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.”
“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.”