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.

Labor must draw lessons from Electoral Defeat - But not Compromise its Values

Sco-Mo ; supposedly 'the every-man's politician'

Dr Tristan Ewins

Labor has lost what had been seen as an unlosable election. How could everything go so wrong? How could the polls have got it all so wrong?

Firstly, here, is the United Australia Party vote and Clive Palmer’s money. Regardless of whether he achieves a Senate seat, Palmer is channeling roughly 3.5% of the vote in the form of Liberal preferences.   What can Labor do about ‘big money’ in politics?   Nothing straight away ; but over the long term the rules must be changed so billionaires cannot ‘buy their way into parliament’. Or otherwise 'harvest preferences' for the Conservatives.  Labor needs to run hard on this over the long term.

Secondly, there was the re-invention of Scott Morrison – as ‘Sco-Mo’.  ‘Sco-Mo’ was supposed to be ‘an everyman’s politician’.  With his baseball cap ; at various sporting events ; a dad and a Christian. 

This may have been clearly shallow for many of us ; but obviously it gelled with a great number of people. The Liberals chose to focus on ‘the character of Sco-Mo’ and to distract from the dysfunction within ‘the Liberal Team’.  The strategy was reinforced in Newscorp media over months.  Labor failed to smash this invented idea of ‘Sco-Mo the every-man's politician’ when it should have tackled it head on.

Thirdly: the Liberals turned to all the usual prejudices against Labor. The propaganda asserted ‘Labor can’t handle money’ ; and warned of  ‘the Bill Australia can’t afford’.  The fear campaign was not sufficiently interrogated in the media ; and ultimately it worked.  Labor failed to establish that deficits have continued under the Liberals – and much more than necessary because of measures enhancing the incomes of the –already-rich; and that a deficit was in fact necessary under Rudd in order to stimulate the economy and avoid recession.

In fact there was a narrow base to much of Labor’s tax reform.  Measures on franking credits affected less than 5% of the population.  But Labor did not establish this in the public consciousness  either.

Further, there is the melding of neo-liberal Ideology and the legacy of 80s ‘reconciliation politics’.   

The Hawke-Keating governments delivered Medicare, superannuation and various tax reforms.  But they also consolidated in the public consciousness that class conflict was ‘bad’.  And it was up to unions to ‘take a hit’ with wage restraint for the sake of the economy ; but without the delivery of anything ‘Nordic’ in return.  The problem was that once the unions traded away a general right to withdraw labour, and conceded to enterprise bargaining – as its position further weakened it had little else to bargain with.  And ‘reconciliation’ was seen as organised labour’s responsibility to be flexible in response to ‘employer needs’.

The ALP started talking about reducing the number of days lost to strikes as a virtue in of itself ; when in fact it was also a signal of a weakening movement.  Where the legitimacy of industrial action itself had been reduced to an impression of ‘disruption, thuggery, and unnecessary inconvenience to the public’.    Here all redistribution is also reduced to ‘the politics of envy’. 

The Liberals speak of “a fair go for those who have a go”.  But was Morrison arguing that cleaners, nurses, child care workers, aged care workers, teachers – do not ‘have a go’?  This is the same kind of warped take on ‘meritocracy’ which ‘naturalises’ privilege and inequality.   But Gina Rinehart did not ‘work her way to prosperity’.  And yet inheritance taxation is still stigmatised as a ‘death tax’ ; and this also featured in Liberal disinformation and scare campaigns.

Morrison tried to ‘shame’ Shorten for ‘not looking a man on a $200,000 income in the eye’ that he was increasing his tax by 2 per cent. (!)  Shorten should have responded strongly that the flattening of the tax system had to stop ; and everyone else was paying the price.  But he did not confront Morrison directly on this.  This was a wasted opportunity that let Morrison off the hook in constructing his ‘meritocratic mythology’. 

For decades the ALP was also complicit in the politics of ‘small government’.  Breaking that consensus was always going to be difficult after all this time.   As things are reform here has to be slow, deliberate and cautious.  But without such a plan Labor cannot achieve any significant reform agenda.

Also there was the question of Morrison’s alleged Christianity and the case of Israel Folau.  Themes of ‘freedom of religion’ could have been a real sleeper issue which influenced a significant number of votes.  Labor needs to balance freedom of religion with anti-discrimination measures. Much scripture in many faiths contains elements which grate against the grain of modern liberal society.  But effectively repressing the expression of the contents of scripture might simply consolidate a significant portion of ‘the Christian vote’ in the Conservative camp.  There’s a clash of liberties and rights which simply cannot be resolved: it can only be negotiated.  But even accepting religious freedoms, there will be no ‘turning back the clock’ on minority rights when it comes to issues like  equal marriage.   At the same time we cannot make it easy for the Conservatives to 'divide and conquer'.

This is a devastating loss for Labor. It amounts to a victory of fear over hope and vision.  But Labor cannot give in.  It needs to draw tactical and strategic lessons without abandoning its values.  Labor cannot give in on the project of re-structuring the tax mix to pay for social wage and social insurance measures.   Next time Labor needs to look at tax reform in the vicinity of 1% to 1.5% of GDP: but squarely aimed at the top 10% demographic.   And Labor needs to establish that the remainder will not be adversely affected.   With the exception that superannuation tax concessions still need to be tackled ; and may cost the Budget tens of billions into the future if this is not done. And perhaps with the additional exception of a dedicated progressive levy to fund a National Aged Care Insurance Scheme.  The Aged Care Royal Commission should provide momentum.

Labor also needs to establish that a ‘flattening of the tax system’ means that most of us pay proportionately more: not just through the tax system itself ; but also as a consequence of the user pays which ensues.

The coming term will be marked most likely by economic crisis – intensified by the trade war between the US and China.  And by the moral imperative of responding to the Royal Commission on Aged Care.  If the Liberals take Australia into recession Labor needs to punish them on this relentlessly.  And ‘burst the bubble’ of ‘Liberal economic management’.  In addition to pressing hard for a full implementation of Royal Commission recommendations on Aged Care, Labor needs to continue focusing on restoration of funding for the NDIS and Gonski education recommendations.  Next time we need to provide certainty that we will legislate for a higher minimum wage ; and also address the income of low-wage workers more broadly.  (that includes through the social wage)

Most importantly Labor needs to debunk the Liberals’ warped construction of ‘meritocratic Ideology’.   Labor needs to establish that all kinds of people work hard ; and we should not be naturalising privilege.  This is a core Ideological battleground which Labor must contest if it wants to embrace policies involving distributive justice.  And to make sure the public is fully aware of the arguments next time the entire movement needs to begin campaigning on these principles and issues immediately.  We have three to four years and we cannot afford to waste a single day.

Finally there is the question of the labour movement and broader social movements’ response to inevitable Conservative austerity.   Progressive social forces need to prepare for a defensive fight against austerity ; and continue the fight for wage justice at the industrial level.

The danger is that Labor will retreat into a conservative ‘small target’ strategy.  Instead Labor needs to draw tactical and strategic lessons while remaining true to its values.

Lack of Funds amounts to Elder Abuse: But neither Party is Talking about it

Dr Tristan Ewins

In a reflection in Saturday’s Age (11/5) Merle Mitchell explained that institutionalization in aged care left her without a home.  Institutionalized care can mean loss of social networks and community.  In her opinion, there was the feeling that death would be a better resolution for everyone.  Fortunately, though, she did not lose contact with all her friends, and that helped preserve her “cognitive capacity”.   She presses the case for a counselor for all residents and for staff. And suggests that if the effort was made to keep residents engaged that may enable stimulating discussions on all manner of issues.   Merle also enjoys extra exercise half an hour a day ; but that is an ‘extra’ that has to be paid for ($50 a day).    Many cannot afford it.  In the end some of the biggest problems are the lack of ratios, and of personal control over everyday life. With ‘institutionalization’ you get up when you’re told to ; you eat when you’re told to ; you go to bed when you’re told to.

Merle’s story is one of an extraordinary number being considered by the Aged Care Royal Commission.  Unless the process is somehow corrupted the Commission will almost certainly advocate for better ratios for nurses and staff. It will consider the quality of food ; the provision of privacy ; the provision of mental stimulation – whether through discussion of politics, philosophy, religion ; or if you prefer - discussion of the football ; and remembrances of years past.  Just sitting people in common rooms to stare at televisions is not the answer!


Better ratios would mean more time to dress and wash in the morning.  It could help ensure residents stay healthy and actually eat their food. Gentle exercise should be provided for everyone capable – regardless of cost. There must be a wide range of books, and increasingly internet access as well.  A nurse on site 24/7 is crucial in the case of emergencies.  And morphine must be made available to the dying.  (I have been told it’s only available in hospitals)  There must be outings for those capable.  And preferably facilities must include gardens where residents can relax and be at peace.  Personal choice must be extended as far as possible.

At home care must also be a viable option and there has been progress ; but some are still left waiting too long for packages. Staying at home in familiar surrounds full of memories is very important.  But again maintaining social engagement is crucial. Including several outings a week ; taxi vouchers ; gatherings with like-minded individuals ; in short – general quality of life.  The support of family is crucial in all this ; but some families neglect their elders (and some lack family as well) , and in such instances communities must step in to provide support and affection. Obviously not everyone can do that work ; only people whose hearts are ‘in the right place’.

A lot has been made of elder abuse recently.  And there are some shocking stories.  But Conservatives prefer to focus on individual instances and deflect attention away from SYSTEMIC ELDER ABUSE in the form of insufficient regulation and funding.  So far in the current election campaign neither side has had anything much to say about Age Care reform, and provision of extra funding.  The initiatives suggested here are crucial to the well-being of our loved ones ; but they come at a cost: probably billions a year.  Meanwhile Conservative PM Scott Morrison focuses on tax cuts for the already well-off and thinks he can hoodwink us with mantras on ‘economic management’.  Those tax cuts will also mean austerity ; some of which will hurt the poor and vulnerable.

Sometimes  Aged Care workers (mainly women) need better training ; and to retain the best workers a Labor government should subsidise Aged Care worker salaries – as it is doing with child care workers. It can be a grueling job ; but it is one of the most important jobs of all to care for the most vulnerable of all. Loved ones we would not forsake for all the world.  Those workers need respect ; and they need support.

Labor is bringing in money from tax reform ; closing loopholes and so on ; but is not yet committed to significant aged care reform.  Beyond already-mooted reforms it is emphasizing its attempt to outbid the Coalition on a Surplus.  But when the Aged Care Royal Commission hands down its findings it must urge Labor to somehow dedicate comparable funds to those made available for the National Disability Insurance Scheme. (NDIS)  (assuming Labor wins the election)  Even if it means imposing a dedicated-purpose, progressively structured levy.  The political parties have treated this issue like a political football for over a decade.   That has to stop ; and we need real action on Aged Care NOW. 

Shorten is beginning – tentatively – to ‘break the mold’ – on small government.  The sufferings of the aged ; and their need for love and dignity is too important to again “leave it until next time”. Morrison is a hypocrite ; parading his ’Christian credentials’  while preferring tax cuts to caring for the vulnerable.   But Bill Shorten needs clarity and resolve.  It is an argument he can win.  We’re talking about our loved ones here ; and possibly of our own futures.  Bill Shorten must foreshadow the necessary commitment of resources now ; or he must support an immediate shift of policy on funding, ratios and standards following the Aged Care Royal Commission.   Lack of funds amounts to systemic abuse of our elderly.  Elder abuse cannot be ‘fixed’ without the provision of extra billions every year. 

Aged Care Reform NOW.