Aged care – Royal Commission into Aged Care Quality and Safety

Aged Care in Australia: A Shocking Tale of Neglect

The Royal Commission into Aged Care Quality and Safety’s Interim Report

… the aged care system fails to meet the needs of its older, vulnerable, citizens. It does not deliver uniformly safe and quality care, is unkind and uncaring towards older people and, in too many instances, it neglects them.

The Commissioners’ investigation into Australia’s aged care system led them to describe the aged care system as ‘a shocking tale of neglect… far from the best that can be done…a sad and shocking system that diminishes Australia ..a fundamental overhaul of the design, objectives, regulation and funding of aged care in Australia is required.https://agedcare.royalcommission.gov.au/

The Interim Report makes this very important point clearly:-

“A number of people will seek out aged care services either independently or at the urging of family, friends, doctors and hospitals. Unfortunately, it is at this point, when the aged care system should be welcoming and easy to navigate, that the first problems emerge.People are met with a telephone and internet-based national aged care entry system called My Aged Care that many people in their eighties and nineties find frightening, confronting and confusing. They are then referred for a face-to-face discussion to assess how much care they can receive and whether that will be in their own home or a residential care provider. This is the first of many assessments. Too often they must tell their story over and over again.Left to fend for themselves at this point…”

I have had the good fortune to have had tertiary education, many years with computers and websites and no obvious disability despite being in my 85th year. I wanted to see what I should do about aged care for my wife and I and encountered this –

“Request activation code for Aged Care Client Portal – Please enter the email address that was provided in your user access request form. An activation code will be sent to this email address with instructions on how to complete the account activation process. A user account has not been created for this email address within the Department of Social Services application. Please try again or contact the My Aged Care Service Desk on 1800 200 422 or email macservice@myagedcare.gov.au for assistance”.!!!!

Rock Fishing for Seniors and Paragliding for  the Aged and Infirm may be better options than seeking access to an Aged Care described by a Royal Commission as “… .a sad and shocking system that diminishes Australia”

Some comments and examples offered to Royal Commission

  • Under-staffing  … providers are accused of running understaffed homes to keep surpluses up. More than half of Australia’s residential aged care facilities have unacceptably low numbers of staff.- https://agedcare.royalcommission.gov.au/publications/Documents/research-paper-1.pdf
  •  About 80 per cent of the workforce are personal care workers who can be paid as little as $18 an hour — the same rate paid for packing supermarket shelves.
  • There is no standardised training … courses dished out by dozens of organisations varying in duration and quality from as little as six weeks’ online to 12 months at TAFE
  • The number of registered nurses has dropped from 25 per cent to 19 per cent over the past 12 years, while personal care workers, who previously made up 50 per cent of staff, now represent over 70 per cent.

Other relevant observations

 A  Report Commissioned by the Australian Nursing & Midwifery Federation –

“.. By number of beds, not-for-profit providers are the largest aged care provider group in Australia (52% in 2013-2014), however there has been a rapid growth in the size and spread of for-profit companies.. 6 for-profit companies operate over 20% of residential aged care beds … were given over $2.17 billion AUD via government subsidies http://anmf.org.au/documents/reports/ANMF_Tax_Avoidance_Full_Report.pdf 

Rural Doctors Association of Australia Submission to the Royal Commission into Aged Care Quality and Safety –

Aged care providers will not continue to operate where their business model is unviable. Where this is the case Commonwealth and State/Territory governments have a responsibility to make other arrangements for aged care provision that allows people to live in the places of their choosing for as long as possible. However, where market-based models of service delivery are not working to improve access to health and other aged care professionals and services, non-market-based models must be implemented to ensure aged care services are available for those who need them.”

 

A Fair Go –  Suitable Aged Care Versus Profits for Investors and others

The provision of … uniformly safe and quality care and profits for investors and others highlights fundamentally incompatible practices and cultures. The following are some of them –

  • To make a $, a business will hire as few staff as possible; pay them as little as possible. Paying low wages will see a business hiring less qualified staff, often less caring and empathetic.
  • Management level staff come and go frequently, as do  most others – often in disgust with a $ Versus  care and need culture.
  • A business will locate its facility only in densely populated areas and often where land is cheaper – on the outskirts or near a road/railway or industrial area.
  • A business that sees it business model or location as no longer viable (in terms of $$$) will close or move or “Phoenix” its structure to set aside its assets or coffers.
  • There are undoubtedly many business operators who are ethical, caring and totally above board. Unfortunately, those who have an eye only for $$$$ have major advantage in a competitive environment.  

Conclusions and suggestions aimed at delivering  ‘uniformly safe and quality care’

  1. Safe and Quality Aged Care, available to all Australians, should be provided and available to all by an Australian Government Agency at facilities, places and institutions manged and controlled by the Australian Government Agency.
  2. The responsible Australian Government Agency should urgently develop ‘best practice‘ to include evidence-based management process, staffing levels, work practices and such other matters found to be necessary to deliver ‘uniformly safe and quality care’
  3. Aged Care provided at all places, facilities, and institutions by any party – the  Australian Government Agency  itself or any  other Aged Care provider, either non-profit or for-profit, must be required to adopt and meticulously follow ‘best practice‘.
  4. An  Aged Care provider, either non-profit or for-profit, that can demonstrate by all relevant means including where necessary an on-site Government Auditor, that it uses and meticulously follows ‘best practice‘ may be deemed to be manged and controlled by the Australian Government Agency.
  5. A non-profit Aged Care provider that may consider that its business model is nonviable if it must follow mandatory ‘best practice‘  should be encouraged so seek to work with the Australian Government Agency to for example, permit the Agency to conduct the health and care requirements of residents at the premises, leaving the non-profit provider to manage premises, catering , outings, cultural practices and such other things as it may value.
  6. If a for-profit Aged Care provider does not wish to be subject to these contractual conditions then they must leave  the Industry leaving the Australian Government Agency free to negotiate a market based price for relevant assets or to  instead simply go into liquidation if that is its choice.
  7. Small and medium-sized business and privately owned firms have advantages that enable them to operate profitably and more effectively in satisfying the needs of a major enterprise that must focus on its prime function – in this case to deliver ‘uniformly safe and quality care’. A local business can provide and deliver meals (subject to mandatory quality and nutrition). Cleaning, lawns and gardens, data management, communications – so much more. Involve the local community!

How do we Balance the Budget and pay for all this?

 Australia issues its own currency, $A. It can  run a pure deficit, without borrowings. A budget surplus  drains savings from the private sector and that leads to loss of jobs and less work done. The Government has to spend money into existence. Without that there can be no tax. 

A Sovereign Currency Nation’s government like Australia’s primary purpose is to improve the well-being of its population. Balancing budgets is an irrelevant and destructive blind alley. The real economy is what is relevant to well-being, care for the environment, defence, research education, aged-care and employment (and so much more).

A Sovereign Currency Government issues the currency and it must first spend it by crediting private bank accounts before it can tax – by debiting bank accounts. The claim that governments must tax or borrow to ‘finance’ its spending is false under a fiat-currency system. See – https://www.investopedia.com › Economy › Economics

The restrictions on government spending are the quantity of real goods and services available for sale in its own currency, including all the unemployed labour. The only constraint that a currency-issuing government, such as the Australian government faces, are how many real goods and services are available for sale in $A.

Our wide-spread quasi-superstition about balanced budgets is a blight on public policy discussion. However this Blog is about Safe and Quality Aged Care and there is ample material on the Web about monetary theory and practice – see for example- http://bilbo.economicoutlook.net/blog/?p=41133#more-41133

All about a Budget Surplus

. Both Labor and Liberal/National Coalition are still making Policy decisions based upon  outdated ideas about how a modern economy really works. Governments, much of the media, some economists, academics and others are just as uninformed.  Most of the rest of us believe what we have been told without looking too hard at the substance of what we are told: economics is boring and we have our lives to live.

Related image
The Australian Budget 2017/2018 intended to-

  return to balance in 2020-21 and continuing projected surpluses ….will enable a reduction in debt. This will place Australia in a better position to withstand any future economic downturns. It will reduce the need to increase taxes or cut back on essential services ….by living within its means the Government will not burden future generations with debt from today’s everyday spending. From 2018-19, debt will not be required to fund recurrent spending for the first time since the GFC.

See  Australian Budget.

These statements of intent are totally at odds with the reality for a Sovereign Currency Nation’s public purpose. Australia issues its own currency, $A. It can  run a pure deficit, without borrowings. A budget surplus  drains savings from the private sector and that leads to loss of jobs and less work done. The Government has to spend money into existence. Without that there can be no tax. 

A Sovereign Currency Nation’s government like Australia’s primary purpose is to improve the well-being of its population. Balancing budgets is an irrelevant and destructive blind alley.

The real economy is what is relevant to well-being, care for the environment, defence, research education, aged-care and employment (and so much more).

A Sovereign Currency Government issues the currency and it must first spend it by crediting private bank accounts before it can tax – by debiting bank accounts. The claim that governments must tax or borrow to ‘finance’ its spending is false under a fiat-currency system. See – https://www.investopedia.com › Economy › Economics

The restrictions on government spending are the quantity of real goods and services available for sale in its own currency, including all the unemployed labour. The only constraint that a currency-issuing government, such as the Australian government faces, are how many real goods and services are available for sale in $A.

A currency-issuing government can, for example, mitigate the economic and social disaster caused by mass unemployment by spending enough. Aboriginal and Islander Communities could see a Job Guarantee based around care-for-country and the public good rather than destructive handouts and associated misguided measures.