At the beginning of the week the Australian Medical Association (AMA) released a report entitled, Position Statement On Resourcing Aged Care outlining its findings and recommendations for the sector.
Through a critical examination of the sector at large the AMA has released a detailed report of the needs of the aged care sector, highlighting the elements and areas that have been neglected. Due to the expertise of those in the investigative team, the report is a significant point of verification and validation for change that many within the sector have been calling for.
Quite simply the report highlights the AMA’s position on the workforce and funding measures they believe are necessary to reach a high quality, efficient aged care system that ensures equitable access to health care for all senior people.
Dr Tony Bartone, the AMA’s Vice President outlines the context of the suggested measures by detailing Australia’s future aged care situation. Australia has an ageing population, this trend he says will require increasing amounts of medical support in correlation with the substantial increase in the amount of chronic and complex medical disorders and higher life expectancy.
A consistent concern that runs through the report addresses the tendency of general society to disregard and neglect the needs of the vulnerable among us, particular our seniors.
“The aged care system, now and into the future, must be adequately resourced so that older Australians are able to access the same level and quality of medical care as other people,” Dr Bartone said.
“They should not receive lesser care or attention just because they are old. Care for older people in the best and most appropriate environment is a basic human right.”
Image: AMA Vice President, Dr Tony Bartone [photo credit AMA website]
Dr Bartone spoke on behalf of AMA in positively acknowledging the Government’s decision to create the Aged Care Quality and Safety Commission as well as the compulsory mandate for aged care providers to offer influenza vaccinations to all their employees. Yet these measures he argues are not enough to ensure older Australians have the appropriate access to the care they need and deserve. The AMA’s report details further recommendations.
Weighing into the ratio debate surrounding the proportion of registered nurses to junior personal care attendants and residents, Dr Bartone says, ““It is unacceptable that some residents, who have high care needs, cannot access nursing care after hours without being transferred to a hospital Emergency Department.”
“We need more nurses employed full time in aged care. We need to provide greater incentives for doctors to attend aged care facilities on a more regular basis to meet demand and ensure quality medical care for older people.”
In light of the future Australia is staring down, many health care professionals are emphatically calling for us to prepare. The number of Australians aged over 65 is projected to hit 8.7 million by 2056, 22% of the entire population. In 2009-2010, more than half of aged care residents had dementia this proportion is only set to grow over time.
Regardless of the argument over the basic human right in accessing suitable medical care, ignoring the needs of older Australians means increasing (avoidable) hospitalisation and strain on Australia’s health system. To act now is to ensure appropriate care for thousands out there, as well as ourselves, none of us are getting any younger. These measures or lack of them will affect us all.
The problem is not a shortage of funding. The problem is that providers are not providing care in order to make ‘profit’. There is no shortage of Doctors. I can see a GP anytime I like in the community. The problem is that older people are being held captive and are being encouraged to see ‘their’ Doctor in the nursing home where they are living. Older people should be allowed to bypass the business model that is currently in operation and see any Health Professional they like whenever they like.
One wonders what the prospects of getting what the AMA wants and of addressing the problems in the aged care system are, when we look at the pressures on the system we have.
In 2015 John Menadue, who was private secretary to Gough Whitlam wrote that the major barrier to change was “the power of providers“. He indicated that “A succession of Australian health ministers may have been in office but they have not been in power” and that “The community is effectively excluded”. Rob Oakeshot who held the balance of power in the Gillard government wrote that “democracy is going through its own sort of privatisation. Bigger dollars come into the party coffers at exactly the same time as less and less of the necessary work gets done”. He claimed that politicians “took the money and ran”. In 2015 the executive director of The Australia Institute suggested that the government was “trying to run the country like a private company.
The ministers new reforms will certainly detect major failures earlier and enable regulators to keep tight control over how they are managed and so limit publicity. Those who have major problems will have them promptly addressed and will benefit but none of the chronic problems in the system are addressed and the agency’s own data shows that unannounced visits will have minimal benefit. The reforms seem to be directed to the next election and not to fix aged care.
Accreditation has never been an effective regulator and our system has failed despite repeated patching. Regulatory authority John Braithwaite researched what was happening and in his 2007 book claimed a revolving door with industry and that “business values are capturing regulatory values”. He described how accreditation results were reported in a way that underestimated the number of failures each year and how compliance was driven to “ridiculously, artificially high levels over the years”. He described how finding noncompliance was discouraged and his teams “observation of indefensible ratings of compliance during our fieldwork” and concluded that things “have to be bad for non-compliance to be recorded or strong criticisms to be made in an accreditation report.” The book also noted that regulation was successful in keeping accounts of failures out of the press. He warned Australia of the consequences of all this. The many submissions to inquiries from staff and families suggests that little has changed. Not much chance of these reforms fixing that.
A proposal for an empowered visitors scheme in the1989 Ronald report was blocked by industry. The way to address the fundamental problems might be a system of distributive oversight and regulation – restructuring aged care oversight around a local empowered visitors scheme, working with and supported by local community organisation’s, including doctors and nurses. This would ensure total transparency. Both providers and government would be directly accountable to local communities. Real social change comes from changing the balance of power and this would do that. In 2014 Professor Ian Maddocks suggested that the profession should do something quite similar to this but it did not get the support from the profession it needed.
There are so many commentators putting in their opinions on what should happen in the industry, but I can tell you from experience, the small, not for profit provider who actually provides the best care possible is almost never included in this conversation. The peak bodies, government committees, consultation processes are almost exclusively driven by the big providers, both for and “not for” profit.
I challenge any decision maker to spend a week alongside the team of a small not for profit like mine, and at the end of that week, tell me that we are “gaming ACFI”, “hiding poor practice” or any of the other accusations which are regularly aimed at us.
Firstly, the small non profit does not have the time nor resources to engage in “sharp” practice. as it is a struggle to just break even. My organisation puts a huge amount of effort into making sure our residents receive the care that they deserve, are assessed for, need and also want, and for us at least our commitment to quality comes at a great cost to us.
People who say funding is not the issue are wrong, and yet partially correct. Funding is most certainly a big issue for us. If anyone cares to compare the level of funding “per bed, per day” for hospitals vs residential care would be incredulous to see an almost 8 times variance. Yes hospitals do need more funding, but where the same amount of funding is provided for a senior aussie who could easily receive the same care in Residential Care, you would see why I find this frustrating.
Here is an example. the basic daily care fee is currently $50.16 per day. For a resident who has low or no means, and for a provider who is not “significantly refurbished” the maximum accommodation supplement is $36.59 per day. The current maximum ACFI funding for the HHH (Highest level of care) is $214.06 per day. Grand Total $300 per day. (My organisation has a mix of care needs, and only 2 out of 57 receiving HHH funding), “running a business” (utilities, insurances, maintenance, goods and services). Someone please tell me how funding is not an issue?
I completely agree though, that just “throwing money” at providers is not the answer. increased funding needs to be better targeted to firstly cover the basics (all “non staffing or “direct care”). ACFI, which is under review at the moment should then be less complicated, with ACFI being for “individual care needs” specific to the person, based on a “cost of provision” model.
It is about time we stopped looking to “MEGA MART” as a model for care, and re-focus on the type of provider where the management team know every staff member, every volunteer, and of course every resident. you may be pleasantly surprised!!
Well said Stefan, I agree with you entirely. It is the smaller nonprofits that have maintained their commitment to provide good care that have given the best service (I am not referring to the rural facilities who have more difficulty). The problem is that they are most at risk from market pressures and most likely to be acquired when things get tough.
I have been following this internationally and in Australia for about 25 years. In the USA where they collect data, this shows quite clearly that the more profit driven the companies are the poorer the staffing and the greater the number of failures in care. The larger more profit driven nonprofits that are trying to compete do not perform as well as the nonprofits that are in there primarily to care for their community and make sacrifices to do this.
In Australia the government favours and supports the larger nonprofits who have brought in business managers and are making more money because in the way the government thinks they are seen to be more reliable and credible.
If you look at StewartBrown charts (mostly nonprofits) you will see that those who are not making a profit are bad and need to improve and those making a large profit are good and show what can be done. Other analyses do the same and this interpretation is translated to care in everyone’s minds. Its much more likely that those who are struggling to make a profit are employing more staff and providing better care but none but the data to confirm this is not reported.
Australia does not collect and disclose staffing or the instances of failures in care. The accreditation agency has consistently claimed that there is no difference in performance between for-profit and nonprofit but their data shows that regional and remote facilities perform poorly when compared with metropolitan facilities.
As there are no for-profits in rural and remote areas it is clear that nonprofits must be performing several times better when like was compared with like. In 2008 Aged Care Crisis had collected reports and confirmed that this was so. They also forced the minister to admit that the agency’s report and her statement to parliament was incorrect and that four times as many had failed a standard than was reported.
Our impression is that we are now seeing more failures in nonprofits and that this is because more and more of the big ones are thinking and behaving like for-profits
Aged Care Crisis 2nd supplementary Nov 2016 submission to the 2016 Senate Workforce Inquiry was made when Australian staffing data came into our possession. We compared Australia with the USA and examined all of these issues in some depth. This was to the 45th parliament (not the 44th) that reconvened the inquiry after the election. These additional submissions are on a separate web page and we were disappointed that the final report did not include any of this new material.
There are many other issues related to regulation, that are similarly based on our research and our suggestions are based on them. It is not a simple issue and our arguments challenge much of what is currently accepted so is not welcomed by politicians or industry. Our submissions to more recent inquiries explore and explain these issues. Our most recent to the Zimmerman Inquiry has not yet been published,
Everyone has a different experience and is shouting about a simplistic solution that they want, but when the sector is examined it is clear that much of it will not work. They attack others who make different suggestions.
Most expect government to fix it and that is most unlikely to happen because the sort of regulation they have has not worked here or in any other country and is unlikely to do so. What is needed is a considered debate where evidence is presented, arguments are made and issues are debated without emotion. That is not happening.
Hi Michael ..your in-depth coverage and knowledge of aged care in Australia is what I have been looking for for a while. Are you a provider or aged care professional in some way ? Do you have a website perhaps where I can read further information ?
No Danielle but I have been closely following health and aged care for 25 to 30 years because I have been unhappy about the path followed..
Web site’s http://www.corpmedinfo.com (old site)
https://www.insideagedcare.com/ (latest but incomplete – delayed by all the inquiries)
for submissions to the recent and older inquiries where we have addressed issues in depth and with data see.
https://www.agedcarecrisis.com/publications
Months of reading there!
Hi Stefan,
I have just starting looking for work with smaller providers as I feel it’s the best direction to go in terms of being able to provide quality care. May I ask who the company is you work for ?
Many thanks
Danielle