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WHATEVER steps the federal government takes to implement the recommendations of the Royal Commission into Aged Care Quality and Safety, it will require a plan agile enough to evolve over time, according to a leading expert.
Professor Joseph Ibrahim, aged care advocate, geriatrician and Head of the Health Law and Ageing Research Unit at Monash University, has been a prominent voice since giving evidence to the Commission.
Responding to the release of the Commission’s final report by the government on 8 March, Professor Ibrahim said even if all 148 recommendations were followed through, the aged care system would “never be fit for purpose”.
“If they do what is stated, then we will have a system in 2030 that is fit for use according to 2020 – that should not preclude making changes, rather it requires us to plan for a system that evolves,” he told InSight+.
“It will never be fit for purpose, it is a dynamic system that must address change in health care needs and changes in lifestyle which continuously evolve with our society.”
Speaking to InSight+ in a wide-ranging and exclusive podcast, Professor Ibrahim said that changing the Aged Care Act 1997 was fundamental to improving Australia’s aged care system.
“It started with John Howard and the 1997 Act, which made aged care corporatised and [established] that the free market will take care of it,” he said.
“What the new Act actually needs to do is remove the corporatisation or the commercial aspects of the Act that presumed that a free market has sufficient applicability to work as a safety valve, that your ability to choose contains and controls the market.
“If the government does follow through on the principle and philosophy behind a human rights strengthened Act, it then requires changes in how the Act exists, how the providers behave, the education and training for staff, and having enforceable and visibly enforceable mechanisms for residents whose rights are abused or neglected.
“That requires a substantive overhaul.
“It also requires recognition that an 83-year-old woman with multiple diseases, with dementia, who is a resident who chose to go to a home after having a catastrophic life event, is not actually an activated consumer who’s able to evaluate homes and choose the one most suitable for her.
“The whole thing about free market is a nonsense from the very beginning. It’s actually an abuse, and it’s very surreptitious and cynical. There is no ability to get information about the care homes that have any real meaning for the resident.”
Professor Ibrahim said the bones of a good aged-care system already exist.
“We know what’s wrong with the human side of care,” he said.
“We have enough people that know and want to do a good job. We have structures and we’ve got the knowledge, both in aged care and in health in particular around quality and safety, how to work together, how to generate teams.
“We’ve got the science around measurement, both quantitative, qualitative.
“We have all of those things already but we’re using them either not at all, suboptimally, or not paying sufficient attention to them.
“To start again for me [means] to rewrite the Act so it shows respect and honours that respect for the resident. So you have a clear pathway for the resident to readily access any complaints or concerns that has meaning and shows respect for the staff.
“If we have a system that shows respect to the residents, that shows respect to the staff, pays the staff what they’re actually worth, then there’s really no problem. Everything else gets fixed because we know how to fix everything else.”
On 8 March the Prime Minister announced five immediate actions in the wake of the Commission’s report:
- $18 million to “enhance the oversight of the government’s Home Care Packages Program”;
- $32 million to “enhance the capacity of the Aged Care Quality and Safety Commission and greater regulation around the use of restraints in care”;
- $189.9 million for residential care providers to “provide stability and maintain services while the government considers the recommendations of the Royal Commission’s final report”, and $90 million to “support a Viability Fund to assist those facilities which are facing financial challenges”;
- $92 million to “create over 18 000 places for workers between now and mid-2023; and
- $30.1 million to “strengthen the governance of aged care providers and legislative governance obligations on the sector”.
Speaking on the ABC following the Prime Minister’s press conference, Professor Ibrahim was critical of the initial response.
“Saying that it’s going to take 5 years to get anything done means another 200 000 older people will have lived and died in aged care before we see a change,” he said.
“The $450 million that’s been allocated now is less than 3% of the total annual budget for aged care.
“They’ll simply be doing more of the same. The things that aren’t working, we’re just going to do more of them. We’ll do more audits with the regulator when we know the regulator’s been ineffectual and not working.”
Professor Ibrahim said the Prime Minister’s comments that changes to the aged care system would “be hard and will take a long time” were a “set-up”.
“They’ve agreed with the basic principles of life, that all life matters and that we should live in dignity, so it looks like they’ve agreed,” he said.
“They’ve released five or six different strategies. Most of them won’t make any substantive difference to aged care.
“They’ve dropped another $450 million to make it look like they’re doing something. To me, this is really a very cynical staged, managed approach with no substantive reform.
“And again the Prime Minister is setting us up by saying, ‘This is going to be long and hard and take a long time to get anywhere’.
“The harsh reality in life is, if you want something done, you can get it done pretty quickly. And we see that governments are very quick to authorise and approve buildings such as casinos, making decisions around airports. When the government wants to act quickly, it can,” he said.
“They’re telling us now that this is going to be slow because they’re not really planning to act.
“We have the money; we’re a wealthy country. Aged care takes less than 1% of our [gross domestic product (GDP)]. To double the amount of money that goes into aged care means that we’d be spending 2% of our GDP. For a rich country like Australia, that’s really not very much.”
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The neo liberal model of government like its broader economic counterpart is not up to the task of deivering quality aged care Not only the 97 Act but also the 2011 reforms now look like mid stepd
Aged care reform is complex and challenging area of policy and of human need. I applaud Prof Ibrahim for calling for a dynamic response. The last thing we need is to entrench more dogmatic “solutions” by so-called experts who never set foot into a care facility or observe the day to day challenges facing honest and hard-working staff and carers.
So it is disappointing to read such dogmatic responses to this article. Particularly the hostility to corporations supplying the funding that allows the modern and high quality care facilities being constructed around the country. In fact the “profit” being generated for those facilities is very small indeed, and the amount of regulation and additional administrative compliance increasingly required each accreditation cycle acts as a type of churn which decreases the efficiency and profitability even further. Many new sets of “recommendations” are apparently based on some instance of bad behaviour somewhere, presumes incompetence and bad faith on the part of staff everywhere else, forcing managers to take nurses and carers away from patient care in order to spend hours each day “documenting” their compliance and detailing the care they provided.
The result is the aged care workforce is increasingly demoralised, not so much from the lack of pay, but because they are presumed to be working in bad faith, and forced away from providing the care they were once passionate about and trained to provide.
TIn my opinion the Royal Commission model was the wrong approach. It is set up with an expectation and indeed intention to find fault, and in such a context very few participants have the courage to stand up and push back against the accusations, to try and maintain a balanced perspective, and to defend what is working well in the system. We will be labelled as working on behalf of evil “corporations” and profiting from the misery of others!
And I have to say to the colleagues who commented already, the assertion that “As matter of principle no one should be allowed to profit from the difficulties let alone misery of others” is ludicrous – every doctor (and nurse!) must only work for free to comply with such a “principle”. Because by definition our work involves people in difficulty and frequently miserable.
And in fact, virtually every occupation consists in profiting from the “difficulties” of others. I find it difficult to grow enough food to feed myself. I find it difficult to generate electricity to light my home and cook and clean. I find it difficult to educate my children without the assistance of teachers. I find it difficult to build a house. Must farmers, teachers, power companies, builders and everyone else provide their services gratis? To my knowledge of history, such communes have never been able to sustain themselves, and often result in even more misery.
“Difficulty” is an inevitability, and sadly, some periods of misery will be part of every human existence. If some people have the capacity and willingness to provide assistance and care to others in such predicaments without charge, that is an act of personal virtue previously called “charity”. But if “in principle” it is actually obligatory, then there can be no such thing as charity. Only entitlement, guilt and resentment. Be careful what you wish for.
There is no place for corporate age care none
There is no doubt that the main problem with aged care homes is privatisation and corporatization by John Howard, one of his many catastrophic legacies. As matter of principle no one should be allowed to profit from the difficulties let alone misery of others. It has been made worse by the substantial with-drawl of funding from the aged care sector
I have concerns that there has not been mention that families also need to stay involved and add human support and love. Responsibilities still exist for families and often make an enormous difference. The population of residents in RCFs is frail with deteriorating health and the aim is maintaining functionality and connectedness as much as possible, but the end point is end of life/ death, achieved with as much comfort and dignity as is possible. Death of a resident is not a failure but avoidance of acceptance of that, and all comfort measures being in place, including place of death, is.
People in ahem care have families affected by thd constraints of thd aged care system,,
No mention is made of spouses left at home while the resident is in NH,, the financial burden on the non NH spouse is enormous