Canberra’s first independent dementia home is just months away from opening but owner Rodney Jilek is already thinking about replicating the idea elsewhere.
The not-for-profit cottage-style residential aged care option will accommodate up to six “guests” at a time. There will be a house manager, two carers and a registered nurse. It will operate alongside a day therapy centre for people living with dementia.
Jilek, an aged care consultant with 30 years’ experience in the sector, is privately funding the project through his own business (along with a fundraising drive through his registered charity Community Home Australia), which he hopes will become a blueprint for the delivery of dementia care.
While it will have unique characteristics, including a high use of technology and a focus on normalising residential care with outings and connections to the broader community, it is a household model successfully used in disability care and one repeatedly referred to in submissions to the Royal Commission into Aged Care Quality and Safety, which is due to hand its final report to the government on February 26.
Kambera House will operate outside the Aged Care Act, which Jilek says is too restrictive to provide proper consumer-driven or directed care. Pitched at self-funded retirees or older people receiving funding through the National Disability Insurance Scheme, care and accommodation will be provided on a fee-for-service basis.
His biggest challenge, he says, will be to make it work at scale and as a sustainable project to help more people.
Taking an existing model and adapting it to a much more acceptable and successful form of care delivery for older Australians is front of mind for a number of critical thinkers and concerned citizens.
LDK Healthcare’s adaptation of the retirement village model into a “one-move promise” is an example.
Another seemingly obvious business model for the delivery of aged care in the form of member-led mutual organisations dates back more than 200 years. Yet there is only one major co-operative mutual enterprise (CME) in the aged care sector: Australian Unity, a friendly society that offers residential and home-care services.
CMEs active in other parts of aged care include housing and support services such as Meals on Wheels in NSW, primary healthcare, transport and a number of indigenous co-operatives in several sectors, including aged care.
Business Council of Co-operatives and Mutuals (BCCM) chief executive Melina Morrison believes member-owned organisations are a perfect match for those who need aged care services and those who provide it.
By their nature, mutuals are about people with a shared need. In aged care, it is generally either individuals wanting care delivered tailored to their needs, or workers dissatisfied with current approaches to care coming together to do something collaboratively and provide a mechanism to meet everyone’s needs.
Many of us are familiar with the demutualisation of once democratically engaged organisations like AMP or National Mutual, but Morrison says – beyond cultural change – there is little stopping some of the existing aged care providers from restructuring to become mutuals and giving members the vote on how they want to be cared for, the conditions they want to work under and the care they want to deliver.
Recent changes to the Corporations Act that define a mutual and support new provisions for capital raising removed a key impediment for larger mutuals to invest in aged care.
Australians have for years embraced the collective ownership concept. Eight in 10 are now members of at least one of the more than 2000 co-operative or mutual business ranging from superannuation and banks to food growers.
The Co-operative Life is one such business. It was founded in 2013 by two contractors working in the disability and aged care sectors delivering what they perceived as sub-standard care with poor working conditions and low wages.
‘People were falling through the gaps.’
— Robyn Kaczmarek, The C-operative Life
Writes founder and co-owner Robyn Kaczmarek on her website: “I was shocked at the quality of care provided by agencies. People were falling through the gaps and there wasn’t enough service or continuity of staff for people to be getting good care. People weren’t in the office, so they didn’t complain.”
The Co-operative Life, which has 30 members, believes that engaged employee-owners deliver a higher quality of care and support than traditional forms of home care service providers.
The BCCM is arguing its case for the co-operative and mutual model to be seriously considered as a viable option for the users of services and the people delivering them, particularly for a more satisfactory level of aged care.
Its recent report, Action to Empower, is a call to action to demonstrate how targeted policy measures focused on enabling different forms of ownership can increase diversity and choice in social services in Australia, with positive outcomes for the quality and productivity of those services.
After the introduction of Britain’s Mutuals Support Program in 2009 as part of a big government initiative to increase the delivery of public services in Britain, social care is successfully delivered by more than 100 employee and/or consumer-owned organisations.
A 2018 report found that 92 per cent of British social care co-operatives made a profit in the most recent financial year. Other benefits were faster and easier decision-making than when part of the public sector; a happier, better trained and more engaged workforce; and a higher level of innovation through the development of new products and services.
Ageing with agency
Ageing is a problem we all share, but until we start to have some diversity in models for care delivery, says Morrison, the pathways to ageing with agency is limited.
If there is one thing most of us know – and the royal commission has articulated this in its interim report – the design, objectives, regulation and funding of aged care in Australia needs a fundamental overhaul.
Hopefully, the drive for further regulation reform will bring about essential and long-term change, including funding for some of the previously planned and tried innovative approaches to supporting older people in need of home or residential care.
Regardless of government response to the recommendations of the royal commission, there is a groundswell of change and innovation across the sector.