Perhaps the key observation made by Grattan Institute authors in a new report on the need for a rights-based approach to aged care is that “the structural and systemic problems in the aged care system are deep-rooted and reflect society’s underlying ageism”.
The report goes on: ..”this underlying ageism has contributed to the chronic under-investment in aged care and support by governments, resulting in under-funding, poor regulation, and a lack of meaningful reform to fix the system.”
Stephen Duckett and his colleagues are surely correct. There’s a reason successive governments have been allowed to underinvest, under-regulate and recklessly outsource the provision of support for ageing Australians: voters have allowed them to.
The periodic, almost routine, revelations of shocking neglect and mistreatment in a deeply flawed system have only been a drumbeat to an ongoing pattern of indifference.
The anger of families who have discovered the abuse of loved ones hasn’t disrupted a long-term pattern of not valuing either seniors or those who care for them, a massive workforce in the hundreds of thousands that is underpaid, heavily female and relies on migrant workers operating in increasingly precarious employment.
That workforce, and the unions that represent it, is the only continuing voice for more investment and better regulation in the sector; most families of seniors needing residential aged care have a necessarily limited period in which they are exposed to its inequities, scandals and structural problems, before death ends their engagement in the system.
It is the workforce that sees the same problems year in and year out, and the workforce that has been marginalised and ignored by policymakers, in favour of the interests of private aged care providers.
As the aged care royal commission pointed out last week, this absence from policymaking extends beyond the political level and into the health bureaucracy level, with aged care experts missing from key decisionmaking fora for the pandemic.
While it lacks the global implications and economic damage of climate change, aged care shares some of the thornier aspects of that challenge. It is resistant to simple answers, given even a large investment of new funding will require a workforce expansion that will take years to achieve and it is at the intersection of quite different issues such as health, housing and retirement incomes.
It is steadily growing as a policy challenge as more Australian require either support at home or residential support, and will continue growing for decades yet. And there is an industry of vested interests eager to sway government policy.
What it also shares is that the government has been resistant to substantial action or reform. The Aged Care Quality and Safety Commission established last year has proven to be hands-off and low-key at best.
The government’s response to the devastating interim Aged Care Royal Commission report in December was woefully inadequate, consisting of around $500 million for extra home care packages. The government has seen aged care more as a political problem to be managed, rather than a structurally flawed sector requiring a fundamental overhaul, with a low-profile and low-impact minister left to be a punching bag for critics.
While the royal commission final report is still months away, there is plenty for the government to be starting in today’s budget, including ramping up long-running and to-date fruitless workforce planning, funding the establishment of minimum staff ratios to bring all aged care facilities up to a reasonable standard in staff-client numbers and funding a more aggressive and interventionist regulator that won’t settle for phone checks and online self-assessment.
The economy will recover. But without major reforms and substantial funding, aged care will continue on exactly the same path as it has for the last twenty years over the next twenty. Along with climate change, it’s the most pressing national policy problem we face. A budget that doesn’t address it is a failure.
How do we convince parliament to start taking the aged care crisis seriously? Let us know your thoughts by writing to [email protected]. Please include your full name to be considered for publication in Crikey’s Your Say section.