A new “neighbourhood nursing” scheme could keep older Australians in their own homes longer and save the economy $4.5bn a year, the aged-care royal commission has been told.
In a new submission to the commission, the Nurses Professional Association of Queensland has called for a radical in-home aged-care approach based on the Dutch “Buurtzorg”, or “neighbourhood care” model, in which teams of up to 12 nurses look after a community of about 60 older people, with middle management costs stripped out of the system.
The NPAQ has also called on the commission to include a specific “right” for older Australians to remain in their own home and receive qualified nursing support in that home as part of the aged-care charter of rights that came into effect in July 2019.
It cautioned against the push for blanket nurse staffing ratios, a consistent theme during the commission’s hearings.
“Our current system is costly, cumbersome, overburdened with bureaucrats — and does not work,” NPAQ director Graeme Haycroft told The Weekend Australian. “At the moment, we are trapped in a dysfunctional system that robs the elderly of happy retirement. Most elderly people do not want to leave the family home, so why should they be forced to?”
Under the Buurtzorg model, a team of 10 to 12 nurses looks after about 40-60 seniors who would otherwise be forced to live in hostels or nursing homes or aged-care facilities.
Each nurse visits about three or four patients a day. They may only drop in for a cup of tea and a check-up once a week or visit more regularly. The visits are a minimum of 25 minutes, which the NPAQ said would in many instances give patients more contact with nurses than in a formal residential care setting. Some of the care provided may be everyday tasks such as feeding pets or cleaning out the fridge.
If necessary, the nurses not only liaise with a local network of GPs, physios, occupational therapists, social workers and other allied health workers, but also community guardians such as the police.
“The nurses themselves decide how long they stay with each person,” Mr Haycroft said. “They work in self-managed teams so there simply isn’t a need for a massive bureaucracy.”
The NPAQ’s submission said overhead costs at Buurtzorg centres in The Netherlands average 8 per cent of turnover, significantly less than the 25 per cent market standard in Australia.
Another saving is in the fewer hospital admissions and shorter hospital stays required by its patients. It calculated its $4.5bn annual saving on an equivalent study conducted by Ernst and Young of the Buurtzorg system.
The aged-care royal commission has been examining quality and safety in the sector in Australia. Its interim report in October described a “shocking tale of neglect” of older Australians, prompting the Morrison government to commit about $500m in additional funding, mostly for in-home care support.
Mr Haycroft said the commission’s finding that 16,000 people had died waiting for an appropriate home-care package to be approved was “a national disgrace”.