After two years of often harrowing evidence from 450 witnesses and 10,000 submissions, the Royal Commission’s multi-page report has fallen short on a clear path to lasting and meaningful reform.
First, the report failed to spell out how much its reforms will cost, only that aged care will be more expensive than the predictions made in any of the multiple intergenerational reports before it. This inability to provide a proper costing makes it difficult for society and government to assess what is financially viable and what is not.
Second, the report fails to deliver a clear consensus on a way forward. Commissioners Tony Pagone and Lynelle Briggs disagreed on nearly a third of their recommendations, most notably on governance and funding.
Pagone recommends an Independent Commission model; Briggs favours a Government Leadership one.
Pagone’s model would end what he sees as a concentration of powers and functions in the Department of Health and its minister, and suggests creating a new independent statutory body. Briggs disagrees with Pagone on both his premise and his solution, arguing for a ‘new, enriched role for government’.
And then, of course, there’s the huge issue of funding.
‘I fear that society as a whole undervalues older people and their contribution. The acceptance of poorer service provision in aged care reflects an undervaluing of the worth of older people, assumptions and stereotypes of older people and their capabilities, and ageism towards them.’
Sustainable funding, and making it politically acceptable, is critical to the success of any nation-building reform. Senior government ministers were hoping for a clear recommendation on that, but it never came.
Briggs wants a 1 per cent Medicare levy increase, branded as aged care improvement, and which will be tipped into consolidated revenue. Pagone punted on the possibility of a ‘hypothecated levy’ to the Productivity Commission for their consideration.
These two divergent approaches don’t give much political cover to politicians looking for ways to fund the reform.
It is no surprise then that Treasurer Josh Frydenberg immediately played down any prospect of a new tax: ‘I notice that the Commissioners had different approaches with respect to the levy or the tax proposals, but it is fair to say our government’s track record has been about delivering lower taxes.’
This is not to devalue its contribution, but merely acknowledge that it has failed to meet some of the more difficult challenges put to it — that it reach consensus on a pathway forward, that it work out how much it might cost, that it find a way to fund it and that it make it as easy as possible for the government to adopt its recommendations. It has not done this.
Having said that, it is also important to recognise that the Commission has reached a range of important conclusions on the sector. Let’s look at three which are particularly interesting.
Firstly, the Commission confirms the ‘community will ultimately be responsible for bringing aged care into the light’.
Commissioner Briggs soberly concludes: ‘I fear that society as a whole undervalues older people and their contribution. The acceptance of poorer service provision in aged care reflects an undervaluing of the worth of older people, assumptions and stereotypes of older people and their capabilities, and ageism towards them.’
It is a sad truth that as we grow older we become increasingly invisible. Older Australians recognise their increasing invisibility, whether in seeking service at the local cafe or simply making eye contact walking down the street. Think about it — when was the last time you made eye contact with an older Australian walking down the street?
The macro consequence of this, of course, is that issues of critical importance to older Australians are unfairly ignored. As a community, we must proactively address ageism and make an effort to recognise older Australians and their needs.
'It is the community that must be encouraged to take responsibility for the care of its elderly.'
Catholic Health Australia has been involved in two public campaigns on aged care in the past year in order to address this issue. This includes CHA’s ‘Fight for Better Aged Care’ campaign in the Eden-Monaro by-election last year, as well as the Australian Aged Care Collaboration’s ‘Time to Care about Aged Care’ campaign.
Both aim to encourage the community to bring aged care into the political discourse, that is, to make the concerns of the elderly visible. It is a recognition that only the community can drive change. It is the community that must be encouraged to take responsibility for the care of its elderly.
Secondly, the Commission has recognised the centrality of relationships to the provision of care. This should be obvious to most of us — but it’s interesting how the very human nature of care can be lost in arguments about policy reform and funding mechanisms. To this end, the Commission has explained, ‘Aged care is all about people, and relationships are the foundation of all human engagement’.
To achieve this, the Commission has recommended minimum quality and safety standards for staff time (200 minutes of care provided per resident per day by 2022, increasing to 215 minutes by 2024) as well as minimum qualifications for the personal care workforce. Unfortunately the Commission has also failed to address how one goes about ensuring that personal carers possess sufficient empathy — something critical to the development of strong relationships but not easily found or taught in the working population.
Finally, little comment has been made on the Royal Commission’s recommendation that any new Aged Care Act must enshrine the rights of older people seeking or receiving aged care. This is a completely novel approach in the Australian context.
In this sense it has proposed a rights-based approach to aged care and has recommended that any new Act enshrines: the right to equitable access to care services; the right to exercise choice between available resources; the right to freedom from degrading treatment or abuse; the right to liberty; the right to autonomy; the right to fair and non-discriminatory treatment; and the right to voice opinions and make complaints.
These rights will no doubt raise care standards giving elderly Australians another avenue for redress.
One might also assume the implementation of such rights will mean that rights enforcing litigation will increase, and that what the courts think about how aged care should be delivered will need to be considered by providers in the future.
Pat Garcia is CEO of Catholic Health Australia
Main image: A rearview shot of a senior woman sitting in a wheelchair (Shapecharge/Getty Images)