Australian Approaches to National Issues and Local Action: Improving the Quality of Life of Older People 1 Simon Biggs (1), Lindy Clemson (2), and Hal Kendig (2) 1. University of Melbourne and Brotherhood of St Laurence 2. University of Sydney and ARC Centre of Excellence in Population Ageing Research (CEPAR) Symposium ‘Developing Collaborations between central and local government to improve elders’ quality of life’ Convenors: Aaron Azulai, Ministry of Senior Citizens, Israel and Ariela Lowenstein. Haifa University, Israel International Federation on Ageing, Global Conference on Ageing, 28 May-1 June, 2012, Prague Czech Republic

Overview Australian Context and Health & Care Initiatives (Kendig) Falls Prevention: A National and State Priority (Clemson) Not for Profits: Brotherhood of St Laurence (Simon Biggs) 2

Australian Society in Context Modest population ageing so far (now 13% 65+) Highly urbanised with vast rural hinterlands a third born overseas (Europe early & Asia recently) Babyboom cohort entering later life Strong economy (s0 far) & high incomes (for most) Concern for fiscal costs of an ageing population (Intergenerational Reports) The financial crisis & ‘return to surplus’ Weak Labor coalition national government and Conservative state governments 3Kendig

Australia in Context (Government) Financial hegemony of national government Income taxes, income support, and grants to states State government delivery of health & welfare Local government weak (property services etc) Strong voluntary tradition in aged care Labor minority national government Conservative Coalition state governments Council of Australian Government (to ‘resolve’ tensions) Election due next year 4Kendig

The ‘Local’ in the Health Policy Reform Long term State government responsibility for co- funding and delivery of hospital and health services National government responsibility for Medicare (compulsory health insurance) Health System reform underway (we think)? Local Health Networks (co-funded) Medicare locals? How can we better integrate national and state in region? And what if the government changes? 5Kendig

The Local in Aged Care Policy Reform National responsible for all residential care and (recently) home and community care State governments (with their regions and health and community care responsibilities) vacating the field? Government has now accepted the Living Longer, Living Better aged care reforms Tipping the balance towards community care More equitable user pays Proposed ‘Gateway’ for regional integration Can national government deliver at a regional, integrated level? 6Kendig

Focus on restorative programs Government policy and funding initiatives Self management 2008 Prevention an outcome of national summit 2011 Productivity Commission Caring for Older Australians. Restorative programs as part of community care 2012 Living Longer-Living Better aged care reform package. Gateway to include ‘re-ablement’ and wellness programs 7Clemson

Falls prevention: a national and state priority Falls are a major cause of expensive hospitalization National implementation plans for falls prevention emerged in 2001 – not legislated, success depends on cooperation States – varied leadership, organization and support Committed ground-up fall prevention activities at local levels 8Clemson

Example of uptake of evidence- based program Stepping On program supported in US centrally, some states Australia at a state level Translation into practice- issues of sustainability and lessons learnt Different models of delivery, partnerships Developing network of support Planning for sustainability Service provision across traditional boundaries Education, capacity building 9Clemson

Not For Profits in Australia A bridge between civil society, State and federal Government. Religious, charitable and community groups 84% of Community care packages provided by not-for- profits The not-for-profit sector provides approximately 65% of the county‘s residential aged care services Simon Biggs University of Melbourne

Brotherhood of St Laurence Simon Biggs University of Melbourne

Mission Statement Our vision: an Australia free of poverty We work with others to create an Australia free of poverty for this and future generations: a fair, compassionate and just society where all can fully participate in social and economic life, create and share prosperity and treat each other with dignity and respect. Our mission is to research, develop and deliver innovative and high quality services, practices and policies to drive change that benefits all Australians. Simon Biggs University of Melbourne

Tensions around Power, Knowledge and Legitimation Research and Policy Analysis Campaigning and ‘Influencing’ Agendas Financial dependence on Government Government dependence on Supply Government regulation of numbers of licensed places Legitimation through Consultations Simon Biggs University of Melbourne