Very few of us wish to dwell on how the last years of our life might play out. If we did, we would surely pay more attention to the increasing privatisation of aged-care services.  Do we really want our end-of-life experience to be defined by market forces?  Should the desire for profit underpin the care of those who can no longer care for themselves?...

This columnist is of the view that caring for people at the end of life is a community responsibility and should not be abrogated to those who seek to make private profit from the vulnerabilities of frail older people. We are all dependent on others for care at various times during our lives - as infants and children for example. Or when we are ill - and almost always when we are old and frail.

So what is the impact of the increasing privatisation of aged-care services in Australia? Some things are clear. Firstly, aged care, in spite of the rhetoric about inadequate funding, is seen as a cash cow for private business – including the large corporations. How else to explain why entities such as Macquarie Bank, ING, Westpac AMP and the Development Corporation of Australia are buying into aged care big time?

The view that government subsidies equals heaps of money is symbolised by the now notorious Gold Coast would-be aged-care provider when he commented, "I hit the jackpot with my block of land at Merrimac on the Gold Coast, receiving an allocation of 94 places from the Government." Yep, he got a $3.7 million gift, courtesy of the taxpayers. 

Secondly, economies of scale are becoming the order of the day. Corporations are setting up huge aged-care homes on cheap land on the fringes of our cities. Some have more than 100 beds.

These facilities are usually well-appointed, pleasant, purpose-built places and a far cry from the dreary little cottage-industry homes that used to prevail. But what about the care? Economies of scale generally means economies of staff – as staffing costs take up by far the highest proportion of the aged-care budget.

One staff member who was interviewed on Queensland ABC radio opinied that staffing is now much worse than it was in the 70’s. And we are learning about facilities where only two carers are rostered on at night – while they care for 100 residents. The bleakness of that scenario should send shivers down all our spines.

Thirdly, cutting down on the expensive staff budget often means fewer skilled staff. Take, for example, the facilities where trained nurses are now being asked to reapply for their jobs – but as lower paid personal care workers.

And this is occurring at a time when the high care needs of residents have never been greater.   More shivers down the spine.

Finally, what do these massive changes in aged care mean for those who work within the sector? ABC television (Four Corners) broadcast this week a chilling expose on the pressures applied by Telstra on its staff.

Staff working in aged care are also feeling this pressure. Good hearted people, wishing to take pride in their work, have no time to attend to the needs of residents – let alone talk to them. Often, the most dedicated nurses find the forced neglect of residents so disturbing that they leave to find less stressful, and more satisfying, employment. They are replaced by those who are more able to accept, and accommodate, the consequences of the most minimal staffing. Those flash facilities can be very lonely places for both staff and residents.

So who are the individuals behind the companies? Presumably, they are people who believe they are immortal – or that they will suddenly drop dead and thus will never grow old, frail or experience dementia. How else to explain? Or perhaps such individuals shield themselves from what they do behind a façade of business jargon and by operating in a shadowy, complex network of boards and entities – well away from the messy business of actually caring for people who are dying.

Failures are seldom acknowledged and so we have some people, who have been involved with facilities that have significantly failed aged-care standards, and yet are now out there running other places. That is clear from reading the transcripts of the May Senate Estimates Committee meetings.

Who then should be held accountable when neglect and abuse occurs - the board of directors, the facility manager – or perhaps the director of nursing? At least when the not-for-profits get it all wrong (and sadly, they sometimes do) we have clearer idea of who is responsible.

Maybe the buck stops with our ever-so-quiet Minister for Ageing, Christopher Pyne, and with a government whose market place policies leave frail older people, their families and their carers sadly wanting.