions is to shelter medical students from this influence by having stronger conflict-of-interest policies, such as those mentioned above.

    A second is better guidance for individual doctors from professional organisations and regulators on the types of funding that is and is not acceptable. We believe no doctor actively involved in patient care should accept payments from a drug company for talks, international travel or consultancies.

    Third, if Medicines Australia is serious about transparency, it should require companies to list all payments – including those for food and drink – and to link health professionals’ names to their Ahpra registration numbers. This is similar to the reporting standard pharmaceutical companies follow in the US and would allow a more complete and clearer picture of what’s happening in Australia.

    Patients trust doctors to choose the best available treatments to meet their health needs, based on scientific evidence of safety and effectiveness. They don’t expect marketing to influence that choice.

    Barbara Mintzes, Professor, School of Pharmacy and Charles Perkins Centre, University of Sydney and Malcolm Forbes, Consultant psychiatrist and PhD candidate, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: