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Episode 28

Helping families figure out if home care is for them – a conversation with OPAN Australia

Jeff Howell (00:01):

Welcome to Home Health 360, a podcast presented by AlayaCare. I’m your host, Jeff Howell, and this is the show about learning from the best in home healthcare from around the globe.

Jeff Howell (00:18):

Hey everyone, and welcome to another addition of Home Health 360 where we speak with leaders in home care and home health from across the globe. Today we have Craig Gear, who is the CEO of Older Persons Advocacy Network. OPAN is a national network comprised of nine states and territory organizations that have delivered information education and individual advocacy services to older people throughout Australia. In 2020 and 2021, OPAN provided individual advocacy for over 23,000 seniors completing 2,600 education sessions and get this had more than 73,000 webinar views. Craig, welcome to the show.

Craig Gear (01:07):

Thank you. Yes Covid definitely made us pivot is that wonderful word of pivoting to when you can’t get to a residential age care facility, we can’t go out the community to provide face to face education. What do you do? You go to online. And so that was a, a great opportunity for us to make something out of what a really bad situation was.

Jeff Howell (01:27):

Yeah. And I suspect those weren’t 73,000 live webinars. I’m sure you had some automation built into that, right? ,

Craig Gear (01:35):

Yeah. Yeah. So that, that, that were views of people viewing the, the webinar series across the time. So yeah.

Jeff Howell (01:41):

So you’re funded by the Australian Government’s National Aged Care Advocacy Program and you’re founded in 2017. So what’s really the purpose behind what OPAN really does?

Craig Gear (01:55):

Yes. So as you mentioned that we’ve got nine member organizations. They’ve been delivering this program, which the government funds, but is independent of government, independent of the aged care providers cuz it’s really important people, older people know that we are on their side. We are, we do class ourselves as partisan because we wanna represent and support the older person themselves. Cause they’re often the person who’s human rights are kind of impeded or there’s a power differential when you’ve got a provider providing care and then someone who’s the recipient of care. And so what a lot of what we’re doing is balancing that power dynamic, helping people to be able to raise their issues and get the best out of their their age care experience. Often we don’t know that we think we’re doing the right thing and we think we’re providing really great care and no one’s provided us feedback.

Craig Gear (02:46):

So everything must be all right. What our age care advocates do, and we’ve got about 200 now across the country, is actually go and speak to the older person themselves and have let them say, Look, I’m not really confident in raising this, or, I just don’t wanna make a fuss, but I’m not really happy with what’s going on. And so we often work with the provider and say, Let’s find a solution that works for the older person. So we’re on the older person’s side, we take direction from them. We’re free, confidential, and independent. What OPAN does is bring those nine organizations that have been doing this for about 30 years, has brought them together under a national umbrella so we can make sure there’s consistent practice, but also that we can promote the value of age care advocacy right across the country.

Jeff Howell (03:28):

Got it. And so I would imagine one example would be helping families to figure out if home care is for them or residential care.

Craig Gear (03:37):

Absolutely. So it’s giving people about options, about understanding how to navigate the aged care system what is available and out there and what is the, the benefit. We work with a thing called the charter of age care rights, which is 14 statements about what older people can expect from their aged care provider and how they expect to be treated. So things like being treated with dignity and respect to be able to live free of abuse and neglect. And the one that people always come to us when we speak to older people about the charter is right number nine, I have the right to my independence. And so home care is what people are telling us they want. They want to be having delivered, they wanna stay in the home as long as possible. They want their family around them, they wanna be connected to their community, they want a village type approach to this.

Craig Gear (04:27):

And so getting people to understand what good home care is like and how they can navigate that, how they might be able to self-manage, or how they actually get the rostering right so that they’re getting the care and support they need. That’s what people are telling us that they want, and that’s what some of our age care advocates will do. And then when people are in the services, if issues do arise, which they will from time to time, how do you get those issues resolved? How do you navigate and coordinate and negotiate with your age care provider as well?

Jeff Howell (04:59):

So these 200 advocates that you have, that they’ve had careers within home care and residential care, where how do, how do you find these people and what are their qualifications?

Craig Gear (05:11):

Yeah, it’s a really interesting mix. We’ve just taken on a, a new intake into our, what we call is our advocacy academy, which is teaches everyone all things age care, but about teaches them how do you actually deliver this advocacy program in a way that is framed in human rights, upholds the human rights of older people, but also doesn’t take over from older people to maintain their independence so that we are actually looking for them to be given the skills and empowerment to advocate for themselves. That would be the ultimate joy of mine. If older people felt that they didn’t need us anymore, that we’d given them the skills and that sort of thing. So these advocates, some have come out of teaching, some have come out of healthcare, the care services, and yeah, a lot of people have come from aged care providers themselves and gone, I wanna actually be on the side of the old person and make sure that the things I’ve seen that might not go so well, I can actually do something about that and I wanna champion the older person’s rights.

Jeff Howell (06:10):

And how would your clients typically find you?

Craig Gear (06:13):

Yeah, so that is interesting because we think we see about 2% of older people per year. And we at least want to get to a minimum of, of 5%. We really, we’d be wonderful if we were seeing and supporting seven to 10% of older Australians receiving aged care, which is around about 1.4 million. So we’ve got a way to go. We’ve gotta work with our partners such as home care providers, some really good providers who give the charter of aged care rights to the recipient. The older person say, Here, this is the way we’re gonna treat you. We’re gonna, you, you can hold us to account on this, and here’s OPAN’s number 1, 800, 700, 600 down the bottom there, You can ring them anytime. So that’s where it works really well and getting it into information. We do a lot on social media, so there is a lot of older people who are digitally savvy to some level on Facebook and definitely over covid.

Craig Gear (07:10):

A lot more people got on there. So we do a lot on social media. We also go into print into what’s called the senior newspaper in Australia. That, but we need to do more. We need more. We, we want 20, 30 to percent of people to know that we are here and available and free and they should give us a call. So providers are fantastic partners in when they do that. And it, it shows that they’re really open to taking feedback and hearing these things. It’s not about bashing up the providers, it’s about making sure that they know what’s going on and what we can help them to provide really good care.

Jeff Howell (07:45):

And how would you describe, like what are the different types of home care in Australia?

Craig Gear (07:50):

Yeah, so there are four types, which makes it quite confusing for people. There’s the Commonwealth Home Support Program there, that sort of low key supports just to help around the house, but there is a little bit of access to some medication management, things like that, monitoring in that as well. There are home care packages, which have four levels at the moment, and there are a bucket of money that is directed by the client about how the care and support will come into them and support them. There’s short term restorative care or transition care, and that’s often when people have gone into hospital or they’ve deteriorated and they need some rehabilitation services, physio, OTs, those sorts of things. Exercise physiologist to come in for a period of week to get ’em back on their feet and stay in their home. And then the final bit is flexible care, which is a program which is around there for First Nations people to say, Look, there is a different way that we want to provide culturally safe home care services, and we need to be more flexible in how we we do that.

Craig Gear (08:55):

So those four programs available, the bulk of people, it’s around about 800,000 older Australians receive the Commonwealth Home Support program and there’s closely probably getting closer to 200,000 in receiving a home care package now as well. So it’s much bigger than residential aged care where we see about 180,000 people in residential aged care. There is a lot of people receiving home care and the more they can do it, more they can receive and get those Allied Health services in as well, the more they can maintain their independence and stay at home longer.

Jeff Howell (09:30):

Okay. So interesting. So under Commonwealth and the Home Care packages, there’s about a million people right there. And then REI is is about 180,000 in total?

Craig Gear (09:40):

Yeah. Yeah. So it’s much more cost effective and much, much happier customers if they can stay in their home longer and have really good coordinated care there. But as you can see, that’s a bit bit confusing of a system and for people to understand. One of the things that’s happening out after we had a rural commission is looking at an integrated system of home care called Supported Home. And so that’s being designed at the moment that bring those programs together, which is much more, doesn’t matter which program you got, we’ve gotta look at your needs and we’ve gotta make sure you get the care you need with the right staff, with the right attitudes at the right time and the right place, which people say is in their home.

Jeff Howell (10:17):

Right. Has the self-directed care really taken off? I think that’s the term for it. That’s where instead of getting a prescribed level of care, the government will provide a check and then the, the client can actually decide how those funds are allocated.

Craig Gear (10:33):

Yeah, we’ve got a program called the National Disability Insurance Scheme, and that does a lot more probably of, of self-directed care, client directed care, consumer directed care is various terms for it in home care packages. Yes, it’s built on a model of consumer directed care and also the ability to have a, a choice to choice and control about whether you want a case manager that is gonna coordinate and check in with you and make sure that the effectiveness of your care or other people who say, I wanna manage this myself. I’ve actually managed my bills, my invoices, run a house, run a business my whole life. Why do I have to have someone else come in and take over from me now? So I want the ability to, yes, with appropriate checks and balances, so make sure these taxpayers money that’s being spent on the right things, appropriate inclusions and exclusions.

Craig Gear (11:20):

But I wanna actually manage that package myself, and I wanna determine how care is provided to me. And that’s where it’s really important just to have the software, the backend, the business sort of supports that allow providers to come in and and coordinate that sort of support for someone that’s with a case manager, but also importantly with someone that’s self-managing their home care package as well. And one of the things we’re seeing at the moment is rostering is so important, workforce is really important, and being able to coordinate and schedule that appropriately so that it meets the needs of what the older person is asking. I might need 15 minutes in the morning to get me up, and then I have my shower at the end of the day, and I need someone to come back to do that. And it takes a lot of careful planning and rostering so the person can say, And I want the person of my choice who I like to be doing that. So there needs to be systems and business processes behind that, but actually support that person having choice and control and maintaining that independence.

Jeff Howell (12:21):

Got it. And then within those four original buckets you had talked about, I can see how there’s a level of complexity, because I think you even said that within home care packages there’s four different levels. Curious if, you know, if you look at the United States as an example, it’s rather straightforward in that they have Medicaid for families that are at the poverty line and they have Medicare, which is essentially, you’ve paid into it your whole career, and now it’s your essentially retirement healthcare fund. Yes. I’m curious, is there a, a level of is there anything comparative to that within, you know, if there’s 800,000 people in the Commonwealth Home Support Program, I’m also curious if there’s degrees of income or what you’ve paid into and when you’re 65 and above, is there the equivalent?

Craig Gear (13:13):

It’s a really interesting discussion we’re having at the moment around co contributions and how do you build a sustainable supported home program. And the government hasn’t made a decision on that as yet. Under the current systems, there are some levels of co contributions and depending on which package you’re on, those sorts of things, open’s position is that no one should be pushed into poverty to be able to receive care and people need the care and support that they need, but there are times when people can afford to contribute to that care as well. So there needs to be more than just a safety net. It needs to be that it actually is doing what it does and supports people to stay in their home. But there is a significant amount, billions of dollars that go into home care and commonwealth’s home support each year of taxpayers money. And that’s, that’s the right thing. That’s the thing we need to do for our older citizens. Old Australians, they’ve paid taxes their whole life. We’ve got the responsibility to provide the care and support they need into their old age.

Jeff Howell (14:15):

What are families most surprised about to find, find out about home care and residential care when the time comes for them to take a look at what their options are?

Craig Gear (14:25):

Yeah, I think probably the, the complexity of the system at the moment it’s, it is still challenging to navigate. There’s been a lot of improvement in the program. We’ve got online website and call center called My Age Care. But there are a number of steps that people need to go through, and they, they’re also surprised that often they have to wait. So a lot of the stuff we’re doing at the moment, the Australian government’s doing is around reforming and making this the program simpler. That, but they are surprised at what it also can do to actually keep someone in, in, in their home longer if it’s coordinated well. And they work with the older person to direct their care. So it, it’s probably the system navigation that’s probably people find the most challenging at the, at the beginning. And then when it’s established that some of the difference that actually can make in someone’s life, that they can still stay connected to their community they can receive supports. We just wanna see that those, those supports are based on need. Rather than just a capped out package of money

Jeff Howell (15:31):

In the United States. There’s something like 25,000 home care agencies. There’s a pretty low bar to get into, at least the private pay side of the business. Should I assume that the Australian market is an equally fragmented home care provider market as well?

Craig Gear (15:50):

It’s, it’s fragmented in the sense that there’s a lot of providers, but look, I don’t think finding a provider, the my age care system does allow you to sort of put in your post code your needs and those sorts of things that could be improved, of course. But there has been a lot of work to, for people to be able to look at that, the quality standards, the aged care quality standards also apply to both residential and home care providers. So there’s a lot of work going on around making sure that the, the quality systems are in place, that you get a good quality of care that providers are investing in their staff that they are providing appropriate training and checks and balances. We’re about to have a code of conduct that comes in that sets that sort of bar of expectations on how worker will behave. So it’s, it’s improving regulation and we’re trying to get that balance right so it doesn’t knock people outta the market who are really good providers, but also providers of appropriate set of standards and expectations on providers of how they’ll provide care and the, the quality of that care.

Jeff Howell (16:55):

There’s a little thing called caregiver shortages. Not sure if you’ve heard of it or not. .

Craig Gear (17:01):

Oh, just a little bit, Yeah. . Yeah,

Jeff Howell (17:04):

We were not gonna not talk about that. I’m curious what the situation might be like in Australia and if you’ve seen any changes over time.

Craig Gear (17:12):

I think, and Covid has exacerbated the workforce issues with people either leaving the workforce or finding a, a challenging place to work that’s in home care and, and particularly residential aged care. Everyone is having workforce challenges. We’ve also got expansion in our disability care sector, in our veterans care sector, and then also in the home care and residential age care sector. And everyone’s what’s called fishing from the same pond sort of thing. So that, that is a challenge. We, we are looking at training up our own, we’re looking at migration options that the government is looking at as well, but we need the right staff with the right training in the right place. And home care I think has got great opportunities for people because you have got that flexibility. It is a different type of care.

Craig Gear (18:05):

We have some models which are around more sole provider sort of thing with someone setting up their own business and working with, with under the banner of a provider. But having that independence of support. So there’s some real advantages to working in the sector. But unfortunately there’s no magic wand of suddenly giving this instant workforce. But I think it is the workforce of the future, the care sector needs to be there. And one of the things we really need to do is actually pay and value the workforce. If we don’t do that, no one will want to come and work in age care or disability care or the care sectors. And so what’s called our Fair Work commission is actually looking at a, a wage case at the moment to really look at upping the wages of what is just such a vital workforce and the value that older people get, but also from of workers when they say they’ve got that personal connection. And this is about relationship based care that they’re delivering and it’s joyous when they do it, but they need to be valued and respected and that need to understand that value of that work as well.

Jeff Howell (19:06):

And is it typical then that a care worker in Australia would make minimum wage and its fee for service? There’s no government subsidization?

Craig Gear (19:16):

Yeah. unfortunately some people get more money in Starbucks than they do at working in aged care. And that’s why our, our industrial associations have put the case and, and our provider aged care providers have supported it. And now with this, with the labor government, the easy government that’s just come in are supporting the wage case as well. So everyone’s on the same page as saying have to be paid more. The unions have said 25% more. And that’s what the commission is looking at at the moment what that increase. But it’s, it’s rare. You get government providers, consumer groups and the unions all on the same page saying, we need to do this. So that’s, that’s a positive that we all, we all want the same thing, even if it’s there’s discussions about what that increase is, but everyone’s, the community’s calling it for it. Older people are calling for it, We need to just get on and do it.

Jeff Howell (20:11):

Yeah. And the demographics are undeniable and you combine that with, you know, 99.9% of people want to age at home.

Craig Gear (20:20):


Jeff Howell (20:21):

You know, it’s those are forces that are just undeniable. So Covid hits, I’m presuming that you would’ve seen a, a big spike in activity on people that are looking to become educated on home care. And I’m assuming the 73,000 webinar views is a two year high, and in the previous two years it was nowhere near that.

Craig Gear (20:51):

Correct. Yeah,

Jeff Howell (20:53):

Just, yeah, just curious to some of the changes that you’ve seen, cuz I, I’m just imagining that, you know, the, the 200 advocates that you have, maybe that’s been a, you’ve gone through a huge hiring spree and you know, as people are trying to pull people out of residential care and, and a spotlight is shining on home care, curious to hear from you all the changes over since Covid has started.

Craig Gear (21:15):

Yeah, so one of the biggest changes I’ve said before, so one of the things about how do people come to us, well, we also go out in the community and our advocates are out there in age care homes or wherever we can find we’re older people are, which is sometimes harder in home care. But cuz we can go to the long term care facility or the Aged Care home and say, Hey, we’re gonna tell you about your rights and about the availability of these services, harder to do that in the community, harder, do that during a lockdown. So one of the things, I was sitting there with a colleague at the pub just before the lockdown started in Australia and said, this is gonna really affect older people. How are we gonna do, what are we gonna do to get messages out? How are we gonna help communicate to older people?

Craig Gear (21:52):

And so the webinars were a strategy of ours. It’s something we’d done small scale before, but we knew that people would be then sitting at their home wanting accurate information they could be confident in, but it was not just government speaker was translated into where the way they heard it, but it was also older people speaking to them. So that was a strong focus. We saw huge demand for our services, particularly in residential aged care facilities where there was restrictions on visitors. There was huge impacts on and, and loss of life. People were worried, people in home care didn’t wanna let their home care provider or their home care worker in, in case they transmitted. So what, what is appropriate ppe? What was the appropriate thing to ask your aged care worker to do? How did we actually keep services coming to you?

Craig Gear (22:41):

Don’t lock your services out because that will mean you’ll deteriorate. How do we actually make sure you’ve got food and support that you need? And that was a real partnership with home care providers to make sure that those systems were working, but with local governments and state and territory governments as well. So it’s, it’s had a big impact of getting the right information to people to actually for them to ask their questions so that it wasn’t just one way information. And that’s it’s been a big growth for us over covid, but it’s actually meant that people understand the value of age care advocacy and why it’s important to access an age care advocate and get information. And that you need,

Jeff Howell (23:21):

And I love that you guys are independent of the providers as well, and you’re not a referral source, right? And so you can truly be this independent, unbiased third party,

Craig Gear (23:32):

Very strict on that as well. And while we take government money and that sometimes people criticize us, Why are you, you paid for the government so you’re not gonna bite the hand that feeds you. The other option is older people have to pay for these services and they shouldn’t have to pay. You should be able to have independent supports that are free. And so that’s, that’s why this is the money. But we still, because we hear from about now 27,000 people each year we hear about what their issues are and we can take those issues up collectively to government and say, the system’s not working in these areas. We we need to keep working on reform in these areas. So that’s the power of, I suppose, of the network of having Oppa n together and hearing from the voices of older people every day about the issues that in the life experience that they’re having and that, that that’ll drive an improved system over time.

Jeff Howell (24:20):

Yeah. And you have an elder abuse program as well. How does that work?

Craig Gear (24:24):

Yeah, so often we come in contact people or providers come in contact with older people and say, Something’s not quite right here. I’m not sure what’s going on. I don’t know what I should do. And so part of that for support providers, but also ultimately support the older people to have their voice. And if we someone notices something, we want ’em to say something and we want ’em to bring in an advocate who can have a discussion with the older person about what might be going on. The trigger factors, how do you prevent abuse, where it is abuse to get them the, the information about options but then still staying in control of that discussion because we know sometimes it’s about family dynamics and relationships is about financial systems but also it’s about the person feeling disempowered or that they’ve had to check in in their human rights to make choices and control in their lives at the door when they’re starting to receive aged care services. And that shouldn’t be the case. So that’s a lot of the work is education but also allowing people to know what supports are out there and how to prevent abuse and the sorts of scaffolding that you can build around someone. So they’re still connected to community, which is a, a mitigating factor for abuse.

Jeff Howell (25:38):

Yeah. Tell me about the award winning documentary that you have. And it’s, I believe you can get access to it from your website as well. If that’s the case, please provide the URL and how people can go take a look at it.

Craig Gear (25:53):

So I can’t claim wanting to, to be the award winner on this one, but our public broadcaster which is the called the ABC in Australia, and two programs we’ve been involved with. This one was the Old People’s Home for four year olds, where they did some intergenerational work and brought young people in as sort of these mini trainers for older people into both residential. But then the second series looking at it, them working with older people living in the community and receiving home care, and it was really about people staying connected with their community. It did win as Shirley McLaren, who was one of the participants keeps telling me that she’s now an international Emmy award winning person from this, from this series . The other work that we’ve been doing is with a group called with Jason and his family a beautiful experience of home care and someone supporting someone with living with dementia.

Craig Gear (26:52):

And it’s called Everybody’s Omar, and it’s actually out in cinemas or online and we can send you through the links to, to both of those programs. But everybody’s, Omar talks about this family’s journey with dementia and how, how that can be challenging, but it can also be absolutely joyous and it’s up for a number of awards. And programs at the moment are really courage people, anyone working in home care, anyone working with older people to see the reality but also the joy that Omar brings when you see that smile on her face. And that interaction she has with, with such a, a tight family unit. And it was only possible because of home, the home care supports that they got and the, the wonderful providers that actually worked with them as a family so that they could stay at home with Omar as long as possible.

Jeff Howell (27:44):

That’s great. And what’s what’s your website? It’s op, is it

Craig Gear (27:48): Uh and anyone listening in Australia that wants to refer someone, there’s a free call number one eight hundred seven hundred six hundred that gets through to our age care advocacy services.

Jeff Howell (28:03):

1 800 700 608 76

Craig Gear (28:07):


Jeff Howell (28:07):

Oh 8 76. Well, Craig, we’re bumping up against our time here, so I’ll get you out of here on this last question. Give us a reason to be optimistic about the future of care and the place that the client calls home.

Craig Gear (28:21):

I think it’s because of the wonderful aged care workers, providers, and families. Everyone wants the same thing. Everyone wants the human rights of older people to be respected, to be upheld, to be understood, and to deliver really great care. And so if we’re all working towards the same thing and then we can sort of start bringing in people behind us into this sector I think that that brings a wonderful opportunity to deliver great care that really respects and provides dignity to older people.

Jeff Howell (28:52):

And it’s, it’s heartwarming to hear that you have 200 advocates that no matter who I speak with on this podcast we as humans want to be in denial about the need to have any type of care for as long as possible. And you know, when you go through the four different types of care Australia has, and THEC packages even have four subcategories, it’s definitely confusing, it’s overwhelming, and people leave these things to the last minute. And so it’s it’s great to hear you guys are doing such great work in providing truly independent, unbiased advice to deliver you know consulting to people that you know, are in need and they don’t know what to do next. And love to see that, you know, you’re not a referral source. You’re truly an impartial party to really help them out.

Craig Gear (29:50):

Absolutely love the work we do. We’d love to not have to do it. That’d be great. .

Jeff Howell (29:54):

Yeah. Well, thanks for being on the show, Craig. I’ve learned a lot today. I’ve, I’ve taken a few pages of notes here that I always keep from my archive. And look forward to maybe having you on the show another time in the future, or if I ever make it to Australia for a home care or conference, I’ll be sure to look you up.

Craig Gear (30:12):

Sounds good, thanks.

Jeff Howell (30:15):

Home Health 360 is presented by AlayaCare. First off, I wanna thank our amazing guests and listeners. To get more episodes, you can go to, that’s spelled Home Health 360, or Search Home Health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts. We also have a newsletter you can sign up for on to get alerts for new shows and more valuable content from AlayaCare right into your inbox. Thanks for listening, and we’ll see you next time.

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Episode Description

Home Care is on the rise across the globe but how much do families actually know about what home care can offer? We sat down with Craig Gear, CEO of Older Persons Advocacy Network (OPAN), which delivers information, education and individual advocacy services to older folks throughout Australia. From education services to webinars, OPAN helps those interested in home care and/or residential care to understand how to navigate the aged care system, what services are available to them, and what are the benefits.

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