The recent Royal Commission into Aged Care Quality and Safety interim report was titled “Neglect.” The report states: “Left out of sight and out of mind, these important services (aged care) are floundering. They are fragmented, unsupported and underfunded. With some admirable exceptions, they are poorly managed. All too often, they are unsafe and seemingly uncaring. This must change.”
Yet the report’s “urgent” recommendations do nothing to address the underlying reasons for these appalling conditions, which governments, Liberal-National Coalition and Labor, municipal councils, corporations and trade unions have known about and presided over for decades.
The three recommendations are “to provide more Home Care Packages to reduce the waiting list for higher level care, to respond to the significant over-reliance on chemical restrain in aged care and to stop the flow of younger people with a disability going into aged care.”
No numbers or time frames are given for these recommendations. There is no indication how they will be implemented without a significant influx of funds by governments or the corporations that run most aged care facilities. In short, the recommendations are a sop, which the royal commission has no intention or means of enforcing.
Prime Minister Scott Morrison announced the inquiry in September 2018 to head off the public outrage over media revelations of abuse, malnourishment and neglect of many elderly residents of nursing homes. It was a calculated attempt to defuse this anger while avoiding any commitment to increase funding after years of budget cuts by Coalition and Labor governments alike.
The shocking revelations outlined in the interim report are based on evidence presented in over 6,000 submissions from residents, families, staff and service providers, 12 public hearings, nine community forums and roundtable consultations with nursing home operators. However the report concedes that the commissioners heard nothing different from the previous 18 inquiries held since 1997—almost one a year for more than two decades. The commissioners found that many of the previously identified failings remained widespread.
What is revealed is that virtually no aspect of the aged care system is uniformly accessible, transparent and affordable, let alone safe, caring and adequately funded or staffed. The report notes that the first step in seeking aged care services is via a telephone- and internet-based system called My Aged Care that “many people in their eighties and nineties find frightening, confronting and confusing.” The report states: “Unfortunately, useful information is the exception, not the rule.”
The average waiting time for a Home Care Package, which provides funding for people to stay in their home, is between one and three years. Many people die while waiting.
Payments for residential aged care services consume 85 percent of the aged pension plus hundreds of thousands of dollars as a security bond, often derived from the sale of the family home. Only a portion of this bond is refunded to the estate on death.
Once deemed eligible for an aged care service, the old and frail are subject to a cost-cutting, budget-driven framework in what is now a multi-billion dollar a year industry.
According to the report, as at June 2018 more than 1.2 million people in Australia received some form of aged care service—847,534 had home support, 116,843 received home care and 241,723 were in permanent residential aged care. Half the residents in permanent residential care had been diagnosed with dementia.
Increasingly, governments have relinquished their responsibility to provide for older people, handing over this task to the corporate and “not-for-profit” charitable, community-based and religious organisations. Only 9 percent of aged care facilities are managed by governments, with 58 percent by the not-for-profit sector and 33 percent by companies.
The privatisation of this rapidly expanding industry has led to staff reductions and casualisation, the rationing of basic necessities and a precipitous decline in standards. According to a report by IBISWorld, Australian aged care providers were predicted to make $1.7 billion in profits from a revenue of over $20 billion in the 2018-19 financial year.
The chronic understaffing levels condemn nurses, carers and residents to a system where the physical, psychological and medical needs of the residents are sacrificed for profit. The consequences are clear, predictable and damning.
Up to half the residents in aged care facilities suffer from malnutrition as a result of inedible and non-nutritious food or the lack of enough staff to assist residents who cannot feed themselves. Testimony was presented of some providers budgeting less than $7 per day per resident for food.
More than three quarters of residents suffer incontinence, with the majority in the most dependent category. Daily restrictions on the number of incontinence pads and nappies per resident result in distressed and agitated people sitting for hours in wet and soiled nappies.
Evidence was presented of the widespread use of “chemical restraints” to control residents suffering multiple forms of behavioural problems. “[R]esearch involving 150 residential aged care facilities found that 61 percent of residents were regularly taking psychotropic agents, with 41 percent prescribed antidepressants, 22 percent prescribed antipsychotics, and 22 percent prescribed benzodiazepines,” the report states.
“An Australian Department of Health expert clinical advisory panel estimated that psychotropic medication is only clearly justified in about 10 percent of cases in which they are prescribed in residential aged care.”
The use of such drugs, which are known to cause increased falls and injuries, is a direct product of understaffing. A 2017 Medical Journal of Australia study found that preventable deaths in nursing homes had increased fourfold over a decade. The study reported 3,291 premature deaths, from potentially preventable causes, between 2000 and 2013.
The situation facing staff tasked with caring for the most vulnerable, defenseless and ailing members of society is almost impossible. Despite the growing number of people entering aged care and the increased complexity of their health conditions, the proportion of registered nurses has decreased from approximately 21 percent in 2003 to 14.9 percent of aged care staff. In their place, unskilled or poorly trained personal carers are hired at a rate of around $21.50 per hour.
Aged care nurses are paid, on average, 10 percent lower than their counterparts throughout the health industry, and personal carers are paid 15 percent less. Surveys were presented of unsustainable workloads. One Assistant in Nursing said she had 15 minutes each morning allocated to each high-care dementia patient to shower, dress and attend to their needs.
The interim report in no way challenges the basis on which the aged care industry is run. On the contrary, it blames the population as a whole, stating: “As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities.” The budget cutting of Coalition and Labor governments alike, which has created this dire situation, is not indicted. Promises by Prime Minister Morrison that funding will increase are belied by the government’s budget statements that spending will be restricted to the slowest growth in 50 years.
The government projects it can slow growth in health funding, after inflation, to just 0.7 percent a year over the next four years despite an aging population and a broken private health insurance system.
Increasingly, the elderly are regarded by capitalism as a burden, an encumbrance and a cost for which governments are not willing to pay. Despite working their entire lives, contributing to society and providing for and raising families, the retired workers are treated as if they should die to save the cost to society.
The royal commission is continuing. But the outcome is already clear. It will follow the previous 18 inquiries and act as a cover for those responsible for the disgraceful conditions faced by those who are forced to live and work in the aged care industry.