above: Aged Care residents need more to do than to be sat in front of a television all day
Dr Tristan Ewins
The recent Budget
announcements are
a mixed bag for Aged Care. They
represent a step in the right direction ; but much is still left to be
done. Specifically the Budget outlines
an extra $17.7 billion over five years in new funding ; but with an upwards
trajectory. This is intended to provide
an additional 80,000 home care packages over two years, while increasing the
Basic Daily Fee by $10 a day. This will provide for things such as better food. And average staffing levels will increase,
with 200 minutes of personal attention allowed for, with 40 minutes of this
with a registered nurse. By comparison,
the Royal Commission concluded that residents require at least
215 minutes of personalised care a day. (including 44 minutes with a
Registered Nurse) And while the Budget initiatives
will see an increase in the numbers of
Aged Care workers attaining a Certificate III qualification, they have
stopped short of mandating this as a minimum standard.
The
Conversation concludes that while the changes, including a new Aged Care
act in 2023, are significant, they stop short of the ‘needs based’ model demanded
by the Royal Commission. We still need minimum staffing ratios. Mandated personal time with staff needs to go
further. To attract and keep the best
workers we need significantly better wages and conditions for all staff. A landmark improvement in wages of at least 20
per cent, and end casualisation for those who prefer part time or full time
work. This is also a matter of fairness
in relation to the demanding nature of the work. We require more workers with a Certificate IV
minimum. We need as many workers as
possible with a Certificate IV, and none with less than a Certificate III. What’s
more we want better standards without falling back on user pays to provide for
this. In
Paul Keating’s words, we don’t want people to have to ‘eat their house’ and
die broke. This also requires an
improvement in the Aged Pension, with an easing of means tests. And we need to
provide for a waiting list of around 100,000 for at home care. We also need
stringent regulation to ensure new funding goes entirely towards staff,
infrastructure and services, and not profit margins.
There’s also the problem of Aged Care homes being ‘warehouses for old people’. People
are just sat down in a common room in front of a television all day. Tied funding needs to be provided for
facilitated interaction ; outings for those interested and capable ; visits,
gardens and access to a variety of books and information technology ; as well
as interesting and engaging activities. Once everything is accounted for we’re looking
at something more like a minimum of $10 billion new funding every year indexed
to account for rising costs and inflation.
This is necessary just to make up for the money withdrawn from the
system in the form of ‘efficiency
dividends’ over the past 20 years. The public sector also needs to take more
responsibility, with more public investment in aged care facilities. For profit aged care does not have the
interests of residents at heart, and even not-for-profits can be prone to diverting
funds for expansion.
But by comparison Labor has made little in the way of monetary
commitments in
its Budget Reply. Nonetheless it’s true,
Albanese has hinted at ratios. He argued
that : “a Labor Government will deliver that care by ensuring that
every dollar spent in aged care goes to employing a guaranteed minimum level of
nurses, assistants and carers and to daily needs like decent food – rather than
into the pockets of the more unscrupulous providers.” This
includes a registered nurse on site 24/7.
And a commitment to levels of personalised care recommendation by the
Royal Commission. He backs the Royal Commission findings ; though he does not
commit in areas where there was disagreement ; such as funding. Albanese also mentions issues like the wages
and conditions of staff, which the Liberals did not even touch upon. The bottom line is that while Labor is saying
some good things, it needs to commit on funding. And that funding mechanism should be as
progressive as possible. For a start,
tax cuts for the well-off need to be stopped or reversed. It needs to provide at least twice the
monetary commitment made by the Conservative Government in Aged Care ; or at
least an additional $10 billion a year.
And that funding needs to kick in as a matter of urgency, as soon as
possible.
Albanese is also highlighting Labor’s ambitious child care policy, as well as
its high tech industry policy, an emphasis on wages, and a big commitment to
social housing - with 20,000 new social
housing dwellings, including 4,000
places for women and families escaping domestic violence. There is no explanation how wages will be
driven upwards however, or why social housing is thought preferable to public
housing. After all, public housing would
ultimately be more affordable for recipients. If the Fair Work Commission will
not lift Aged Care workers’ wages significantly enough Labor needs to intervene
more directly. And the NDIS needs
support so recipients are not adversely affected by cost-cutting.
As the Federal election
approaches, the issue of revenue and funding will become unavoidable. A ‘small target’ will not suffice when people
are demanding details. An Aged Care Levy could be progressively structured, and
would probably be relatively popular if linked directly with Aged Care funding. The Coalition has been driven by the findings
of the Aged Care Royal Commission to go further than it is probably comfortable
with. But Labor needs to go further still
if it is to address the findings of that Commission, and clearly distinguish a
superior policy from that of the Coalition.
