Aged care exemplifies the limits of markets

 

Allocating care of the most vulnerable age groups, the very young and the very elderly, to profit-driven companies is a recipe for the disaster we are witnessing in aged care and, sometimes, in child care. Community engagement can help in various ways. The staff at nursing homes know people are interested in what is happening at their facility, the residents see that people are interested in their welfare and value them, not as objects of pity, but as people with rich histories. It's essential that well-trained staff are caring for residents of nursing homes and equally important that management have ideals about what their facility stands for. Even more important: the community visits, engages and honours people who make their home in a nursing facility.
Pam | 24 September 2018

Thankyou Kate for this straight and clear response to the crisis that exisits in both the Aged Care "Sector" and, Iets add the Disability "care Sector" and Early Years Care "Sector". We have accustomed ourselves to the idea that "The Economy" is only about Profit.. and that Human beings can be commodified to be in service of The Economy". Aristotle first spoke of the economy as the management of a household. In these times with the changed sense of the "economy" we manage our household so that some benefit by monetising others of the household, calling them consumers and using them as commodities to create wealth for others. This is certainly the result of agreeing that our Care for others be placed in the Economic Sector as it stands. We agreed to this. But we dont need to continue to agree? There are ways to create a New Economy based on different values and agreements!
Heather Lawrence | 25 September 2018

Thank you for this timely piece, which usefully identifies and investigates the context of drivers in this 'market'. It seems to me likely that once the Royal Commission is under way, popular (populist?) media coverage will likely be a mix of cherry-picked sound bites and sensationalist outrage. To have an argument - with due gravity - presented just now around the foundational issues is especially helpful.
Richard Jupp | 25 September 2018

The very fact that we talk about care for the elderly as an industry rather than a service says it all.
Joanna Elliott | 25 September 2018

This critique also applies to many of the so called reforms enacted in the name of economic efficiency over the past 30 years. In pushing for the privatisation of the Commonwealth Bank, Treasury lost control over the banking sector and created a quasi-monopoly which has been ripping us off ever since, by failing to adequately regulate the health care sector, the Government is progressively destroying Medicare, the privatisation of electricity generation and transmission has doubled electricity cost, the privatisation of Telstra was the privatisation of a natural monopoly and it bin turn helped destroy the new NBN, flexibility in the workforce is undermining security of employment at great social cost, the new start allowance has created a new group of undeserving poor, unrestrained advertising is turning us into avaricious consumers, and Rupert Murdock is gradually undermining our political institutions.
Lee Boldeman | 25 September 2018

Sadly Scomo has proved himself to be, as if we didn't already know, just another politician. And one without vision. Horror stories about the misbehaviour of banks were rife. The opposition promised a Royal Commission. The parties of the free market, the Coalition, would not have a bar of it. Their vision for the banking sector was - Let them maximise profits. When the pressure became too much the government relented and the Banking Royal Commission was set up. It soon showed there was more to the pub and sewing circle talk than the government could ever imagine. Along comes the Aged Care scandals. Once again the debacle caused by free market forces dictating behaviour by Aged Care entrepreneurs was there for all to see. Thanks to the pesky media not to any supervision by the government departments/agencies responsible. The only thing this Coalition is really good at is fear-mongering. Fear of great powers (except the USA). President Trump is a bit of a worry but our Ambassador plays tennis with him, so we can relax. As long as Mr Hockey let's Trump win. Fear of unions is a good stand by. Pathetic!
Uncle Pat | 25 September 2018

Thanks Kate, this is very interesting piece which makes some good points but I don`t think it gets to the heart of the issue. This I believe is another example of federal government`s piecemeal meddling, poor governance and a vain attempt to try and please everyone, leading to a complete mess. Much the some could be said for healthcare, education and energy policies, but this in now an especially sensitive area. The fundamental issue is funding, and how government gets involved in this both as a payer and a regulator. One could make the case that government should pay for everything but that would mean ruinously high taxes (including on the 60% who currently pay nothing net!), and almost certainly give a poor and a rigid, highly unionised system. On the other hand the market could provide an excellent system but only for the minority with the means to pay for it. Currently, we fall badly between two stools. So, one needs a viable partnership between government and providers, whether charities or businesses. Government contributions need to be within fiscal realities, means-tested with its main concern being looking after the truly poor. But the "means" taken into account need to include everything the individual has, including the family home, and there should be no artificial cap on costs....indeed, whatever it takes. The money needs to meet the real needs-based costs and guarantee quality and choice! What all governments have been trying to do is protect its own fiscal and also political interests, the latter including featherbedding the interests of the offspring of the frail elderly so that their inheritance is largely protected. But the interests of the old should be at the centre! This is not market failure but failure of social policy, which currently interferes with the freedom of the elderly to use their accrued financial resources to look after their own interests in the last phase of their lives.
Eugene | 25 September 2018

We walked for some days with a CEO of aged care facilities many years ago on a nature hike in New Zealand. He had a very cynical view on children and their willingness to allocate the parents own money for their good aged care. The children he said, would profess “only the best” care for their parents only to decide for a more modest offering after calculating financial impacts on their inheritance. POA holders would actually make inheritance calculations in front of his staff as they made decisions on care levels. Often these inheritance discussions would be put in terms of renovations and overseas holidays. The money was always there to pay for the best care but rarely decided in favor of such care. Yes to regulation and oversight, no to the nationalization of such services. Question : why should the public purse pay anything for an aged person who needs care if that person has the assets (not necessarily income) to pay? In so many instances today, are we not simply facilitating a tax free transfer of wealth to the children where the rest of the population is paying for this transfer. Solution : For people that do not have the income to pay for their own health care as they get older, the cost of care should accrue as a payable and an invoice be provided to the estate by the state on the persons passing. Interest could be calculated at inflation. In this way the person pays their own way all the way into the grave. Many have the money to pay for their care but their families chose not to spend it. Of course this then simply provides for estates to be transferred tax free before passing so the elder person has no income and no assets. The corporate raider would call this an asset strip. We need a better system but it will come at a cost. The point is, as this CEO pointed out, no one wants to pay for it.
Patrick | 26 September 2018

A thought-provoking article Kate. The power imbalance you refer to is very real. While visiting an elderly aunt of mine (sharp as a tack at 95) she commented on the flurry of activity and attention during the previous week’s accreditation review, but then sadly commented that things had now returned to normal. Aged care accreditation agencies are unfortunately too removed from the day to day to provide the checks that are needed. We need to look at additional ways of building in advocacy for people in aged care. Models such as legally sanctioned community visitors (akin to Public Advocates Office Victoria) may be one model.
Mike | 26 September 2018

Men are often disempowered by suffocating atmospheres in age care that allow little in the way of ‘dignity of risk’ – in large part a product of a lack of gender diversity in staffing. I recall my father in law, a rough and tumble plumber and contractor being asked ‘do you want vegies with your parmi dearie’ and would you like to enter the competition to name the nursing home cat! He just rolled his eyes.
Mike | 26 September 2018

Thanks Patrick...exactly right! And so Australian.
Eugene | 26 September 2018

Excellent comments by Eugene and Patrick, IMO. The "market", being a thermometer, not a thermostat, is only a reflection of the people in the market. It's the most efficient deliverer of people's choices, ... whatever they are. So if you love your parents, the market will reflect that. If you don't, ditto. Don't shoot the messenger. The number of nursing home patients parked there to die unvisited by their children is the real evil. No legislation to cope with the alleged "evils" of the market can fix that.
HH | 26 September 2018

Thanks for a good article, I work in aged care and it has become apparent to me over time that facilities although on the surface seem genuine, often are driven by money. Frequently short staffed and , certain basic care needs hurried or not done at all. Most staff feel like they are on the ragged edge.
Peter Day | 27 November 2018

Hello Kate, you have stated "For example, nursing homes have the right to refuse entry. If an older person has relatives who complain, that family might be excluded" I was denied access to see my beautiful Mother in the final months of her life. The Assistant State Manager of the Complaints Investigation Scheme WA told me that the provider had the right to do so. I downloaded the Aged Care Act 1997 and found Section 23.8 (now superseded) which states something to the effect 'if a care recipient has asked a representative to attend to their needs, the nursing home must allow access at any time'.
Linda McGough | 29 January 2019