2018-2019 STATE BUDGET SUBMISSION
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2018-2019 STATE BUDGET SUBMISSION
A SNAPSHOT OF AGEING
IN SOUTH AUSTRALIA
Aboriginal
people die more
1 in 5 people than 10 years
earlier than
non-Aboriginal
Australians
There is particular 14% of older South
disadvantage for many older Australians are
women because of low levels migrants from
of superannuation, under culturally and
employment and not owning linguistically diverse
a home backgrounds
Around one
quarter of
older people
live in rural
areas
Australia has one Our older age
Life expectancy has
of the highest life in Australia
increased by about 14 years
expectancies in is healthier than
over the last 60 years
the world ever before
INTRODUCTION 01
There are distinct differences between modern An important part of this is the recognition that
ageing and the ageing experienced by the older people are not a homogenous group.
generations before us. Among other points of difference, older people
reflect enormous diversity of culture, income,
COTA SA, as the peak body representing the health and geography. Broad engagement and
needs, interests and aspirations of more than opportunities to influence what ageing is and
633,000 South Australians aged over 50, has a could be in 2018 and beyond is critical. We need
pivotal role in challenging South Australia to a fresh approach to using the resources and
embrace our modern ageing and particularly to capabilities of older South Australians side by side
celebrate and enable the inclusion of all older with other stakeholders.
South Australians in government policies and
decision-making. This submission for consideration in the 2018-19
Budget deliberations builds on the promising
Adopting policies and legislation that reflect start by the new government and offers a range
ageing as a time of opportunity and influence of directions that address the things that matter
remains a challenge for governments around the most to older South Australians. While the list of
world. recommendations is not exhaustive, it prioritises
critical elements of an ageing well vision.
COTA SA is pleased that the new State
Government has already taken steps towards The submission continues to pursue the
recognising the need to involve older South predominant theme and challenge in
Australians in the decisions that affect them. supporting ageing well in South Australia – the
need to overturn the ageism that stymies the
We welcome the government’s pre-election opportunities, inclusion and contribution of
promise to engage older people in the co-design older people. The current risks of increasing
of services. This emerged as a key theme in isolation and invisibility need to be converted into
the conversations COTA SA held across South initiatives that create a place at the centre of our
Australia in 2017, with older people expressing a community for older South Australians beside
level of frustration that their ideas and feedback other generations.
were often overlooked. The Plug-in is a new COTA
SA social enterprise that enables older people to
engage directly and influentially in innovation,
research and design opportunities and is an
excellent vehicle for supporting such co-design.
COTA SA also acknowledges and welcomes
the new government’s focus on implementing
adult safeguarding legislation and services. The
government has led the country in honouring
its pre-election commitment and, in doing so,
has capitalised on the considerable cross-party
support that exists around this issue.
The State Government’s “Ageing Well’’ focus has
created an expectation for an active, positive
and holistic approach that supports our modern
ageing as both a driving demographic trend and
a new set of opportunities for our state.
LIST OF RECOMMENDATIONS
Recommendation 1
EMPLOYMENT The State Government fund a 2-year project with key stakeholders
to research best practice and propose solutions to support the
employment of older workers. Estimated cost $100,000 per annum.
Recommendation 2
The State Government undertake a proof of concept trial (in
partnership with industry) of mid-career planning for low skilled, low
paid workers. Estimated cost $200,000 per annum.
Recommendation 3
The State Government work with COTA SA, utilising the experience of
older people, to explore and implement new health delivery models
- including through use of new technologies - that would reduce
the need for hospitalisation by providing services where people live,
including aged care facilities.
Recommendation 4
HEALTH
The State Government fund COTA SA to extend its existing extensive
peer education model to improve older people’s health literacy and
provide information about the choices available to them to better
manage their existing conditions and delay the onset of other illnesses.
Recommendation 5
The State Government engage The Plug-in to match older people with
opportunities to be involved in the redesign of the health system.
Recommendation 6
The State Government fund COTA SA to increase the understanding,
active completion and use of Advance Care Directives. This campaign
should also target community and health practitioners utilising COTA
SA’s existing peer education model to improve awareness. Estimated
cost $100,000 per annum.
Recommendation 7
The State Government double its investment in the Strength for Life
program to extend its reach to 7000 older people per week. Estimated
cost $100,000 per annum over 4 years.
HOUSING
Recommendation 8
The State Government ensure the Housing Strategy being developed
for South Australia includes disadvantaged older Australians
specifically, and sets targets to meet the needs of older South
Australians living in housing stress.03
Recommendation 9
The State Government fund a service that assists vulnerable older
people to secure ongoing and appropriate accommodation. Estimated
cost $500,000 per annum.
Recommendation 10
The State Government explore innovative housing models that target
disadvantaged older people such as shared equity schemes, co-
housing and intergenerational models.
Recommendation 11
TRANSPORT
The State Government supports the development of transport options
for people without access to private transport to travel within and
between local communities and suburbs.
Recommendation 12
The State Government funds the extension of transport concessions
beyond off-peak times. Estimated cost $1.5 million per annum.
Recommendation 13
The State Government invest in peer led digital literacy training with
an emphasis on older people including those in rural areas. Estimated
cost $300,000 per annum over 3 years.
Recommendation 14
PROMOTING The State Government fund COTA SA to trial and scale an engagement
ENGAGEMENT and capacity building project in rural SA led by local peer champions
to support information and advocacy about the issues that are
important in their communities. Estimated cost $100,000 per annum
over 2 years.
Recommendation 15
The State Government increases funding for ZestFest to promote
positive roles and opportunities, enable new programming and
increase participation in rural areas. Estimated cost $100,000 per
annum for 3 years.
Recommendation 16
The State Government fund a 2-year project to support the emergence
of a community “hub” for older LGBTIQ South Australians to network,
exchange information, exchange support and provide a physical space
for groups to meet. Cost $60,000 per annum over 2 years.04
RECOMMENDATIONS
Recommendation 1
The State Government funds a 2-year project
with key stakeholders to research best
practice and propose solutions to support
the employment of older workers. Estimated
cost $100,000 per annum.
Recommendation 2
The State Government undertake a proof of
concept trial (in partnership with industry) of
mid-career planning for low skilled, low paid
workers. Estimated cost $200,000 per annum.EMPLOYMENT 05
There is an emerging consciousness in the
community that age discrimination is stopping
older South Australians from keeping and getting
jobs that will be the key to their ageing well1.
While South Australians want and need to work
into their 50s, 60s and beyond, widespread age
discrimination2 means only one third of people
aged over 55 participate in the workforce and
unemployed older job seekers take twice as long
as other age groups to find work3. Investing in
older workers is likely to bring a rich return for
South Australia – on a national basis increasing
the workforce participation of older workers by
just 3 percentage points adds $3 billion to GDP4.
There is an opportunity for SA to lead the way in
raising awareness of the prevalence and cost of
age discrimination among employers, to research
best practice interventions and to explore options
for older workers to continue to work and earn.
It is proposed that this be funded initially as a
project where employer groups and older workers
combine to explore the barriers to employment
and propose practical solutions.
In South Australia, low skilled workers, including
those losing manufacturing jobs or needing
careers that better suit their physical attributes,
need particular support to restructure their
careers5. Mid-career planning6 would provide an
opportunity for workers to plan for their future
(in areas such as health, housing and financial),
and for any upskilling or reskilling that may be
required. People are more likely to get new jobs
and to stay employed as they age if they keep the
job they have, making the adjustments, changes
and upskilling that are required along the way.
1 For example, Female, 50 & Unemployed, Sunday Mail June 10 2018, p. 1
2 Work Well; Retire Well, findings of the Work, Care, Health and Retirement Ageing Agenders Project, 2017, p. 17
3 http://www.abc.net.au/news/2017-05-19/age-discrimination-over-50s-worst-bracket-to-be-unemployed/8540548
4 Willing to Work: National Inquiry into Employment Discrimination Against Older Australians and Australians with Disability
(2016)
5 Work and retirement intentions among SA “Baby Boomers” A Mixed Method Approach (2016), David Waterford, Jo
Battersby and Jane Mussared (unpublished)
6 Mid-Career Checks were first proposed by former Age Discrimination Commissioner, Susan Ryan, as part of the Willing to
Work InquiryHEALTH
A persistent theme in feedback from older people COTA SA urges a focus on designing and trialling
to COTA SA about health services is a preference different approaches with an emphasis on
for services to be local and accessible. In recent exploring better practice for older people as
years, Transforming Health’s exclusive focus on significant stakeholders. The Plug-in and its
in-hospital services in South Australia has blocked promise to match older people with a range of
the exploration of new approaches - including innovation, research and design opportunities,
virtual and mobile teams and other partnerships should be used to bring active health system
- that would offer services at home and in local users to redesign initiatives.
communities, and avoid unnecessary admissions
to hospital. There is an increasing expectation among older
people that they will take more control of their
There is coincidental value for our government own decision-making. As the People Powered
in exploring opportunities to provide access Health Model of UK-based innovation think tank,
to services – including some of those currently Nesta, has found, peers are a very important
provided by our hospitals – in people’s own resource in changing health paradigms11. COTA
environments. Hospital care is expensive and SA has been developing our peer support model
inappropriate admission carries with it particular for well over a decade, offering up to 350 formal
risks for older people. Indeed current estimates peer education sessions for almost 7,000 older
are that 35% of people in public hospitals do people per year on a wide range of topics. While
not need to be there and could get their care at this is an established model that is working well,
home facilitated by adoption of new technologies its potential to support health objectives such as
including the virtual hospital7. increasing the take up of Advance Care Directives
or returning to exercise is not fully realised.
In Australia in 2016–17, 42% of separations and
48% of patient days were for people aged 65 and The emphasis on ageing well has a consequent
over, an increase from 39% in 2012-13. Moreover requirement for investment in health promotion,
in the four years up until 2016-17, separations health literacy, self-management and peer
for people aged 65-74 increased by an average information thereby mobilising community
of 6.3% per year, faster than the 4.1% per annum assets. Nesta estimates that co-design approaches
average rate of population growth for this age such as self-management and peer processes can
group8 and, in 2014-15, 48.7% of potentially reduce the cost of managing patients with long
preventable admissions to hospital involved term health conditions substantially. COTA SA’s
people aged over 65 years9. peer information programs have demonstrated
over more than a decade that they deliver cost
While older people are very important effective information and health messaging
stakeholders in health care10, they have struggled on topics such as Advance Care Directives, falls
to have their voices heard in the design of health prevention, mental health and medication
services in South Australia and many report that management. COTA SA also recommends
the system is hard to use. In their conversations investment in peer approaches to improve the
with COTA SA, older people have expressed a completion and use of Advance Care Directives
strong desire to be partners in the redesign of the (ACDs).
hospitals and in understanding any non-hospital
options that might deliver better outcomes for More than 19,000 admissions to SA hospitals each
them. year are as a result of falls12. Exercise that focuses
on strength and balance is a proven protective
7 The Future of Medicine, The Advertiser, 27 June 2018 p. 19
8 https://www.aihw.gov.au/reports/hospitals/ahs-2016-17-admitted-patient-care/contents/summary
9 Health Performance Council Fact Sheet prepared for COTA SA July 2016
10 p396, Australia’s Health 2014, AIHW
11 The Business Case for People Powered Health, Nesta, UK, April 2013
12 http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/
falls+prevention07
factor against falls13. Currently fewer than half of
people aged over 50 undertake 150 minutes of
exercise a week, and this proportion reduces to a
RECOMMENDATIONS
quarter by age 7514. COTA SA uses a current grant
from SA Health of well under $100,000 per Recommendation 3
annum to support 90 gyms and community
centres across SA to roll out its Strength for Life The State Government work with COTA SA,
program, used by about 3,500 older people a utilising the experience of older people, to
week. People tell us that cost, lack of confidence explore and implement new health delivery
and not knowing where to start are major blocks models – including through use of new
to starting exercise. This lack of access is technologies - that would reduce the need
compounded for rural South Australians and for hospitalisation by providing services
people from CALD and ATSI15 backgrounds. As where people live, including aged care
part of this submission, COTA SA recommends facilities.
an extended investment in Strength for Life to
extend access to these groups. Recommendation 4
The State Government fund COTA SA to
extend its existing extensive peer education
model to improve older people’s health
literacy and provide information about the
choices available to them to better manage
their existing conditions and delay the onset
of other illnesses.
Recommendation 5
The State Government engage The Plug-in to
match older people with opportunities to be
involved in the redesign of the health system.
Recommendation 6
The State Government fund COTA SA
to increase the understanding, active
completion and use of Advance Care
Directives. This campaign should also target
community and health practitioners utilising
COTA SA’s existing peer education model to
improve awareness. Estimated cost $100,000
per annum.
Recommendation 7
The State Government doubles its
investment in the Strength for Life program
to extend its reach to 7000 older people per
week. Estimated cost $100,000 per annum
over 4 years.
13 COTA SA licences more than 90 gyms and community centres throughout SA to offer Strength for Life, a tailor-made, low
price fitness program focusing on strength and balance training for older people
14 3-5 Physical Activity, State of Our Health, SA Health Performance Council 2016
15 Aboriginal and Torres Strait Islander (ATSI)08
RECOMMENDATIONS
Recommendation 8
The State Government ensure the Housing
Strategy being developed for South Australia
includes disadvantaged older Australians
specifically, and sets targets to meet the
needs of older South Australians living in
housing stress.
Recommendation 9
The State Government fund a service that
assists vulnerable older people to secure
ongoing and appropriate accommodation.
Estimated cost $500,000 per annum.
Recommendation 10
The State Government explore innovative
housing models that target disadvantaged
older people such as shared equity schemes,
co-housing and intergenerational models.HOUSING 09
South Australia already has a sizeable population vulnerable older South Australians living in
of older people for whom affordable and housing stress to secure ongoing and appropriate
appropriate housing presents real problems, and accommodation.
this population is growing at an alarming rate.
We note the government’s pre-election
According to 2016 Department of Social commitment to engage the Australian Housing
Services data there are at least 4,900 older South and Urban Research Institute (AHURI) to audit
Australians living in accommodation that creates our state’s current housing assets and map
housing stress because it is unaffordable for future demands, with the results to drive
them16. The latest Census data indicates this is a comprehensive strategic plan for the full
a conservative estimate. As home ownership spectrum of housing options for older South
becomes less attainable not only for the young Australians. The Housing Roundtable supports
but also for people who are 50 plus, more older the continued exploration of innovative housing
South Australians are forced to turn to private models that target disadvantaged older people
rental to meet their housing needs. For many such as shared equity schemes, co-housing and
of them this creates real risks of homelessness intergenerational models.
due to insecure and short term tenure, physical
design that cannot be moderated to meet
changing needs, and unaffordability. Frequent
moves required by some people in private rental
compounds isolation.
Over the last two years COTA SA has convened
and run a Housing Roundtable with members
from stakeholder organisations in South Australia
including key researchers, providers, funders,
policy makers and peak bodies. The roundtable
discusses issues and potential solutions related
to adequate housing for a growing number of
disadvantaged older South Australians.
Results from the 2017 report Finding a Suitable
Home for People at Risk of Homelessness in SA17 and
stories from some of our Housing Roundtable
members indicate that there is a pressing need
for a service that will support older people to
achieve secure, long term and affordable housing.
A specialist early intervention service using
existing resources to support older clients to
better navigate the system has the potential to
save significant public money and will prevent
homelessness18. A useful and successful model is
the Victorian government funded service Home At
Last one-stop support service for older people.
COTA SA urges the Liberal government to
prioritise a specialised housing service to assist
16 Authors Jeff Fiedler, Housing for the Aged Action Group and Debbie Faulkner, University of Adelaide, June 2017
17 ibid
18 Home At Last10
RECOMMENDATIONS
Recommendation 11
The State Government supports the
development of transport options for people
without access to private transport to travel
within and between local communities and
suburbs.
Recommendation 12
The State Government funds the extension of
transport concessions beyond off-peak times.
Estimated cost $1.5 million per annum.TRANSPORT 11 Older people tell us that affordable, accessible the time restrictions on weekdays of free travel and timely community and public transport before 9am and after 3pm. We often hear their makes a huge impact on their lives. When it frustration - “Our lives don’t just take place operates well, it helps them get to and from their between 9 and 3!” medical appointments, it gives them confidence to make the decision not to drive, it enables COTA SA welcomes the government’s pre-election them to shop, use services and facilities and, commitment to re-examine the costings and see most importantly, it prevents their isolation and if there is any opportunity to expand the free promotes their lives as active citizens. travel program. Sadly, however, people tell us that alternatives to driving themselves are often inadequate, inappropriate and expensive especially where people live in regional areas. The infrequency and expense of transport outside metropolitan areas is a huge barrier to older people being able to access health and other services. As well, having severe constraints around being able to visit friends or take part in social activities results in dangerous levels of isolation. We often heard the comment “no car = no life” and reports that people feared living without their car. Travel between local communities is a real problem – going from Berri to Murray Bridge for example involves a transit via Adelaide. And the same is true for travel between many regional centres. Transport from the regions into or via the City of Adelaide increasingly necessitates a tram commute from one part of the city to the other. The Royal Adelaide Hospital is particularly nominated as really “fiddly and difficult” to get to by public transport. Older people tell us they want to stay in their own homes and within their own communities. An accessible, affordable and appropriate public transport service is a vital component to enable that to happen. The cost and limited availability of transport outside Adelaide and between regional centres impacts a broad spectrum of older lives. COTA SA welcomes the Liberal Party’s pre-election commitment to evaluate transport options to give people without access to private transport better public transport and connectivity opportunities. The Seniors Card is a very significant support for people using public transport in the metropolitan area. However, people are frustrated at the lack of transport at night and weekends as well as
12
RECOMMENDATIONS
Recommendation 13
The State Government invest in peer led
digital literacy training with an emphasis on
older people including those in rural areas.
Estimated cost $300,000 per annum over 3
years.
Recommendation 14
The State Government fund COTA SA to
trial and scale an engagement and capacity
building project in rural SA led by local peer
champions to support information and
advocacy about the issues that are important
in their communities. Estimated cost $100,000
per annum over 2 years.
Recommendation 15
The State Government increases funding
for ZestFest to promote positive roles and
opportunities, enable new programming and
increase participation in rural areas. Estimated
cost $100,000 per annum for 3 years.
Recommendation 16
The State Government fund a 2-year project
to support the emergence of a community
“hub” for older LGBTIQ South Australians to
network, exchange information, exchange
support and provide a physical space for
groups to meet. Cost $60,000 per annum over
2 years.PROMOTING ENGAGEMENT 13
The Digital Inclusion Index in 2017 continues Older people tell us that ageism and age
to show that South Australia is the second least discrimination are alive and well, diminishing
digitally included state with only Tasmania having opportunities for volunteering, work, being
a lower score. While older South Australians are heard and having a say. For 51 years, COTA SA has
increasingly able to engage on line, there remain coordinated a series of events (now referred to as
affordability and capacity barriers. Older South ZestFest) that enables older people to celebrate
Australians are among those most likely to be their place in our community. The program
excluded from the digital world making the digital includes well over 200 events with a particular
divide ‘narrower but deeper’19. COTA SA supports focus on rural SA. There is an opportunity to grow
the government’s commitment to doing what and develop this in rural SA, supporting local
it can to ensure that government services and communities to evolve their offer to older people
information remain available in offline formats. to promote inclusion and support a contemporary
view of ageing well.
Many older people want to take their place in
an inevitably digitised world. Many will need The LGBTIQ People Ageing Well Project
specialist help to do that including through commenced in April 2017 as a 12-month
programs to assist with literacy training. We would joint project between COTA SA and the South
particularly encourage that peer approaches are Australian Rainbow Advocacy Alliance (SARAA),
considered to support learning for older people. funded by the State Government. The project
engaged with older people from the LGBTIQ
26% of older South Australians live outside community throughout the state and learned
the metropolitan area with many of our rural about the strengths, needs and priorities of
communities having much higher age profiles people as they age. In order to progress the
than metropolitan Adelaide20. Older people report’s recommendations, COTA SA urges
living outside Adelaide report that they feel the funding of a 2-year project to support
they are being left out of decision-making and the emergence of a “hub” that will assist the
consultation both locally and on statewide community itself, together with government and
matters. This feeling of disengagement combines the ageing and aged care sector, to support and
with an increased risk of isolation for older people extend existing community capacity.
in country SA because of reduced access to
services, geographical isolation and separation
from family21.
COTA SA proposes the trial of a project to support
the engagement and building of social capital
in a regional area based on the peer champions
approach. This is an approach that COTA SA
is trialling in partnership with the SA Country
Primary Health Network (PHN) to support the
dissemination of aged care information.
Scholars and practitioners agree that ageism - the
structural devaluation and resulting isolation
of older people within a society (which often
intersects with other forms of discrimination) -
heightens the risk of abuse22.
19 SACOSS 2017
20 Dr Helen Barrie, University of Adelaide supplied Jan 2017
21 COTA Victoria Social Isolation Working Paper, 2014
22 ALRC Elder Abuse Discussion paper, Dec 2016You can also read
