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1999 paper, The Third Wave of Aged Care Reform -- the question is
whether Gray intends to remain at the centre of things.
"I'm 73 now so I've got to think about moving toward retirement.
I know the day will come when I don't have a choice," he says.
"I'm down to three days a week. That makes it more
challenging - when you start to reduce - to pace yourself. I need
to think about how I use my time and how much I exert myself to
ensure I can keep doing it.
"I'm my brother's informal carer now. My late wife died of
cancer a few years ago and I was her informal carer too. Unless
I have health problems, I'd like to be able to gradually step down
gracefully," he said. n
"Peter Staples was my first minister and he became a friend. There
was Brian Howe for a short time, then Carmen Lawrence; then Judy
Moylan who was very committed but not treated well by the Howard
government; Warwick Smith, Bronwyn Bishop, Kevin Andrews, Julie
Bishop; Santo Santoro; Christopher Pine; and Justine Elliott.
Mark Butler is an enormous asset -- in fact I worry he is too
much of an asset and will be moved. He is not only engaging; he is
incredibly bright with a great memory for detail and is so articulate.
But you work with whoever you have as a minister. You can develop
a likeness for them but I don't get into thinking about favourites."
ON WORKING WITH THE BUREAUCRACY
"Generally, the people I have worked with in the department have
been smart and good people who understand good arguments
and policy points of view. We know the department comes in for
criticism but in my 20 years, by and large I have considered them
top class people. I think they are critical to program and policy
reforms being effectively achieved."
ON RETIREMENT VILLAGES
"I think retirement villages have a very bright future in the aged
care continuum. They offer a good option to downsize, and a social
life; and it's more practical to deliver community care to ILUs.
I do get concerned that too many are development driven
though. They squeeze as many units as possible onto the land;
they all look the same, they're small, with no private space; no
street differentiation. You think to yourself, could I live here?
Also, too many villages have been built as massive
developments on the outskirts of cities. Older people want to be
able to walk to facilities that are close by. Why not have smaller,
boutique developments in inner city areas? I think in the future,
that will have to change to meet what the market demands."
ON DEFERRED MANAGEMENT FEES (DMF)
"When it comes to the financing model, the DMF needs to be
flexible. I see no reason why retirement village operators can't
offer flexible financing arrangements. Why can't the DMF be one
in a range of models? Why not offer a rental option?
Some offer a flexible loan arrangement. Say, you need half
a million but can only get $400,000, then maybe you can have
the option of a lower price but a higher DMF. Or why not have a
flexible monthly maintenance fee? Pay a higher DMF and a lower
maintenance fee, if you want more disposable income. Why not?
So many seem to be locked into this one and only model."
ON THE INDUSTRY TODAY
"It's now no longer a cottage industry but it is still in a maturing
phase. It's moved from youth to young adult but it's still quite a way
from being fully mature. That won't happen until the 2030's at least.
A mature industry would be one where consumers can access
what they want, when they want it, that is responsive to need, and
that is affordable, deliverable and sustainable for providers."
ON PROUD ACHIEVEMENTS
"I'm probably most proud of seeing the Aged Care Act
come into being. Obviously looking back, you can see the
improvements that can be made; but at the time, it was
important in bringing about the second wave of aged care reform."
ON WHAT THE FUTURE LOOKS LIKE
"I think there'll be small, group-style care homes in the
community -- with options enabling family and staff to work more
closely. For large residential aged care providers, who have units
and wings that we can dedicate to sub-acute, hospice or rehab/
And dementia care and support will be a major area of
challenge. Dementia care is palliative care -- no question. Dementia
is a terminal condition but often it can be ten years from diagnosis.
That means services should be flexible as part of a health system
that embraces acute care, nursing care at home, specialist
residential care facilities and the community care system.
There will be a wellness and re-ablement approach where
people are assessed and supported to help them regain function.
That will minimise the cost on the system."
ON HOPES FOR THE FUTURE
"I'd like to see the reforms articulated by the PC implemented,
[...] ensuring that the system architectural changes are not
diluted down to endanger the principles of reform. We need an
entitlement system with an equitable co-contribution system. We
need the system to be able to provide for the growth from the
baby boomers and certainly the system needs to be sustainable
and the consumers and providers need to have choice.
We still need quite a strong regulatory framework. I believe
there needs to be an approved provider system, a quality
monitoring system and a good and timely complaints process.
I've seen an enormous improvement in standards and the quality
of building stock over time but there's a certain amount of
regulation that is just unnecessary, burdensome and dragging
the sector down and backwards."
"You can't be revolutionary in changing things -- change needs to
be incremental so the community and the systems can adapt and
accept the change."
AAA | JANUARY -- FEBRUARY 2012 | 33
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