- A sad and shocking system that diminishes Australia as a nation.
The media release began as follows:
- The Royal Commission into Aged Care Quality and Safety’s Interim Report has found the aged care system fails to meet the needs of its older, vulnerable, citizens. It does not deliver uniformly safe and quality care, is unkind and uncaring towards older people and, in too many instances, it neglects them.
Commissioners Richard Tracey AM, RFD, QC and Lynelle Briggs’s AO investigation into Australia’s aged care system led them to describe the aged care system as “a shocking tale of neglect”.
“The neglect that we have found in this Royal Commission, to date, is far from the best that can be done. Rather, it is a sad and shocking system that diminishes Australia as a nation.”
Entitled Neglect, the Interim Report of the Royal Commission into Aged Care Quality and Safety, which was tabled in the Australian Parliament today, found that a fundamental overhaul of the design, objectives, regulation and funding of aged care in Australia is required.
Joseph Ibrahim of Monash University has a useful overview in The aged care royal commission’s 3 areas of immediate action are worthy, but won’t fix a broken system. The three areas are:
1. Home care packages
At 30 June, 2019 there were 72,062 people* [see note below] waiting on a home care package. Julie Collins, Shadow Minister for Ageing and Seniors told Radio National that people in their 90’s with a prognosis of six months to live were having to wait two years for a package.
The funding is effectively given to the client to choose a service provider on an open competitive market, which can be not-for-profit, or profit-making. When mental powers are diminishing and family members play a role, this whole process can go more than a little strange.
My wife worked in this area for five years after a career of teaching. It’s not an easy gig. Ibrahim is right when he says there is not a standing army of personal carers or health professionals waiting to step in. My wife says she started with a week’s training, followed by a week with a buddy, then worked while doing a TAFE certificate online. She says there was lots of formal and informal training by the organisation with outside speakers etc along the way.
So I don’t know what the form is in the industry, but the organisation she worked for had a high reputation. There was no long preservice training requirement.
Collins is right in saying that there are some obvious priorities, especially with a $500 million underspend sitting there.
2. Reducing the use of chemical restraint
Completely horrific, but fixing it is easier said than done. Can’t be fixed without more staff and a change in culture.
3. Getting young people out
- The third area is stopping the flow of younger people with a disability entering residential aged care – and speeding up the process of relocating those younger people who are already in residential aged care into community living.
- The logistics of building new housing and developing services in areas of need take careful planning and time.
As Ibrahim says, fixing those three is a long way from fixing the system. The full report is due in November 2020.
ABC Insiders today gave the issue a fair workover.
The Government seemed surprised that the interim report made specific recommendations for action. They had been quite happy to kick the can down the road.
We were all diminished by having the silver-tongued Greg Hunt front the cameras. Richard Colbeck is the actual Minister for Aged Care and Senior Australians. Niki Savva in her book says Hunt was among the least liked and trusted by his colleagues.
This government with its small-government values does not inspire confidence that the short and long-term changes will be made.
Jonathan Green in talking to July Collins (linked above) tried the usual ABC schtick of “both sides of politics are equally to blame”. Collins pointed out that Labor had been in power for only six years of the last 20, and that when they were in charge they enhanced aged care with a Living Longer, Living Better package, a staged process that was to be introduced over four years. She said Scott Morrison took $1.2 billion out of aged care in his first budget, and never put it back.
Labor promised improved aged care last election. The Liberals ran a specific scare campaign as well as telling all the oldies and everyone generally that Bill had his hand in their pocket and was going to take all their money.
Sarah Martin at The Guardian lays out the horror of what the Commission has found:
- More than half of the online submissions to the commission raised issues about substandard care, mostly relating to neglect, dignity, personal care, clinical care and medication management. Concerns were also raised about nutrition, malnourishment, emotional abuse, physical abuse or assault, discrimination and restrictive practices.
That sounds criminal. Then:
- The report also highlights concerns about the country’s “ageist” mindset, saying this culture had led to an indifference to how older people were treated, with the conversation about aged care too often about burden, encumbrance and obligation.
“As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities,” the report says.
“Sadly, this failure to properly value and engage with older people as equal partners in our future has extended to our apparent indifference towards aged care services.
“Left out of sight and out of mind, these important services are floundering.”
- Staffing problems are also severe, with difficulties finding people who want to work in a sector marked by heavy workloads, and poor pay and conditions. The report also notes a lack of leadership, patchy education and training and a system that signals working in aged care “is not a valued occupation”. Cases where staff and providers are providing “exemplary care” are happening “despite the aged care system in which they operate, rather than because of it”.
According to the commission, the way the system has been framed as a “market” where old people are treated as customers who can shop around for a service is a fundamental failing.
It says that many older people are not in a position to negotiate prices, services or care standards.
“The notion that most care is ‘consumer-directed’ is just not true. Despite appearances, despite rhetoric, there is little choice with aged care. It is a myth that aged care is an effective consumer-driven market.”
In May this year, before the election, Andrew Donegan and Emil Jeyaratnam wrote an article at The Conversation Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis.
Here’s their story on staffing:
From 2003 to 2016 staff in residential nursing homes ‘personal care attendants’ increased from 42,943 to 69,983, an increase of 63%. At the same time qualified nurses have declined from 27,210 to 23,690 – that’s minus 13%, while the number of allied health workers has declined by 31.5%.
A 2011 Productivity Commission report estimated the workforce will need to grow to about 980,000 by 2050 to meet the demand of aged care consumers, a figure that has since risen. Time we got serious.
We truly need to ask ourselves whether every single person should be treated with dignity, respect, and recognised as having inherent worth. The Liberals and Nationals don’t seem to be able to come to grips with the concept of basic human decency.
There is real confusion in quoting figures. Ibrahim cites “72,062 people waiting on a home care package” as at 30 June, but his link takes you an official data report which says this:
- At 30 June 2019, there were 72,062 people waiting on a home care package at their approved level, who had not yet been offered access to a lower level package. Of these people, 95.6 per cent (68,900) had been provided with an approval to access support through the Commonwealth Home Support Program (CHSP).
Commonwealth Home Support Program (CHSP) Guidelines show that the ongoing home care package is but one of four sub-programs. So I think what people are being offered is either high-intensity short-term or episodic help, or alternatively lower-level ongoing support, rather than the real deal.
The shortfall in home care I recall is 120,000, which is what Paul Bongiorno used in The aged care sector is dying for urgent action (whence comes the photo up top) where he also says last year 16,000 elderly Australians died while waiting for their approved home care package.
The whole program costs about $20 billion pa. Increasing funding may just mean more profits for private providers. Biongorno says:
- According to the Tax Justice Network, between them the six largest for-profit companies were given over $2.17 billion in government subsidies – 72 per cent of their total revenue – and made profits of $219 million per year between 2016 and 2018.
One of the 10 charts shows profits peaking in 2016, and then falling in the following two years to land at 2014 dollar levels while presumably expanding. Capital is restless and may go elsewhere for greater rewards.
What the current government is really good at is pretending they are serious when they are not, and then misleading everyone with statistics.
It should also be noted that the Commonwealth Home Support Program (CHSP) Guidelines says the purpose of the program is to meet Australian government objectives. It does not say the purpose is supporting older folk in the community.
Meanwhile Anthony Albanese is campaigning on aged care in Tasmania. That article has a precise figure of “119,524 elderly Australians waiting for a home care packages, including 2115 in Tasmania.” Perhaps sometimes in the outer reaches of the Murdoch empire the truth slips in by accident.