Home | Industry & Reform | Tip of the iceberg? The neglect and abuse seen in residential care is simply the most visible part of a larger problem

Tip of the iceberg? The neglect and abuse seen in residential care is simply the most visible part of a larger problem

The Royal Commission into Aged Care needs to go beyond the urgent problems of residential aged care to look at the full formal system of care and support. We need to ensure we can increase staffing levels in residential care and ensure a high quality of care is available to all who need it.

To address the problems of abuse within the aged care system in Australia we must ensure that there are viable alternatives to residential care for as many people as possible. Only then can we prevent even larger disasters that are just around the corner.

Today the guiding strategy for aged care is set out in the ‘Aged Care Roadmap’, released by the Department of Health in 2016. The roadmap directs us to a path towards further deregulation and competition. According to the roadmap the destination is ‘A single aged care and support system that is market-based and consumer-driven, with access based on assessed need’.

Often, experience overseas will serve to guide the way. But in this case, there are no examples overseas where this approach has been shown to be successful. Nor have there been successful demonstrations of the approach in any region of Australia.

Given what we know already about the impact of other aged care reforms, such as the abolition of staffing ratios in residential care in Australia, how can anyone be certain the proposed reforms will work?

Many of the major moves have already been put in place and this gives us some insight into the potential outcome. One of the less publicised impacts to date has been the unintended effects of the introduction of consumer choice principles and new procedures for assessment.

Eligibility for all care at home, for example, is now formally assessed. Although it was previously possible to simply approach a Home Support service directly and be accepted for care immediately, the introduction of Consumer Directed Care (CDC) and the new assessment procedures have come at a huge cost.

Despite the massive expansion of the assessment program to take on the increased task, long waiting lists have developed. As Aged Care Insite reported at the time, official reports earlier this year confirmed waiting times of a year for CDC Home Care packages.

Instead of trying to funnel an additional 800,000 consumers who use CHSP (the Home Support Program, previously called HACC) services into a single assessment program designed for 90,000, might it be better to think of the CHSP as a low-cost tier of primary care service which consumers can approach directly, just as we do with GPs and dentists?

Is it desirable to proceed with the planned reforms and effectively collapse the CHSP into the Home Care Program to produce a single system? The move, which will see the block funding of CHSP services replaced by fee-for-service payments under which they will compete with Home Care Services, is now scheduled to take place from 2020. It was previously scheduled for 2017 and then 2018, so perhaps there is some trepidation about the move at the Commonwealth level.

And what will be the impact on the non-profit, block-funded CHSP services? Will the volunteers continue to work without pay when a fee-for-service payment is in operation?

There are many other existing and potential problems that require attention, including the new approach that sees carers as a consumer group, that is quite distinct from the aged care consumers.

If we want to prevent the even larger disasters that are just around the corner, there are alternatives to residential care. We must ensure these are viable, sustainable and available to as many people as possible.

The roadmap suggests we are currently heading towards even greater problems. One thing is certain: we need the Royal Commission to go beyond the urgent problems of residential aged care to look at the problems of the full formal system of care and support.

Michael Fine is an honorary professor in the department of sociology at Macquarie University.

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One comment

  1. Michael makes some excellent & very relevant points. Great to see he is still around – I used to work with him years ago!!
    After 40+ years of managing aged care facilities from 40 bed units to over 600 beds as CEO / Director of Nursing, I firmly believe many of the issues relate to the skills & efficiency of staff – 75% of staff now are unskilled even though the levels of need & complexity of, given the assessment process, is now very high.
    Managers are not actually supervising & ENSURING that care is being delivered – instead, everything these days depends on the staff ‘tick sheets’ – i.e. if the sheet is ticked then it happened …..
    Good & effective supervision is not ‘rocket science’ – it just needs those in charge to walk around the facility a few times every day & actually CHECK as to whether care is being delivered & that staff behavior is professional & skilled!! Onsite training meetings are also important so that all care staff know their responsibilities & work together in the interest of each individual resident.
    As Michael says, unfortunately our aged care system has deteriorated from world-class to much worse due to increased complexity & failure to recognize the simple solutions !!!!

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