Even if we discount the current pandemic, Richard Colbeck has had a turbulent time as aged care minister.
Constant criticism has come his way, from his apparent lack of knowledge of the aged care interim report in Senate questioning, to the government’s handling of a BUPA scandal, and most recently due to a spat with the royal commission over the ACAT process.
Of the ACAT issue, Colbeck believes it was all a misunderstanding.
“I can understand royal commissioner Pagone’s statement because what he was reacting to was a report of what I had said in the media, not necessarily what I had said. And I respect that and understand it perfectly. I have no truck with the commission at all,” the minister tells Aged Care Insite.
Instead, Colbeck says that privatisation of ACAT was not the plan, rather the main focus was to bring ACAT and RAS together, a recommendation that David Tune made to him personally.
“If you look at it, the government doesn’t actually conduct any of those assessments right now. All of it is outsourced to the states or providers around the country. So, there are a number of providers providing the RAS service. Some of it’s state based, some of it’s a not for profit, some of it’s private,” he says.
“The issue for me was how you brought them together. That was always my focus. And the reason I made the final decision I made was that it’s dependent on having the appropriately qualified workforce.
“Once I got a better sense of what was happening with that, that dictated the final path for me in my process to bring them together. We’re still working on that. That’s still an intention – to bring the RAS and the ACAT workforce together and to do that we’ll be negotiating directly with the states.”
A waiting game
Another constant criticism of the government has been the ever-expanding wait times for aged care places.
The report also showed that those Australians waiting for the highest-level home care package have an average wait of 34 months.
Data for the 2018–19 period tells us that 41.9 per cent of older people entered residential aged care within three months of their ACAT approval. However, the median wait time is now at 152 days, an increase from 121 days in 2017–18 and 105 days in 2016–17.
Colbeck points to continued investment from the Morrison government as proof that this issue is being taken seriously.
“We’ve made significant inroads into the provision of home care packages. Over the last couple of years, we’ve invested about $2.7 billion since the 2018/19 budget into our home care packages. And the number of packages has grown significantly in that period of time.
“In fact, I think the wait list is now down under 110,000. There’s about 146,000 Australians or a bit over that who have access to or who are in a home care package,” he says.
“But we also have said that we want to reform the way that home care packages are delivered because I think that we can get more value for the investment that we’re currently putting in.”
As for residential wait times, he disagrees with the productivity commission’s 50 per cent rise statistic. Instead, he says that this is likely a “decision making time” that older Aussies are using decide whether residential care is for them.
“There’s no constraint on people taking up a residential aged care place. The occupancy right across the country has dropped from 96 or 97 per cent about four or five years ago down to close to 90, so there is capacity in the system.
“I think that is a decision-making process on the behalf of senior Australians. It’s not an availability thing.”
Bang for your government buck
Aged care finance can, at times, seem like the be all and end all. On one hand we have the Government announcing more money and package after package. The other sees the peak bodies who reply that it is still not enough.
However, studies have shown that 56 per cent of residential care facilities are operating at a loss, with that figure increasing to 65 per cent of regional residential care facilities.
The royal commission interim report said that the aged care system needs a “reality check” and to focus less on acting like an “industry” and a “market” force which views people as “clients” and “consumers”.
Is it time to take the free market out of the provision of care for our elders?
“There are high quality aged care providers in a corporate perspective and there’s very high-quality aged care providers in the community and not for profit perspective. So, I think there’s room for all of them within the sector,” Colbeck says.
“We need to make sure that there is capacity where it’s needed, particularly in thin markets out in regional Australia and looking after people who are disadvantaged. But the corporate providers provide a significant amount of the aged care in the Australian community and they provide a lot of the capital to actually build that as well.”
And what of the large providers, such as BUPA, who have been a consistent offender when it comes to poor care yet continue to receive millions in government funding?
Last year, the ABC reported that more than half the nursing homes run by BUPA are failing basic standards, and 30 per cent are putting residents at risk due to poor health and safety practices, despite aged care profits of $663 million and $460 million in government subsidies.
“If you actually have a look at where BUPA are at, and their results as of the back of some of their failures with respect of care provision, it has been a very expensive exercise for them. So, I’m not sure that their aged care division has contributed significantly to their overall profit over the last 12 months or so.”
He says that his department has been working closely with BUPA to bring them back to compliance and for a company of this size, it is what Colbeck expects of them.
“They’re a very significant healthcare provider and they understand that they need to bring those facilities back into compliance.
“I see them as too big not to come back to compliance. They should have the capacity to bring those facilities back to compliance because of their scale. That’s what I expect.”
So they are, in fact, too big to fail as has been the accusation?
“Can I say I see that as a jargon that goes back to 2008, I don’t look at it in that context. I see these organisations as large organisations with the capacity to put the resources to bring themselves back to compliance. I actually don’t want to see them fail. And it’s not as if we’re providing them with any additional resources to do the job that they need to do.”
“And in fact, some of the impacts of them having sanctions means that they have to put additional people in there that provide the oversight and the capacity to do that. So, it’s a very expensive process for them. And again, I repeat quite unequivocally, my expectation is that they bring the facilities back to compliance.”
A ‘cruel and harmful system’
Shortly before the royal commission’s interim report was handed down last year, Colbeck made an appearance on Q&A, where Monash University professor Joseph Ibrahim, sitting in the audience, kicked off proceedings by asking the panellists if they, like many Aussies, would rather die early than enter an aged care home.
Colbeck replied that he “wouldn’t share that view”, and the ex-building contractor stands by that view today.
“My view hasn’t changed in that context. I know a lot of facilities, I’ve seen a lot of facilities and there are some very, very good aged care facilities around Australia. The way that they’re providing services has changed enormously over the last three decades.
“As I said, I’ve seen it because I’ve worked in them as a contractor. I’ve modified them to change the way that they provide that service and it continues to change,” he says.
“But the reality is that for a proportion of the population, the continued availability of high quality residential aged care is going to be really important.”
And although he believes the sector does a largely good job, he admits that he was surprised at that scathing interim report eventually handed down by the commission.
“I don’t think anybody was prepared for that sort of language. I did say in the weeks leading up to the interim report that I thought that it was going to provide a simple message towards all. It certainly did that. It sent a message to government. It sent a message to industry.
“And I think it sent a message to the broader community because the commission was also talking to the broader community in respect of some of our attitudes as a community to senior Australians.”
If the royal commission has laid anything bare it is that ageism, as well as financial interests of some providers, has played a large role in the neglect of older Aussies and this is something that Colbeck and his department want to work on going forward.
He also says that he is working on policy so the government can be ready for the commission’s final report and act quickly.
“The work that [the royal commission] is doing now with some of the papers that they’re publishing and some of the round tables and panel work that they’re doing is giving some indications in that direction.
“There will be a period of time of reform that comes off the back of the royal commission, two or three, perhaps four years. So that’ll be significant.
“But being prepared with policy I think is going to be extremely important because there will be an imprimatur that comes with the royal commission’s final report that will probably be some very difficult decisions that have to be made, and really to make those as soon as possible [and] I think remove some of the political temptation that might exist to play politics with some of those more difficult decisions.”
A sector in flux
Going forward, Colbeck is preparing for a post-COVID-19, post-royal commission aged care sector. He would like to see every facility implementing its own quality assurance system to provide quality indicators that can be reported back to government, back to residents, back to families and the community.
He is also looking hard at the way aged care is funded.
“And I’m expecting that the royal commission will make some recommendations around that as well because I don’t believe that the taxpayer can afford to pay for it all.”
Mostly, he says, he is looking to make a difference to older Australians.
“It’s a pretty tough gig. And there’s been some very, very hard to deal with stories that have come out from the royal commission and some of the things that have occurred before that. But I think it’s an opportunity to grasp as a minister, for me to lay down a strong policy platform, it’ll serve the sector and senior Australians well for the next decade at least, so that’s the way I’m looking at it.
“I’m looking forward to it. I’m enjoying the work. I enjoy the interactions with the people in the sector.
“To have the opportunity and the imprimatur of a royal commission to implement some strong policy reform is a rare opportunity for a minister so I’m looking forward to it.”Do you have an idea for a story?
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