Australia’s Care Together Program – Co-ops and mutuals showing the way on innovative delivery of social services

December 2024, Republished from the ICA AP’s COOP Dialogue 7

By Nick Hislop, Senior Consultant, Business Council of Cooperatives and Mutuals, Australia

Like many other advanced and emerging economies, Australia is being forced to pay closer attention to aged care and health care. The pressures of growing and ageing populations and the spiralling costs associated with modern advances in medical technology and services present enormous challenges for governments, industries, and society at large. While aged and health care are such fundamental planks in any society that aspires to be equitable, it remains of concern that they are still not being better delivered in Australia.

Taking aged care as an example, a Royal Commission into Aged Care delivered its findings and recommendations more than three years ago. A progress report in the middle of this year revealed that many older Australians still encounter significant obstacles when trying to access quality care. Difficulties often arise from service rationing and challenges in navigating the system to secure timely and appropriate care.

Providing the best possible social care underpins the well-being of individuals and communities. As part of that, a key objective should be making sure that vulnerable people also receive the support they need. However, the systems and structures currently in place across Australia are falling short on quality and targeted care delivery. Because of Australia’s geographical size and a population heavily concentrated on the coastal fringes, and in metropolitan centres, those people particularly lacking in adequate services tend to live in harder to reach communities in regional, rural and remote areas of the continent.

Addressing this specific issue, Care Together has been established as Australia’s first program to support communities to develop cooperatives as a way of delivering care services where recipients actually live. The Australian Government has allocated AUD 7 million over two and a half years to explore a different way of operating that will prioritise the needs of both the people receiving care and those of the caregivers.

The program is being delivered by the Business Council of Cooperatives and Mutuals (BCCM). The BCCM is the national cross-sector peak body for cooperatives and mutuals (CMEs), formed in 2013 after a spike in interest in the movement following the UN designated International Year of Cooperatives.

For more than a decade, the BCCM has promoted the model in all sectors of the economy – including care – through advocacy, research and cooperation between cooperatives. In total, there are more than 1,800 CMEs in Australia with a combined turnover of more than AUD 43 billion.

The core operational team of Care Together is supported by a cross-sector, highly skilled Program Advisory Committee (PAC) that includes senior Government officials from participating Government social care agencies, the Department of Prime Minister and Cabinet and subject matter experts in rural health and CMEs.

The Care Together program has initiated 13 projects across Australia. It is working with individuals, communities, not-for-profit organisations and smaller care businesses to develop sustainable business models and service delivery plans. The program ranges across the care sector, taking in aged care, disability care, veterans’ care, First Nations’ services, allied health and primary health care.

Projects include a mix of new CMEs and growth projects where existing CMEs can scale up, or organisations can convert to a CME structure.

A flagship shared services project is also part of the program. It should enable smaller organisations to network through a secondary cooperative structure which will provide back-office services for sustainable care delivery in priority areas.

Coops are critical to care. The International Labour Conference (ILC) 112th Session, which took place in Geneva in June 2024, said in the Conclusions concerning decent work and the care economy, that “public and private enterprises, cooperatives and other Social Solidarity Economy entities, play a role in the provision of quality care, investment in sustainable and modern care infrastructure, and provision of training and employment opportunities.”

Effectively underscoring the role of coops, the United Nations General Assembly has also proclaimed 2025 as the second International Year of Cooperatives. The UN’s resolution encourages member states to foster a supportive legal and policy environment for cooperatives, emphasising their importance in various sectors, including care.

The world is pivoting towards inclusive, people-centred systems. For example, new laws in effect in Australia from December 2023 have ramped up the governance responsibilities for care providers and have placed clear accountability on the boards of providers for the quality and safety of aged care. Cooperatives are emerging in response to this, and also in other domains of care, because they are well-suited to this focus on a rights-based approach that puts the consumer at the centre.

At the same time, there are aged care supply gaps across 41% of regional and remote Australia and this is forecast to increase. Additionally, the sustainability of primary healthcare in regional areas is at breaking point. There are significant challenges with workforce attraction and retention, as well as an over-riding concern that “market based” models are not working.

Innovation is clearly needed.

In aged care, the Australian government says it is determined to foster innovation in the sector so that it is more agile and needs-based and there are more options for older Australians to age independently, but to still have access to essential clinical care when they need it.

The BCCM believes innovation is not just about technology, but includes new business models, policy practices, behavioural insights, or ways of delivering services that benefit people and communities.

This is precisely what the Care Together program has been set up to stimulate.
Care Together is at the forefront of innovation in social care, aiming to disrupt and diversify the aged care and disability sectors through community-owned cooperatives that prioritise individual empowerment and community collaboration. It is addressing complex social care and health challenges while promoting regulatory harmonisation across sectors and doing this at a time when major reforms are happening in aged care and disability services.

Part of the innovative approach includes supporting individuals with choice, flexibility and control over their health, care and support services. Such an objective is challenging traditional norms in aged care. This is furthered by integrating local insights and community input into service delivery and providing an alternative way for care and support workers to organise how they work cooperatively. Addressing the needs of First Nations people, the program envisages Aboriginal-led cooperatives tackling cross-sectoral social and health issues, including disability services, aged care and the chronic health concerns of First Nations communities.

CMEs are a unique form of organisation for people to collaborate on providing a solution to a shared problem that would be a challenge for them to solve alone. It is a model particularly relevant in rural, regional and remote Australia, or markets sometimes referred to as ‘thin’ or ‘unprofitable’.

When people in community settings are empowered to cooperate on the care they receive or build the capacity of caregivers and care workers to determine how they provide care, then service quality improves, and the care workforce grows.

One of the Care Together projects has been undertaken in conjunction with the Council of the Ageing Australia (COTA).

It seeks to address perceived weaknesses in the existing government-subsided program, “Home Care Packages” (HCP), which provides long-term support for older people who want to stay living at home.

Providers charge older people to manage all or part of their package. Recipients and their families say the HCP program model falls short of offering them genuine choice and control over the day-to-day functions of their package. Many, including those who self-manage, have described the program arrangements as imposing greater than necessary dependence on providers. This is seen as further entrenching paternalism and ageism among the care providers.

Care recipients want and have the experience and skills to take more responsibility in managing their HCP program involvement and the service purchasing decisions. For example, aged care consumers could pool their buying power to access the economies of scale typically enjoyed by a large entity, but still have the independence, choice and control of individuals with personal budgets.

In essence, it is about co-designing with older Australians and their carers a way to self-manage their home care packages cooperatively, enhancing their lives where they reside and wish to age.