From onion sandwiches to filet mignon: the changing of the guard in residential aged care!

He told me her house (which had been vacant for the three years she had lived in the facility) was going to auction in a couple of weeks time as the family had not been able to bear letting it go while she was alive.

The irony struck me - a well maintained house in a good suburb of Brisbane worth hundreds of thousands of dollars standing vacant while the owner had to share a bedroom with three others for the rest of her life.

While this didn't particularly concern Mary given the challenges she had faced, the contrast with the generations that followed her could not be more stark.

The number of Australians aged 65 plus is growing rapidly in its own right and as a proportion of the total population. The extent of this growth is unparalleled in our history:

• in Australia the proportion of the population aged 65 years and over is estimated to double from 11.2 per cent of the population to 22.5 per cent by the year 2051;
• there will be a decline in the 15-64 years age group from 66.6 per cent of the total population to 60.2 per cent by 2041;
• there will be an increase in those aged 65 years and over from 8.7 per cent of the total population to 22 per cent by 2041. Within this group, the fastest growth is anticipated to be for those aged 80 years and over, with numbers increasing more than four-fold between 1993 and 2041. This group's share of the total population is expected to increase from 2.4 per cent to 6.9 per cent in 2041;
• it is well-known that Australia is a nation of homeowners. For those aged 65 years and over outright home ownership is the highest for all age groups (81.9 per cent), followed by those aged 55 to 64 years (72.2 per cent). There is only a small proportion of aged persons in the rental sector; and
• housing wealth (as measured by equity in the family home) is highest for those aged 55-64 years at $392,000 and slightly lower for those aged 65 years and over at $355, 000

However, all of these stats and their significance are dwarfed by the challenge of managing the completely different set of expectations and demands that Mary's daughters and granddaughters will have when they start to enter aged care in only a few years time.

Shared accommodation, modest physical environment, bus trips, bingo games and sing alongs just won’t cut the mustard any more. Mary's daughters and granddaughters will lodge a complaint if the pattern on the throw cushions doesn't match the curtains.

That's where the real challenge lies - in resourcing, on an economically viable and socially just basis, the specialised accommodation, services and care for record number of frail aged recipients who require it.

The answer of course is as obvious as the nose on your face.

As do its contemporaries in the OECD, Australia has to ask residents who are able to do so to pay more of the costs associated with their long-term accommodation and services rather than having the major burden fall on the taxpayer while hundreds of thousands of dollars of the residents own assets are left for the benefit of others.

It’s not a concept which is inconsistent with policy and practice in Australia - generally everyone uses the proceeds from the sale of their old home to finance their new one. Low care (hostel) facilities have been charging accommodation bonds (Government guaranteed and refundable on departure less legislated draw downs) for years; even for residents with dementia.

It is not contrary to the concept of a caring society; the health system was never meant to fund long-term accommodation and services - just quality health care.