During the past 50 years much has been achieved globally to instill the principles of healthy ageing as a way of promoting individual wellbeing in this era of longevity. Since 1978, the principles of primary health care (PHC), as defined by the World Health Organisation, have advanced rights based approaches for all people in all communities and have supported a system approach to improving healthy ageing from an equity perspective. Depending on the boundary of the health sector and health and social systems in each country, multisectoral and intersectoral approaches are essential when embedding models of ageing well that incorporate multilevel service pathways.
In Australia, a regional focus has been adopted to achieve multisectoral policy and action through establishment of primary health networks that address the broader determinants of health. Finance arrangements through joint commissioning with individual organisations, some of which service aged care, has fostered improved integration and coordination of services across state and federal health service sectors. However integrating services across primary health care and aged care has been slow, with impacts on empowering both service providers to adopt more holistic, person-centred models of care and individuals, families and communities to take charge of their own health and wellbeing.
More recent research focused on ageing well and health equity provides evidence to support the physical-socio-economic-political context and health outcomes that are person-centred rather than disease specific. In this context the relevance of Australia’s ‘ageing in place’ policy continues to be a major driver of aged care reform and supports ageing well through person-centred models of care such as reablement, where individuals are supported not only to remain at home for as long as possible, but to enhance their independence and functioning.
We know that from both financial and wellbeing perspectives, there are major benefits for older people staying at home. Providing community based services aligned with primary health principles, including achieving one’s full health potential despite the experience of multiple morbidities, would support this. It would also ease the burden on residential aged care facilities. To address the current inequity in provision of services in aged care, more investment is required to support older people through context driven strategies to ‘level up’ inequalities and reduce health and social inequity.