Budgets come and, all too soon, budgets go. A big deal in the latest one was the government’s response to the royal commission’s report on the scandal-plagued aged care system. We were told lots of changes will be made, at an extra cost of “$17.7 billion over five years”. Problem solved. Now we can all move on.
Sorry, not so fast. The bright young things of the media may have lost interest, but I’d like a closer look. You can put that down to my advancing years if you wish.
I’m old enough to have stopped deluding myself I won’t be ending up in any aged care home. Both my brother and elder sister are there already. My sister-in-law was too before, as the Salvos say, she was “promoted to Glory”.
I’ve looked at the government’s response and, though it wasn’t nearly as good as it should have been, it’s better than I feared.
To borrow a cliche from the interest groups – who always hope that if they sound grateful, they might get a bit more – it was “a good first step”. But, as Dr Stephen Duckett and Anika Stobart, of the Grattan Institute, put it less diplomatically, “even an investment of this scale does not meet the level of ambition set by the commission”.
Actually, the “$17.7 billion over five years” doesn’t do justice to the government’s willingness to spend. Because its measures are phased in, Grattan calculates their cost builds up to an ongoing $5.5 billion a year. That’s more than half the $10 billion a year the commission estimated the government saved on its aged care spending over the years using annual “efficiency dividends” and rationing.
Grattan groups the many decisions in the budget under four headings. First is a change in the basis on which aged care is delivered. The commission’s report called for the present Aged Care Act, which seeks to maximise the government’s freedom to limit its spending, be replaced by a new act enshrining everyone’s statutory right to decent aged care, according to their needs. As with Medicare, access to aged care proper (as opposed to ordinary living costs) should be “universal”, the commission proposed – free at the point of delivery, because the cost is funded from general taxation.
The government will introduce a new act in 2023 putting consumers at its centre but, Grattan says, with “no clear commitment to the rights of older people or to universal access”.
Many of the those who write to me believe that for-profit providers of aged care put their profits ahead of the quality of care, and fear that extra government spending won’t necessarily go to raising quality.
So, second are steps to improve the governance of providers and make them more accountable. The government will establish an independent inspector-general for aged care, and an independent mechanism for setting prices.
But, Grattan observes, it hasn’t committed to the hard part: changing the present approach to governing the system, which the report found had failed. It’s leaving the federal Department of Health in charge, and reforming rather than replacing the Aged Care Quality and Safety Commission, which is responsible for regulating the system.
Grattan doesn’t say it, but you suspect the bureaucrats have got a bit too close to the providers.
To allow people to be better informed about the quality of a provider’s care, the government will eventually introduce an American-style system of star ratings. Fine – provided it can’t be manipulated.
Third, moves to increase the number and training of staff. The key measure here, following the report’s recommendation, is a requirement that each resident receive three hours and 20 minutes of personal attention a day, including 40 minutes from a registered nurse rather than a care worker.
If properly policed – a big if – this should increase staffing, giving workers more time to help with toileting and feeding, and just to chat with residents, many of whom are lonely.
There’s a shortage of qualified staff, and the government is spending $680 million mainly on a one-off increase in TAFE training for personal carers in the first few years. The report wanted minimum Certificate III training for all personal carers, including mandatory dementia training, but this hasn’t been done.
There’d be fewer shortages of nurses and care workers, and less staff turnover, if award wages were increased, but the government’s done nothing about this.
Finally, funding changes. One of the main ways the government has limited its spending on aged care is by allowing a long waiting list for at-home aged care packages to develop. It’s decided to let through 80,000 more applicants over two years.
But it hasn’t acted on the report’s recommendation that waiting times be limited to 30 days. Rationing will stay.
The report wanted means-tested rental payments in residential care, with “refundable accommodation deposits” phased out, but no change was made.
Adequate reform of the system has a long way to go. Until it gets there, the critics are right to fear it will be only a few years before the system’s back in crisis.
