At the current Senate Inquiry into ‘Financial and tax practices of for-profit aged care providers’, there was plenty of spin but little evidence by industry bodies that real reform has been delivered by the 2011 Productivity Commission’s ‘Aged Care Roadmap’. In this opinion piece, Michael Wynne of Aged Care Crisis, an independent volunteer organisation which advocates for aged care residents, argues that the roadmap has failed, should to be thrown out and work commenced with the caring professions to develop a more sensible system.
SOME INTERESTING but unsupported claims were made by industry organisations at the public Senate hearing on 17 July 2018 into ‘Financial and tax practices of for-profit aged care providers’ — an inquiry by the Economics References Committee.
Sean Rooney, CEO of the industry body Leading Aged Services Australia, representing providers of care asserted twice that “we do have a good aged-care system in this country”. And from Matthew Richter, CEO of the Aged Care Guild, the body representing the eight largest corporate businesses in the sector — “ We have demonstrated how private aged-care providers in Australia are delivering high standards of care”.
Both claim that the recommendations of the 2011 Productivity Commission report ‘Caring for older Australians’ were beneficial. The report was conducted by an economist. It reaffirmed the market principles of the 1997 “reforms” and gave the industry everything it wanted. This led to the industry-developed reforms and then to the industry/government policy document the ‘Aged Care Roadmap’.
Both Rooney and Richter expressed support for all this and reminded government that this was the plan they had all agreed on.
Wonder how many times this tired old line has been trotted out when aged care residents are over-medicated: "… No, (she’s) just tired. This happens to people when they get old … " https://t.co/1GdwEyCVPJ https://t.co/l0hkAUuzcl
— Aged Care Crisis (@agedcarecrisis) July 31, 2018
But how valid was all this?
If we look at the roadmap we see that it “is market based and consumer driven”. It claims
“Contestability of delivery will promote quality, productivity, efficiency, innovation and value for money services that are responsive to consumer needs and preferences”.
In addition to this
“a light touch approach to regulation will give providers freedom to be innovative in how they deliver services.”
“Consumers will drive quality and innovation by exercising choice” and
“There will be a strong focus on positive images of aged care.
But these are the same general policies that drove the Howard government to make the changes that they made in 1997. We have heard them over and over again since then — hardly reform. They have been imposed in the face of warnings that the customers, now called “consumers”, lacked knowledge, were vulnerable and were easily confused. Most were not in a position to contest anything let alone drive quality or really make choices.
The system created failed to collect any useful measures of care, so even those with the capacity to make choices could not do so. We have had many crises in care since 1997 and each has been followed by government reviews and then the inevitable reforms that were simply more of the same. How valid is all this?
The aged care system after 20 years of market policy
Nurses who provide the care have been complaining about working conditions and their inability to provide the care needed since the early 2000s. No one has listened. Nurses and families making submissions to the senate workforce inquiry in 2016 desperately pleaded for help. Others pleaded with the Carnell Patterson Review.
They said things like “please, please open your eyes, your hearts, your minds” … “Please, please change things” … “ a hidden humanitarian crisis” … “an industry that has been hijacked by big business. Care of our residents and staff come a very distant second” … “There is no care what so ever and I include management in that statement. In fact management is the worst”.
“It is horrendous the deceit that prevails and anyone who is prepared to speak up to uncover it, is quickly ‘short shrifted’ out of the home”… “facilities with magnificent interior design and no staff! Please can we focus on humanity for residents, rather than ‘glamour’”. In a comment on an article about aged care “the things I saw in nursing homes will haunt me forever.”
Dr Richard Kidd who has provided care in nursing homes since the early 1990s said that care is worse now than it was 20 years ago. Dr Tony Bartone, another GP and now president of the Australian Medical Association, has also been providing care in nursing homes. He said “the current aged care workforce does not have the capability, capacity, and connectedness to adequately meet the needs of older people”.
Well-trained nursing staff are very critical of the “light touch approach to regulation”. Clinical nurse consultants working in the industry have been scathing about the lack of clinical attention in accreditation visits. These overlook problems in infection control, nutrition, hydration and skin care.
What data is available?
Like Australia, the USA aged care system is market driven. In an attempt to constrain the consequences an extensive data collection and oversight system is in place. It is useful to compare the two.
Comparing staff. Safe minimum staffing levels based on careful research have been recommended in the USA for 20 years. Studies in Australia showing similar requirements done in 1985 and 2016 are rejected by industry. Instead, we use benchmarks, developed by financiers, to advise more than an hour less care each day.
On average, US nursing home residents get twice as much care from trained nurses as Australian residents and over a third (1 hour) more total nursing care each day than in Australia.
In Australia, the number of sicker high care residents needing skilled nurses has increased by 53 per cent at the same time as the number of trained nurses needed to provide that care has fallen by 35 per cent. But incredibly during the same period accreditation performance has increased 53 per cent to near perfect levels. So are they all wrong and does reducing staff improve care?
Comparing failures in care. In the USA, 175 items of data about care are collected on all 15,000 nursing homes and reported quarterly. This is checked when facilities are evaluated yearly. In Australia, only 48 accreditation processes are evaluated three to five yearly but data showing failures in care are not collected. From 1 July this year, the number reduced to eight. Whilst Agency staff visit yearly, these findings will not be published — only the result of the reaccreditation three or five yearly cyclical site audits will be. This is no more than is currently available.
In spite of far superior staffing, only seven per cent of US nursing homes get a perfect score compared with 98 per cent in Australia. In the USA, 93 per cent have some problems and 20 per cent are serious. In Australia just two per cent have problems. Doing so much more with so many less staff is simply not possible.
In 2010, a prominent member of the industry was furious when a visiting US academic asserted that in Australia “there is little regulation to protect the rights of elderly residents” and that he “would not put any elderly relative, or indeed even a family pet, into a residential aged care facility because of the chronic abuse, neglect and exploitation rampant in our aged care facilities.”
Outsiders can often see more clearly than we can.
Unlike Aust, the US govt openly acknowledge StaffingLevels&Skills R the most critical determinants of care. They also recognise significance of employee turnover & tenure as a “vital component of quality care 4 NursingHome residents" https://t.co/aBulkSugap pic.twitter.com/2cUSSMnP8i
— Aged Care Crisis (@agedcarecrisis) April 12, 2018
In our society, our trusted banks have been exposed by the royal commission as ruthlessly exploiting the vulnerable. A multitude of franchising businesses like 7-Eleven stores, pizza companies as well as many others, have exploited vulnerable students, tourists and visa holders. The banks including AMP, the worst offender, have invested heavily in aged care. Multiple franchising companies are entering aged care to offer us “choices”.
Is the aged care market really different? Are we still going to believe the confident businessmen, managers and politicians isolated in their offices? Would we be wiser to believe the anxious staff providing care — the families who know enough to identify problems and the available data about staffing?
Politicians and businessmen have invested their lives in this Aged Care Roadmap and have much to lose. Could it be that the policy of “there will be a strong focus on positive images of aged care” has been too pervasive and gone much too far? Only blind believers and the gullible are persuaded. The roadmap was the industry’s policy and not our policy and the illusions they marketed at us were enticing.
After 20 years, it is time to look at the warnings that were ignored, to throw out this failed roadmap and work with the caring professions to develop a more sensible aged care system. Government is not capable of doing it alone. The community will need to lead the way.
Michael Wynne is a retired academic surgeon from Queensland. He has had a long interest in dysfunctional social systems and has written two web sites examining corporate behaviour. During the 1990s he was a whistle blower and actively researched US health and aged care companies that were being welcomed into Australia. He collected data for state probity regulators. This contributed to these companies leaving or abandoning plans to operate in Australia.
Since the turn of the century he has tracked aged care in Australia and has been writing submissions to inquiries and reviews.
The Aged Care Crisis’ submission can be read here.
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