Abstract

For many years, researchers, policymakers and planners have called for the development of integrated service delivery models in order to address the perpetual problem of poorly coordinated, inefficiently delivered aged care for older persons in Australia; yet only a small number of providers in New South Wales have moved in this direction. Of the 619 aged care service providers studied, only six per cent have adopted an integrated aged care service structure with a wide array of community and residential services as well as some of the necessary integrating mechanisms-–i.e., case management or information systems.

This paper contributes to the on going interest in integrated care by investigating the factors associated with adoption of integrated aged care service structures. The paper presents results from multinomial logistic regression modelling that reveal non-profit providers, those with common sponsorship, and with greater capacity (more beds and community services) are more likely to adopt integrated structures. These results are illuminated by case studies of a subset of these "innovators" where both the decision-making process around the adoption of the integrated structures and the culture of innovation are explored. The discussion is placed within the current policy context where Australia is poised to create additional opportunities for the development of integrated systems for aged care, as it will soon start a new approach to financing its major aged care service programs

In July 2012, the Commonwealth is to take over fully policy, funding and operational responsibility for the major ageing programs including those programs for which responsibility was formerly shared with the States and Territories. In exchange, the States and Territories will be fully responsible for funding support services for people with disabilities under the age of 65. The Commonwealth can strengthen its capacity to deliver integrated aged care by using this new financial arrangement to remove previous barriers between streams of money. This allows them to offer more flexible arrangements with providers so savings can be used for things like additional services, care coordination and other kinds of integration infrastructure. Moreover, an open competitive bidding process is used for contracting with aged care providers “who can best meet the identified care needs of the community.” Presumably this determination of who can best meet the needs of the community must take into account a number of factors including the extent to which service integration is available. By now having information about how best to target capacity building, the Commonwealth is in a position to significantly increase aged care service integration in the near future.

Slides