More than 160,000 Australians live in an aged care home. Recent media reports have highlighted inadequate personal care, neglect, abuse and negligence suggesting that the quality of care in some aged care homes is a disgrace.
During the past decade, privately owned aged care facilities have grown at twice the rate of those in the non-profit sector. Publicly listed companies are now the fastest growing owners of aged care facilities. Major aged-care providers such as BUPA, Japara, Regis and Estia receive substantial government subsidies. Estia, for example, received a 10.9 per cent increase in government subsidies during last financial year.
The changes to Aged Care Funding Instrument (ACFI) announced in the recent budget are intended to help curb a predicted $3.8 billion blowout in government subsidies. The changes will save the government $1.2 billion.
The Aged Care Guild, a peak body that represent large providers of residential aged care, has described these changes as a “budget cut”. The Aged Care Guild complains that the budget is fuelling uncertainty in the industry and could force a rethink on future investment plans.
To increase competition within the aged care sector, the Aged Care Roadmap promotes “lighter deregulation” and a “consumer driven and market based system”. Paradoxically, the providers of aged care homes lobby simultaneously for a decrease in regulation and an increase in government subsidies.
Government subsidies in aged care often serve the interests of the providers more than residents. When a resident is reclassified as requiring a higher level of care, the provider receives more money from the government. However, staff levels rarely change nor are extra services provided to the resident.
Currently, funding for aged care homes is based on a “terminal decline model” rather than “restorative care”. The provider receives additional subsidies when a resident declines. There is no financial incentive for providers to introduce services such as strength training or lifestyle programs that would improve residents’ quality of life. Instead, a provider is rewarded for promoting dependency rather than encouraging wellness.
Under the current arrangements, the providers do their own assessments for government subsidies. Many providers employ staff purely to complete the ACFI paperwork. The role of these staff is to generate income for the employers rather than provide care to residents. Some providers employ Aged Care Consultants who specialise in “ACFI optimisation”. These Aged Care Consultants promote themselves as specialists who help to maximise funding for the aged care home.
It is not only the for-profit organisations that are making massive profits in residential aged care. Mecwacare , for example, is as a not-for-profit organisation that offers residential aged care. According to its Annual Report, it made a net profit of $3.9M for the year ended June 30, 2015.
The federal government will be introducing fines to curb a growing trend of incorrect, or deliberately false, claims for subsidies. Whether a fine of merely $10,800 for providers who repeatedly make false claims will act as a deterrent remains to be seen. Money may speak louder than the coroner.
Coronial inquests into separate deaths at two aged care homes, BUPA Kempsey and Arcare Hampstead in Melbourne, exposed inadequate care, mismanagement and cover-ups in response to complaints. Despite this inadequate care, both BUPA Kempsey and Arcare Hampstead were fully accredited by the regulator, the Aged Care Quality Agency, with perfect scores of 100 per cent in all criteria. This suggests something is wrong with the accreditation processes.
Following the coronial inquiries, both homes were asked to improve their policies and procedures. However, the Aged Care Quality Agency has not changed the accreditation processes. The accreditation and outcome standards remain woefully inadequate. Vague phrases such as adequate nourishment and hydration, effective continence management, optimum levels of mobility and dexterity and sufficient staff continue to be used.
Aged care homes requires greater scrutiny, accountability and transparency. We need evidence-based information so that we can have informed discussions about how to provide the best possible care for frail, elderly people who live in aged care homes. We need to feel reassured that government subsidies are being used to improve the quality of life of residents, not the pockets of providers.
This content was originally published in The Sydney Morning Herald.
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