Recent airing of shocking treatment of elderly residents in Australian aged care facilities has led Prime Minister Scott Morrison to announce a royal commission. Sadly, however, the allegations of abuse and appalling conditions in nursing homes are not new. The question becomes, therefore, what has resulted in poor outcomes for vulnerable citizens, and why have we permitted such treatment to go on?
In a society whose foundation unit is the nuclear family peopled by individuals who are workers and consumers, we are accustomed to outsourcing care of the vulnerable: small children and the elderly among them. As life expectancy increases, frailty and disease can take hold and institutional care is more than simply a convenience for family — it becomes a necessity.
That is not to say that home care of the elderly is an idyll. Caring work is difficult physically and emotionally, even when performed with love. Sadly also, elder abuse is now a well-documented phenomenon. However, the conditions in nursing homes speak to institutionalised malaise at best, and racketeering at worst. What is most offensive is that corporations profit from the abuse that is allegedly occurring.
While there is a mix of for-profit and not-for-profit aged care providers, there is no doubt that aged care is an industry that it is market-driven, and that this is intended. The Productivity Commission, for example, made a series of recommendations in 2011 designed to enhance consumer choice in aged care.
In 2016 the government published the Aged Care Roadmap. It reports that 'the aged care system is operating more like a consumer-driven market' but seeks to build on the Productivity Commission recommendations including to 'increase choice and control for consumers' and to develop a 'lighter touch approach to regulation' for providers. In addition, since 2013, to increase efficiencies in the industry, the government has withdrawn more than $2 billion from the industry.
It is difficult to argue against affording 'choice' to the elderly seeking appropriate accommodation. It may also seem logical to free up the 'red tape' of administration, to 'permit innovation' in aged care services. The reality is, however, that the language of markets, including consumerism, free choice, efficiency, and the absence of regulation (or an 'agile and proportionate regulatory framework'), do no favours to those entering into care.
A market system thrives on an assumption of consumer choice. In reality however, it is profits that provide the incentive for suppliers. In circumstances where consumers are vulnerable, there is a power imbalance that interrupts the assumption of their free will. In the case of aged care, the 'consumer' is the elderly. The profit motive, and the question of power, is evident in so many of the reports of abuse and poor conditions.
"While cutting costs may meet the accounting requirements of providers, it is generating extreme suffering in residents."
For example, nursing homes have the right to refuse entry. If an older person has relatives who complain, that family might be excluded. Complaints to regulatory bodies are not made public, leaving providers unaccountable for unsatisfactory conduct and other consumers none the wiser. Residents or their relatives who need care run the risk of losing their place if they pursue their complaint.
While the Roadmap identifies the importance of 'attracting and maintaining a well-led, flexible and responsive workforce', these words tend to indicate a casualised workforce. The profit motive of corporations is a well-known driver of poor pay and conditions. And this is the case in aged care.
Compounding the low pay for a 'flexible' workforce is the low staff ratio, including the ratio of nurses to residents. Evidence of chemical restraint of residents (who will not require care if they are sedated), low quality (cheap) food, and unsanitary conditions, similarly point to attempts to save costs. While cutting costs may meet the accounting requirements of providers, it is generating extreme suffering in residents.
The industry, on the other hand, responds that it cannot afford to spend more. Yet what is the purpose of running a 'care' facility if the provider provides no care? For all the rhetoric of market mechanisms to provide 'choice' for 'consumers', those very consumers are being sold a lemon. A product that is consistently unfit for purpose is evidence either of market failure, or of the inappropriateness of the market mechanism to undertake what is really a social responsibility.
The royal commission will hopefully give voice to the concerns of those hurt by our manifestly inadequate aged care system and come up with recommendations for reform. Of concern, however, is that despite so many aged care reviews, the absence of care remains.
What is needed is a fresh commitment to develop a model of aged care as a community enterprise. One that is based on and upholds dignity, love and respect in care. While it may not be impossible to marketise such a service, for example as a social enterprise, the profit motive offers too great a corrupting influence to be permitted as an organising principle. If ever there were a case for the very non-market approach of responsible government funding and oversight, supported by community engagement, it is the care of our elderly.
Kate Galloway is a legal academic with an interest in social justice.