Not all apartment amenities are immediately visible.

Swimming pools, gyms, rooftop terraces and residents' lounges have long featured on buyers' wishlists, but as the way Australians live has changed, so too have the features that make apartment living more convenient.

Increasingly, buyers are placing value on the practical aspects of day-to-day life. Fast internet, EV charging, secure bike storage, flexible workspaces and parcel management are becoming just as relevant as lifestyle amenities, reflecting changing habits and expectations.

Online shopping has been one of the biggest drivers of that shift.

Australians spent a record $82.6 billion shopping online in 2025, with almost one in every four retail dollars now spent digitally, making parcel deliveries a routine part of everyday life rather than an occasional convenience.

For apartment residents, however, receiving those deliveries isn't always straightforward.

Without someone home to accept a parcel, deliveries can be redirected to a nearby Post Office, left in building foyers or common areas, or require building management to temporarily store packages. As apartment living continues to grow across Australia's cities, parcel management has become an increasingly important consideration for both residents and developers.

Australia Post's Parcel Locker network is one response to that shift.

<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" referrerpolicy="strict-origin-when-cross-origin" src="https://www.youtube.com/embed/KPZ9j5FRdsQ?si=Qztc1dNP3ZvEIUhb" title="YouTube video player" width="560"></iframe>

Rather than relying on home delivery, eligible parcels can be directed to a nominated Parcel Locker, where they're securely stored until collected. Once a parcel arrives, residents receive a notification through the AusPost app or SMS and can retrieve it using a one-time code or QR code at a time that suits them.

The network has expanded to more than 1,500 locations nationwide, with Parcel Lockers positioned at Post Offices, shopping centres, supermarkets, transport hubs and, increasingly, within or alongside residential developments.

That growing presence reflects a broader change in how apartment buildings are being planned.

Developers are increasingly considering the operational side of apartment living alongside traditional lifestyle amenities. Just as secure mailrooms, bicycle storage and EV charging have become more common inclusions, parcel management is emerging as another feature that supports everyday convenience.

It also helps preserve the arrival experience within a building. Carefully designed lobbies and communal spaces can quickly become cluttered when deliveries accumulate, while secure parcel solutions reduce the likelihood of missed deliveries or parcels being left unattended.

For buyers comparing apartments, these everyday details are becoming part of the decision-making process.

Location, floorplans and finishes remain fundamental, but the features that simplify daily life are carrying greater weight than they once did. As online shopping continues to shape consumer behaviour, secure parcel delivery is increasingly becoming another amenity worth looking for.

Joel Robinson

Parcel delivery is joining the apartment amenity checklist

Inca Property Group has lodged a State Significant Development Application (SSDA) for Dawn, a 53-apartment oceanfront development overlooking Mona Vale Beach.

The proposal, at 35-39 Darley Street East, would replace an existing 18-apartment strata building with a new owner-occupier-focused development comprising 53 two and three-bedroom apartments, including nine affordable built-to-rent residences delivered under the State's infill affordable housing scheme.

Positioned on a 2,679 sqm elevated site around 280 metres from Mona Vale Beach, the development has been designed to maximise panoramic ocean views while responding to the site's sloping topography.

<a href="https://www.apartments.com.au/developers/inca-property-group">Inca Property Group</a> Managing Director Josh Thompson said the State Significant pathway provided greater certainty for projects of this scale.

"This State Significant pathway gives the team real certainty to progress <a href="https://www.apartments.com.au/new-apartments/dawn-35-39-darley-street-east-mona-vale-nsw-2103">Dawn</a> through to completion," Thompson said.

"It allows us to acquire a one-off site, design it carefully and deliver the right offering for the suburb, assessed by the NSW Government's planning department."

The project is one of the first developments in the area to be assessed under the NSW Government's Low and Mid-Rise Housing policy, with the site sitting on the edge of the policy's designated inner area.

The proposal includes three basement levels providing 124 car spaces, alongside a range of resident amenities including a swimming pool, gym, sauna, wellness facilities and private plunge pools for selected ground-floor and penthouse apartments.

<img alt="Dawn" data-entity-type="file" data-entity-uuid="fc1a1daf-0ce4-4f12-9076-b1fa553c7a91" src="https://s3.ap-southeast-2.amazonaws.com/www.urban.com.au/s3fs-public/inline-images/Screenshot%202026-07-21%20at%208.42.11%E2%80%AFAM.png?VersionId=4GZ9h.gpNkTljbxyAET8Jfhv51XUamDm" />

Thompson said Dawn had been designed specifically for owner-occupiers and downsizers, a buyer profile that has driven demand across Inca's recent Upper North Shore developments.

"The majority of buyers in our recent North Shore projects have been downsizers, and we are learning exactly what this market is looking for. Beyond the location itself, we have included resort-style amenities to deliver a genuine lifestyle offering," Thompson said.

Located within walking distance of Mona Vale Beach, the town centre, Mona Vale Golf Club and the Royal Motor Yacht Club, Dawn represents Inca's first Northern Beaches project following the sell-out of Tara on Park in Waitara and Ellis Residences, currently under construction in St Ives.

Construction will be undertaken by Inca's in-house construction arm, GOP Constructions.

Dawn is the latest major apartment proposal for Mona Vale, with the suburb emerging as one of the key beneficiaries of the NSW Government's new Low and Mid-Rise Housing policy.

New developer One Living, led by industry veteran Joseph Scuderi, recently secured a site on Mona Vale Road, on the border of Mona Vale and Pymble, where it is planning around 140 apartments.

IPM is also planning its third project in Mona Vale, significantly increasing the scale of its previous developments with an 82-apartment proposal at <a href="https://www.apartments.com.au/new-apartments/159-167-darley-street-west-mona-vale-nsw-2103">159-167 Darley Street West</a>, opposite Bayview Golf Course and less than 800 metres from Mona Vale town centre.

Read more:&nbsp;<a href="https://www.apartments.com.au/news/nsw/one-living-enters-sydneys-new-apartment-market-with-northern-beaches-site-acquisition">One Living enters Sydney's new apartment market with Northern Beaches site acquisition</a>

Read more:&nbsp;<a href="https://www.apartments.com.au/news/nsw/first-look-ipm-plans-third-mona-vale-project">First look: IPM plans third Mona Vale project</a>

First look: Inca eyes Mona Vale with State Significant DA for Dawn apartments

Seasoned Victorian apartment developer <a href="https://www.apartments.com.au/developers/central-equity">Central Equity</a> has logged more than $400 million in sales in its luxury apartment project Palmera Residences at Northcliffe on the Gold Coast.&nbsp;

Central Equity Director Karl Kutner said the sales result reflected a combination of location, product quality and delivery certainty with the project already under construction by building powerhouse Multiplex.&nbsp;

"Surpassing $400 million in sales since launch is a significant milestone and an outstanding endorsement of <a href="https://www.apartments.com.au/new-apartments/palmera-residences-gold-coast-18-garfield-terrace-surfers-paradise-qld-4217">Palmera Residences</a>,” he said.&nbsp;

"We believe one of the key reasons for this strong result is the confidence purchasers have in knowing the project is under construction with Multiplex. Buyers are increasingly looking for certainty. They want to know that the project they commit to today will be delivered by an experienced team with a proven track record."&nbsp;

[smartcode_project:default project_id=108274 project_image_fid=365782]

Kutner said it was clear there was still high demand for luxury projects that offered certainty of delivery.&nbsp;

“We are in a market where many residential developments have faced delays due to rising construction costs, labour shortages and financing challenges,” said Kutner.&nbsp;

"But having construction underway has provided our buyers with resounding confidence backed by more than 40 years of development delivery by Central Equity combined with construction by one of Australia's most respected construction companies."&nbsp;

[smartcode_project:default project_id=108274 project_image_fid=365785]

Central Equity is one of Australia's most experienced privately-owned property developers. Over more than four decades, the company has delivered in excess of 85 residential developments including 10,000 apartments and many thousands of stand alone homes.&nbsp;

Located on Garfield Terrace at Northcliffe, between Surfers Paradise and Broadbeach, Palmera Residences occupies one of the Gold Coast's most sought after beachside locations. The development has been designed to appeal to owner occupiers seeking premium residences that combine generous living spaces and resort style amenities.&nbsp;

Palmera Residences will feature an exceptional collection of resort style amenities, including two swimming pools: a generously sized family pool with safe shallow zones for relaxed recreation, and a 20 metre lap pool positioned to maximise all day sunlight.&nbsp;

Residents will also enjoy exclusive access to wellness and recreational facilities including a magnesium pool, sauna, yoga studio, expansive fitted gymnasium, resident lounge, outdoor BBQ’s&nbsp;and indoor and outdoor dining areas, together with a dedicated concierge and luxurious hotel inspired entrance foyer.&nbsp;

[smartcode_project:default project_id=108274 project_image_fid=365767]

A unique feature at Palmera Residences has been designed to enhance the Gold Coast lifestyle which includes both indoor and outdoor gymnasium facilities, together with thoughtfully designed indoor and outdoor dining and entertaining areas. A corner café has also been incorporated to provide residents with a destination for their everyday needs.&nbsp;

Kutner said buyer demand had been broad based with purchasers attracted from interstate as well as throughout South East Queensland.&nbsp;

"We're seeing strong interest from owner occupiers, lifestyle buyers and people relocating to the Gold Coast. Many purchasers have been searching for a premium beachside residence where quality, design and delivery are equally important."&nbsp;

[smartcode_project:default project_id=108274 project_image_fid=365771]

Kutner said the sales milestone was an important achievement, but the focus remained firmly on delivering an exceptional development.&nbsp;

"While reaching $400 million in sales is an important milestone, our priority remains delivering a project that exceeds purchaser expectations,” he said.&nbsp;

"Palmera Residences has been designed to become one of the Gold Coast's landmark residential addresses, and we look forward to welcoming our purchasers to their new homes."&nbsp;

There are a limited number of residences remaining in selected configurations with pricing from $2,950,000 to $8,950,000. Palmera Residences is also crowned by expansive penthouses with wrap around views.

[smartcode_project_cta:default project_id=108274]

Construction certainty and strong buyer demand drive major sales result for luxury Gold Coast development

Palmera Residences fly out the door as sales pass $400 million

National property developer <a href="https://www.apartments.com.au/developers/goldfields-group">Goldfields</a> has appointed BINAH as its construction partner for Quartet, its new Brisbane apartment development in the undersupplied suburb of <a href="https://www.apartments.com.au/developments/milton-qld-4064">Milton</a>.

Located just two kilometres from the Brisbane CBD and moments from key 2032 Olympic precincts, <a href="https://www.apartments.com.au/new-apartments/quartet-milton-33-manning-street-milton-qld-4064">Quartet</a> will deliver 131 one, two, three, and four-bedroom apartments priced from $1 million to $4.2 million, combining elevated design with a wellness-focused lifestyle offering.&nbsp;

[smartcode_project:default project_id=108736 project_image_fid=368000]

Goldfields’ Chief Executive Officer, Lachlan Thompson, said the appointment of <a href="https://www.apartments.com.au/builders/binah-constructions">BINAH</a> marked an important milestone for the project.&nbsp;

“Bringing BINAH on board as our construction partner will allow us to bring our vision for Quartet forward with a team that has a proven track record of delivering high-quality residential projects,” Thompson said.&nbsp;

“We’ve taken a considered approach to progressing the site because we wanted to deliver the whole package. Buyers ultimately back great developers, great projects and great builders, and with Quartet, we’ve made sure all three line up.

“People want certainty, they want to know the project will be built, that the homes will be delivered as promised, and that the developer stands behind the quality of what they create. That’s something Goldfields has built its reputation on over many years.”&nbsp;

[smartcode_project:default project_id=108736 project_image_fid=367993]

BINAH’s Managing Director, Khalil Hafza, said the company was proud to be partnering with Goldfields to deliver Quartet.&nbsp;

“Quartet is an exciting project to bring to life, particularly given the level of detail in the residences and the extensive rooftop amenity planned for the building,” Mr Hafza said.&nbsp;

“Our focus is on delivering a high-quality build that brings that design vision to life and creates homes residents will enjoy for many years.”&nbsp;

[smartcode_project:default project_id=108736 project_image_fid=367999]

The facilities at Quartet have been feared towards the roof, with a&nbsp;25 metre lap pool, spa, sauna and cold plunge, and a communal barbecue area and alfresco.

Town planning was designed by <a href="https://www.apartments.com.au/architects/rothelowman">Rothelowman</a> and brought to life by Melbourne-based architecture firm Cera Stribley.

<a href="https://www.apartments.com.au/interior-designers/cera-stribley">Cera Stribley</a> Co-Founder and Managing Principal, Dom Cerantonio, said the project responds to both its riverside setting and Brisbane’s evolving urban character.&nbsp;

“Quartet has been designed to sit comfortably within its riverside context, offering a refined take on urban living through well-planned, generously proportioned residences that will stand the test of time,” Mr Cerantonio said.&nbsp;

“An emphasis on natural light, natural textures and carefully selected finishes from timber and marble to premium appliances, creates calm, considered interiors designed for comfort and long-term liveability.”&nbsp;

Construction of Quartet will commence in July 2026, with completion anticipated in Q4 2028.

[smartcode_project_cta:default project_id=108736]

Construction to commence on 131-residence tower designed around wellness-focused living

Goldfields appoints BINAH for Quartet apartments in Milton

The first partnership between national developer <a href="https://www.apartments.com.au/developers/fortis">Fortis</a> and Adelaide-based developer <a href="https://www.apartments.com.au/developers/otello">Otello</a> has made a strong start, with the pair securing $21 million in unconditional sales at <a href="https://www.apartments.com.au/new-apartments/one-four-four-hutt-adelaide-144-hutt-street-adelaide-sa-5000">One Four Four Hutt</a>&nbsp;on the edge of the Adelaide CBD.

Over a third of apartments have been snapped up in the boutique 44-apartment project on the corner of Hutt Stret and Wakefield Road. Local downsizers and owner-occupiers wanting to remain in Adelaide's tightly-held southeast quarter have been the most prominent purchasers.

The DKO-designed, mixed-use development is one of the few new apartment projects in the precinct, an area where new housing supply has remained limited despite continued demand from buyers wanting to stay close to the CBD, Victoria Park and Adelaide's established east-end amenities.

[smartcode_project:default project_id=151233 project_image_fid=375378]

Fortis Head of Development SA Arthur Dendrinos said the early sales reflected both the strength of the local owner-occupier market and confidence in the Hutt Street location.

"The level of early commitment reflects the confidence local buyers have in the Hutt Street precinct," Dendrinos said.

"Many purchasers are long-term east-end residents who love the area and want to stay connected to the neighbourhood. They recognise the value of a well-designed, well-located development.

"Our partnership with Otello has been central to this success, and the number of unconditional sales at this stage only strengthens our confidence in the South Australian market."

[smartcode_project:default project_id=151233 project_image_fid=375379]

Otello Director Daniel Harris said the sales result also highlighted the lack of new apartment opportunities within the Hutt Street precinct.

"One Four Four Hutt has clearly resonated with buyers, with strong early sales reflecting both the appeal of the Hutt Street corridor and the lifestyle on offer," Harris said.

"The activated ground-floor retail has also been a key drawcard, with purchasers responding to the vision of a more vibrant and connected streetscape, not just the residences themselves."

One Four Four Hutt will deliver 44 one, two and three-bedroom apartments, alongside a collection of penthouses, above a ground-floor retail offering designed to further activate the Hutt Street precinct.

Construction is scheduled to commence in the third quarter of this year, with completion anticipated in 2028.

[smartcode_project_cta:default project_id=151233]

Fortis Head of Development SA Arthur Dendrinos said the early sales reflected both the strength of the local owner-occupier market and confidence in the Hutt Street location.

Fortis makes Adelaide debut with Otello as One Four Four Hutt records strong early sales

Aged Care

<html><body>
GUEST OBSERVATION
The <a href="https://agedcare.royalcommission.gov.au/hearings/Pages/default.aspx" target="_blank">Royal Commission into Aged Care Quality and Safety</a> is this week turning its focus to aged care in the home.
So far it has heard evidence of <a href="https://www.smh.com.au/national/elderly-australians-dying-while-they-wait-for-in-home-aged-care-20190316-p514qt" target="_blank">long waiting times</a> to access home care services and a <a href="https://www.propertyobserver.com.au/https://www.abc.net.au/news/2019-03-18/royal-commission-told-of-bottom-feeder-applicants-for-home-care/10912738" target="_blank">complicated system of fees</a>. It’s only a matter of time before it questions the reasons behind those wait lists and fees.
Unlike aged care, access to many health care services is unlimited. Anyone can seek an appointment with their GP or turn up to a hospital emergency department, in most cases for free.
But the number of home care packages available to older Australians is capped, and the frail elderly are asked to foot some of the bill.
While some may argue to uncap the number of home care places, and replicate parts of the health system by providing free care for all, it’s not that simple. Governments will keep increasing the number of subsidised home care services in response to needs, but costs will also keep rising.
The challenge is to find the right funding balance between individuals and taxpayers, and for the system as a whole to remain sustainable.
Why are many health services free?
Australia has a high standard of health care, which supports people to live to a longer, and <a href="https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf.aspx?inline=true" target="_blank">generally healthier</a>, old age.
Our Medicare system of funding is based on the principle of universal public health insurance which is paid for by the government (that is, the taxpayers). Public patients receive free care in public hospitals. Medical services by GPs and specialists are subsidised, as are many blood tests, X-rays and other imaging, allied health services (such as optometry), and most medicines.
In the year to September 2018, <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/Quarterly-Medicare-Statistics" target="_blank">86% of all GP attendances</a> were “bulk billed” (provided at no cost to the patient).
These benefits, however, come at a cost. About <a href="https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf.aspx?inline=true" target="_blank">10% of Australia’s economic output</a> (gross domestic product) is spent on health care and two-thirds of this is funded by governments.
And, of course, not all health services are free for most people. Visits to dentists, physiotherapists and others are regular reminders of this. A more equitable way of funding <a href="https://www.propertyobserver.com.au/https://www.abc.net.au/news/health/2019-03-18/calls-for-medicare-funded-dental-health-scheme-in-australia/10903574">dental care</a> is one of the emerging issues for the upcoming federal election.
What is home care?
Aged care plays a different role to health care in supporting people to stay at home. There are two forms of home care.
First, the <a href="https://www.myagedcare.gov.au/help-home/commonwealth-home-support-programme" target="_blank">Commonwealth Home Support Program</a> assists with daily activities such as meals, transport and personal care (showering, dressing, and so on) and some allied health services such as physiotherapy and podiatry (foot care).
In 2016-17, <a href="https://www.myagedcare.gov.au/help-home/commonwealth-home-support-programme/accessing-commonwealth-home-support-programme" target="_blank">around 723,000 people</a> received one or more of these services.
Second, Home Care Packages provide <a href="https://agedcare.health.gov.au/programs/home-care/home-care-packages-program" target="_blank">expanded support</a>, with daily activities as well as more complex health care from nurses and allied health workers.
At September 2018, there were <a href="https://www.gen-agedcaredata.gov.au/www_aihwgen/media/Home_care_report/HCP-Data-Report-2018-19-2nd-Qtr.pdf" target="_blank">over 90,000 people</a> receiving one of the government’s subsidised Home Care Packages.
Why are many elderly asked to help pay for home care?
Australia’s population is ageing. In 2017 3.8 million Australians were aged 65 and over. In the next 40 years this will probably <a href="https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/demographics-of-older-australians/australia-s-changing-age-and-gender-profile" target="_blank">grow to 8.8 million</a>. The costs of funding aged care will continue to increase.
In 2011, when one of us (Michael Woods) was the presiding commissioner on the <a href="https://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-volume2.pdf" target="_blank">Productivity Commission’s inquiry into aged care</a>, we put forward three principles to help governments create a sustainable funding models for aged care:
<ul>
<li>
accommodation and everyday living expenses should be the responsibility of individuals, with a safety net for those of limited means
</li>
<li>
health care services provided through aged care (such as nursing and allied health care) should be subject to charging arrangements consistent with those in the health care system
</li>
<li>
individuals should contribute to the cost of their personal care according to their capacity to pay, but should not be exposed to catastrophic costs of care.
</li>
</ul>
The current fee arrangements broadly reflect the intent of these principles.
The government aims to keep fees for the basic <a href="https://agedcare.health.gov.au/sites/default/files/documents/01_2018/client_contribution_framework_guide.pdf" target="_blank">Commonwealth Home Support Program</a> at very affordable levels and has produced fee guidelines for providers. There are no formal income tests and while some providers do no more than seek a voluntary contribution for some services, others may recover around 10% of the cost of some services as direct fees or membership subscriptions.
For the more complex and higher cost home care packages, providers can charge consumers a basic daily fee of <a href="https://agedcare.health.gov.au/programs/home-care/home-care-fees-for-consumers-entering-a-home-care-package-from-1-july-2014#Basic%20daily%20fee" target="_blank">17.5% of the basic rate</a> of the single age pension.
There is also an income-tested care fee, which recognises many older people have a greater capacity to contribute to the costs of their everyday living expenses. As a safety net for all, however, there are annual and lifetime caps on these fees.
The home care system has many issues to address, but it is not in crisis
Despite the <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2019-wyatt003.htm" target="_blank">growing number</a> of government-subsidised home care packages, the latest aged care statistics show that at December 2018 there were <a href="https://www.gen-agedcaredata.gov.au/www_aihwgen/media/Home_care_report/HCP-Data-Report-2018-19-2nd-Qtr.pdf" target="_blank">over 127,000 people</a> on a national priority list for services that met their needs.
The wait time for some, sadly, is <a href="https://www.smh.com.au/national/elderly-australians-dying-while-they-wait-for-in-home-aged-care-20190316-p514qt" target="_blank">too long</a>. However, some subsidised help is available for nearly all people on the list. Over 96% of people on the list had been offered, and were generally accepting, a lower level of subsidised support while they waited for a higher level of service.
There are also questions about how this queue is created and the assessment process itself that the royal commission may want to follow up.
For example, not all assessments and referrals to services are necessarily based on current needs. At December 2018, <a href="https://www.gen-agedcaredata.gov.au/www_aihwgen/media/Home_care_report/HCP-Data-Report-2018-19-2nd-Qtr.pdf" target="_blank">96,000 people</a> who were waiting for their approved level of home care package also had an approval for a permanent place in residential aged care. This suggests the assessment process may contain an element of anticipating future needs, rather than reflecting current needs.
Another concern with the current assessment process is a lack of focus by some assessors on helping older people to regain a level of independence through short-term “reablement” programs rather than adding them to the queue for ongoing services. As the <a href="https://consultations.health.gov.au/in-home-aged-care-division/streamlined-consumer-assessments-for-aged-care-ser/supporting_documents/Discussion%20Paper%20%20Streamlined%20Consumer%20Assessment%20for%20Aged%20Care.pdf" target="_blank">Department of Health</a> notes, a wellness and reablement approach in assessment and service delivery is not being consistently and effectively applied across the regions.
For the foreseeable future we can expect the government to keep increasing the number of subsidised home care services, but it will also keep a careful eye on the balance between public and private funding, and seek to keep the overall cost to the elderly and to the budget within sustainable limits.<img src="https://counter.theconversation.com/content/112963/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Michael Woods, Professor of Health Economics, University of Technology Sydney
Sarah Wise, Senior Research Fellow in Health Policy, University of Technology Sydney
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/would-you-like-to-grow-old-at-home-why-were-struggling-to-meet-demand-for-subsidised-home-care-112963" target="_blank">original article</a>.
</body></html>

j.ballantyne1990-6AQqhLzZaK

Would you like to grow old at home? Why we’re struggling to meet demand for subsidised home care

<html><body>
GUEST OBSERVATION
Getting aged care right is difficult. It involves staff training, qualifications and ratios, the entry of for-profit providers and ensuring access in regional areas – many of the issues highlighted in this year’s two-part Four Corners special.
A key challenge, from which must of the rest will flow, is increased funding.
Medicare – an Australian success story – provides one model.
Even the Medicare name works magic. The Medicare levy has been appropriated and boosted in order to brand and part-fund the National Disability Insurance Scheme.
We could do a Medicare
Medicare takes its features from both the public and the private sector. It is framed as an insurance levy, but unlike most insurance levies, it is linked to income. This means it reflects ability to pay rather than the likelihood of getting sick. As a result, it is affordable for everyone.
There have been many proposals to do something similar with aged care.
To date policymakers have instead opted for another common Australian funding model – combining user payments with a safety net of public funding for those without means or facing high costs.
The Productivity Commission has consistently plumped for this model over a more universal funding system, although there is little evidence that user fees are effective as a funding source.
So why not introduce an aged care levy on income?
But would that be right for aged care?
Oddly, the main argument against an income-based levy revolves around equity. Older people are income-poor but asset-rich. An income levy would set them back little even though they have been the primary beneficiaries of the enormous increase in house prices.
It would be paid instead by younger workers who are often facing insecure work, stagnant wages and expensive housing.
It’s a reasonable objection, and it drives much of the Productivity Commission’s thinking. The commission has focused instead on helping older people draw down their housing wealth to fund aged care payments.
But this too has problems. It can discourage preventive forms of care and it requires vulnerable people entering care to make complex financial decisions.
Tapping superannuation might be better
A third way, suggested by aged care expert Anna Howe, is to use superannuation.
After all, super is supposed to fund our post-work life, and aged care is a big part of that.
Despite more than $2.5 trillion being amassed in super, it does a poor job of providing either income security or security of care for older people. These responsibilities continue to fall on government.
Income within super is taxed unfairly
Super is also taxed very differently to other income. The rest of the income tax system is progressive, so those with higher incomes pay higher rates of tax. Income within super funds faces a flat tax.
For most people that matters little, but it creates enormous gains for those on very high incomes, which are made even bigger when they direct what extra income they can to super.
The flat tax on super earnings costs the budget A$23.25 billion per year. The Treasury says that’s set to climb to A$28.95 billion in 2020-21, a growth rate that dwarfs the projected growth in the cost of the pension.
Efforts to curb the cost to the budget of super tax concessions have largely focused on limiting how much extra cash we put into it.
But most of the cost comes from the income earned by money already in super.
Taxing it better could fund aged care
A Medicare-style insurance levy applied to the income earned by money within super would in principle be no different to the insurance premiums already taken from super accounts.
And it wouldn’t be paid by the young while they are young. Given that younger workers can’t access super until retirement, it would effectively be a levy on their future super wealth.
And because older people have larger super accounts than younger people earning more income to be taxed, the levy would fall far more heavily on baby boomers than younger generations.
And address gender equity
This approach would also address another important justice question – gender equity. Men have much more super than women.
That partly reflects the gender pay gap, but also the unpaid work gap, in which women typically spend more of their working lives than men out of paid work caring for family members.
Ironically, it is women who then rely more heavily on paid care in older age, largely because they outlive their partners. Women provide men’s care for free, but then pay for their own.
A levy on (mainly) men’s super would help even the books.
But the details would matter
A fair way to do it would be to apply the levy to super fund income only when it climbed to a threshold of (say) A$5,000 a year. That way it would protect small accounts while helping close the tax loophole enjoyed by those on the highest incomes.
All of us have an interest in properly funded aged care. More properly taxing super fund income would be one way to do it.<img src="https://counter.theconversation.com/content/103767/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Ben Spies-Butcher, Senior Lecturer in Economy and Society, Department of Sociology, Macquarie University
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/two-birds-with-one-stone-how-better-taxing-super-could-fund-aged-care-103767" target="_blank">original article</a>.
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How better taxing super could fund aged care: Ben Spies-Butcher

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Last week Apartments.com.au highlighted the growing number of <a href="/news/555-collins-street-continues-the-commercial-theme-for-2018">residential projects being shelved in favour of commercial use</a>, but there has also been a more recent trend towards aged care, with various developers shifting their residential focus in a bid to capitalise on the growing downsizer market.

According to Mcrindle Research, 3.7 million Australians were aged 65 and over in 2016, a number that is set to double by 2057. In response to this developers are delivering residential and retirement hybrid projects designed to cater to those entering the retirement stage of life that want to retain their inner-city, amenity-rich lifestyle.

The sector which is expected to boom over the next few years, is relatively unprecedented and presents a unique opportunity for developers to set themselves up as the market leaders in this sector. The Federal Government’s has also reacted by increasing its investment in the aged care sector, spending approximately $17 billion in the 16/17 financial year, of which 69 per cent went towards residential aged care.

This has also seen the likes of EcoWorld International who recently launched its <a href="/news/ecoworld-international-rethinks-retirement-living-for-south-yarra-project">Lifestyle One service at their Yarra One</a> project in South Yarra, which will provide residents with access to a range of services such as home maintenance, home cleaning, dry cleaning, massage, pet walking/grooming, and personal care.

According to Marshall White Projects director Leonard Teplin, the last few months has seen an unprecedented number of developers seek to amend existing planning permits for independent living uses, both to navigate around the uncertain residential market and tap into the growing demand from the downsizer market.

Earlier this year, we also reported on<a href="/news/lendlease-revisits-richmonds-gtv9-site"> Lendlease's revised intentions for the GTV9 site</a> in Richmond which would include aged care, retirement living and affordable housing with the developer engaging Catholic Healthcare Limited and Women's Housing Limited as the operators upon completion.

<figure><a class="colorbox colorbox-insert-image" href="https://res.cloudinary.com/dz9xllyip/image/fetch/q_auto:good/https://s3-ap-southeast-2.amazonaws.com/www.urban.com.au/s3fs-public//pictures/article-images/aged_care_inline_image.jpg" rel="gallery-all" title="A number of developers are changing their focus to aged care. Images: FKD Studio | Bates Smart"><img alt="" class="image-article-full-width-580px" height="321" src="/sites/urban.melbourne/files//styles/article_full_width_580px/public/pictures/article-images/aged_care_inline_image.jpg?itok=OBO6ukkh" title="A number of developers are changing their focus to aged care. Images: FKD Studio | Bates Smart" width="580"></a>

<figcaption>A number of developers are shifting their focus to aged care. Images: FKD Studio | Bates Smart</figcaption></figure><h2>What they say...</h2>

<blockquote>
It’s no secret the past few years have seen developers adjust their focus to downsizers and seen incredible success - independent living is the next step. Developers are seeing an opportunity to tap into this demand for over 55s, which is a market that’s emerged as a counter-cyclical sector to traditional apartments.

Rather than sit on sites for the next market cycle they are seeking amendments to their existing permits so they can take advantage of this new trend. Australia’s over 65 population is growing at an exponential rate, as is the number of people moving into aged care, which has increased by 31 per cent in the past 10 years.

Marshall White Living caters to those that are looking to downsize and find a home for life, but offers more freedom and flexibility than a traditional aged care environment. The Grace offers architectural excellence in a highly sought-after inner-city locale while each aspect of the design, including intuitive internal functionality and cutting-edge technology, has been created to offer optimal safety and comfort.

These premium independent living environments enable our clients to enjoy life, immersed in a rich community of like-minded people.

-  Leonard Teplin, Marshall White Projects director
</blockquote>

 

<blockquote>
The increasing acceptance of apartment living among the older demographic has paved the way for retirement living to be repositioned as a modern vertical village, rather than the traditional horizontal-style village where residents are often isolated from their families in the outer suburbs. This new iteration, independent living, caters to a broader audience of downsizers who want the added levels of security, comfort and convenience of retirement living but still want to live in the inner suburbs where they’ve spent most of their lives.

Developers can make some easy-to-implement changes in the planning process of their projects to make them adaptable to cater to this buyer, and consequently find themselves filling a big gap in the market. It’s relatively unprecedented at the moment, which leaves a unique opportunity for developers to get their product out there first and win big. Developers that do this now will set themselves up to be the market leaders in Australia’s fastest-growing development sector.

- David Carabott, Director, CHT Architects
</blockquote>

 

<blockquote>
With residential house prices rising at alarming rates, independent living is a wise financial solution for the over 65s. Typically it allows residents to enter the complex at 70 per cent of the existing median house price in the same location, which gives them the opportunity to sell their house and access significant equity in their homes to assist in enjoying their retirement years.

Independent living also offers significantly more amenities and lifestyle luxuries than standard residential, such as a clubhouse where residents can host group events, billiard rooms, communal gardens, library, etc. On site management provides an additional layer of security and assistance with collecting deliveries, arranging events and helping with tasks related to their home.

The combination of a strong demographic shift towards this buyer, the affordability of the product and the lack of supply make this sector extremely attractive to developers.

-  Matthew Chun, Director at Springwood Living Group
</blockquote>
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Laurence Dragomir

Developers turn to aged care to cater to growing downsizer market

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GUEST OBSERVATION
ABC’s Four Corners coverage showing mistreatment of residents in Australia’s aged care facilities has led to much discussion about ideas to improve care. One proposal is to introduce ratings, which would provide a score reflecting the quality of residential aged care services.
Ratings have come up before in reports about aged care in Australia – in the 2004 “Hogan Review”, the Productivity Commission’s 2011 Caring for Older Australians inquiry and, most recently, in the 2017 Carnell-Paterson Review, which led to the government establishing a new Aged Care Quality and Safety Commission. These reports all refer to the ratings system used in England.
In Australia, aged care homes are expected to meet 44 accreditation standards, receiving either a pass or fail for each one. These standards will be replaced in 2019 with new aged care quality standards, but homes will still only be expected to pass or fail each standard.
In the past, virtually all providers passed accreditation. This means it has been impossible to tell the difference between providers that excel and those that just scrape through.
England has had two attempts at using ratings since 2004. The current system was introduced in 2014 by the Care Quality Commission (CQC) – the body responsible for inspecting care in nursing homes. During CQC inspections, each home is given a rating against five questions: is it safe, is it effective, is it responsive, it is caring and is it well led?
The four ratings are: outstanding, good, requires improvement, or inadequate. At the end of the inspection, the home is given an overall rating. Homes are legally required to display their ratings, both at the home’s location and on its website.
Recent research shows these ratings are a good indicator of how residents feel about their quality of life in the home. Unsurprisingly, homes with lower rates of staff turnover and fewer staff vacancies also tend to perform better.
So, what are the lessons for Australia?
1. Ratings rarely affect consumer choice; they improve provider quality
Consumers don’t usually use ratings to find care. Choosing an aged care home is not like choosing a hotel or restaurant.
People looking for care are often in the middle of a crisis, such as the death of a partner or an unexpected stay in hospital. The older person is too unwell to make the decision themselves. All too often, families simply choose the closest home or settle for any home that has a place.
Ratings work mostly because they change the behaviour of care providers. When a previous system of ratings in England was abandoned in 2008, providers that had been sceptical of the ratings beforehand argued for their re-introduction.
People I interviewed for my research said this was because homes with the best ratings could negotiate better rates for care, and care home companies could use the ratings to set goals and targets for their staff.
2. Quality is subjective, but only for the little things
Discussions about quality in aged care often come back to the issue that everyone has personal preferences and it is difficult to agree on one definition of quality. The sort of example that comes up is whether a resident would be more interested if a home had Foxtel or Sky or if wine was served with meals.
These are not the sorts of questions that need ratings. Older people, or more frequently their families, can answer these questions themselves by visiting homes, trying the food, seeing the quality of accommodation and asking questions about, for instance, en-suite bathrooms and menu options.
What people need help with is understanding what they cannot easily judge for themselves. Such as:
<ul>
<li>does the home have enough staff and the right mix of skills?</li>
<li>does the home support its staff to form meaningful and supportive relationships, not only with the residents but also with families and with each other?</li>
<li>does the home use good practice in supporting people living with dementia, or in caring for people at the end of their lives?</li>
</ul>
This is where the right sorts of ratings can help shed light on the parts of care that are difficult to assess. Most importantly, it gives providers a good steer on where to focus their efforts.
3. Be prepared to publicise poor care
An important feature of the system in England is that the CQC regularly draws attention to poor care. It does this not just through the ratings but also through other reports it produces about care in England, such as the annual State of Care report. The CQC also provides reports on specific issues – for instance, the difficulties older people with dementia face when they move between care homes and hospitals.
In the first three years of the current ratings scheme, while most homes were rated “good”, 21% of providers received “inadequate” or “requires improvement” ratings, something highlighted in the State of Care report. While about a fifth of the homes rated “inadequate” stayed the same at re-inspection, the CQC found 82% had improved their overall rating. Of the homes rated “requires improvement”, 58% improved at the next inspection.
Such transparency is currently impossible in Australia as the Aged Care Act 1997 restricts what can be made public about poor care in the first place.
4. Ratings are part of a package
While not perfect, the ratings system in England has helped to communicate what good care looks like and given providers something to aim for. This is demonstrated by the popularity of practice guidance on how to get an “outstanding” rating.
But Australian policymakers need to assess other differences with England’s system. The CQC has considerable enforcement and legislative powers when compared to the Aged Care Quality Agency in Australia. The CQC can shut down providers and even bring criminal charges. Australia’s Quality Agency has to refer providers to the Health Department for action.
The UK also has a raft of rights-based legislation to protect vulnerable residents, such as the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. In Australia, reports into human rights and elder abuse have highlighted the gaps in the legislation to protect the rights of older people.
There are also more organisations involved in care in England and the CQC’s activity is supplemented with safeguarding and quality monitoring by local councils, which organise care.
Ratings may be useful for improving quality in Australia, but should be seen as only one part of a very large and complex puzzle.<img src="https://counter.theconversation.com/content/103688/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Lisa Trigg, Research Associate, London School of Economics and Political Science
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/four-lessons-for-australia-from-englands-system-of-rating-its-aged-care-homes-103688" target="_blank">original article</a>.
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Four lessons for Australia from England’s system of rating its aged care homes

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EXPERT OBSERVER
Residential aged care facilities should be more like a home and less like a hospital.
Most older people <a href="http://www.who.int/mental_health/publications/dementia_report_2012/en/" target="_blank">want to stay at home</a> as long as they can. When this is no longer possible, they move into residential aged care facilities, which become their home. But Australia’s care facilities for the aged are growing in size and becoming less home-like.
In 2010–11, 54% of residential aged care facilities in major Australian cities had <a href="https://www.aihw.gov.au/reports/aged-care/residential-aged-care-in-australia-2010-11/contents/table-of-contents" target="_blank">more than 60 places</a>, and the <a href="https://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-overview-booklet.pdf" target="_blank">size of the average facility</a> is growing.
Today, more than 200,000 Australians live or stay in residential aged care on any given day. There are <a href="https://www.gen-agedcaredata.gov.au/Topics/Services-and-places-in-aged-care" target="_blank">around 2,672 such facilities</a> in Australia. This equates to an average of around 75 beds per facility.
Large institutions for people with disability and mental illness, as well as orphaned children, were once commonplace. But now – influenced by the 1960s <a href="https://psychcentral.com/encyclopedia/deinstitutionalization/" target="_blank">deinstitutionalisation</a> movement – these have been closed down and replaced with smaller community-based services. In the case of aged care, Australia has gone the opposite way.
Why is smaller better?
Evidence shows that aged care residents have better well-being when given opportunities for self-determination and independence. Internationally, there has been a <a href="https://www.sciencedirect.com/science/article/pii/S1525861016300482" target="_blank">move towards</a> smaller living units where the design encourages this. These facilities feel <a href="https://www.propertyobserver.com.au/https://www.ncbi.nlm.nih.gov/pubmed/26743545" target="_blank">more like a home</a> than a hospital.
The <a href="http://apps.who.int/iris/bitstream/handle/10665/186463/9789240694811_eng.pdf;jsessionid=731A680E51575BBDBEC07AFC9C449F23?sequence=1" target="_blank">World Health Organisation</a> has indicated that such models of care, where residents are also involved in running the facility, have advantages for older people, families, volunteers and care workers, and improve the quality of care.
In the US, the <a href="https://www.thegreenhouseproject.org/resources/research" target="_blank">Green House Project</a> has built more than 185 homes with around 10-12 residents in each. Studies show Green House residents’ enhanced quality of life doesn’t compromise <a href="https://www.propertyobserver.com.au/https://www.ncbi.nlm.nih.gov/pubmed/26743545" target="_blank">clinical care</a> or <a href="https://www.propertyobserver.com.au/https://www.ncbi.nlm.nih.gov/pubmed/21158746" target="_blank">running costs</a>.
Older people have a better quality of life if they can be involved in outdoor activities.
Around 50% of residents living in <a href="https://www.gen-agedcaredata.gov.au/Resources/Factsheets-and-infographics/Care-needs-factsheet.pdf?ext=" target="_blank">aged care facilities</a> have dementia. And <a href="https://www.propertyobserver.com.au/http://journals.sagepub.com/doi/abs/10.1177/1471301214532460" target="_blank">research has shown</a> that a higher quality of life for those with dementia is associated with buildings that help them engage with a variety of activities both inside and outside, are familiar, provide a variety of private and community spaces and the amenities and opportunities to take part in domestic activities.
In June 2018, an <a href="https://theconversation.com/caring-for-elderly-australians-in-a-home-like-setting-can-reduce-hospital-visits-97451" target="_blank">Australian study</a> found residents with dementia in aged-care facilities that provided a home-like model of care had far better quality of life and fewer hospitalisations than those in more standard facilities. The home-like facilities had up to 15 residents.
The study also found the cost of caring for older people in the smaller facilities was no higher, and in some cases lower, than in institutionalised facilities.
There are some moves in Australia towards smaller aged care services. For example, aged care provider <a href="https://www.wintringham.org.au/" target="_blank">Wintringham</a> has developed services with smaller facilities for older people who are homeless. Wintringham received the <a href="https://www.wintringham.org.au/built_environment" target="_blank">Building and Social Housing Foundation World Habitat Award 1997</a> for Wintringham Port Melbourne Hostel. Its innovative design actively worked against the institutional model.
Bigger and less home-like
Historically, nursing homes in Australia were small facilities, with <a href="https://www.anu.edu.au/fellows/jbraithwaite/_documents/Articles/The%20Nursing%20Home%20Industry.pdf" target="_blank">around 30 beds</a> each, often run as family businesses or provided by not-for-profit organisations. Between <a href="https://www.parliament.nsw.gov.au/lcdocs/other/9768/Aged%20care%20industry%20facts.pdf" target="_blank">2002 and 2013</a> the proportion of facilities with more than 60 beds doubled to 48.6%. <a href="http://www.stewartbrown.com.au/images/documents/StewartBrown---ACFPS-Residential-Care-Report-March-2017.pdf" target="_blank">Financial viability</a> rather than quality of care drove the increase in size.
Today, around 45% of facilities are operated by the private for-profit sector, 40% by religious and charitable organisations, 13% by community-based organisations, 3% by state and territory governments, and less than 1% by local governments.
In 2016, the Australian Institute of Health and Welfare (AIHW) reported that residential care services run by government organisations were more likely to be in small facilities. One-fifth (22%) of <a href="https://www.gen-agedcaredata.gov.au/www_aihwgen/media/2017-Factsheets/Services-and-Places-Factsheet-2016%E2%80%9317_2.pdf?ext=.pdf" target="_blank">places in these facilities</a> are in services with 20 or fewer places. Almost half (49%) of privately-run residential places are found in services with more than 100 places.
All of this means that more older Australians are living out their last days in an institutional environment.
Once larger facilities become the norm, it will be difficult to undo. Capital infrastructure is built to have an <a href="https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/09_2016/2016_report_on_the_funding_and_financing_of_the_aged_care_industry_2.pdf" target="_blank">average 40-year life</a>, which will lock in the institutional model of aged care.
The built environment matters. The royal commission provides an opportunity to fundamentally critique the institutional model.<img src="https://counter.theconversation.com/content/103521/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1">
<a href="https://theconversation.com/profiles/ralph-hampson-161263" target="_blank">Ralph Hampson</a> is the Senior Lecturer, Health and Ageing, University of Melbourne
This article is republished from The Conversation under a Creative Commons license.
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Australia's residential aged are getting bigger and less home-like: Ralph Hampson

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GUEST OBSERVATION
All humans have fundamental needs. These are physiological (food, drink, clothing, sleep), safety (emotional security, physical safety, health), love and belonging (friendships, community), esteem (respect, dignity) and self-actualisation (accomplishment, personal development).
For people living in Australia’s residential aged-care facilities, these needs are often not met.
Most residents do not feel they are loved or belong in the facility. Like aged-care resident Neda Borenstein, whose secret camera footage broadcast on ABC’s Four Corners showed her singing the Australian national anthem in bed while she waited more than three hours to be changed. “I’m just a number,” Neda told her carer when she finally returned to help her up.
Less than one-third of residents we interviewed said they were friends with another resident. This means most don’t have the social support associated with friendships. Most residents said they felt socially isolated, which is associated with poor well-being.
A 2016 study of residents’ lived experiences in an aged-care facility found many felt they had little dignity, autonomy or control. Outside of meal and structured activity times, people with dementia spend most of their time stationary, alone and doing very little or nothing.
One study looking at interactions between residents and their carers showed residents were alone 40% of the time they were observed. When staff were present, they mostly did not engage verbally, emotionally or physically with the resident.
Aged-care facilities can also feel psychologically unsafe to residents. Residents with dementia may be locked in secure units or physically restrained, using mechanisms such as bedrails or restraining belts.
Residents sometimes don’t get along. They might argue yell, swear, pinch, hit or push each other. We don’t have good data about how often resident-to-resident verbal and physical aggression happens, but it can result in injury and even death.
The consequences of unmet needs?
Residents can react negatively when their needs are not met. They become bored, sad, stressed, cranky, anxious, depressed, agitated, angry and violent.
In people with dementia, we used to call these reactions “behavioural and psychological symptoms of dementia” (BPSD). But people with dementia have been pointing out these are normal human responses to neglect, not symptoms of dementia. Almost all (90%) aged-care residents display one or more of these negative reactions.
In many facilities, staff “manage” such reactions with the use of sedating antipsychotic medications. But clinical guidelines recommend looking at the reasons people may be reacting that way and addressing those before medication.
Half of nursing home residents have symptoms of depression, and a third have symptoms of anxiety. More than half of residents have been found in studies to behave in ways that might suggest they no longer wish to live. This includes refusing food or medication, one-third of residents having suicidal thoughts and a small number of nursing home residents actually taking their own lives.
Why does Australian aged care fail to meet fundamental human needs?
We might not be spending enough on aged care to enable providers to meet fundamental human needs. Australia spends about 1% of its GDP on long-term care – less than the OECD average of 1.5%.
Private investment in aged care is growing, as have residential aged care profits, but it’s a difficult industry in which to make money. Insufficient funding translates to insufficient staff and less skilled staff. Our funding system rewards dependency, and there are no funding incentives for providers to improve the psychological well-being of residents, or go beyond that to help them flourish.
People looking for a nursing home don’t have any independently provided information by which to compare quality or performance.
The National Quality Indicator Program – a program for measuring care in residential aged-care facilities that began in 2016 – was meant to provide information for people trying to compare facilities on clinical indicators of care quality.
But participation in the program is voluntary for providers. Neither quality of life nor emotional well-being indicators are included in the suite of quality indicators (even though one has been trialled and found to be suitable). We also don’t know if or when the data might be published.
What is needed?
We need a fundamental shift in community, government, service provider, staff and regulatory expectations of what residential aged care does. Our model of aged care is mainly about clinical care, while neglecting emotional care.
For instance, friendships are a unique social interaction that facilitate healthy ageing, but many residents told us that the social opportunities in their nursing home did not align with their expectations of friendship.
We need our model of care to be a model of a home. In a home everyone contributes, has a say in what happens in the home (such as the menu, interior design, routine and functions), is able to invite their friends to their home for a meal, and can leave during the day and come back at night. A home is a safe place, where people are loved and nurtured, and where they can be active and fulfilled.<img src="https://counter.theconversation.com/content/103336/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Lee-Fay Low, Associate Professor in Ageing and Health, University of Sydney
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336" target="_blank">original article</a>.
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How our residential aged-care system doesn’t care about older people’s emotional needs

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GUEST OBSERVATION
Prime Minister Scott Morrison announced a Royal Commission into Aged Care Quality and Safety on Sunday, responding to concerns about the sector one day before an ABC Four Corners program which was to air them.
Aged care is where the challenges of population ageing are most apparent and where policy choices have direct impact on the lives of Australians.
So, it’s not surprising that the system is under increasing scrutiny. Various reviews have looked at different aspects of aged care since 2011 when major reforms were first ushered in, including into quality, public financing, workforce, and the overall progress of reforms.
The outcomes all point to similar conclusions. Responding to the needs of older, often vulnerable, Australians is an extremely complex business. But it is also one in which making money is tough. The danger is that a combination of cost pressures, profit incentives, and inadequate oversight encourage or force providers to cut corners.
How providers make money
Most funding for aged care comes from government. Direct government expenditure on the overall system was about A$17 billion in 2016-17, with A$12 billion going to residential care.
The users of residential care topped this up with A$4.5 billion of their own money, via regulated fees that are capped for users who pass a generous means test.
But costs of care are high. Providers spend more than A$11 billion on staff, yet those staff aren’t highly paid. This is in part because they are mainly females, who face an unremitting gender pay gap.
The pause that hurt
The Aged Care Financing Authority reports that profits are climbing over the long term but are precarious year-to-year.
The residential industry saw profits fall by 4% to 5% in 2016-17, partly because of a pause and then a scaling back of the indexation of government funding.
Although one quarter of residential care providers made losses in 2016-17, two thirds continued to record profits.
Bigger centres
The tighter funding was justified as a measure to drive efficiency, but it provided further impetus to the longer term trend of big providers to merging with or taking over the small ones. While the number of care places has climbed 8% in four years, the number of providers has shrunk 13%.
One reason why unprofitable providers remain in the market is because they are, by definition, not-for-profit. So the system relies heavily on good will. While still dominant, they have lost share to private, for-profit providers, some of which have the advantage of economies of scale or capital ownership structures that allow them to pay less tax.
While some of those listed on the Australian Securities Exchange saw drops in their share prices in recent years, the sharp declines when the Royal Commission was announced may reflect investor concern about the risk of greater scrutiny of the relationship between their profits and quality of care.
Uncertain quality
It will be open to the Royal Commission to examine how these trends are affecting the quality of care.
The government influences the quality of care in other ways that might attract the interest of the Royal Commission. It sets standards and helps design the incentives that discipline the market.
The standards cover indicators including management, the health and personal care of residents, resident lifestyle, and resident safety. They have been enforced by initial accreditation, subsequent re-accreditation, self-reporting, the examination of complaints and (until recently) pre-announced visits.
In 2017 the government announced a move to unannounced visits after evidence suggesting that some were “staged” in order to present the centre “in the best possible light”.
In July 2018 the government began charging for unannounced visits, raising what it expects to be A$10 million a year.
It’s hard to switch
Consumers can themselves apply market pressure on poor performers, and it is increasingly possible through a move to so-called consumer directed care, where care recipients or their carers are given a budget and the ability to decide how to spend it. If one provider turns out to deliver poor services, they can switch and spend their money elsewhere.
But the transaction cost of switching can be high. The process isn’t easy for users experiencing cognitive decline and there’s not always another centre or service to switch to.
Next steps
The Royal Commission will expose much. For providers, it will be an opportunity to examine their operations to ensure that efficiencies and profits don’t come at the cost of quality. For government, it will be a chance to examine how its funding mechanism, regulations, enforcement and market design are working out in practice.<img src="https://counter.theconversation.com/content/103339/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Rafal Chomik, Senior Research Fellow, ARC Centre of Excellence in Population Ageing Research (CEPAR), UNSW
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/its-hard-to-make-money-in-aged-care-and-thats-part-of-the-problem-103339" target="_blank">original article</a>.
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It’s hard to make money in aged care, and that’s part of the problem: Rafal Chomik

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GUEST OBSERVATION
ABC’s <a href="https://tv.press.abc.net.au/who-cares-four-corners" target="_blank">Four Corners</a> aired the first of a two-part investigation into the often shocking treatment of the elderly in aged care homes around Australia.
The timing coincides with Prime Minister Scott Morrison’s weekend <a href="https://www.propertyobserver.com.au/http://www.abc.net.au/news/2018-09-16/scott-morrison-announces-royal-commission-into-aged-care-sector/10252850" target="_blank">announcement of a royal commission</a> into Australia’s aged care system. The prime minister said poor standards had led authorities to close one aged centre per month since the Oakden aged mental health home scandal.
South Australia’s Oakden facility <a href="https://www.propertyobserver.com.au/http://www.abc.net.au/news/2017-09-22/oakden-closed-as-last-two-residents-moved-out/8974156" target="_blank">closed nearly a year ago</a>, following revelations of abuse and neglect dating back a decade.
While the terms of reference are yet to be determined, the royal commission will likely look into issues already raised by previous inquiries into the sector. These include the changing demands of Australia’s ageing population, staffing ratios, funding levels and the mental health, well-being and safety needs of nursing home residents.
Below are five articles in which our experts have previously explored the complex aspects of Australia’s aged care system, drawing on research which has exposed where the problems are, and have been for some time.
Lack of medical care
Our ageing population, and the focus on helping the elderly stay at home for as long as possible, means by the time people enter aged care they are older and sicker than before. Around <a href="https://www.gen-agedcaredata.gov.au/Resources/Factsheets-and-infographics/Care-needs-factsheet.pdf?ext=">half of people</a> living in aged care today have dementia, depression, or another mental health or behavioural condition.
In fact, the proportion of older people requiring high care for complex needs, which includes assistance with all activities of daily living such as eating and bathing, has quadrupled from 13% in 2009 to 61% in 2016.
Yet there is no legal requirement for all aged care facilities to provide 24-hour registered nursing care. In the article below, Jane Phillips, David Currow, Deborah Parker and Nola Ries explore how today’s nursing home residents have minimal access to quality medical care.
1. <a href="https://theconversation.com/australias-aged-care-residents-are-very-sick-yet-the-government-doesnt-prioritise-medical-care-88690" target="_blank">Australia’s aged care residents are very sick, yet the government doesn’t prioritise medical care</a>
In a separate piece on health care in nursing homes, Sarah Russell has also written: "nursing home providers looking to cut costs are bypassing registered nurses and employing less-skilled personal care attendants (PCAs) who aren’t adequately trained for the job."
2. <a href="https://theconversation.com/heres-why-we-need-nurse-resident-ratios-in-aged-care-homes-59682" target="_blank">Here’s why we need nurse-resident ratios in aged care homes</a>
<hr>
Funding for older Australians to stay at home
Research <a href="http://www.naca.asn.au/Age_Well/Blueprint.pdf" target="_blank">consistently shows</a> more people want to stay in their own homes as they age. In the <a href="https://www.budget.gov.au/2018-19/content/speech/download/budget_speech.pdf" target="_blank">2018-19 budget</a>, the government announced an extra A$1.6 billion over the next four years for an additional 14,000 <a href="https://www.myagedcare.gov.au/help-home/home-care-packages" target="_blank">Home Care Packages</a>. These deliver an agreed set of services to meet the specific needs of aged Australians who want to remain at home.
The government also subsidises a number (currently <a href="https://theconversation.com/australias-aged-care-residents-are-very-sick-yet-the-government-doesnt-prioritise-medical-care-88690" target="_blank">around 283,000</a>) of residential care places for older people unable to continue living independently.
Aged care subsidies are allocated <a href="https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/08_2016/2016_report_on_the_funding_and_financing_of_the_aged_care_industry_0.pdf" target="_blank">through a ratio</a>, which aims to provide 113 subsidised care places for every 1,000 people aged 70 and over. This ratio will increase to 125 places for every 1,000 by 2021-22. Within the overall number of places, the government also sets sub-targets for the numbers of Home Care Packages and residential care places.
The government is aiming to amend the ratio in favour of more home care packages. By 2021-22, the target for home care packages will increase from 27 to 45 per 1,000, while the residential target is to reduce from 88 to 78 per 1,000.
But as Professor of Health Economics at University of Technology Sydney, Michael Woods has written, this still won’t be enough to meet demand.
3. <a href="https://theconversation.com/there-is-extra-funding-for-aged-care-in-the-budget-but-not-enough-to-meet-demand-96403" target="_blank">There is extra funding for aged care in the budget, but not enough to meet demand</a>
<hr>
Poor mental health
Older Australians living in nursing homes represent one of society’s most vulnerable populations. More than 50% of <a href="https://www.aihw.gov.au/reports/aged-care/depression-in-residential-aged-care-2008-2012/contents/table-of-contents" target="_blank">residents in nursing homes</a> suffer from depression compared to 10-15% of adults of the same age living in the community.
Recent <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/gps.4862" target="_blank">research</a> conducted by Briony Murphy and Professor Joseph Ibrahim from Monash University’s Health Law and Ageing Research Unit, found around 140 Australian nursing-home residents took their own lives between 2000 and 2013.
The authors found nearly 70% of those who took their own life were male, 66% had a diagnosis of depression and nearly 80% were experiencing one or more major life stresses, such as health deterioration. Around 43% were experiencing isolation and loneliness, and nearly 30% had trouble adjusting to life in a nursing home.
They wrote:
"The small proportion of adults over 65 living with depression in the community shows that depression is not a normal part of the ageing process… the much larger figure of those suffering depression in nursing homes raises some serious questions."
4. <a href="https://theconversation.com/too-many-australians-living-in-nursing-homes-take-their-own-lives-92112" target="_blank">Too many Australians living in nursing homes take their own lives</a>
<hr>
Poor oral health
Stories of abuse and neglect in nursing homes have also highlighted the issue of poor nutrition and oral health. In November 2017, the dire state of this was shown in a report of a <a href="https://www.smh.com.au/national/nsw/push-for-inquiry-after-woman-found-with-maggots-in-her-mouth-at-nsw-nursing-home-20170509-gw0p1j" target="_blank">nursing home resident in NSW</a> who was found with maggots in her mouth the day before she died.
Researchers have long highlighted people living in aged care have substantially poorer oral health and three times the risk of untreated tooth decay than people living in the community.
Bronwyn Hemsley, Andrew Georgious, Joanne Steel and Susan Balandin collated a list of ways family members can help ensure their loved ones’ oral health is adequately looked after. This includes visiting your family member around mealtimes "…or helping the person to eat… Ask the resident permission to look into her mouth to check if she is swallowing or removing leftover food promptly".
5. <a href="https://theconversation.com/the-shocking-state-of-oral-health-in-our-nursing-homes-and-how-family-members-can-help-77473" target="_blank">The shocking state of oral health in our nursing homes, and how family members can help</a>
<hr>
If you or someone you know is experiencing depression or another mental health problem, contact <a href="http://www.lifeline.org.au/" target="_blank">Lifeline</a> 13 11 14, <a href="http://beyondblue.org.au/" target="_blank">beyondblue</a> 1300 22 4636 or <a href="http://www.sane.org/" target="_blank">SANE Australia</a> 1800 18 7263.<img src="https://counter.theconversation.com/content/103325/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Sasha Petrova, Deputy Editor, Health + Medicine, <a href="http://www.theconversation.com/" target="_blank">The Conversation</a>
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/essential-reading-to-get-your-head-around-australias-aged-care-crisis-103325" target="_blank">original article</a>.
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Essential reading to get your head around Australia’s aged care crisis

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<a href="/developers/stockland">Stockland</a> is making good on a plan to realise a major mixed-use development in suburban <a href="/new-apartments/epping-nsw-2121">Sydney's Epping</a>, lodging plans last week that will pave the way for a substantial tower.

At the heart of the $181.5 million build is a new 29 storey building that would be dedicated to a residential aged care and independent seniors living units. The size and sophistication of aged care developments across the nation has advanced markedly in recent years, although Stockland's bid for <a href="/developments/epping-nsw-2121">29-33 Oxford Street</a> and 6-14 Cambridge Street is by far and away the nation's tallest.

Already a leading retirement living provider, Stockland in league with the Catholic Diocese of Broken Bay intend to deliver the project which would stand on the grounds of Our Lady Help of Christians Church.

As such the project is multi-faceted in that offices, retail, a primary school and ancillary church uses are also included.

<h2>29-33 Oxford Street application summary</h2>

<figure><a class="colorbox colorbox-insert-image" href="https://res.cloudinary.com/dz9xllyip/image/fetch/q_auto:good/https://s3-ap-southeast-2.amazonaws.com/www.urban.com.au/s3fs-public//pictures/article-images/image41_13.jpg" rel="gallery-all" title="Street level perspective. Image: Architectus"><img alt="" class="image-article-full-width-580px" height="255" src="/sites/urban.melbourne/files//styles/article_full_width_580px/public/pictures/article-images/image41_13.jpg?itok=l4eHlKNK" title="Street level perspective. Image: Architectus" width="580"></a>

<figcaption>Street level perspective. Image: <a href="/architects/architectus">Architectus</a></figcaption></figure><ul>
<li>Tower to stand 95.9 metres</li>
	<li>Included is a 132 bed residential care facility and 205 independent seniors living units</li>
	<li>2-3 storey primary school for 210 students with a second stream school planned, boosts student numbers to 420</li>
	<li>200 seat parish hall</li>
	<li>Landscaped public areas</li>
	<li>Basement provisions for 372 vehicles</li>
</ul>
<a href="/architects/architectus">Architectus</a> conceived the precinct design, and in their Urban Design report outlined the opportunity the sizeable site provides:

<blockquote>
This is an extraordinary proposal for an extraordinary site. Unlike adjacent developments, the proposal will provide great public benefit to the locality, including parish, education, cultural, residential and retail facilities.

The proposal has been designed for the long term and intends to consolidate the Parish’s contribution to the community for the next 100 years. The proposed housing in the vicinity of the Town Centre and Epping Station, will keep elderly residents engaged and connected to the community for a longer period of time.

Similarly, the proximity of the elderly to young children creates the potential for mutual benefit, while prolonging the health and happiness of our oldest citizens.
</blockquote>

Stockland first flagged its intentions for the site during May after announcing the tie up with the Catholic Church. At the time Stockland’s CEO of Retirement Living Stephen Bull noted:

<blockquote>
The site for the proposed new community is within walking distance to rail, which will soon be upgraded to Metro, and the Epping town centre.

We know seniors want to be part of a vibrant, thriving community close to public transport, shops, clubs, cafés and restaurants, and we want to provide options for people to remain living in the communities they know and love as they age, close to families, friends and services.
</blockquote>

The existing heritage-listed church will be preserved enhanced externally.

<figure><a class="colorbox colorbox-insert-image" href="https://res.cloudinary.com/dz9xllyip/image/fetch/q_auto:good/https://s3-ap-southeast-2.amazonaws.com/www.urban.com.au/s3fs-public//pictures/article-images/image37_10.jpg" rel="gallery-all" title="Aged care among many purely residential towers. Image: Architectus"><img alt="" class="image-article-full-width-580px" height="356" src="/sites/urban.melbourne/files//styles/article_full_width_580px/public/pictures/article-images/image37_10.jpg?itok=CLVIUjkW" title="Aged care among many purely residential towers. Image: Architectus" width="580"></a>

<figcaption>Aged care among many purely residential towers. Image: Architectus</figcaption></figure>Stockland is already heavily vested in the national aged care sector with over 12,000 residents calling a Stockland retirement village their home.

Whilst the Epping application is noteworthy for its sheer height, it is not the only substantial development Stockland has on its agenda. The developer continues to push for a <a href="/news/stockland-pushes-for-the-pines-to-include-retirement-apartments">mass redevelopment of its Stockland the Pines shopping centre</a> in <a href="/new-apartments/doncaster-east-vic-3109">Melbourne's Doncaster East</a>; included there were 283 retirement living apartments although Manningham City Council stymied the application mid year.

Birtinya Vertical Village also counts itself in the Stockland stable. South of Sunshine Coast, the project is all but complete and features a string of multi-level retirement villages with supporting services.

<figure><a class="colorbox colorbox-insert-image" href="https://res.cloudinary.com/dz9xllyip/image/fetch/q_auto:good/https://s3-ap-southeast-2.amazonaws.com/www.urban.com.au/s3fs-public//pictures/article-images/image91_4_0.jpg" rel="gallery-all" title="Stockland's Doncaster East bid. Image: Plus Architecture"><img alt="" class="image-article-full-width-580px" height="273" src="/sites/urban.melbourne/files//styles/article_full_width_580px/public/pictures/article-images/image91_4_0.jpg?itok=82tZnH32" title="Stockland's Doncaster East bid. Image: Plus Architecture" width="580"></a>

<figcaption>Stockland's Doncaster East bid. Image: Plus Architecture</figcaption></figure>
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silvermb

Stockland moves on the nation's tallest integrated aged care development

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Jewish Care Victoria has listed the former Mark &amp; Dina Munzer Community Residential Aged Care facility in Melbourne’s Caulfield North. 
Gary Peer &amp; Associate, inconjunction with CBRE, are handling the sale of the 52-58 Northcote Avenue property. 
The 3,683 sqm site has remained vacant since the aged care facility’s closure in March 2017.
The property is expected to attract the attention of local and overseas developers, aged care operators and not-for-profit and charitable organisations looking to establish new headquarters.
Jewish Care Victoria CEO Bill Appleby said the property did not align with the organisation’s recently released Strategic Plan, which would determine its key strategic priorities for 2018-2020.
Gary Peer &amp; Associates’ Philip Kingston said the former aged care facility was the most significant allotment the firm has handled for public sale. 
“The property is more than double the size of any landholding in the notoriously quiet street, and more than 1,000sqm bigger than anything we have handled in the Caulfield precinct over the last five years,” Mr Kingston said.
The property features all the amenities required of an aged care facility, including 45 beds, full line commercial kitchens and formal living and dining areas. 
Offers close September 6.
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