Aged care is a bit like the proverbial iceberg - the visible part above water gets all the attention, writes Michael Fine.
The Productivity Commission submitted their final report Caring for Older Australians to the Assistant Treasurer on June 28. The government is required to table the report in parliament within 25 sitting days of receiving it. For those in the know, the wait is on.
We don't know exactly what is in the report but can be confident that the emphasis will be on the paid and formal part of the aged care system. How will the services Australia will need in the future be paid for? How will they be organised? What will happen to our jobs and our careers?
Aged care is a bit like the proverbial iceberg - the visible part above water gets all the attention. All those services and proprietors groups struggling to be heard make sure this is the case. But like the unseen seven eighths of the iceberg under water that keeps the visible bit afloat, so too is aged care sustained by an invisible and unpaid workforce: the family carers and alongside them, the volunteers. While we wait for the PC's report and the government's response, it is a good time to think again about their future.
Thinking anew about carers and caring was a big part of a conference in which I recently took part, held in Toronto, Canada. It was set up, ambitiously, as the Festival of International Conferences on Care, Ageing, Disability and Technology (FICCDAT), bringing together speakers from across the world and from our different specialities with the aim of cross-fertilising each of the separate fields and stimulating new ways of thinking about the issues we face daily and have come to understand as obstacles. For those that are prepared to open their minds, there were lots of lessons to be learnt.
One of the most important is about the link between paid and unpaid care. In Australia, we already know that we can't think of them as alternatives. We need to think of them together, how they support each other and how they can work together. A message I carried home concerns what we might consider our rights to care. To make sure that those who need care, as well as those who give it are treated inclusively, we need to find solutions that ensure that we will have the right to receive appropriate and expert care when we need it. We must also be able to assume the responsibility to give care when we seek to do so. And we must also have the opportunities and ability to care for ourselves and to take charge of our own lives as far as possible, at all times.
But I also brought home new questions. If we should all think of ourselves as carers with the rights to give care when it is needed (I'm speaking to the Aussie blokes here, not just the women) what about the responsibilities of those who receive care? Does someone in need of support have a right to refuse services? Who should decide in such cases anyway? This philosophical and ethical question was raised by the NY philosopher Eva Kittay at the beginning of the conference. If our refusal to accept help has consequences for others, she argued, surely we must accept that we have a responsibility to accept the help that is offered.
Demographers have long pointed out the coming shortage of family carers: Where will carers come from in a time when low birthrates mean there are far few adult children in any family? When divorce and family breakup have become more prevalent? Will the 'ex' take on the duties? How about the step-children or our close friends? This is no longer an issue to be faced in the future. It's already with us today. New research in the UK and elsewhere seems to show that, surprisingly, these larger networks of family and friends are stepping-in in many cases. Will the same thing happen here? And if we see them, will that be as carers or volunteers?
There are new questions about technology, too. So far care seems to be delivered almost exclusively in-person, but might new inventions change this? To date, much of the emphasis seems to be on the development of Assistive Technology (AT) for people with disabilities, but we too have to ask how such innovation might help us in aged care. One of the most immediate changes I think we're likely to experience is the impact of social networking software as an organizing tool for carers, services and those who depend on them. This has already taken off in the resource starved world of disability support in North America. How long will it be before we take it up here as well?
Altogether, thinking about care and carers is enough to make you wonder whether the PC report will still matter in another 25 sitting days.
Associate Professor Michael Fine is head of the Department of Sociology and deputy director, Centre for Research on Social Inclusion, Macquarie University
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