The aging of population is a common issue facing most countries and regions in the world, which brings great pressure on society and family, as well as new challenges to the aging care service delivery (Hughes, 2004). For example, older people are more likely to have chronic diseases due to the function decline¼Œ such as cardiovascular¼Œ cerebrovascular diseases, Parkinson’s disease, arthritis, and diabetes mellitus and others, or accident trauma such as injures by falling. As a result, there are mental/psychological issues facing those older people, and the caring needs are even more complicated than those for the younger adults (Fleming and FitzGerald, 2009). Moreover, this will increase the health care needs of the aged population with a burden which has been increased on the aged care system. With the increasing aging population, there are more number of older people in the need of aged care service delivery. However, the aged care service delivery is under the influences of various factors in the community or society, facing different kinds of issues. As in this paper, it will then focus on how the health care needs of older people are being addressed today and to the future. To be specific, it will firstly figure out the current status of aged care service delivery, particularly involving the problems existed; secondly, the paper will then critically analyse the economic, social, cultural and political issues associated with aged care service delivery; afterwards, in response to the indicated issues and problems as well as the impacts, the future directions for the quality care of older people will be discussed. At last, it will be the conclusion summarizing the main points of the paper.
2.0 Current Status of Aged Care Service Delivery in Australia
As indicated, with the increasing proportion of older people, the aging of population has already grown into a huge social issue, bringing increasing burden on the health care system of Australia.
2.1 Growth of an Aging Society in Australia
During the recent decades in the 20th and 21st century, there have been significant changes in human society, in particular the population demographics. Specifically, due to the increased longevity and low fertility rates, migration and technological advances, the aged population accounts for increasing proportion during the period. Concerning the Australian population, the age group of people over 65 years old has grown from 8% in 1980-1981 to 13% in 2005-2006, this figure is projected to increase to 26%-28% in 2051, and 27%-31% in 2101. Particularly, when the aging population over 60 years old accounts for more than 10% of the total population or the aging population over 65 years old is more than 7% of the total population in a society, it will be the aging of population in the society. This is naturally bringing great pressure on many aspects of the social life, especially the health care field and the economic aspect (Australian Government, 2004).
The health condition of aged people is fragile, comparing to more energetic younger adults. Because of the body function decline, there is high morbidity rate in the aged population, and the common diseases include cardiovascular, cerebrovascular diseases, Parkinson’s disease, arthritis, and diabetes mellitus and other chronic diseases, or accident trauma such as injures by falling. Furthermore, these diseases are often companied by some mental issues and psychological problems like depression and mental disorders (Fleming and FitzGerald, 2009). In this case, the aged populations are more likely to demand for health care services, with increasing burden on the health care system.
Older people are the major service object of home care. The main demands of older people are assistance in the activities of daily living. This care for the aged people is mainly offered by several types of providers such as the spouse, the children, the nursing staff, community service and other service organizations (Ergas, 2009). The care modes are also different because of different cultures and traditions in different countries and regions. For example, Australia health organizations provide high quality community services to ageing rather than some Asia countries’ home care modes. In addition, economic and financial constraints and other factors also have influences on aged care. For example, high payment will enable the aged people to receive more advanced care, while lack of access to effective health care will hinder the aged people to receive prompt care services.
2.2 Care Insurance System for Aged Care in Australia
There are two types of aged care insurance system, which are insurance of social security and commercial insurance (Jacobs and Goddard, 2002). Concerning the social insurance enforced by the government, there are various sources of the funds, which include the insurance premium paid by the insured, and the subsidies provided by the governments. Regarding the commercial insurance, it has been developed due to the increasing health needs of the aged people (Theobald, 2003). Whether to participate in this kind of commercial insurance is totally depending on the insurance applicants, which is a flexible type of care insurance for the aged people.
As in Australia, national health care system has been adopted, which means that every individual has the right to enjoy appropriate health care insurance, including the aged care provided for the aged people. In this case, the aged people can receive care insurance for the health care services equally in Australia, due to the national system supported by the government. However, with the increasing financial burden on the health care system, commercial insurance has also been largely used, as the government has encouraged the citizens to buy different kinds of commercial insurance packages so as to share the burden. Specifically, the government will provide subsidy for people who purchase commercial insurance; the earlier they purchase it, the more subside they can get. From this perspective, the aged care services in Australia are paid by both the country and the service users. (Australian Bureau of Statistics, 2007)
2.3 Existing Problems Facing Aged Care in Australia
As stated, the aging of population has been a great issue facing the Australian society, with increasing burden on health care system. Specifically, due to this great pressure and burden, there exist various problems facing the aged care service delivery in Australia.
2.3.1 Increasing Health Care Needs and Growing Care Difficulty
Due to the increasing possibility of morbidity of the aged people, the hospitalization rate has been growing, with more demands on the care service delivery, in addition to increasing costs. Comparing to the younger adult patients, the health care for the aged people is much more complicated, involved in the entire process of are evaluation, care plan, and care delivery, because the aged patients are often suffering from more than one disease. Furthermore, hospitalization itself also has great threat to the health condition and body function of the aged patients. According to the studies by Creditor (1993) and Riedinger and Robbins (1998), about one third of the aged people experiencing hospitalization have then experienced a decline in one or several abilities in the activities of daily living, while over 15% of the in-hospital aged patients may suffer from adverse drug reaction. Other problems like lacking of beds, overabundant emergency cases, noisy environment and lacking of space for medical facilities have also increased the risks for the aged patients like patient falls (Courtney, O’Reilly, Edwards and Hassall, 2007). In addition, there also exists information obstacle in the care service delivery, for example, the nursing staff may not be able to obtain first hand information of the patients from relevant staff or organizations, which can greatly affect the quality of care for the aged patients, and also make the care service process even more complicated (Leventhal, 2008).
2.3.2 Lacking of Aged Care Workforce
Lacking of nursing staff is one of the severe challenges facing the aged care service delivery (Stubbings and Scott, 2004). Specifically, the shortage of nurses involve two aspects: one is the reduction of nursing staff including registered nurses, non-registered nurses and other hospital workers; the other is the ageing of nursing staff. There are various reasons contributing to this situation, such as the increasing complexity of aged care, the decreasing enrollment of nurses, as well as the reducing satisfaction of the nurses on their occupation, and the increasing job choices for women workers (Newman and Maylor, 2002). Moreover, the low wages and bad working environment also lead to the decline in nurse enrollment. This shortage of nursing staff, particularly the professional nursing staff whom with abundant skills and experiences in caring the aged people has then been a great problem for the aged care service deliver.
2.3.3 Insufficient Aged Care Education and Training
Due to the traditional views on the nursing occupation, education and training are relatively limited, such as the knowledge on aged care. Thus, there is also lacking of aged care education organizations and qualified senior nurses with sufficient knowledge and skills related to aged care. Further, sufficient education and training on aged care is likely to cause communication misunderstanding between the nurses and the aged patients, so as to negatively affect the quality of care. Particularly, in a study conducted by Jacelon (2002) in the acute care setting, the aged patients regard drug administration and provision of direct care needs as the major responsibility of the nurses; while the nurses themselves regard health education and emotional support as their responsibility. This disparity of attitudes toward nursing responsibility will then cause problems during the aged care service delivery process.
3.0 Issues Associated with Aged Care Service Delivery
In the above sections, the current status of aged care in Australia has been presented, including the general situation of ageing population, and the health care demands of the aged people, as well as the care insurance system to aged care in the country, and the existing problems facing the Australian aged care. From this perspective, it can be indicated that aged care service delivery is a complicated process involving many aspects and issues. More specifically, there are economic, social, cultural and political issues associated with aged care service delivery.
3.1 Economic Issues
Economic issues are the primary influencing factor that has potential impacts on the aged care service delivery. Since the total population of aged people is increasing, it has been difficult for the government or society to afford the aged health care services for this increasing aged population (Access Economics, 2003; Productivity Commission, 2005). Economic status will to a great extent influence the aged care service delivery in a country. To be specific, if Australia is experiencing an economic downturn for a period, then its input into the health care service including the aged care service will be negatively impacted. Furthermore, the increasing burden on health care expenditure due to the increasing cost on aged care is a great economic issue facing the aged care service delivery in Australia.
3.2 Social Issues
The aged population as part of the total population in a society or community is a social issue itself, and the whole society is closely associated with the aged population since they are the elderly family members of other population in the society or community (Beadnell, 2006). Due to this, there are then social issues associated with the aged care service delivery in Australia. First, family members like children and other relatives are also a type of care providers for the aged people; however, in a highly developed country like Australia, the Australian people are often too busy working or with other pressure in their lives, so that they cannot take effective care of the aged people. Second, community care is a common type of care delivered to the aged people, which can also lead to social issue for the aged care. For example, how nursing home or communities for the elderly can be effectively established and managed is a great social issue for facilitating effective aged care service delivery.
3.3 Cultural Issues
Due to the diversified cultures existed in the world, there are different attitudes toward the aged population. For example, in some cultures, the aged people are regarded as burden on the economic development and the society; while in other cultures, the aged people are highly respected. Determined by these different attitudes, the aged care service delivery in different cultures can also be differing from each other. Moreover, the ways to caring the aged people are also differing in cultures. To be specific, in the eastern cultures, the aged people tend to be cared by their families, and it is considered cruel if the aged people are sent to nursing homes since their families like their children do not take care of them. However, in the western developed countries, it is common that the aged people are being cared in nursing homes or accepting community services as these aged people are more independent. Australia is a multicultural country, due to the migration of people from many other countries and regions with different cultural backgrounds. This cultural diversity determines that the aged care service delivery is also varying in these different cultural communities. From this perspective, how to offer effective aged care service in such cultural diversely communities becomes an important issue for the Australian people.
3.4 Political Issues
Political issues mainly refer to the policies and strategies adopted by the Australian government, concerning the health care service provision, which includes the aged care. In particular, the major political issue associated with the aged care in Australia is the issue of health care insurance. As it is know, Australia has adopted a national health care system the Medicare, aiming to provide health care service to all Australian citizens equally. However, health care is too expensive for individuals and even the government to afford. In this situation, the increasing health care costs has been a burden on the government’s health care expenditure, so the government has turned to other ways to facilitate the health care including the care for the aged people.
4.0 Future Directions for the Quality Care of Aged People
Based on the above problems and issues indicated, associated with the aged care service delivery, there are several implications for facilitating quality care of aged people in Australia in the future.
First, the government’s effort and input should be enhanced, paying sufficient attention to the health care needs of the aged people, because it accounts for a large proportion in the national population. From this perspective, the federal government and state governments in Australia should develop more effective policies and strategies for the aged care.
Second, the workforce for the aged care should be another focus for improving quality care of aged people in the future. From this perspective, the working condition for the care providers especially the nursing staff should be improved, so as to attract the nurses to work in this field; in addition, more effective education and training concerning the knowledge and skills of aged care should be developed for the nursing staff and other care providers.
Third, community care services should be put an emphasis since it can lead to more prompt services for the aged population. Generally, not all aged people are committed to hospitals for caring, and a larger proportion of aged people are lacking of abilities in activities of daily living, which require for relevant assistance rather than hospital services. Thus, community services should be promoted for better aged care service delivery.
This paper has focused on the heath care for the aged people and how their care needs are being addressed today and to the future. The current status has been particularly presented. Due to various reasons including increased longevity and low fertility rates, migration and technological advances and others, the aging of population has been a growing trend in Australia. Determined by the function decline, the increasing health care demands that can make a burden on the health care system of Australia. Moreover, it is indicated that the care insurance system in Australia, determined by its adoption of national health care system, as well as the support for the commercial insurance to share the financial burden. However, there are also various issues facing the aged care system in Australia, which mainly refer to the increasing health care needs and care difficulty and complexity, the shortage of care providers or nursing staff, and the insufficient aged care education and training. Furthermore, due to the many different aspects and issues involved in aged care, it has presented a complicated process of aged care service deliver. In particular, there are economic, social, cultural and political issues that may be associated with aged care service delivery in Australia. These different issues determined by economic, social, cultural and political factors can generate great impacts on the process of aged care service delivery. Based on this, the future directions for the quality care of aged people have also been discussed to focus on the government’s efforts; the development of effective workforce; and the community care services for aged people.
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