industry & reform
“ Like saying sorry , taking responsibility seems to be the hardest thing for the current government to do .
Now for the hard part
Who will care after the Royal Commission ?
By Michael Fine
We ’ ve lived with it for so long , it was beginning to seem like the Royal Commission on Aged Care would always be with us . But now that the astonishing , apparently never-ending series of revelations that shocked the nation will no longer be the subject of further public hearings , the hard part starts .
The RC ’ s report presents a final and extensive set of recommendations by the commissioners . After reading , digesting and debating their learned words , Australia enters the next stage , facing the true challenge of finally taking action .
Of course , few people will read the actual report . Will you ? It will take a lot of time , real dedication and probably a pack or two of tissues to get through it all .
Most people are far more likely to shoot off their own opinion about what is needed , based on their experience with their parents or their long-held beliefs about what works . Those who wish to be informed are likely to rely on short and quite selective , often unreliable summaries presented in the media . Typically , these will focus on the proposed solutions but lack documentation of the evidence on which the Commissioners have reached their conclusions .
The second and much harder part of the challenge is about actually taking responsibility by doing something and implementing changes . Even the simplest changes , such as introducing staffing standards that include numbers of registered nurses to be employed in residential care services ( as was the case before the 1997 Act ), are highly contested .
The options for action will be simplified in the process of public debate , with competing interests forcing people to take sides in dumbed down debates . My bet is that the biggest debate will be around costs and funding . Should we spend more money on people in their final years of life ? If so , where will the money come from ?
Richard Colbeck indicated that this would be the Federal Government ’ s main response . The government ’ s answers to the RC , he announced recently , will come in the budget which is released in May .
Most aged care workers have long deserved better pay , decent careers and improved work conditions . Beyond this , throwing money at the system won ’ t change much . In many cases it will
reward and perpetuate bad practice , perhaps , as happened in recent years , simply swelling management salaries and financial costs .
As Dr Sarah Russell , director of Aged Care Matters pointed out in the Age and SMH two days before the report ’ s release , there should be no more money given to aged care providers without fundamental reform of the system . She called for nothing less than a complete rewriting of the 1997 Aged Care Act as a starting point .
Many others , myself included , have been calling for renewed attention on the design and funding of home care services . This must go beyond fundamental reform of the Home Care
Package program , with its vast waiting lists and ever-increasing management and care coordination costs that consumers find incomprehensible . We need renewed commitment to block funding to strengthen the Commonwealth Home Support
Programme , and the removal of the assessment barrier to entry to such basic services . Family carers need a much better deal , and the current approach of MyCarer Gateway and MyAgedCare needs to be completely rethought .
Whatever responses are made to the RC ’ s report , the complexity of governance in aged care needs to be acknowledged and managed , not ignored . This has been the central problem of the two keystones of system redesign since the 1997 Act , both of which have failed to deliver the intended outcomes .
In constitutional terms , the most significant change over the past decade has been bringing responsibility for all aged care under Commonwealth control . This was supposed to reduce duplication and waste when states were involved , helping to provide equal access to services no matter where those in need lived .
But that responsibility has then been contracted out to proprietors and service providers , as the system has been radically reshaped into a market . In theory , markets are believed to be self-regulating . But we ’ ve seen the system fail too many times , the horrifyingly large numbers of care home deaths due to COVID-19 being just the most recent and sensitive example . In the aged care field , regulation can ’ t be left to the market , any more than can funding .
An awareness of the governance and legal issues uncovered by the RC requires the Commonwealth government to take responsibility , not avoid it or hide behind yet more enquiries . But , like saying sorry , taking responsibility seems to be the hardest thing for the current government to do .
The release of the RC ’ s final report will not be the end of the revelations . These are likely to continue unabated , as shown by the emerging discussion of the prevalence of sexual abuse in residential care homes and the ABC ’ s expose of ‘ a luxury nursing home ’ in WA where residents can pay $ 1.4 million in accommodation bonds .
But March 2021 clearly draws a line in the sand . From here on , the whole business of government taking responsibility for aged care gets serious again . ■
Michael Fine is Honorary Professor at Macquarie University .
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