The government’s pre-emptive announcement of an aged care royal commission was one part smart politics, but two parts poor policy. They were right to try to get out ahead of the Four Corners programs that would have led to huge pressure for a government reaction. But the haste of the move inevitably led to policy on the fly, as Adele Ferguson pointed out.
Moreover, the royal commission will be covering very well-trodden ground. Aged care is very likely the single most reviewed area of public policy in Australia — and has been for decades. By one account there were 30 inquiries dealing with aged care between 1997 (kerosene baths etc) and 2010, when the productivity commission began yet another aged care funding inquiry.
The Department of Health lists even more. In 2011, the productivity commission completed a comprehensive review into the aged care sector that led the Gillard government to implement the “Living Longer Living Better” reforms. At that point, the PC noted that it was the sixth major examination of the area and that they’d all come to the same conclusions. And since then, there have been over 20 more reports into the aged care sector; 2017 alone saw at least six inquiries from various government bodies. These are just the recent ones:
- Oakden scandal. A number of inquiries were launched in 2017, following the discovery of the cover-up of widespread abuse at the government-run Oakden Nursing Home in Adelaide. In mid-2017, the Senate Standing Committee on Community Affairs launched an inquiry into the effectiveness of aged care quality assessment and accreditation. However the inquiry received just 77 submissions and conducted a single public hearing last November. An interim report has been released, with the final product due this November. In December 2017, the government announced an inquiry by the House of Representatives Standing Committee on Aged Care, Health and Sport into quality of care in residential aged care facilities.
- Legislative changes. The reps committee on Aged Care, Health and Sport is also currently conducting an inquiry into the Aged Care Amendment (Staffing Ratio Disclosure) Bill, while the senate standing committee is accepting submissions on the Aged Care Quality and Safety Commission Bill.
- Carnell and Paterson Review. An independent review into aged care regulatory practices was conducted last year by Kate Carnell and Rob Paterson, also in response to the Oakden scandal. The review, which received over 400 submissions, made 10 recommendations, including the establishment of an aged care quality and safety commission, tasked with centralising accreditations.
- David Tune review. Just weeks before the Carnell and Paterson report was released, another review conducted by former finance head David Tune was tabled in Parliament, which looked at capacity issues, and encouraged changes to means testing of residential aged care.
- Australian Law Reform Commission response. In 2017, the Australian Law Reform Commission released its national legal response to elder abuse, following a year-long inquiry, recommending various reforms to safeguard against abuse in aged care, including the creation of a serious incident response scheme, enhanced screening of potential employees, and greater alignment between inconsistent rules and regulations across the states.
- Disability care. In 2015, there was also a Senate inquiry into Violence and Abuse Against People with a Disability in Institutional Settings that exposed widespread incidents of violence, abuse and neglect in disability care centres. The report, which condemned the “devaluing of people with a disability”, recommended the establishment of a royal commission.
In a way this will make the work of a royal commission easier: it will have a massive evidence and analytical base on which to draw. But it also prompts the question of exactly why a royal commission will have any more impact than the dozens of previous inquiries, including many by politicians themselves, into one of the most vexing areas of public policy.
As Bill Shorten pointed out yesterday on Insiders we already know what some of the solutions are. Number one – staffing. Funding MUST be tied to staffing levels. Staff are the most expensive cost in aged care and managers, especially in the for-profit sector are ruthless in cutting costs wherever they can. Further, wages in the sector are woeful – mostly about $22.00 per hour. I have worked with middle aged women ( and they are mostly women) who are earning less per hour than their teenage children who work weekends. The providers will fight this measure tooth and nail. If i dared complain about the impossible work load i was told on numerous occasions that I should look to my time management. This was when I was in charge of a 76 bed nursing home for 8 hours plus – during this time I had to problem-solve, oversee care, dispense medications and make sure they were swallowed (often not easy or quick), plus be the receptionist (answer phone calls), queries from relatives, contact doctors when necessary (and it often was). Decide whether a deterioration in health was cause for transfer to hospital, after consulting the doctor and relatives. I could go on, but you get the picture. I don’t think I ever left work on time, and of course overtime was not paid – in fact were told not to enter actual hours worked on time-sheets.
I had to insist that my staff take a break (just to use the toilet or have a drink if nothing else) after five or more hours of hard physical work. Of course corners get cut when staff work under this sort of pressure – they hated this as much as I did, but complaints to management fell on deaf ears. Showering a frail elderly resident, cleaning teeth, attending to toilet needs, and settling into bed for the night takes as long as it takes. Being told that 15 minutes is sufficient for all this is plainly ridiculous.
Further, although most frail elderly residents do not have big appetites they do need nourishing and appealing meals. An evening meal at 5.00 consisting of sandwiches, or party pies or savoloys do not fit this description. Especially when the next meal is at 8.00 next morning, apart from a hot drink and biscuit at 7.30 pm.
The accreditation systems in place address none of these issues – they are systems designed by bureaucrats for bureaucrats and far too much valuable time is taken up by the requirement to document everything, often in three or four different places.
I could go on, but suffice to say that my family are well aware of my loathing of the nursing home sector. I would much rather expose myself to a freezing winter night and die of hypothermia, or take some other means of exit.
Mary, I’ve been there too. You should consider making a submission to the RC. Your experience and that of people all over the country needs to be documented. The RC will bring everything together which individual inquiries on separate incidents has never achieved. I totally reject the idea being pushed by Keane that nothing can be done because nothing has been fixed. Time for the big nationwide reveal.
Ditto, in both disability support and aged care.
I wish that you could be a witness at any upcoming enquiry.
Followed by inmates’ families, assuming that they know or care, rather than just impatiently awaiting their inheritance.
The Royal commission into look over there from the floundering Morrison Govt.
As a previous post.
As I see it, it’s as good (or a better) a distraction, for a government stuck in the “polldrums” needing a fillip in the face of a leadership change with an election looming, as :-
a) a war (including “on drugs”, “on terrorism”, “lore & ordure”, “African gangs”);
b) “Children Overboard”;
c) a patronising, paternalistic “Intervention” :– by-passing elders and the authors of “Little Children Are Sacred”; and
d) especially if it rakes back over 20 years of government policy and how that’s led us into the “battery farm” profit driven parlous state of this “industry” we have now?
* The effects of 14 (of those 20) years of federal Limited News Party government, beginning in the aftermath of revelations of what was going on under Bronwyn Bishop’s kerosene dip/bath “stewardship” and subsequent “opening up” of the windows of aged care, to the chill winds of “for profit”/”free market” forces?
* Such things as “unannounced” audits being watered down to the much more industry-friendly “announced audits”?
* The effect of DIY fend-for-yourselves “burger and a shake” tax cuts – underwritten from proceeds from the mining boom : rather than using those proceeds to fund infrastructure that could have gone to funding such “essential services” as Aged Care?
If policies institutionalised under this government – starting under Howard – have contributed to this profit-first maladministration of care for our vulnerable, commodified aged, the ranks of which we’ll be joining soon enough ……… now Scummo, about East Timor …..?
…. And/or that M-DBA rorting?
“Reviews” are a nonsense. They make bucketloads of money for the usual vultures – management consultants and advisors, but don’t result in outcomes. Governments, state and federal want fluffy reports that they can file away and never act upon; repeating the process every couple of years. The reviews are simply about apearing to be doing something.
Granted, findings of a Royal Commission can also be deferred, but the surrounding publicity tends to make that more difficult.
As I see this, the systemic problem that afflicts aged care is the same in principle that afflicts any service that is government funded. The crooks and cheats flood into the industry sector and promptly start gouging. The problem is lack of adequate regulation not funding, although the sector will always demand more funding (see Mary Wood’s response – I can’t see any comment that invalidates any of my current views and comments). Whether not-for or for-profit, the incentive is to get more funding and reduce costs. The for-profits will do this more slavishly using the customary toe-cutter techniques – by cutting staff; reducing the quality of meals and maintenance; importing cheaper foreign workers (this is very common according to those I know who work in the aged care sector); not having a qualified nurse on each shift; imposing impossibly difficult performance standards (e.g., morning showering to take no more than 15 or 20 minutes) and finding devious ways to cut shifts to reduce the cost of penalty rates. The sector doesn’t attract people who care about the welfare of the aged – it attracts way too many who care only about profit. This is true right across the care spectrum and medicine and health is the worst area – involving a massive transfer of wealth to those providing services and worse, there are no real standards that link those additional incomes to improvements in outcomes. Take the debacles in South Australia with Labor’s health improvement strategy – a name that sounds impressive; a grossly overpaid (and corpulent) imported CEO and lots of weasel words, but no discernible improvement in health outcomes and if anything, a further decline in healthcare standards – but I’ve no doubt that doctors and the corporates in the health area continues to accumulate wealth.
That extra 20 years of “life” expectancy is a nebulous prize… irrelevance becomes your only visitor.. and free drugs are not what they seem..
When announcing this RC, to such fanfare, our stand-in PM told us (in as many words) to be ready to be shocked?
If he knew this was the case, why wasn’t it such a priority last week, last month, last year, or 11 years ago?
Why was it stored up ’til now?
This sort of insitutionalised failure and suffering was stored up for just such a rainy day?
“Where the bloody hell have you and your concern been Scummo?”