The billions of extra dollars going into aged care has to improve the system, but it is not the “generational change” the Prime Minister is touting.
When the royal commissioners into Aged Care Quality and Safety Tony Pagone QC and Lynelle Briggs wrapped up their $90 million, two-and-a-half-year inquiry into aged care, they had one wish: a “landmark Australian social policy reform” which would ensure well trained, well paid staff overseen by an independent auditor and with complete transparency for the billions of dollars in taxpayer funds given to the industry each year.
Best calculation to achieve that: an extra $10 billion a year.
What Australia received is almost $18 billion over five years, no guarantee of mandatory minimum training of workers, a refusal to lift wages, a bolstering of an inept regulator and continuing freedom for providers to spend money as they see fit.
Some good initiatives, but a lot is lacking
That’s not to say there are not good initiatives here, such as: desperately needed transparency on the quality of food, staffing and clinical care; more respite for unpaid carers at home; mandated minimum care times by staff; and hundreds of millions more going into the regions and Indigenous communities.
But there’s a lot lacking. And one of the biggest questions is a very practical one: what about the staff?
From the time we broadcast our Four Corners investigation Who Cares? in 2018, the lack of trained staff was the number one reason given for neglect, abuse and chemical restraint. The royal commission came to the same conclusions.
Yet there is no provision to increase the training of staff (beyond 38,000 training places for new and existing workers) or to increase the staff numbers. The government itself says 1 million workers are needed by 2050, so there’s a lot of work to do.
The government is spending millions on a recruitment campaign to attract workers into a job that receives an hourly rate that is among the lowest in Australia and requires those workers to deal with hands-on personal care which most people eschew — toileting, showering and feeding.
The majority of that work has been undertaken by new arrivals to Australia — from Nepal, India and China. But that work supply, which is most needed now, is drying up due to the international border closure and won’t reopen until mid next year.
Where will the staff come from to provide the extra 80,000 home care places in the next two years? How will nursing homes provide 200 minutes of direct care per resident per day as promised by the government without employing a lot more staff?
While the government has allocated $4 billion to employ more staff in residential care, there is $3 billion more going to providers simply on the condition they compile a report on nutrition, food and cleanliness — nothing about tying it to employing more staff.
Insufficient training has a knock-on effect
As for training, the royal commission recommended mandatory training in dementia and palliative care, which are the two biggest needs in the sector. That too has been rejected, with staff being “encouraged” to do training. Millions are being devoted to that optional training and the money, it seems, is also going directly to providers rather than educational bodies.
Lack of training in dementia care has a knock-on effect in terms of the overuse and abuse of antipsychotics. The royal commission wanted to restrict their use by insisting only psychiatrists and geriatricians make the initial prescription for antipsychotics. Although the government says it accepts that “in principle”, it’s clear that won’t be instituted, judging by earlier submissions from the Department of Health and the regulator, the Aged Care Quality and Safety Commission, which rejected the proposal.
Back before John Howard reworked the Aged Care Act in the late 90s to favour private operators, 70 per cent of taxpayers funds had to be spent on staff. There’s no such requirement here. And the government has baulked on another royal commission recommendation which was required back in the day — a registered nurse on duty 24/7.
Instead, the Morrison government has mandated a registered nurse for just 16 hours a day. What happens if an emergency occurs during the other eight hours?
All of this has the unions, the workers, and some doctors’ groups up in arms. But the media coverage of the budget was dominated by the aged care industry and Council on the Ageing (COTA) talking up the changes.
It has left many feeling cynical about the industry, which denied there was a problem for decades, and which is now so effusive about reforms that include much more red tape, reporting and transparency.
Can a new look reflect real change?
The industry has regrouped under the banner of Australian Aged Care Collaboration with a blue heart as its logo. It is purposefully marketed to look like a caring advocacy group.
In reality, it is a lobby group comprising the biggest for-profit and not-for-profit aged care chains. It was preparing to launch a campaign against the government in marginal seats but that now appears to be forgotten.
There are still some good initiatives to come — such as a new Aged Care Act to enshrine the rights of the elderly and expanding a pricing authority to ensure the correct funding is allocated each year.
Then it will be a case of seeing whether the regulator can actually grow the teeth it has lacked for so long to get rid of the bad providers.
The problem is the government shirked on the royal commission’s urgent timetable for reform. It will be years before many of these changes are in place. So, unfortunately, for those already living in aged care, you’re unlikely to live long enough to see if any of it works.