Funding and Services Crucial for Aged Care in Australia

   

   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 need to attempt to lead debate and apply pressure as best we can while there is a ‘window of opportunity’ for change.

Talking about Aged Care

The following article by Tristan Ewins examines the huge deficit of Aged Care services in Australia; and the need for progressive tax reform to fund a radical improvement in the sector. The author regrets that Aged Care did not seem to have been prioritised by the Greens in a recent survey: but is hoping this will change with a shift of policy by botht the ALP and the Greens.  At its conclusion, the article also includes a response to ALP activist Daniel Pocock on the question of the appropriate funding mechanisms for Aged Care and similar social services.  At the Facebook 'ALP Socialist Left Forum' page Brenton Baldwin has argued that Aged Care will be a priority for the Federal Government in the coming Budget.  Let's hope they get it right!

by Tristan Ewins

The Greens are to be applauded for their recent web-video putting the case for a reformed Mining Tax to fund social welfare and services, and to invest for the future.

See: http://greensmps.org.au/mining-tax

But while the Greens provided a survey asking people which areas they think the money from such reform ($100 billion) should be spent, they did not include Aged Care. I was upset at this for a number of reasons – all related to the urgent need for reform in that area.

Firstly: We have an ageing population. Even to maintain current quality of service will require greatly increased funding.

Secondly: Staff including nurses are underpaid, and there are inadequate ratios. This impacts upon residents’ quality of life – as staff need to turn residents in their beds to avoid bedsores; check to ensure residents are eating their meals; facilitate exchange and communications between residents to ensure they remain socially engaged… Not having enough nurses and staff to check that residents eat their meals can result in starvation and literally a physical 'withering away' so that those concerned cannot even stand up or walk.

Thirdly: The current funding mechanism is grossly unfair: requiring families to sell or take equity out against their homes operates like a regressive tax. Yet levying more proportionately from the wealthy and the upper middle class is considered ‘taboo’ and referred to as ‘class war’.

Finally: There are broader questions of quality of life for these most vulnerable Australians that barely register in our public discourse. Provision of gardens could provide an escape and a diversity of scenery that in its way could radically improve quality of life. Private rooms could help maintain a sense of dignity, private space and connection with past and one’s identity which could also radically improve quality of life. In the future information technology could be crucial in keeping residents socially and intellectually engaged.

Furthermore where possible residents should be taken on outings to create diversity and quality of life. And those aged Australians who would be better suited to lower intensity care – eg: hostels – should not be forced prematurely into high intensity care in order to ‘save a buck’.

By the same principle there must be greater assistance for aged Australians to remain living in their homes – if that is what they choose; and for family/carers’ to provide the necessary support without having to make too great a sacrifice.

When the shortfalls are considered: service quality, the funding mechanism, the wages and conditions of staff – and the ageing population is also taken into account – a figure of an additional $3.5 billion/year to be invested in the system -  is not unreasonable at this point, with 'more in the pipeline' for the future.    Though this should be in the context of a funding mechanism which operates like a progressive tax – and enables investment in the quality of life for vulnerable families, and working class families who deserve better after spending a lifetime paying their taxes. A more robust mining tax could pay for such Aged Care reform.

My hope is that the Greens and the ALP will respond to this issue and run with it as we approach the next election. But the Coalition often takes the votes of many aged Australians for granted. They should also be pressed to ‘put their money where their mouths are’ when it comes to Aged Care. The bottom line is that this is a matter of basic human rights – and of the acute suffering of our most vulnerable spending their final years in circumstances of public neglect, dehumanisation and despair.

If any of you reading this are Greens/ALP members I urge you to take this issue up in your branches and via your parliamentarians. For the Greens especially – their survey should have included reference to this most critical of issues. Here at ALP Socialist Left Forum I think we would all appreciate an official response.

And if by some miracle there are Conservatives reading this – I ask them to look within their hearts – to their basic underlying humanity – To confront the suffering and neglect experienced by our most vulnerable aged – and to DO SOMETHING.

In place of tax cuts instead commit funds for aged Australia.

Tristan Ewins

Around March 16 2012 Daniel Pocock at Facebook argued against using MRRT money this way:

“I definitely think the bias should be on construction of long-lasting public infrastructure. That will create jobs, more taxes, and the taxes on salaries should fund the welfare state. I think it is actually dangerous to use taxes from non-renewable resources (like mining) to fund ongoing expenditures (like welfare).”

To which I respond here:

I appreciate that the MRRT money isn’t going to last at current levels forever. Hence I can understand Daniel’s concern about being ‘structurally locked in’ to funding Aged Care or other social wage measures via the MRRT.

On the other hand BOTH investment in infastructure AND welfare measures are necessary - and using the MRRT money could be part of that picture - using MRRT money to 'free up' *other* money for Aged Care.

MRRT money could also be put in a Sovereign Wealth Fund with the profits from that being directed - sustainably - into Aged Care and other services as well. The point, here, is that Sovereign Wealth Fund investments could provide a source for social wage expenditure for decades into the future. But since then that fund would be slow to build up it begs the question where the money would come from for Aged Care now.

That means there would have to be tax reform elsewhere. I support such an agenda 100% - raising in the vincinity of $20 billion new money a year for programs like Gonski, the National Disability Insurance Scheme, Aged Care and welfare reform. The question is whether Labor and the government can be convinced of the need for such a far reaching agenda.

Arguably Labor is now in the position where only a radical policy shift – only a radical ‘delivering of the goods’ – can shift voters’ perceptions and voting intentions. Radical reform of Aged Care could be part of this ‘big picture’ policy agenda which could turn the tide for Labor again by re-engaging with working class Australia.