WHOLE OF GOVERNMENT AGEING STRATEGY

Ideas pack

September 2011

Overview

1 Whataretheopportunitiesassociatedwithpopulationageing?

2 Whatispositiveageing?

3 Whatareolderpeople’sviewsonpositiveageing?

4 Whattypesofstrategiesareeffectiveinsupportingpositiveageing?

5 Whoisresponsibleforstrategiestosupportpositiveageing?Howdoweengageasbroadlyaspossibletosupportpositiveageing?

6 Whataretheunderpinningprinciplesoftheinternationalframeworksonageing?

7 Whatarethecharacteristicsoftheageingstrategiesinplaceinotherjurisdictions?

8 Whatotherissuesshouldbeconsidered?

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1Whataretheopportunitiesassociatedwithpopulationageing?

Declinesinfertilityandincreasesinlongevitywillincreasetheproportionofolderpeopleinthepopulation.InNSWtheproportionofthepopulationover65isprojectedtoincreasefrom13.8%in2006to22%in2031and26.3%in2051.

Atpresent,thevastmajorityoftheseindividualsliveindependentlyinthecommunitywithnoformalsupportservices.Nearlythreequarters(74%)ofthoseover65willinprivatedwellings,includingthosewhoareover85years.

Opportunities presented by the growing older population

Labour force participation

■ Theproportionofthoseoftraditionalworkingagewillfall,withsignificantimpactsoneconomicgrowth.TheAustralianTreasury’sTowards2050IntergenerationalReporthasidentifiedthattheannualaveragegrowthinrealGDPof3.3%p.a.overthelast40yearswillslowto2.7%p.a.overthenext40years,withpopulationageingasthemajordriverofthischange.

■ Participationoftheolderpopulationintheworkforcewillbecomemoreimportant.Howeveratpresent,Australia’s‘matureage’participationinthelabourmarketisbelowthatofmanyothercomparablejurisdictions,includingtheUS,NewZealand,theUKandCanada.

■ Olderpeoplearemakingasignificantsocialandeconomiccontributiontothecommunitythroughtheunpaidworkforce.Participationinvolunteeractivitiesorcaringrolescanplayapartinchangingtheimpactonthegovernment.

What are the challenges and opportunities associated with population ageing?

Health and support services

■ Peoplearenowlivinglonger,howevertheyarelivinglongerwiththepresenceofdisease.Demandforhealthservices,aswellasothersupportservicesandage-relatedpayments,willinturnincreaseaspeoplereachthelatterstagesoflife.

■ Thecostsoftheseservices,particularlyhealthservices,ispredictedtoincrease.Thispricerisewillbedrivenbythedemandfornewtechnologiesaswellasgrowingexpectationsaboutreceivinghighqualitycare.

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Geographic location

■ Thenextgenerationofolderpeoplearepredictedtoliveindifferentareastothecurrentgenerationofolderpeople–mostlikelyinthelowdensityoutersuburbsorouterregionalareas.Forexample,theSLAswiththehighestproportionofpeopleaged65yearsandoverareestimatedtobeGreatLakes(38.4%),HastingsandEurobodalla(37%)andBombala(37.3%).

■ Thenextgenerationofolderpeoplearealsoexpectedtoliveagreaterdistanceawayfromtheirchildrenthanpreviousgenerations.Inturn,olderpeoplearepotentiallylikelytobemorerelativelyisolatedfromcommunityandfamilysupportsastheyage.

Transport

■ Transportneedschangeaspeopleage.

Forexample,manypeoplemaystopdriving,becomingincreasinglydependentonpublictransport.Thiscanbeproblematicwhengrowingnumbersofpeoplearelivinginoutersuburbswhichdonottraditionallyhaveeffectivepublictransportconnections.Olderpeopleoftencommuteoutsidepeakhours,thusrequiringservicesatdifferenttimesofthedaytothemajorityofthepopulation.

■ Transportoptionshoweverareveryimportantforolderpeople.Travelgivespeople

–accesstoplacesandservices

–opportunityforphysicalactivity

–psychologicalbenefitsofsocialandcommunityparticipation.

Urban planning

■ Olderpeoplebecomemoredependentontheircommunity–thuslocalcommunitiesmustbecomemore‘liveable’tosupporttheolderpersontoliveasindependentlyaspossible.

Thisbenefitstheolderperson,whoretainstheirautonomy,andbenefitsthecommunity,throughlesseningtheneedtoprovidesupportiveservices.

■ Therearearangeoffeaturesofacommunitywhichpromoteitsliveability.Theseinclude:

–proximitytobasicamenities(e.g.medicalcare,grocerystores)

–transportlinksbetweenhousingandbasicamenities

–personalsafety

–appropriatehousing

–featureswhichpromotesafeandeasyaccessinpublicspaces(e.g.safeandwelllitfootpaths,theprovisionoframps).

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Diversity

■ ‘Olderpeople’areadiversegroupandmustberecognisedassuch–theypresentthefullbreadthofdiverseneedsandpreferencesfoundinanypopulationsegment.

■ Characteristicssuchasage(‘young’oldand‘old’old),gender,sexuality,ethnicity,socialclass,wealth,localityandhealthwillallleadtodifferingneedsandaspirationswhichshouldbeconsideredwhendevelopingpolicyordeliveringservices.

■ Flexibilitywillbeacriticalelementinthinkingaboutfuturestrategiestosupportolderpeople.

Discussion questions

Doyouagreethatthechallengespresentedinrelationtopopulationageingarethekeypolicyissues?

Arethereotherkeypolicy/populationchallengesthatneedtobeconsidered?

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2Whatispositiveageing?

Biomedical models

■ Positiveageingisoptimisationoflifeexpectancywhilstminimisingphysicalandmentaldeterioration

■ Focusesonabsenceofdisease,orriskfactorsfordisease

■ Limitedascategorisespeopleinto‘disease’and‘notdiseased’states,whichdoesnotallowforeffectivefunctioningof‘diseased’people

Psychosocial models

■ Positiveageingisassociatedwithlifesatisfaction,socialparticipationandpersonalgrowth

■ Considershowlowdiseasestatesandhighcognitivefunctioningcaninterplaywithactiveengagementinlife

■ Resourcesforpositiveageingareconsideredtoincludeapositiveoutlook,senseofworth,senseofcontroloverlife,independenceandeffectivecopingstrategiesinthefaceofchangingcircumstances(e.g.illhealth)

Low probability of disease and disease-related

disability

High cognitive and physical and

functional capacity

Active engagement

in life

Rowe & Khan (1997) The new gerontology

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Positive ageing definitions – theoretical views

Consideringbothpsychosocialandbiomedicalviews,themainelementsofpositiveageingare:

■ lifeexpectancy

■ goodcognitivefunctionandmentalhealth

■ lifesatisfactionandwellbeing

■ personalgrowthandlearningnewthings

■ psychosocialresources–e.g.perceivedautonomy,control,independence,adaptability,coping,selfesteem,positiveoutlook,goals&senseofself

■ socialandcommunityintegrationandparticipation

■ strongsocialnetworks.

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3Whatareolderpeople’sviewsonpositiveageing?

ResultsfrombothsurveysandfocusgroupsinvolvingolderadultsfromAustralia,theUS,theUKandHongKongsuggestaconsistentsetofattributeswereperceivedasimportantforsuccessfulageing.

Theseincluded:

■ goodphysicalandcognitivehealth

■ socialparticipation

■ socialandfamilynetworksandsupport

■ independence

■ adaptability

■ financialsecurity

■ personalsafety.

Differences between self-perceptions and assessment against theoretical principles

■ Severalstudiesidentifiedthatthereisadifferencebetweenolderpersons’viewsabouttheirdegreeofsuccessinageingandhowtheirsuccesswouldberatedifmeasuredbypre-setcriteria.

■ Thatis,respondentsratedthemselvesasageingsuccessfully,whentheassessmentagainstthesetcriteriadidnot.

■ InoneUSstudyitwashypothesisedoneofthecontributingfactorstothisdiscrepancywastheimpactofchronicconditions–i.e.thiswouldprecludeapositiveratingonsomecriteriabasedassessments,howeverolderpeoplemaynothaveperceivedthechronicdiseasetoprecludethemageingsuccessfully.

■ Thismayindicatethatolderpeopleagreethathealthisimportant,butadeclineintheirhealthmaynotpreventsuccessfulageing.

Discussion questions

Doyouagreethatthekeyattributesidentifiedarethosethatmostinfluencepositiveageing?

Hasyourexperiencewitholderpeopleidentifiedotherimportantattributes?Ifsowhatarethey?

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4Whattypesofstrategiesareeffectiveinsupportingpositiveageing?

Specific interventions

Work

■ Workingorvolunteeringbeyondthecurrentretirementagehaspositivebenefitsonmentalhealth.

■ PositiveoutcomesnotedinbothUSandAustralianpopulations.

■ Benefitsextendnotonlytotheolderpersonbutalsototheemployer:olderpeoplehavehighlevelsofloyalty,motivation,abilitytomentor,apositiveattitudeandastrongworkethic.

■ Matureagedworkershavegreatercapacitythanpreviousgenerationstoworkbeyondretirementageastheyarehealthierandcomparativelybettereducated.Finnishstudiesestimatethatby2016over80%ofthelabourmarketgrowthwillcomefrompeopleovertheageof45(inFinland).

■ Challengesinclude:managingdemand–demandforolderworkersdependsontheirproductivityrelativetolabourcost

changingindustriesandworkpracticesrequiringachangingskillbase.

■ Interventionstosupportcareercounselling,skillsdevelopment,andculturechange(minimisingageism)areposedaspotentiallyeffective(butlittleevidencetoempiricallysupportthem).

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Specific interventions (2)

Social participation

■ Identifiedasimportantbyresearchersandolderpeople.

■ Keyelementssupportingsocialparticipationinclude:

–mobility(physical)

–accesstocommunitygroupactivities

–accesstotransportnetworks(manyolderpeoplestopdriving).

Preparedness for retirement

■ Retirementplanningprogramsarebecomingincreasinglycommon.

■ Intendtoaddressissuesofpartiallossofidentity,fearofentryinto‘oldage’andeconomicconcernswhichmayfacilitatedepressionandsocialwithdrawal.

■ Noclearevidenceofeffectivenessnoted.

Specific interventions (3)

Promoting mobility

■ Physicalmobility,goodhealthandpositiveageingareidentifiedasimportantbypositiveageingacademicsandolderpeople.

■ AnacademicreviewoftheNationalPhysicalActivityPlansofsixdevelopedcountriesrevealedthatthereisminimalornospecificfocusonolderadults.

Liveable communities

■ Clearacknowledgementthatinordertomaintaingoodphysicalhealthandsocialparticipationfactorssuchasadequatefootpathsandcrossings,goodpublictransportcoverageandintegration,accessibilitytosupermarkets,pharmaciesandhealthcarefacilities,highpersonalsecurityandaccesstocommunitysupportservicesarekey.

■ AreviewoflocalgovernmentandregionalstrategiesacrossAustraliaidentifiestheseareasareconsistentlyincluded.

■ Noreportsevaluatingtheeffectivenessoftheselocalstrategies.

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Specific interventions (4)

Income support

■ Interventionsaimtoallowolderpeopletomaintaintheirindependence,despitelivingonalimited(usuallyfixed)income

■ Interventionsareusuallymeanstested,andincludethosewhich:

–increaseincome,forexamplefull/partpensions,rentassistance,homeequityconversionloans

–reducethecostsofliving,forexampleconcessionsonutilitiesorpublictransport,orsubsidiesonpharmaceuticalsandotherhealthcarecosts.

Appropriate housing

■ Healthandwell-beingofolderpeoplecanbenegativelyimpactedbyhousingcharacteristicssuchastheabilitytoheatproperlyinwinter,theabilitytonavigateduetostairsorpoorlayout,andtheproximitytopublicamenities

■ Interventionshavedemonstratedthatolderpeoplelivinginaccessiblehomescanhavebetterwell-beingandlowerratesofdepressionthanthoselivinginhomeswithaccessibilityproblems.

Specific interventions (5)

Access to information

■ Olderpeoplefacechallengesinaccessinginformation–partlyduetoreductionsinphysicalmobility,declinesinvisualandhearingfunction,andchangesinthemediumsthroughwhichinformationisavailable(e.g.themovefrompaperbasedinformationtotheinternet).

■ Interventionstosupportolderpeoplehaveincluded:

–provisionofinformationthrougharangeofmeans(e.g.availabilityofaccessibleformats,materialsinlanguagesotherthanEnglish,orensuringthatthereisfacetofaceortelephoneassistance)

–targetedtraining–e.g.howtousetheinternetorotheronlineinformationsources

–provisionofadaptivetechnologies–e.g.voiceoutputorscreenenlargementcapabilities.

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Integrated positive ageing programsVeryfewevaluationsoftheeffectivenessofpositiveageingprogramsexistinAustraliaandinternationally.Supportive Community program – Israel

■ Runningfor20years,reaching20,000people>65yearsin120communities.

■ Memberspayasmallmonthlyfeewithlowincomemembersreceivingasignificantsubsidy.

■ Servicesprovidedinclude:–Medicalservices(includingGPhousecallsandfreeambulance)

–Emergencycallswitchboard

–Fulltimeneighbourhoodfacilitatortocheckonthewellbeingofmembersandassistwithhouseholdrepairsandmaintenance

–Socialactivities–e.g.lectures,courses,excursions.

■ Evaluationrevealedthat:–80%ofparticipantsarehappywiththeprogram

–Benefitsincludefeelingofincreasedpersonalsecurityandindependence,andenhancedconfidencetoremainathome.

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5Whoisresponsibleforstrategiestosupportpositiveageing?Howdoweengageasbroadlyaspossibletosupportpositiveageing?

Responsibilities sit at multiple levels■ Rowe&Khanplaceresponsibilityattheindividuallevel

“olderpeoplewhoarepreventedfromhelpingthemselvestendtowardsastateoflearnedhelplessness”.

■ However,inequalities(e.g.socio-economicfactors,disabilities,andexperiencesofexclusionbasedonrace,genderandclass)willlimittheindividual’sabilitytopromotetheirownpositiveageing.

■ TheMadridInternationalPlanofActiononAgeing(MIPAA)identifiesthatcoordinatednationalandlocalpoliciesinwelfare,healthandeconomicareasareessentialinensuringthatthegoalofhavinganactiveolderpopulationismet.Thusthereareresponsibilitiesforlocalcommunitiesandastate/nationallevel.

Discussion questions

Aretheinterventionsidentifiedintheresearchthekeyareasoffocus?Ifnot,whatelseneedstobeconsidered?

Doyouagreethattheresponsibilityforpositiveageingsitsatmultiplelevels?

Doyouhaveanycommentsorsuggestionsinrelationtotheresponsibilityformanaginginterventionstosupportpositiveageing?

Aretherewaystoenlistthegeneralpopulationtosupportpositiveageingasasociallyvaluedconcept?

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6Whataretheunderpinningprinciplesofinternationalframeworks?

UN Principles for Older Persons (1991)■ Outlines18principleswhichshouldbeincorporatedintonationalprograms.

■ Non-binding,butAustraliaisamember.

■ Principlesfocusonpromotingtheoutcomesof:

–independence

–participation

–care

–self-fulfilment

–dignity.

WHO Active Ageing Policy Framework (2002)■ Providesapolicyframeworkandconcretesuggestionsforpolicyproposals.

■ Intendedtobeusedtoguidespecificactionatregional,nationalandlocallevels.

■ BasedontheUNPrinciplesforOlderpersons.

■ Requiresactionsonthreebasicpillars:

–health

–participation

–security.

Madrid International Plan of Action on Ageing & Political Declaration (2002)■ UnderpinnedbyUNPrinciplesforOlderPersons-Australiaisasignatory.

■ Intendedtoassistpolicymakerstofocusonprioritiesforindividualandpopulationageing:

–olderpersons&development

–advancinghealthandwellbeing

–enabling&supportiveenvironments.

■ Recommends:

–mainstreamingofolderpersonsconcernsintoallpolicy–making

–holisticinter-generationallife-courseapproachfocussingonequityandinclusivenessforallagegroups.

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7Whatarethecharacteristicsofageingstrategiesinotherjurisdictions?

Strategies reviewed■ Fourinternational

–UK

–Canada

–NewZealand

–Sweden

■ AllAustralianJurisdictions

Definitions

What is positive ageing?

■ Anumberofdifferenttermswereused–e.g.positiveageing,healthyageing

■ Conceptshowever,wereconsistent–toenhancequalityoflifebyprovidingopportunitiesforimprovingandpreservingphysicalandmentalhealth,independence,participationandsecurity

Who are older people?

■ Differedbetweenstrategies–thoseabove50,thoseabove55,thoseabove60andthoseabove65

■ Somestrategiesemphasisedthatchronologicalagedoesnotdeterminequalityoflife.TheWHOActiveAgeingPolicyFrameworkstatesthat

It is important to acknowledge that chronological age is not a precise marker for the changes that accompany ageing. There are dramatic variations in health status, participation and levels of independence among older people for the same age. Decision–makers need to take this into account when designing policy and programs for their ‘older’ populations. Enacting broad social policies based on chronological age alone can be discriminatory and counterproductive to well-being in older age.

■ ThismaybeimportantintheAustraliancontextwheretheaveragelifeexpectancyfortheIndigenouspopulationis10yearsbelowthatofthenon-Indigenouspopulation.

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Strategy focus areasTherewereaconsistentsetoffocusareasidentifiedinthestrategiesreviewed.Theseincluded:

Issue* Description

Inclusion Olderpeopleplayanactiveroleinsociety.Theyhavegoodsocialnetworksandopportunitiestoparticipateinthecommunity

PositiveAttitude Olderpeoplearetobetreatedwithrespect.Ageismiseliminated

Health Promotionofgoodhealththroughhealthylifestyles,accesstoequitableandtimelyhealthcare

Transport&Access Affordableandaccessibletransportoptionsandanaccessiblecommunity

Housing Affordableandappropriatehousingoptions

Income Astableandadequateincometoassistageinginapositiveway.Thechoicetocontinueacareerorchooseanewoptiontobetteraddresstheirchangingneeds.

Safety Olderpeoplefeelingsafeandsecureintheirownhomeandcommunity

Diversity Recognitionofdiversityandflexibilityofservicestorespondtothisdiversity

Independence Focusingonsupportingindependenceandempoweringolderpeople

Supportservices Particularlythoseserviceswhichenableolderpeopletoremainlivingindependently

Information Toenableolderpeopletomakeinformedchoicesandbeincludedindecisionmaking

*Notesomeissuescanbeconsideredsubsetsofothers

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Strategy focus areas (2)Thereisareasonablelevelofconsistencybetweenissuesidentifiedasimportantforpositiveageingaspresentedbyolderpeople,researchers,jurisdictions’strategiesandtheUNprinciples

Issue* UN principles

Older people’s views

Theorists Jurisdictions’ strategies

Independence■adaptability■appropriateinformation

x x x x

Selffulfilment&positiveattitude

x x x

Dignity/diversity x x

Health■physical■cognitive

x x x x

Safety&Security■personal■financial

x x x

Care&Support x x

Socialinclusion■communityparticipation■strongsocialnetworks

x x x x

Access&Transportation*

x

Housing* x

Employment(inclunpaid)*

x

*notethataccess/transportation,housingandemploymentcouldbeconsideredmechanismstoachieveoutcomeslistedabovebutarehighlightedastheyformasignificantfocusofmanyjurisdictions’strategies

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Discussion questions

Aretherekeyfocusareasusedinageingstrategieswhichhavenotbeenconsidered?

Ifso,whatarethey?

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8Whatotherissuesshouldbeconsidered?

Towards 2030 – Key issuesLaunched2008followingtheRoundtableAgeing2030:Creatingthefuture.Thestrategyfocussedonplanningandadaptingtothechangingpopulation.

Whatworkedwell:

■ somegoodprojectshaveresulted–e.g.Planningforlaterlife,worktopromoteliveablecommunities.Muchofthestrategy’sfocuswasinareasalignedwithinternationalframeworks(e.g.MIPAA)

■ theinterdepartmentalworkinggroup,withgenerallyappropriaterepresentation.DPCwastheleadagencywhohadeffectivelevelsofauthority,supportedbysubjectmatterexpertiseoftheOfficeforAgeing.

■ engagementlevelofsmalleragencieswasgenerallythemostsuccessful,oftentakingamorecollaborativeapproach

Challengesincluded:

■ therewerenoadditionalresourcesmadeavailabletoimplementthestrategy’s119actionsover5years.Someagenciesonlycommittedtoworktheyhadalreadyintendedtocomplete

■ thereportingframework/performanceindicatorswerenotdevelopeduntilafterthestrategy’slaunch

■ nospecifiedagreementabouthowandwhenorganisationsoutsidegovernmentwouldbeengaged

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Key federal emerging issues and reforms

Area Issue / Reform

Health&disability

Productivity Commission Report – National Disability Insurance Scheme (NDIS) (2010/11)

■ ArecommendationoftheProductivityCommission,thisschemeadvisesthatpeopleshouldhavetheoptionofmigratingtothesupportsystemthatbestmeetstheirneeds,carryingwiththemtheirfundingentitlement

The National Health Reforms (2011)

■ Underthesereforms,newfundingarrangementsforpublichospitalshavebeenestablished,anewgovernanceandmanagementsystemistobeimplementedintheformofmedicallocalsandlocalhospitalnetworks,andtheAustralianGovernmenthastakenresponsibilityforagedcareservicesunderthenationalagedcaresystem,includingtheHomeandCommunityCareprogram.

Housing Productivity Commission Report - Caring for Older Australians (2011)

■ ThisreportrecommendsthattheAustralian,stateandterritorygovernmentsshoulddevelopacoordinatedandintegratednationalpolicyapproachtotheprovisionofhomemaintenanceandmodificationservices,withanominatedleadagencyineachjurisdiction.Furtheritrecommendsthattosupportthisnationalapproach,allgovernmentsshoulddevelopbenchmarksforthelevelsofservicestobeprovided,termsofeligibilityandco-contributions,andthedevelopmentofprofessionalandtechnicalexpertise

Workforce Federal 2011-12 Budget – Building Australia’s Future Workforce

■ Thiscommittedtoassessandformallyrecognisetheskillsof7500workersaged50yearsandoverwithtraderelevantskillsbutnoformalqualifications.

Pensions Secure and sustainable pension reform (2009)

■ Thisincreasedpaymentforpensions,increasedthebenchmarkedratetowages(thusincreasingtheincentivetoparticipateinpart-timework),aswellasincreasetheagedpensionagefrom65to67

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Key federal emerging issues and reforms (2)

Area Issue / Reform

Agedcare Productivity Commission Report - Caring for Older Australians (2011)

■ TheProductivityCommissionrecommendsaseriesofinitiativesaimingtopromoteindependence,connectednessandchoice.Recommendationsincludeolderpeoplebeingableto:

–contactasimplified‘gateway’ataregionallevelwhichprovides:easilyunderstoodinformation,assessmentsofcareneedsandfinancialcapacitytomakeco-contributions,entitlementstoapprovedservicesandcarecoordination

–receiveaflexiblerangeofcareandsupportservicesthatmeettheirindividualneedsandthatemphasise,wherepossible,restorativecareandrehabilitation

–choosewhereappropriate,toreceivecareathomeorinaresidentialfacilityandchoosetheirapprovedprovider

–contributeinparttotheircostofcare(withamaximumlifetimelimit)andmeettheiraccommodationandlivingexpenses(withsafetynetsforthosewithlimitedmeans)

–haveaccesstoagovernmentsponsoredequityreleaseschemetopayfortheircareandaccommodationchargesiftheyhaveassetsbutlimitedannualincomes.

Discussion questions

ArethereotherkeylearningsweshouldtakefromtheTowards2030strategy?Ifso,whatarethey?

ArethereotherkeyAustralianGovernmentreformsthatneedtobeconsidered?

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