Despite all the appalling stories of the neglect and even abuse of old people we’ve heard during the two years of the royal commission into aged care, it’s hard to be confident this will be the last time we’ll need an inquiry into what’s going wrong and why.
Looking at the eight volumes of the commission’s report – even its executive summary runs to 115 pages – it’s easy to conclude the problem must be hugely complicated. And if you get into the gruesome detail, it is.
But if you look from the top down, it’s deceptively easy. All the specific problems stem from a single cause: we’ve gone for decades – under federal governments of both colours – trying to do aged care on the cheap, and it’s been a disaster.
The basic solution is obvious: if we want decent care of our oldies we must be prepared to pay more for it – a lot more. The problem is, neither side of politics has been game to ask us to do so.
That’s partly because the first side to do so fears it would be attacked by the other: “Don’t vote for them, they want to put up your taxes!”
But also because neither side believes the public is prepared to put its money where its mouth is. We’re happy to be scandalised by the terrible treatment of many people in aged care, and blame it on our terrible politicians, but don’t ask us to kick the tin. We’re paying too much tax already.
I believe that a government with the courage to make the case for a specific tax increase to cover the cost of better aged care could be successful, but in this age of leaders who find it easier to follow than to lead, it’s not terribly likely.
The commission makes no bones about its conclusion that the aged care system has been starved of funds. It finds that the Aged Care Act, introduced in 1997 by the Howard government, was motivated by a desire to limit its cost to the budget.
“At times in this inquiry, it has felt like the government’s main consideration was what was the minimum commitment it could get away with, rather than what should be done to sustain the aged care system so that it is enabled to deliver high quality and safe care,” the report says.
In 1987, the Hawke government introduced an “efficiency dividend” under which the running costs of government departments and agencies are cut automatically each year by a per cent or two. The practice persists to this day. The report estimates that, by now, this has cut more than $9.8 billion from aged care’s annual budget.
Another way the government has limited costs is by rationing access to home care packages – which help people avoid going into residential care (and so, in the end, help the government save money). There’s a long waiting list for home care, with those in greater need of help waiting longer than those needing less.
Every so often the government announces with great fanfare its decision to cut the waiting list by X thousand places. But since the demand for places is growing – and even though many people die before their name comes up – the list never seems to get lower than about 100,000 at any time.
“The current aged care system and its weak and ineffective regulatory arrangements did not arise by accident,” the report says. “The move to ritualistic regulation was a natural consequence of the government’s desire to restrain expenditure in aged care.
“In essence, having not provided enough funding for good quality care, the regulatory arrangements could only pay lip service to the requirement that the care that was provided be of high quality.”
Yet another way governments have sought to limit the cost of aged care is to contract out responsibility to charities – including Anglicare and United Care – and then for-profit providers.
Commissioner Lynelle Briggs finds that government-run aged care providers “perform better on average than both not-for-profit and, in particular, for-profit age care providers”.
This is hardly surprising. All of them are underfunded, but private operators have to cut costs harder to make room for their profits.
The report doesn’t say how much extra we need to pay to have decent aged care, but the Grattan Institute suggests about $7 billion a year would do it. That would be on top of the $21 billion the government already spends, plus user fees of $5 billion a year.
Briggs says the government should introduce an “aged care improvement levy” of 1 per cent of personal taxable income, from July next year.
Would Morrison do such a thing? Well, “you know our government’s disposition when it comes to increased levies and taxes. It’s not something we lean to,” he says.
Oh. Well-informed sources, however, tell us he’d be prepared to introduce the levy if the opposition supported it. If Labor chooses to play politics, he’ll let the aged care misery continue.