President – Nelson Mathews
Australians of all ages receive Meals on Wheels. Those living with mental or physical disabilities or older members of our community. They choose us because they appreciate that-
Meals on Wheels provides 3 services in 1
We Nourish. By providing a well-balanced and nutritious meal
We Care. By providing vital social contact, monitoring health and well-being and giving re-assurance to both our customers and their families. If someone is losing weight or seems distressed, our volunteers notice and act accordingly. This is the preventative care aspect of our service.
And thirdly– We Connect Communities. Volunteers are the heart of our service. They always say that they get more than they give. This engagement and sense of purpose has a massive impact on so many lives. Our services do not work alone, they work with and along-side other organisations to enhance the lives of people in their communities.
Together, these three elements make for a very powerful combination. Getting a week’s supply of frozen meals delivered by a private provider is not Meals on Wheels. We keep people well nourished, we intervene when they’re in trouble, we prevent falls and hospital stays, we keep people at home for longer, which means they spend less time in expensive residential care. It’s been estimated that for every dollar the government provides in subsidy, they get five back in down-stream health savings.
We are truly More Than Just a Meal.
However we are also under-funded. But before I expand on this, I’d like to recall a story …
A few years ago Grace rang up to enquire about getting meals for herself and husband. She was asked if she could still cook? – “yes” – still drive and shop? – “yes”. This call was taken by the then regional assessment team in Western Australia – which incidentally was introduced in that State many years before the introduction of nationally funded Regional Assessment Teams and My Aged Care. She was refused services. Grace had been actively involved in her community and rang the local Meals on Wheels provider directly. The coordinator found out that Grace was the full-time Carer for her incapacitated husband, and was juggling his health appointments and running the household and finding it harder to find the time to shop and cook
By the time an assessment was organised, her husband had to go into care, and Grace didn’t need the service. This story and others like it at the time, were very concerning. Those meals and a friendly chat to a volunteer might have provided special comfort and assistance during those last arduous, emotional and demanding weeks in her role as Carer. She reached out to her local community, who would have been all too willing to help, but both were stymied by the system.
About two and a half years ago, when we were consulted on the Commonwealth Home Support Program manual, AMOWA argued and won the right to put clients on services first, and then refer to My Aged Care. I’m convinced this stopped many more cases like Grace’s occurring. While we do hear regular examples of people approaching My Aged Care who are not referred on to Meals on Wheels, it was a relief to hear that after a year our services reported that none of their referrals to My Aged Care had been knocked back. Fortunately, most people continue to reach out to their local Meals on Wheels service first.
We also highlighted the limits to the policy of ‘reablement’, and the inference that Meals on Wheels was a passive service of dependency. We pointed out that the service was, in and of itself, an enabler.
As WA finally joins all the other States and transitions to direct federal funding next year, it’s worth pausing to reflect. Local Government is the main provider of Meals on Wheels there and because of the low subsidy provided, some chose to opt out, so in many places in WA today you cannot even access a Meals on Wheels service. In five years, from 2012, the number of people getting Meals on Wheels almost halved. The parallels with the UK are sobering. Over a similar time period, when funding for in-home support services, such as delivered meals and social support had their funding cut, hospitalisation rates of malnourished older people increased by over 200%.
Incidentally, during the same period meals provision in SA, QLD and NSW increased. Are people living in the west less deserving than or different from those living in the east?
In some ways, the Australian government is flying blind. Where is the evidence that when consumers are choosing alternatives to Meals on Wheels, that those alternatives are delivering cost effective outcomes? Where is the modelling that says keeping the subsidy so low will lead to better health outcomes? Are there more hospital admissions in areas where Meals on Wheels does not exist or is chronically under-funded? Yes, according American research. Yes, according to UK statistics.
When reviewing the future of aged care in 2011, the Productivity Commission recommended that Meals on Wheels and some other services be left out of the formal aged care system because they considered them fundamental services that should be readily accessible to anyone in the community. In short, this meant that if someone needed help with meals, they should get it.
Meals on Wheels seems to be caught in the middle of government cost shifting.
Let’s consider Victoria in this cost shifting paradigm, the only State in Australia, except WA, where the majority of services, are provided by Local Government. They contribute up to 40% of the cost of a meal. In worrying signs, many are raising their prices to unaffordable levels and in other instances opting out of service provision all-together. Where is their incentive to stay in the business or to market their services to vulnerable people in their communities who might need them? After-all, Local Government doesn’t pay for hospitals or residential care.
It costs about a thousand dollars a day to keep someone in hospital for one night, that’s the equivalent of what the government spends on the total subsidy for one person for Meals on Wheels for a year in many parts of Australia.
Sadly, the people that the cost is being shifted to, more often than not, are those using our services. Meals on Wheels services all over Australia, large and small, are struggling not to pass rising costs onto customers. Yet the government is happy to subsidise other home care services by 50 to 100%. They provide around $40 an hour for housecleaning and the consumer pays about $5. Yet for Meals on Wheels they provide a subsidy that averages less than $5 per meal, with our customers having to pay upwards of $9 per meal. It’s simply not fair. And it puts the health of older people at risk, if they can’t afford their Meals on Wheels service.
Meals on Wheels needs to be adequately funded. We also need to be appropriately funded.
There has been much talk recently about a move away from block funding to individualised funding. The suggestion that the block funding MOW services get now – which they use to operate the service and remain liquid – would be given directly to the consumer. The rationale is that the consumer would then decide if they wanted Meals on Wheels or a week’s supply of frozen meals from a private provider, or a care worker to cook a week’s worth of casseroles and pop them in the fridge (a much more expensive option). Put simply, many, many MOW services would fall over. We welcomed the news that the government has committed to continue with block funding until 2020 and we continue to press the case for block funding in the longer term.
So, where to from here? How do we get the balance right? How do we work with government on developing a sustainable model for the unique and varied Meals on Wheels services across Australia?
Earlier this year AMOWA asked for a very modest 5 million dollars to address the funding inequities in each State, and to stop struggling services having to raise their fees to their customers. In the same submission, we asked for $300,000 for AMOWA to fund the resources to work with the government on a sensible way forward.
We haven’t yet succeeded, but given what I’ve just laid out here in terms of the challenges we face, I’d urge the government to reconsider urgently.
MOW services are adapting and evolving, are focused on consumers, care about providing excellent meals and other services, and need to continue supporting and investing in our predominantly voluntary workforce, which is what makes these biennial conferences so important.
Just before I go, at the last conference I mentioned my in-laws, Ray and Isabel. Isabel had a fall and after hospital the family tried to get various services in. In short, Ray hated the idea, and did his best to deter these hapless service providers. Meals on Wheels weathered the push-back. They were both underweight at the time, so the entire family was relieved, especially those of us far away in Victoria. Ray is now Isabel’s full time Carer. Her dementia is advancing quite quickly and he has come to really appreciate the social interactions with the meals volunteers. I cannot tell you the comfort this gives us. Ray has just been diagnosed with stage 4 cancer so I predict they have very little time left together. There is no way they would have survived as long at home without the service. But let’s just say it’s given them one extra year at home together. That’s cost the Australian government less than $2000 in terms of subsidy per meal for two people, for one year. Ray and Isabel’s little service in rural QLD has just saved the government, a minimum of $100,000 in health costs.
What an amazing service!!!
As we listen, debate and converse over the next 3 days, let’s not forget to celebrate that fact.
Have a great conference.