As the HIV-positive population ages through the life-extending benefits of HIV treatments, age-related illness will (and already have) become an increasing concern, such as heart disease, diabetes, kidney disease, bone density loss, and some cancers. Alongside of this medication and treatment needs will increase, bringing their own complications (such as drug interactions, increased pill burden, side effects, etc). As one reaches this bridge into older age, planning for future life then becomes an important consideration. One aspect of that is seeking help and services to maintain independence at your home or planning to move into an aged-care residential facility (least of all maintaining housing itself, income, finances, employment, food security, medical costs and clinical care monitoring, not to forget the all-important psychosocial needs of mind, body, spirit, companionship and social connectedness). This article touches upon commonwealth changes within the Age-Care Reform Agenda, which commenced in 2012 and are projected to go out to 2021-22, progressively implemented in 3 phases over 10 years. The purpose of the reforms is to “create a better aged care system to give older people more choice and control and easier access to a range of aged care services”.
So why is aged care changing? The central reason is to make aged care more accessible and improve standards of such care because all people are living longer (not just PLHIV) thanks to better health and better health care. Thus we have an increasing ageing population generally, and so quality care is an important consideration for our older citizens for their health and wellbeing.
Some Background: Firstly, although many people living with HIV (PLHIV) are not part of the LGBTI community, in an effort to give inclusion, improve care, and to reduce stigma and prejudice in aged care facilities, separate LGBTI reforms have occurred through the National LGBTI Ageing and Aged Care Strategy which you can read here: http://lgbtihealth.org.au/resources/national-lgbti-ageing-strategy/
Aged Care Reforms: Although the reform agenda commenced in 2012, the first round of changes (1st Phase) occurred on 01 July 2013 with the establishment of My Aged Care website (www.myagedcare.gov.au) and contact centre (1800 200 422). This is the main entry point to the aged care system in Australia, for new Home Care Packages and Supplements for home care and residential aged care.
From 2014 to 2016 (2nd Phase) improvements in choice and access were established, including feedback from consumers for quality indicators (checking how they were going) and the establishment of subsidised fee charges for home care support packages under “consumer directed care” providing choice in the level of care and services.
From 2016 to 2021 (3rd Phase) is being developed in consultation with the aged care sector (providers) in terms of building a single quality framework standard in both home care and residential aged care, with particular emphasis upon “support[ing] people to stay at home, and be part of their communities, for as long as possible.”
From 27 February 2017, older Australians gain more flexibility when accessing Home Care by Increasing Choice in Home Care. This comprises home care package reform (under the Commonwealth Home Support Programme – CHSP) which imparts greater consumer choice (“consumer directed care”) for specific levels of care, whilst assigning the care package directly to the care recipient (rather than to the provider) allowing portability if they wish to change care providers or move. It provides greater transparency to consumers about what funding is available under their care package and how those funds are spent through an individualised budget and monthly statement (which will be easier to use). Support is also available for carers through in home or centre-based respite. The care recipient can also obtain social respite (giving their carer a break as well), and if needed occasionally enter respite residential care. Overall, there will be fairer, broader inclusion with more flexible options for increasing choice for older people, no matter where they live. The improved aged care system allows for the most complex of needs (e.g. requiring medical, health or nursing support at home) to help at home for those daily tasks and domestic or personal needs in home care and maintenance that might get just that bit more difficult to do alone when older. You can read more about Home Care Packages and eligibility here: https://www.myagedcare.gov.au/help-home
Who are the services for? Any person 65 years or older (50 or older for ATSI people), or an older person on a low income, or homeless or at risk of homelessness. (Note: the National Disability Insurance Scheme [NDIS], currently rolling out throughout Queensland, provides disability care package for people under < 65 yo – see www.ndis.gov.au).
What are the costs? Although the government contributes to the cost for these services the care recipient pays a co-contribution subsidised fee for aged care services. For home care packages your service provider may ask you to pay a basic daily fee of up to 17.5% of the single basic age pension (up to $139.58 per fortnight), or apply an income tested care fee if your income is over a certain amount. If you cannot afford to pay you will be protected from the requirement. For aged care homes (and residential respite), the basic daily fee is $48.44 per day (plus an accommodation charge and income test fee). These rates are indexed in March and September each year, in line with changes to the age pension (of itself now subject to harsher income and assets testing, which is another matter). Costs will vary between individuals based upon your level of care and service package and your personal or financial circumstances. You can ask to be considered for financial hardship assistance More Info: http://www.myagedcare.gov.au/getting-started/who-pays-for-aged-care-services
Further Reading Aged Care Reforms:
Further Reading HIV & Ageing: