Aged Care Reform is a Hard Pill to Swallow

Let us all face the harsh reality of Aged Care Reform. Reform may be the current buzz word, but most likely will not eventuate in reality. We have seen the long list of past reviews contained in the current review by the Aged Care Royal Commission recently published in their Background Paper 8 on 28 October 2019. They also released their Interim Report on 31 October 2019. What is clear is that many reviews have taken place in the last 20 years but only a few of the recommendations have been implemented. What is going to be different now?

The Royal Commission has so far done a good job in finding out the weaknesses in the aged care system. They have found that the focus is more on funding than on providing high-quality care for the aged population. According to the Interim Report, the services “are fragmented, unsupported and underfunded… poorly managed... unsafe and seemingly uncaring” The system “is characterised by an absence of innovation and by rigid conformity… lacks transparency in communication, reporting and accountability. It is not built around the people it is supposed to help and support, but around funding mechanisms, processes and procedures.” People are neglected and even abused, something that is embarrassing for all Australians.

My Aged Care has been found to be confusing and frightening for elderly people who are seeking help. Those who are found to be eligible for home care have to wait too long to access the funding, without any progress updates from the Department of Health. According to the Royal Commission, all these things must change.

Basically, the Royal Commission is talking about reform. Many people, including myself, believe in aged care reform. But is it going to happen after this Royal Commission is done? After all, we have not seen much reform after other reviews published their findings. If we are going to be objective and truthful, we have heard a lot of testimonies from parties that have dollar interests at stake. Little of that interest is for the government, the sole purchaser of the majority of the services, or the clients receiving those services. For real reform to take place, the interests of the government, the aging people and their families must be prioritised.

We really need to redesign and create a really and truly integrated system. Or do we need reform and salvage what we have? Here are some of the necessary changes.

1. We need a system that is customer centric. These aging people are our parents, grandparent, neighbours and friends. What we want is a care system that preserves their pride and dignity, is safe, and gives them care, support and attention when they need them. We want them to communicate their needs without fear. They should never be ignored, neglected or abused. When we all grow old and incapacitated one day, we also want to receive high-quality care from the system. If we neglect the elderly now, we are going to experience the bitter pill of the system when we grow old. Reform must include a lot of regulation of the industry to ensure quality of care and safety of the elderly people.

2. The system must have primary care focus with the GP at the centre of care. The government can make sure that there is a pro-geriatric clinic in every community. If there is no clinic in any community, then it must be opened. If there is an existing clinic, then it must be equipped and resourced with health care workers trained in geriatrics. This way, all the elderly people aging at home have easy access to primary care to get fast treatment for their chronic diseases to avoid unnecessary hospitalisation. The primary care clinic then coordinates care from specialists, allied health practitioners, care givers and community members. The whole community must be involved in aged care because families and friends should never leave their elderly people to the system alone.

3. The system must be integrated. Social and health care services must be integrated so that the elderly people can access all their needed services from one point. Right now, the elderly and the disabled have to go the Department of Social Services and the Department of Health to access services. While access is complicated in each case, it become exacerbated by having to go to different offices in order to access all the needed assistance. If the two departments could be integrated, everyone would only have one office to deal with.

4. I would really like to see Australia merge the NDIS and Aged care play books as each program has positives that could improve the other. Both programmes use taxpayers’ money to serve different sectors but they are run in completely different ways. It would be great if the two programmes were compared and the best of each were implemented in each programme. They should look at eligibility criteria, information gathering, planning, implementation, coordination, quality, complaints and regular reviews and make sure these are done effectively in both programmes. That way, no one can ever be left out of either programme and everyone gets all the support that they need.

5. We must find a way to quicken access to home care packages. As at June 2019, more than 72,000 people were waiting for their packages. The population of elderly people is growing and there is no way we can accommodate them all in nursing homes. That is why there is this current move towards home care for the elderly. Many elderly people who can still live independently are keen to age at home with assistance, but they are required to wait for too long for their funding. Some are even dying while waiting. This is not acceptable. If we are going to have genuine reform, then adequate funding must be put in place and it must be accessed fast by a system that enables that to happen.

6. We need proper management of unused funds. Some patients in My Aged Care are not using all their funds and it was reported in June 2019 that around AU$600 million for homecare (about $7,000 per person) was sitting in service providers’ accounts. Why should millions of dollars just sit in these accounts while other people are waiting for more than a year for funding? Isn’t this a prescription for fraud? This problem needs to be addressed. There must be a prescribed way for these funds to go back to the Department of Health at the end of every financial year so that they can be utilised by other people who need them. This should be coupled with adjustment of the following years’ packages for all those who return the money.

7. Wellness and reablement must not just be buzz words. Many elderly people have skills and professions and they can still contribute by working on jobs. Therefore, we must not look at all aged people as if they are “finished.” When we give them assistance, we must look at what they can still do and enable them to go back to work if they so wish. After all, there is a shortage of skilled people in many areas, so why not encourage elderly people to work if they can? Also, these elderly people should be encouraged to stay active and to be involved in their interests. That way they can live a full interesting life instead of simply fading away in a nursing home. Last, but not least, some of them can be retrained to look after themselves at home with confidence after injury or illness. All they need is confidence that they will not fall again and get hurt. So, enablement should be built into the system.

7. We must take diversity into account. Right now, the aged care system is failing part of the aged people population due to diversity issues. Elderly people who cannot communicate properly in English are struggling to access aged care services. Meanwhile, CALD workers who can add value to the aged care industry, and who can help the CALD old people in the system, are not adequately getting access to jobs in the industry. Such workers, who speak other languages other than English, would be particularly useful for companies that want to expand to other countries such as in Asia.

8. We must address the current shortage of human resources in aged care (and health care in general). We are all aware of the staff shortage in the industry which boils down to neglect of elderly people due to inadequate resources, which necessitates the use of drugs for restraint. This is not necessary. Government can estimate the needs of the industry and make sure that colleges and universities produce enough graduates in aged care. This basically should include doctors, nurses and other health care workers and care givers. But government cannot do it alone. The companies that provide care can proactively run training services for care givers whom they can employ at the end of the training. The advantage is that the companies can impart their values to the workers during training, to make sure that such workers respect the elderly people and genuinely give them the care that they need. Meanwhile, there are experienced workers available for hire offshore, for example in the Philippines. These can be recruited and given jobs in the interim while the country catches up with its manpower training.

These are some of the many changes that need to take place. The Minister of Aged Care and Senior Australians believes that reform is already underway but I beg to differ. Reform has not yet started. Aged care reform is not going to be easy with all these changes that need to be implemented. It’s going to be a total industry revolution, if it happens, and it is going to affect the companies that focus on their bottom line while neglecting the needs of the elderly people.