Home' Australian Ageing Agenda : AAA May-Jun 2015 Contents In conversation
On this particular day, Sue
Macri had left her usual
business attire hanging in
the wardrobe, opting instead
for jeans and sneakers.
As a director of community care
provider RDNS, Macri was going out
with the nurses as they provided care to
disadvantaged and homeless seniors.
They visited boarding houses, some
we would see as "terrible places, people
living in rooms that are probably the size
of your bathroom," she recalls.
Of the many people she met
that day, one in particular made a
"He was 78, living in a room you
couldn't swing a cat in," Macri says. "They
had bought him a little fridge; he had a
bed, a tin full of cigarette butts and the
bottle of whiskey on the bench. The toilet
was outside, and a cold shower."
The provider had managed to obtain
for the homeless man an ACAT approval
for residential aged care, on account of his diabetes.
Here he would have his own en-suite room, three meals a day --
all the modern comforts of home.
"He lasted three weeks," says Macri. "He hated it, because he
said it wasn't home. His words were 'they were all mad', in other
words many of them had dementia."
At the root of the man's unhappiness was "the regime".
"He couldn't smoke; he couldn't have his bottle of whiskey.
His mates couldn't come and sit on the end of the bed and have a
smoke with him."
The man left, and went back to his seemingly undesirable
conditions. "He was back in his community; he was back in his old
room, where you couldn't swing a cat. He was getting Meals on
Wheels, the girls were coming every day to do his blood sugar and
insulin, and he was as happy as a pig in mud."
Macri pauses, and then reflects on "how we impose our own
values on people in aged care and the community."
"It was a real lesson for me," she says, "just sitting there and
talking and listening to him. To him, this was home."
Macri has spent more time than most thinking about issues
like this, about how aged care operates, the outcomes for those
receiving care and those providing it; the system's strengths and
weaknesses, its potential.
With the government open to considering some of the more
ambitious proposals put forward by the Productivity Commission
in 2011, sector stakeholders are now determining what measures
they want on the table. Here, one of the report's co-authors
Sue Macri tells Darragh O'Keeffe why she thinks the PC's
recommendations on the uncapping of places and quality of
training must feature in the next phase of reform.
Two decades ago she delivered
the Macri Panel on Nursing Home
Documentation and Accountability
Report to government and in the
following years has been involved in
several other high-level inquiries, most
recently as associate commissioner
on the Productivity Commission 2011
Caring for Older Australians inquiry,
which provided the basis for the
current Living Longer Living Better
With the government late last year
signalling its readiness to consider the
more ambitious PC recommendations
that were not included in LLLB -- such
as relaxing the supply of places and
consumer-held budgets in community
care -- stakeholders are currently re-
examining those proposals and their
For Macri, the first cab off the rank
should be the PC's recommendation 7.1 -
for government to remove the regulatory
restrictions on the number of community care packages and
residential bed licences.
"I firmly believe by the end of financial year 2017 they could
have the phasing in of uncapped community care and then
residential aged care at a later date," she says.
Macri argues that uncapping would remove one of the biggest
problems in community care currently, which is utilisation of
the four levels of packages. Providers are reporting under-
subscriptions to Level 1s, and Level 2s in some areas, while there
are waiting lists for Levels 3 and 4.
She says while the PC recommended a new service to fill
the gap between the then Community Aged Care Packages
(CACP) and Extended Aged Care at Home (EACH), the Labor
Government "for some unknown reason" additionally introduced
the Level 1 package under LLLB.
"Because of the means testing, the services many clients
get are not worth the money they're being charged and a lot of
people are saying I'd rather sit on HACC or I'll go to a private
operator who will do what I need for a lot less than the means
tested fee," she says.
Macri believes the Department of Social Services should
review the utilisation of the lower level packages as a priority.
Addressing the common argument against uncapping the
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