Time to get to work and face the challenges of aged care reform – opinion

It is easy to be cynical about the new Australian government’s very first legislative bill to receive the endorsement of both houses. The Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022, passed on 2 August, was claimed by no less than the Prime Minister to be both a symbol of the government’s intention to deliver promises made in the election, and the beginning of a process of real repair and reform.

More legislation is promised. And importantly, the move to introduce the Support at Home Program (SAH) to replace the CHSP and Home Care programs has been held back until 2024 while the entire scheme is reviewed and more extensive consultation has taken place.

Could this really be the inspirational first steps towards building a world class system from the base up? Or is it just the naive response of an inexperienced new government, promising more than could possibly be delivered?

Over the past decade, there have been many promises about the aged care system in Australia made by those charged with responsibility as the Minster for Ageing. Too often these policy announcements simply came to be understood as a form of political marketing. At worst, they came to be seen by those in the know as misleading and manipulative.

Changes to aged care provisions were often justified as providing consumers with greater choice and better quality of care. Few, if any, changes were claimed to benefit staff. While the new policies promised families and those who relied on support that glittering ideals such as ‘consumer directed care’ would provide new standards of responsiveness and personal attention, waiting lists for home care grew and the quality of care become less and less certain.

It became impossible for any of us with a serious commitment to quality care to believe the promises. Slowly but consistently, the already poor wages and conditions for those who worked at providing personal care deteriorated.

So, given the tightened circumstances under which the new government will have to operate, could that possibly change?

That’s certainly the promise. Yet there is so much to do before we could be confident that Australians can feel confident about the system of care in the twenty-first century. And so many conflicting opinions about how it could be achieved.

The public clearly have high expectations. Can politicians possibly help us meet them?

Here is not the place to go through the policy evidence in detail. Nor can I review the reams of scientific, legal, statistical and economic data necessary to test ambitious claims. But evidence from at least two other major sources suggest that there are sound reasons for optimism and hope.

First, a quick historical check shows that changes of this magnitude have already been achieved at least once before in this country. The problems of the aged care system in the 1970s and 80s in Australia were eerily similar to those experienced today. In the face of similar cynicism and doubt, reforms made under the Hawke and Keating governments were introduced that were able to reset and redesign the system.

At their core were the world leading Aged Care Assessment processes which helped divert many older people from residential care. This reduced pressure on the services that continued and laid the groundwork for fundamental improvements in service quality and culture by providing alternatives that benefitted many older people who needed care, but had previously received no assistance at all.

Other policy reforms introduced at the time saw the development of cost effective alternatives to residential care through the introduction of the Home and Community Care (HACC) program.

Unpaid family carers were recognised for the first time. The Carers Pension and other related developments also saw such carers given a voice and included in service planning.

In-service training and other educational programs were introduced to lift the expertise of care staff. Wages increased and conditions improved for staff, if only modestly. And so the list goes on.

History also shows that many of the improvements in the system were subsequently undermined and ignored. Policy changes saw essential system design features broken. They were replaced by simplistic concepts in a race to build a profitable industry that was typically cheered on by many of the industry leaders.

Beginning with the introduction of the Aged Care Act (1997) and exacerbated by the later shift of all governmental responsibility to the federal level, well grounded foundations of good practice were simply eroded.

A second, alternative perspective, that of international comparisons, also provides evidence that we can do much better. It is a sad but telling comparison (at least for Australians) to compare the outcomes of policy change in aged care over the past 25 years across the Tasman with those in this country.

Our Kiwi cousins have shown us that things can get better without breaking the national budget. Many other countries, too, have shown us that we can do much better. Now it’s our chance to show that we can learn, we can innovate, and we can build.

A great starting point is the early working life experience of the new Aged Care Minister, Anika Wells, who as a law student was employed as a kitchen hand more than 20 years ago in a nursing home and did relief work as a diversional therapist, facilitating recreational programs for the residents.

She is reported as saying that: “It demonstrates that clearly there were staff shortages, even then.”

Systematic change is certainly required in almost every area of aged care. This is not the time for despair. We need to rejoice and get to work. Finally we can start tackling the challenges that need to be met.

Michael Fine is Honorary Professor in the School of Social Sciences at Macquarie University.

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