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The question of equivalence: aged care or the NDIS for those over the age of 65


The legislation to establish the National Disability Insurance Scheme (NDIS) is due to be debated in Parliament this week. Under the legislation, people with a disability aged under 65 will be able to apply to receive NDIS supports but those aged over 65 will not. NDIS participants who turn 65 will have a choice about whether to remain in the NDIS or switch to the aged care sector. However, once NDIS participants over the age of 65 enter the aged care system (either residential care or home support), they will be unable to access the NDIS. This assumes a degree of equivalence between supports available for people with a disability in the aged care system and those that would be provided under the NDIS.

However, the available evidence raises questions about the capacity of some aspects of the aged care system to meet the needs of older people with a disability. Residential aged care services are considered to provide good health care for people with intellectual disability but are often limited in their capacity to provide social support. A survey of people with intellectual disabilities living in residential aged care in facilities in Victoria found that older people with an intellectual disability had difficulties fitting in with the resident community, participation in group activities was limited and they rarely formed meaningful relationships. This would suggest that residential aged care might not be the most appropriate form of care for this group, particularly if access to disability support services are denied or restricted. In the same survey, aged care providers noted the challenges of providing appropriate social support but indicated that these could be overcome by working with specialist disability services.

The Council of Australian Governments (COAG) has previously funded a five year program to reduce the number of people under the age of 50 with a disability living in residential aged care and also provide support services to people aged 50-64 years with a disability either in the community or residential aged care. The evaluation highlighted that the majority of participants were high users of support services such as community access, therapy support for individuals and recreation/holiday programs. This perhaps indicates that community and social supports may not be readily accessible in residential aged care which is likely to be in contrast with what is offered through the NDIS. Given that NDIS participants over the age of 65 who enter residential aged care will no longer be eligible for disability support services, this is likely to be of importance.

Many people with an intellectual disability participate in day support or employment programs. Continued participation is likely to be important, if not critical, for those who chose to enter residential aged care. Additional supports such as accessible transport, upgrades to facilities and extra, appropriately trained staff to facilitate participation may be required. How this will be facilitated, and funded, is not yet known. It has previously been recommended that specialist disability services adopt a brokering role for older client to facilitate access. This is not dissimilar to what has been proposed by the NDIS, where participants have the option of using a disability service provider to navigate the system.

Meeting the needs of people with a disability is likely to pose a challenge to residential aged care providers. And it is not clear if the care provided in residential aged care will be comparable to what is provided by the NDIS, and what assistance individuals will receive when making this assessment. This is likely to vary on an individual basis and by locality, raising questions about equity of access and whether a ‘real’ choice can be made.This is important from the point of view of equity, given that people with a disability aged over 65 will not be able to apply to participate in the NDIS. It may also be important because for some NDIS participants who turn 65, the better option (at least in the short term) may be to remain with the NDIS.

A number of issues in the aged care sector will require resolution if some equivalence of care is to be achieved between the two systems. Funding arrangements are also likely to be contentious. Historically, government funding per capita in the disability sector has been higher than aged care with implications for service provision. Despite this claim, others have argued that age-related disability programs are ‘mile(s) ahead’ of disability programs.

Accommodation, and the support services available in that context, is likely to be a key consideration for NDIS participants. Appropriate services with trained staff are also likely to be important. Evidence suggests that older people with an intellectual disability do not need the level of nursing care provided by the residential aged care sector, raising questions about how this group can ‘age in place’. Both the NDIS and aged care sector offer a level of care but how the NDIS and/or the aged care sector enable people to design a package of services that best meets their needs is likely to be the issue of greatest concern to participants. Yet for people aged over 65 who are not eligible for the NDIS, it would appear that their choices are somewhat limited.

Further information:

The Parliamentary Library will publish a Bills Digest on the NDIS later this week. It will be available here.

The author would like thank Luke Buckmaster for his valuable input to this post.