What the Australian Aged Care system can learn from Canada

Anna Grosse

CANADA and Australia have a lot in common – colonial history, native peoples and a large immigrant population, although geographically they are very different. Both countries have a commitment to provide care for older people in need.

A report by the National Institute on Ageing (NIA), Enhancing Care for Older Adults in Canada and Down Under, identified several opportunities to improve the organisation, governance, and delivery of long term care services in both Canada and Australia.

Dr. Anna Grosse, lead author of the report said: “The challenge both countries face is to create long term care (systems) that have the capacity to coordinate and provide the care that millions of older Canadians and Australians will rely upon over the coming decades.

“A health care system that recognises, appreciates and accommodates individual needs, values, and preferences will become even more important for these ageing populations.” 

Canadian and Australian populations are aging in similar ways; life expectations are around 85 years for women and 81 for men. Nearly 20 per cent of people are over 65 and most (95 per cent) older adults live at home. 

Canada spends more money on the provision of LTC services than Australia, both as a total figure and as a proportion of Gross Domestic Product.

Long-term care providers in both countries are grappling with similar problems –  not only helping people live longer, but to improve the quality of their lives as they age.

Australian aged care is funded by the federal government which provides a single point of access (My Aged Care) to services, both for residential and in-home care.

In Canada, aged care is primarily funded and regulated by the provincial governments through a mix of tax revenue and voluntary contributions. The quality of care can vary depending on the province and there is no universal point of access to long term care services.

In both countries many older adults occupy hospital beds while waiting for a place in a care home or for the availability of home-based care services. This is expensive to the state and unsatisfactory for the patient.

The Australian aged care system has been recently reviewed by the Royal Commission into Aged Care Quality and Safety. The commissioners made 148 recommendations calling for an overhaul of Australia’s LTC system and its governance.

Some of these recommendations are now in the process of being implemented through a National Aged Care Reform plan. The aged care system in Australia is currently largely based on supporting service providers. This is to be changed to a system where the rights of aged people are considered paramount.

One of the most striking differences between Canada and Australia is that inspection of seniors’ facilities in Australia is far stricter. They must pass an accreditation process and be subject to regular quality reviews by the Aged Care Quality Commissioner who audits compliance with eight Aged Care Quality Standards using information that is supplied by service providers and obtained during site visits.

Recently residential care homes have been awarded star ratings based on their facilities and performance.

While the proportion of seniors in residential care in both countries is similar. Around 20 per cent of Australians over 85 live in residential care compared to only 14 per cent in Canada.

In Australia 91 per cent of long-term care homes are run by private for-profit organisations compared to just over 50 per cent in Canada. Two thirds of Australian care homes claim to operate at a loss.

Both Canada and Australia spend more money on providing care in residential homes than on home care services, despite the latter being more cost-effective and consistent with the care preferences of 99 per cent of older adults

Staffing levels are the key to quality residential care. In Canada, a personal support worker may take care of as many as 36 patients. However, many tasks may require two support workers, who may not be available at the same time.

Until recently in Australia, residential care homes only had to maintain an ‘adequate’ number of appropriately skilled staff . But in 2022, the Australian Government mandated that every home have an on-site registered nurse  (RN). Additionally, from last year residents must be provided with at least 200 direct care minutes per day, including 40 care minutes provided by an RN.

What Australia can learn from Canada?

The interRAI assessment systems are used in Canada for clinical assessment, quality improvement and general data collection regarding in-home and residential care. The report authors say the data gathered could add considerable value to Australia’s aged care sector. The systems are also well suited to both in-home and residential care needs assessment.

In some Canadian provinces, older adults can access Home-Based Primary Care – health care services that usually require attendance at a GP clinic. Australians who cannot travel to attend medical appointments are left without appropriate medical care or must rely upon the limited numbers of GPs and locum doctors who perform home visits, ambulance services and hospital emergency departments.

The report also lists eight main ways in which both countries can improve the care they provide for their aged citizens:

  • – Invest more money in long term care systems to ensure their future sustainability.
  • – Prioritise home-based services, to support older people to live in their own homes for as long as possible. 
  • – Encourage small care homes rather than traditional large-scale institutions.
  • – Improve pay, training, working conditions and opportunities for career advancement for staff working in aged care.
  • – Providing better support for unpaid caregivers, recognising them as individuals not just by their relationship to care recipients.
  • – Ensuring that federal and state/province governments work together to better integrate long term care.
  • – Addressing ageism in both governmental and non-governmental areas. 
  • – Empowering older people to make informed decisions about their care and wellbeing. 

The Australian age care system has the potential to improve by learning from the experiences of other countries, especially those like Canada  with similar historical and mixed ethnic backgrounds.

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Frank Smith was trained as an agricultural scientist in the UK, moving to WA in 1974 and shortly afterwards began lecturing at WAIT (now Curtin University) in soils and agronomy. In 1979 he joined the Agriculture Protection Board in charge of publications and media relations, studying part time for a degree in Journalism. In 1992 he spent a year as a visiting professor at the University of Missouri-Columbia. Later he ran a small publication company with his wife Mary-Helen. He then began freelance writing, editing and book indexing. He has written articles for more than 40 magazines in four continents and indexed more than 20 books. In 2007 he started writing for Have a Go News and gradually reduced his writing for other publications. He later took over the subediting, ensuring Have a Go News is consistent in style and highly readable. He and Mary-Helen live in a passive solar home in the Perth Hills with a varying collection of quendas and native birds.