If Australia has known for a long time that its aged care sector is in crisis, why is reform so difficult? Tim Cornwall reports.
AGED CARE is an important sector in many ways.
The customers (for lack of a better word) are some of the most vulnerable people in our community. The workforce comprises some of the most caring members of our community. Despite these facts being obvious, we often fail to deliver even adequate care or stable employment in the sector.
This is not because we cannot afford it. In fact, it would make more economic sense to reform the sector and employ more staff. Instead, there are forces at play keeping the quality of care and work at a minimum while maintaining a lack of transparency with government funding.
The problems in the aged care sector can be traced back to Prime Minister John Howard’s Aged Care Act 1997. This was the beginning of the privatisation of the sector — turning an industry that should be focused on the quality of care above everything else, into the brutal free-market game.
Rather than adequate minimum quality standards, there were pages and pages in this legislation about how government money would support the now-privatised sector. What transpired was that the Howard Government poured billions into the industry, largely losing transparency and control over the quality of care offered.
As private industries are well within their rights to do, they worked towards making profits. In the care-focused industry, this meant reducing the quality of care and making sure that the workforce was underpaid and mostly casual.
Aged care homes spending an average of just $6 on the daily food for each resident is one example of the extremes that are reached. There is no doubt that the casualisation of the aged care workforce has also contributed to the spread of COVID-19 throughout Victoria.
But, why has reform been so difficult if we have known that the sector has been in crisis for so long?
A large part of the problem is the dark figures behind aged care industry lobbying. Industry leaders seem to escape the spotlight, often cycling between lobbying jobs, Liberal Party advisory roles and industry regulators, knowing that as long as they advocate in a certain direction, their pay-packet will increase.
One example is that of Nick Ryan. From 2010 to 2013, Ryan was the chief executive officer of Queensland’s division of Leading Aged Services Australia (LASA). This is a group which has lobbied against providing residents with “comfortable internal temperature” because aged care providers didn’t want to spend their money on air conditioners. Ryan had since become the chief executive officer of the Australian Aged Care Quality Agency (AACQA), which was then the government regulator for the industry.
It seems no coincidence that during Ryan’s time at the regulator, almost 98 per cent of facilities met his standards. This number seems unfathomable during a time in which enough evidence of neglect in the sector was collected to start the ‘Royal Commission into Aged Care Quality and Safety‘. Given his previous positions, however, it shouldn’t be too surprising.
Patricia Sparrow is another great success of the revolving door. Sparrow was deputy chief executive officer of Aged & Community Services Australia (ACSA) between 2010 and 2011 before heading up Council on the Ageing (COTA) from 2011 to 2014.
Both ACSA and COTA have put pressure on governments to make certain that staff-to-patient ratios are not legislated. Much like the merchants of doubt in the climate change debate, they spread doubt on the effectiveness of mandating staff-to-patient ratios despite evidence and logic.
This results in aged care providers being able to use a bare minimum of staff, reducing their costs but also reducing the quality of care and the number of jobs that the industry creates.
After working at these lobbying groups, Sparrow began a role in the office of then Assistant Minister for Social Services, Liberal Party Senator Mitch Fifield. Next, she moved to the office of Liberal MP Sussan Ley in her time as Minister for Aged Care. As a reward for her hard work lobbying on behalf of the industry, Sparrow went back to ACSA where she continues to this day as its CEO.
As long as industry lobbyists are allowed to take advisory positions in our governments, this conflict of interest will continue. This is the case not just for the aged care sector, but for all sectors. As long as most media will not report on the deeper reasons for the neglect of our community’s most vulnerable, there is no reason for politicians to change.
These were the conditions of the aged care sector before the COVID-19 pandemic.
As we knew from the very beginning, aged care was going to be an important part of the pandemic response. Not only do these facilities house those most vulnerable to the virus, but the volume of aged care staff working in several facilities at once meant that the potential for unintentional spreading of the virus was high.
A comparison between the number of COVID-19 cases in private aged care homes compared to Victorian state-owned facilities proves this point.
‘Of 769 cases of COVID-19 in Victoria aged care, only five are in public sector aged care.’
As of 19 August, the difference is even starker with 2,050 cases in private facilities compared with just five in state-owned homes. The main difference between state-owned aged care and the private sector is staff-to-patient ratios.
While Victoria has legislated that between seven and 15 staff must be on duty for each resident, the private sector can do whatever it wants — whatever is cheapest. In some cases, this has resulted in one staff member being responsible for 150 residents. As private companies without adequate minimum quality care standards to adhere to, they are legally within their rights to do so.
The nationalisation and regulation of aged care seem the most obvious solutions here, not only from an ethical perspective but also an economic perspective. In a world of increasing automation and in a country with an ageing population, an aged care sector run properly would mean many future-proof jobs in a sustainable economy of the future.
But it is important to see this first as a human issue. We owe it to the most caring members of our community and we owe it to the members of our community who have given the most, to guarantee them better treatment than the disastrous system currently in place.
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