Funding and Services Crucial for Aged Care

     above: access to sunlight, fresh air and gardens can improve quality of life in aged care

Dr Tristan Ewins

The Aged Care Royal Commission had laid down its findings.  These should be the source of great shame for the Government.  But also for Labor – who failed to prioritise the issue over the decades as well.  It now falls to Labor Federal Opposition Leader Anthony Albanese to drop the ‘small target, ‘no new taxes’ policy and promise to fund comprehensive, needs-based Aged Care with ongoing and significant progressive tax reform.  Labor could plan for incremental reform over a ten year timeframe, peaking at 5 per cent of GDP in new progressive taxation. But aiming for 1% to 1.5% of GDP in a first term.

After scrutiny from the ABC especially in recent years, It should come as little surprise that the Australian Aged Care system has been found to be subject to appalling neglect.  ‘The Guardian’ reports that after over 20 years of ‘efficiency dividends’ almost $10 billion a year had effectively been ripped out of the Aged Care budget.  This funding – and more – needs to be restored.

The Royal Commission has found that since its inception – with the 1997 Aged Care Act – the aim of the system has been to cap costs rather than ensure quality.  Australia spends less than half the amount provided for proportionately in the Netherlands for instance. To improve quality, and wind back inequitable user-pays, funding needs to at least double.   

On the understanding that the system has been under-resourced for decades, now, Aged Care has lacked nurse and aged care worker ratios. Many workers lack skills, are under-paid, and are demoralised.   Casualised labour is common, and makes it difficult for staff to form relationships with residents. Workers often need to move between several workplaces.  Experts informing the Royal Commission have concluded that residents require at least 215 minutes of personalised care a day.  (including 44 minutes with a Registered Nurse) 

It is also notable that about 25% of elderly Australians (over 70) suffer chronic social isolation ; and this needs to be addressed as much as purely-physical needs.  

Abuse also affects between 13% and 18% of residents, and much greater oversight is necessary to defend their rights and dignity.

Because of inadequate ratios it is not uncommon for aged care workers to try and dress and shower elderly residents in around 6 minutes: which must surely impact on the quality of care.  And involve significant trauma. Food is often cheap and un-nutritious.  Dental care and other Allied health services are not always adequate.  Often ‘life’ consists of being sat down in front of a TV in a common room all day. 

Sometimes people develop bedsores or lay in their own urine or excrement because there is inadequate supervision. There is a desperate need for more facilitated social interaction, and excursions for those capable.  People need sunlight, privacy, pleasant surrounds, gardens, books, things to do and aspire to. Rather than receiving specialist care, those with dementia are often literally ‘tied down’, or ‘knocked out’ by heavy application of anti-psychotic medications. 

A largely privatised system has faced inadequate government scrutiny. With funding already critically low, pressures to provide profits and dividends have driven a culture of ‘cutting corners’ in the industry, to residents’ detriment.

Many who require Aged Care would prefer to stay at home with assistance packages.  (this is also more efficient in terms of necessary funding)  But waiting lists have hovered at around the 100,000 mark. Many thousands die every year waiting for care that is never delivered. This is also unfair for Carers.

Scott Morrison has injected almost half a billion into the system in response to the Commission’s findings. But this is only a small fraction of what is needed. He claims reform will take ‘years’ ; but in fact the government is still focused on containing costs as opposed to fixing the system.  They hope that – with time – people will ‘forget’ – and pressures for tax reform will recede. Their ‘low tax credentials’ are more important to them than our vulnerable elderly. Over the long term, Labor is partly to blame as well. If Aged Care was prioritised as much as Covid, reform could be implemented more rapidly.

 Aged Care ‘for profit’ is part of the problem ; but not-for-profits have a hard time sustaining the necessary staff, infrastructure and services also.  Profiteers should be driven out of the system. Government and not-for-profits should step in to fill the void.

A robust, dedicated and progressively-structured Aged Care Levy could raise at least $16 billion to be redirected into the system ; enhancing health and social services, improving ratios of aged care workers and nurses , ensuring more personal attention for residents and those requiring care-at-home.  Capital should also pay its share, with Company Tax rising by at least one per cent. 

Overall, progressive tax should rise as soon as possible (over the short term) by over one per cent of GDP – maybe even 1.5% of GDP. (ie: somewhere between about $16 billion and $24 billion a year)  The Morrison Government needs to be pressed to implement these reforms immediately ; but otherwise a new Labor Government needs to implement such change in its first term.

Labor needs to ‘break the bipartisan consensus of neglect’ and run hard on tax reform for Aged Care, as well as mental health and supporting the National Disability Insurance Scheme. (NDIS)  Jobseeker needs to rise by at least $100 a week, and maybe more. Other pensions could also be strengthened.  There is widespread public support for tax reform if tied to crucial areas of public need.

More is needed over the long term to achieve a social wage and welfare state of Nordic proportions.  Provision of care needs to be ‘needs based’ rather than ‘capped’ regardless of what that means for cost.  Government oversight needs to consider ‘basics’ like food and staffing ratios ; but also broader ‘quality of life’ issues. In the future one priority should be keeping the elderly ‘connected’ with internet access.

Labor needs to mobilise its resources to campaign for extensive Aged Care reform now ; as well as reform for mental health, NDIS, Jobseeker, and other pensions.  Aged Care and Mental Health especially are ‘in the public eye’ for now.  We need to maintain and increase the momentum for change while we have the chance.  These need to be key issues for the coming election, and also in the development of Labor’s National Platform.  (a Special Conference is being held near the end of March 2021– this month!)  

Labor activists and parliamentarians are placed to make a difference in unions, social movements, government and the broader Party.  We all need to attempt to lead debate and apply pressure as best we can while there is a ‘window of opportunity’ for change.