The Politics of Aged Care in Australia

When did we go so horribly wrong?

Last time I looked, over 90% of all aged care homes in Australia were fully compliant with all 44 accreditation outcomes, yet we continue to be controlled and dictated to like a nanny state with a bureaucracy big enough to run a small country.

Can aged care really be as bad as it is portrayed in the media or are we an unfortunate byproduct of the disproportionate level of political involvement in the care of the elderly?

After working in this area of healthcare since 1989, I am left hanging my head in shame and dispair each time I hear another negative report or hear from my colleagues who just throw their hands up in desperation and give up.

So many people give their heart and soul into caring for our most frail and vulnerable yet so many come to the realisation that things could be so much better. I have recently written a series of articles read by thousands of LinkenIn members and thus far, not a single comment in disagreement has been received. Everyone appears to agree with the sentiment, has experienced the difficulties and longs for a better way ... yet our situation is not new and has not changed in decades.

So why is change so hard? 

Because the politics of aged care is bigger than all of us combined. Bigger than the providers, bigger than their staff, bigger than the residents themselves. The bureaucratic monolith that has been created and expanded as a knee jerk reaction to every minute incident has now, as Ronald Regan once famously said in his inauguration speech, "become the problem".

Thousands of bureacrats making thousands of (often conflicting or misinterpreted) rules being layered on like a never ending lasagne. When you add up the sheer number of burearcrats "administering" the aged care portfolio, the numbers (and cost) is staggering.

When you combine the Department of Health, the Aged Care Complaints Commissioner, the My Aged Care program operated by Health Direct Ltd and the Aged Care Quality Agency with their offices and staffing replicated in each state as well as Canberra, the numbers are enormous. 

Given the most common levels of staff involved in aged care programs is APS 5, APS 6 and EL1 and the average salary across these three bands is just under $100,000 you have to start asking for some demonstrable outcomes.

And I don't mean numbers of meaningless papers produced that no one reads, or how many briefing notes written, or inane meetings attended, I mean demonstrable outcomes for aged care residents.

As an aged care provider, I have to account for everything we do, not to one agency but many ... both state and federal. Often I have to repeat the same or very similar information over and over again. I have to complete annual gender equality surveys even though I am a minority in a female dominated profession. 

If I dont meet the standards, I get smacked. I get threatened with compliance action and put on the naughty list, I get threatened with sanction, I get threatened with more visits by government officials. The threats are endless.

If I don't deliver demonstrable outcomes and continuously improve across 44 outcomes, I get smacked again. I have to account for everything we do, every dollar we spend and every decision I make.

The government will say, "we are accountable to the people". Little wonder we change governments like soiled underwear.

The politicans may be ultimately accountable, but where is the accountability of the government departments that change direction like the wind but remain filled with the usual suspects no matter which party is in power. 

It is the government departments who enact political policy, they draw it up (or at least engage an external consultant to do it), they make the rules and they enforce them (albeit haphazardly, subjectively and inconsistently).

In my first four years working in the NSW state office, I met the Minister once. She had no idea what decisions I was making or how I was implementing her "policy direction". At one stage she did however direct me to conduct an unannounced visit on a "despicable" home that was so bad you could smell the faeces from the street. Turns out the home (which was lovely) had just finished their gardening and applied blood and bone. But lets record another "complaint" against a nursing home for the records.

During both stints with the Department, the Ministers were blissfully unaware of the inefficiencies, the inadequacies and at times, the utter incompetence of the Department they supposedly lead all because of the group delusion that aged care providers need constant monitoring, direction and correction so the ever expanding department was a necessity.

The Minister doesn't see (or chooses to ignore) the mad rush at end of financial year to "expend" public money because if you don't spend it, you wont get it next year. They seem oblivious to the fact that our commonwealth Department of Health issued a Aboriginal Women's Health Poster where the woman portrayed had incorrect anatomy. They think its acceptable for people to wait hours to get their phone calls answered or be seen in an shopfront.

But for all the resources that are expended by the departments and agencies, the vast majority of homes are compliant (without intervention), the problem homes are still problem homes and aged care is no better or worse for their input.

So where is the outcome for residents? They are there if you look hard enough but you cant see the wood for the trees and it is questionable whether the amount of resources actually equates to the level of achievement..

So what is the answer?

Reform aged care in Australia. Have the intestinal fortitude to stand up and acknowledge that our current system is stifling innovation, wasting public money and negatively impacting older Australians who need care.

Resolve the issues with applications and assessment to enter residential aged care. Its not like anyone "wants" to live in a nursing home and aged care providers will not admit people who don't require care because they wont get funding so why do we squander millions of dollars trying to keep people out?

Reduce the bureaucratic oversight and meddling and insist on transparency ... make departments and agencies accountable for outcomes for residents.

Stop developing and implementing rules for the sake of rules and fix the ones you already have that conflict with the ones you made a week earlier.

Stop replicating programs at state and federal level and divert the millions of dollars wasted each year back into care and front line services. And for the Love of God, stop changing names just to confuse everyone and divert responsibility.

Fix the complaints system and stop reporting on the number of contacts your Complaints Commissioner has ... report on the number of complaints and the number that are actually substantiated and result in compliance action. Counting the same complainant 50 times is not accurate reporting and is meaningless.

Don't be a pre 1980's government ... Government is NOT the answer to the problem ... government IS the problem.