The latest news of the growing aged-care emergency, with the closures of three more homes in Sydney by Wesley Mission, has been written up as a “shock” announcement and attributed to “workplace pressures” imposed by the Albanese government’s industry reforms. But this coverage ignores the fact that aged care is now in genuine crisis, for which there is no quick fix. It will take planning, time and money to make real progress.
Aged care is perhaps the most conspicuous example of the ultimate costs and disruption of policy neglect. Successive governments have uttered near-endless platitudes and generalities about their intention to deal effectively with our ageing population, promising to provide quality aged care along with all sorts of respect, support and sustainability. Basically, they just never quite get around to it.
While sympathising with the residents and their families in terms of the impact of the Wesley homes closures, and especially with those suffering from dementia and now having to be relocated, it is important to make the point that this should not have come as a surprise to the Wesleyans. After all, it has surely always been reasonable to expect that a nursing home for the aged would provide a certain level of professional nursing care, and the government’s reforms are reasonably requiring providers to staff facilities with a registered nurse 24 hours a day, seven days a week from July 1.
Moreover, apart from tax reform, aged care is probably the most reviewed area of public policy over the past couple of decades, where virtually all reviews have recommended improvements in nursing care, with requirements along the lines announced by the government.
It is difficult to understand why the Wesleyans and others hadn’t recognised the significance of the problem or noted Labor’s election commitments, especially given the volume of recommendations provided over the past two decades, extending from the Review of Pricing Arrangements in Residential Aged Care, undertaken by Professor Warren Hogan in 2003, through to the 2018 Royal Commission into Aged Care Quality and Safety.
Aged-care workers have long been overworked, undertrained, underpaid and poorly equipped, as was described in excruciating detail in the royal commission and became particularly evident during the Covid-19 pandemic.
The government is obviously also working on nurse training as the essential element of its overarching response to the crisis, as reflected by the commitment that nursing care would be “supported by the initiatives we have in place to grow and boost the skills of aged care nurses”. The government has said that about 80 per cent of homes already have a registered nurse on site 24 hours a day, about another 9-10 per cent of homes have a nurse on site but not for 24 hours a day, and another 10 per cent claim to need more time and more support. The government has pledged to work with the latter group to provide that.
The government would be wise to make a formal statement laying out its responses to the various aspects of the aged-care mess, with details of deals with universities and state governments about the number of nursing qualifications it is working to deliver, along with guarantees of university and other training places, and so on.
Surely there is no better opportunity or imperative for the opposition to demonstrate that it can be constructive, working with the government to deliver an effective response on such a significant national crisis. I was appalled by their recent attempt to simply use it as yet another opportunity for the blame game, when the deputy Liberal leader, Sussan Ley, appeared on Sunrise, ignoring their terrible record in government and claiming, “We have been warning about this for months.” While Ley carried on with her accusations, Labor frontbencher Jason Clare documented the findings of the royal commission concerning the disgusting conditions in aged care that had occurred on the Morrison government’s watch, also noting that Ley had been Health minister.
The Coalition has a long track record of neglecting the mounting aged-care problems, since John Howard’s tenure as prime minister. The standout then was the poor performance of Bronwyn Bishop as minister for Aged Care – recall the episode of kerosene baths for some residents of the Riverside Nursing Home in Victoria. Indeed, many consider the Howard government’s Aged Care Act a key contributor to the current weaknesses in the sector, since it served as a trigger for more widespread private ownership of nursing homes, which became motivated by profits, with less concern for the quality of the services provided. It’s questionable whether the provision of essential services should be subject to the profit motive, where interests of owners and shareholders can be placed above those of residents.
This query raises another dimension to the closure of the Wesley Mission nursing homes – namely whether other economic factors may have led to their decision. For example, the demand for residential aged-care places has been significantly constrained in recent years by the attractiveness of home care packages that allow the aged to be supported in their homes rather than moving to residential care.
More broadly, it should be recognised that many charitable and religious organisations originally went into the aged-care industry with the expectation that it would produce healthy cash surpluses that they could then draw on to help fund their other religious and pastoral care objectives. Unfortunately, this hasn’t proved a good choice for those who didn’t have the skills, experience or systems to run their homes efficiently. This raises the issue of whether or not governments should support some homes to ensure the delivery of the range and quality of aged-care services that they wish to see.
There are also important questions as to the appropriate regulatory structure and processes for nursing homes. The Howard government considered a proposal for flying squads of nursing home inspectors that could drop into homes unannounced to review and grade their operations. I am told many in the party room objected to the proposal as it would publicise the homes’ failings, for which the government would be held publicly accountable. So, it’s fair to say that politics is part of the root cause of the neglect that’s now widely identified.
Beyond these issues of nursing home management and operation, there are many others to be addressed in a comprehensive response to the aged-care situation. The cost of residential aged-care services is one. There are two key components to this: the accommodation bond that is necessary to secure a bed and the daily fees for services provided. Accommodation bonds are controversial as they can often amount to hundreds of thousands of dollars, though the bulk is refunded, net of a small administration charge when the resident dies or leaves the home.
In my experience, these bonds seem to be set about the average price of houses in the catchment area for residents of the home. But from the point of view of the nursing home owners, there is a temptation to think of the bonds as interest-free loans. The policy challenge is to ensure these monies are indeed refundable, and secured. This is an important issue given the prospect of homes failing and closing. Over the years several proposals have been put to government, including an industry-wide fund or the requirement for bank guarantees, but none of these has been adopted.
The adequacy of the home-care packages must also be scrutinised. Do they genuinely meet the needs of the aged who choose to stay in their homes, and how are the payments managed for services and maintenance provided in their homes? The providers who administer these packages and the fairness of their charging must be monitored, to avoid any corruption.
A final area of aged-care accommodation that needs careful examination and some reform is that of retirement villages or self-care units. There has been some evidence in recent years of massive rip-offs of residents related to excessive body corporate-type fees and sharing of the capital gains from the ultimate sale of the units. Again, this element is potentially corruptible.
To be fair, we should acknowledge the extensive work done by the aged-care bureaucrats who have been constantly bounced around by the changing whims of their political masters.
Aged care is clearly a crisis that could have been avoided had our political leaders responded earlier and more decisively to the emerging evidence of the consequences of their poor policies and neglect. The government knows what must be done – it is just a question of finding the political will to do it. The opposition should work with the government, putting the blame game aside, to address these issues as a matter of urgency.
This article was first published in the print edition of The Saturday Paper on April 22, 2023 as "Aged care should not weary them".
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