Despite more than 30 major inquiries, governments still haven't fixed aged care
By Christie M. Gardiner, Elieen Webb and Teresa Somes
Australia’s aged care sector has been the subject of more than 30 major inquiries and reviews since 1997.
It is fair to say the findings have been highly critical of the way aged care is run in this country. Many of these concerns have been brought to light again — along with new issues raised — in the ongoing Royal Commission into Aged Care Quality and Safety.
Yet, as the royal commission has noted, successive Australian governments have shown a “lack of willingness to commit to change”. Even the establishment of the royal commission was not based on previous inquiries or recommendations, but in response to media exposés of the appalling conditions in some aged care facilities. From these dysfunctional circumstances, three questions arise.
First, what are the ongoing issues with aged care in Australia?
Second, why have successive governments been comfortable making do with piecemeal solutions rather than truly “fixing” aged care, once and for all?
Finally, and most perplexingly, why have Australian voters let them get away with it?
What’s the problem?
It is important to emphasise that aged care is predominantly a federal government responsibility. The 1997 Aged Care Act is the main law covering government-funded aged care. This includes rules for funding, regulation, approval of providers, quality of care and the rights of those in care.
Since 2019, the federal Aged Care Quality and Safety Commission Act regulates complaints, sanctions and enforcement, but has been criticised for lacking teeth.
The 1997 act diluted many preexisting regulatory protections, such as strict financial accreditation and staffing requirements, and opened the sector up to privatisation. At the time, concerns were raised the new regime could compromise standards of care in aged care facilities and disadvantage older people on lower incomes.
The concerns were raised again and amplified in subsequent years. For example, in 2011, a Productivity Commission report noted Australia’s aged care system needed a “fundamental redesign”.
Here is a brief summary of the recurring issues raised in multiple reports:
- The huge difficulty people have navigating the aged care system, including finding accurate information about facilities
- Failure to meet the needs of vulnerable older people
- Poor quality care, especially for those with dementia and other disabilities
- The use of chemical or physical restraints
- Inappropriate staff ratios and poor training
- The rising cost of care, especially in light of an ageing population
- Adherence to accreditation standards
- Ineffective complaints mechanisms.
Why haven’t these problems been fixed?
One of the major hurdles to real reform is the relationship between the aged care industry and the federal government.
The government funds the sector and provides a relatively “light-touch” oversight, while the providers attend to the day-to-day running of the facilities.
However, there is concern this alignment has meant successive governments are not as involved as they should be and proposals for change are diluted by the influence of industry lobbyists.
Another reason for governments’ reluctance to intervene is many of the providers are “too big to fail”. A facility’s licence and government funding can be withdrawn if standards are not met. Yet this rarely happens.
Why? Because if a licence is revoked, residents need somewhere to go. The issues here can be seen in the closure of the Earle Haven nursing home in July 2019. Here, 68 elderly people were left homeless and had to be moved to hospitals and other aged care facilities.
As a further example, Bupa, one of Australia’s largest providers, continues to operate, despite sanctions or failing fundamental assessments.
Christie M. Gardiner is affiliated with the University of Newcastle
Eileen Webb is affiliated with the University of South Australia
Teresa Somes is affiliated with Macquarie University
This article was originally published at The Conversation. Read the full article.
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