Productivity Commission’s Caring For Older Australians: Aged Care Reform? - Or Economic Darwinism?

In its overview, The Productivity Commission states that its “overriding objective is to improve the wellbeing of the community as a whole” while recognising that “aged care is an integral part of the health system”.

But what does the Productivity Commission consider is the ‘community as a whole’ and why, in its next breath, does the Commission proceed to deconstruct (or, as it says, ‘unpackage’) – “an integral part of the health system” into various components (i.e. personal care, health care, accommodation and everyday living) to which it then attempts to justify attributing separate costs, and responsibility for meeting those costs.

Will the Productivity Commission’s next step be to ‘unpackage’ all parts of the health system into components, and can any hospitalised person consequently expect to (for example) provide for their own bedding, meals and toilet paper? Can we similarly expect maternity or IVF patients to be charged on the basis of the actual cost involved, as well as their individual capacity to pay? Would it not be fair for the government to similarly garnishee their homes? And if not, why is it seemingly acceptable to treat disabled older people more harshly than fit and able younger people? Are the proposed aged care reforms not elder abuse or, at best, ageism?

This email was sent by a daughter who is desperately wanting to move her mother to a nursing home that will look after her mother in a caring environment.  It needs no further introduction. For obvious reasons the name of the author is withheld and forgotten.

MARGARET Gray raised a critical question (Letters, 4/6) that has elicited neither further discussion nor answers.

My mother is also in receipt of an aged care at home package. It is generous at approximately $48,000 a year. The family contributes more than that for her care at home, plus hours of unpaid family care.

The package is paid to a service provider company that doles out the services that can be accessed. 

I calculate these services are worth about $25,000 a year.

So where is the remainder of her grant going?

I cannot scrutinise expenditures made on her behalf because the company will not give me a statement of account despite repeated requests.

We are entitled to access the true value of her package.

Forget about transparency and accountability; these aged care grants are clouded by layers of administration, regulation and double-speak.

Fanny Abrahami, Caulfield North

Source: The Age, Letters

LENGTHY waits for emergency hospital care are the result of elders waiting for aged care beds ("Aged care shortage chokes hospitals", The Age, 2/6). Occupancy rates in nursing homes consistently average around 93 per cent. However, tens of thousands of nursing home residents are classified as "low care". Many of these elders might still be in their own homes if it were not for the severe rationing of community aged care packages by successive federal governments.

The demand for packages outstrips supply by 10 to one. It is socially and economically irrational for this rationing to have continued for so long. This year's budget papers acknowledge consumer preference for care at home and the lower costs. Accordingly a marginal shift has been made in favour of subsidies for home care rather than for institutional care.

Unlike high-care residents, low-care residents are required to pay accommodation bonds to nursing home providers.

The question is just whose interests have been served by the rationing of home care?

Carol Williams, Elder Care Watch, Blackburn

Residents subjected to the alleged events which occurred this time in a New South Wales nursing home, which included the horrors of:

• having resident's genitalia photographed for some sick game;
• depriving a dying man of food; and
• taunting a dementia resident;

Sadly, none of these events satisfied the official government requirements of the "compulsory reporting" regime that was introduced in 2007 to purportedly "protect" residents in aged care.  Although in this case the provider optionally contacted the department, there was no requirement to do so. 

"Compulsory reporting" laws were introduced in 2007, as a result of alleged sexual assaults in a Victorian nursing home. 

I have read through this website, and I am amazed at how much work has gone into it. It is very impressive.  

My mother has been in a nursing home for several years and I've observed power being routinely abused by staff where she lives.   I feel there is a game going on.

Accountability is, in my opinion, a vital ingredient when one group of people have power over another group.  Especially when one of the group's is vulnerable physically and emotionally.

I think Government regulators are incapable of implementing a system of justice and empowerment for Nursing Home residents, that's why it isn't happening. Simple observations tell me this. 

SUGGESTION is to put our seniors in jail and the criminals in nursing homes.

This way the seniors would have access to showers, hobbies, free prescriptions, dental and medical treatment and they'd receive money instead of paying it out.

They would have constant video monitoring, so they could be helped instantly if they fell, or needed assistance.

Bedding would be washed twice a week, and all clothing would be ironed and returned to them.

A guard would check on them every 20 minutes, and bring their meals and snacks to their cell.

They would have family visits in a suite built for that purpose.

They would have access to a library, weight room, spiritual counselling, pool, and education.

Simple clothing, shoes, slippers, PJs and legal aid would be free, on request.

Each senior could have a PC, a TV, radio, and daily phone calls.

And the criminals?

Well, they'd get cold food, be left alone and unsupervised, lights off at 8pm and showers once a week.

They'd live in a tiny room for which they would pay $5000 a month with no hope of ever getting out.

The following article has been written by the daughter of a resident who currently resides in a federally funded Australian nursing home. The intent of the article is meant as a warning for baby boomers. The writer offers some tips and hints to consider, as well as a personal perspective based on the resident's experience. It articulates some of the problems faced by consumers of aged care in this country.

The article should be read with this in mind. While we are aware that not all facilities operate like the one described in this article, it is a sad fact that Aged Care Crisis does receive many complaints that uncannily enough, contain similar scenarios.

It needs no further introduction. For obvious reasons the name of the author is withheld and forgotten.

The following letter was sent by a concerned daughter whose mother currently resides in a nursing home, to Minister for Health and Ageing Nicola Roxon, in an effort to raise their concerns about lack of staffing ratios and skilled staff working in aged care, as well as the lack of care. As well as providing a first hand view of these issues, the author has also provided some practical views on resolving those issues:

The current limited system of late release and early removal of adverse reports from the Aged Care Standards and Accreditation Agency website is unsatisfactory. Consumers are entitled to disclosure of all past, as well as present, reports. Information needs to be presented in a digestible format. Frail older people are one of the most vulnerable groups in society and their protection should outweigh all other considerations.

The NSW State Government is transferring the remaining 11 state owned aged care faculties to the private sector.

The Wallsend Aged Care Facility is one of these facilities. Growing community opposition, frustration, and betrayed individuals are protesting their opposition to this mishandled and demeaning privatisation by stealth.

George Vassiliou applied for the EACHD (Extended Aged Care at Home - Dementia) package to help his then 84 year old mum to stay in her own home - but was shocked to find that two thirds of the money was eaten up by overheads. 

After arguing his case for years, George finally won the right to administer the EACHD package for his mother. 

George's mother's health deteriorated some time later and she now requires full time nursing home care. 

The following correspondence was sent to the Ageing Minister, Justine Elliot, in October 2009, regarding the concerns of care for George Vassiliou's mother.  It highlights the difficulties faced with many consumers, wrestling with a less than satisfactory system.

The Minister quoted: "The data speaks for itself. It shows the vast majority of nursing homes are providing a world class service, but there is a small group - 46 nursing homes - that had failed to meet 44 accreditation standard outcomes under the Aged Care Act." The problem here is that there is an inbuilt assumption that says that if homes pass accreditation then they are 'ipso facto' delivering a world class service.

Thank you Linda Sparrow for speaking so very well on behalf of the residents and staff of nursing homes. I work as a registered nurse at weekends (I teach ethics at a University during the week) at a nursing home, this is my seventeenth year in the job. The facility has over 50 high care and approximately 40 low care beds; 15 of the high care beds are for dementia patients. At weekends we have two registered nurses and one enrolled nurse for these 100 residents.

I began my career in 1994 , as an Enrolled Nurse (EN)working in Nursing homes. There were quite alot of us back then, we had no Personal Care Attendants(PCA) and I was one of 15 ENs over seen by 2 supervising Registered Nurses (RN). We heard of places that were utilising untrained staff, they were cheap and basically it gave the organization "flexibility".

The PCA had to do whatever role was required back then. Slowly the PCA role seeped into most areas of aged care but there was still a large Trained staff componant.  But in time, and because PCAs were cheaper and more pliable, there was more and more of them.

Many Aged Care Homes have a range of facilities. These include some form of catering as an alternative (and for visitors to purchase food) and hairdressing. Usually there some craft facilities and social/entertainment areas for guests as well as residents. There may well be others at different homes.

One rare but necessary facility which seems to be missing is a consulting room for medical practioners when they visit patients who are residents of homes. A consulting room would allow privacy, provide more appropriate surroundings and include some relevant equipment.

Where are we headed with this Government?

Aged Care Homes that people entered in good faith assuming that they would be cared for in their old age are now closing in greater numbers than ever before forcing Residents to find other places to live.

I am a Recreation Activity Officer (RAS) at a (large) nursing home. This home has a mixture of hostel and nursing home accommodation. I work two 6.5hr days per week for $17 per hour (care service employee grade 2 + 3% negotiated in an AWA 2007). The management restructured all staff's working weeks to 6.5hr days around 3 yrs ago...

As you will understand it is difficult for me to share my frustrating experiences working in aged care...I have been conditioned to expect to be punished for speaking out...

I am a registered nurse working in aged care. Since June 2004 I have worked for an organisation that has used bullying tactics from the highest level of management. This bullying has allowed residents to be bullied and their rights ignored...

I had an interesting question put to me not long back by a carer, what do I get paid an hour to provide respite?. I replied $20, he replied with, "where does the other $37 an hour go, paid for by the State government for me to go in the first place?"...

I would like to see all aged care facilities located with in kindergarten and child care facilities so they do not become forgotten...

"The best good news stories are right under our noses..."

One of many being short staffed and being told by management not to say that we are short staffed....

I feel that the difference between the amount of money spent on the first seven years of life and that on the last should be addressed.

If the government really knew what it was like to be worked like a horse for the said $16.20 per hour, they would have to feel shame.

I have been a personal carer for several years now, and for the last few months working in nursing homes.

I care deeply for my residents and treat every one of them as I would my own grandparent and Iam dissappointed that many people believe that Personal Carers (PC's) are careless or abusive. I guess there are people like that out there, but given that where I work Iam pressured to carry out the ADL's with speed... (aim for 15 minutes/ resident), I am not surprised that residents are injured at times.

My darling mother has been in a W.A. Nursing Home for just over 1 year, and yes I do have concerns about the aged care system.

MEMBERS of the Central Highlands community have again been meeting with consultants appointed to assess the feasibility of a multi-purpose service.

We found out something -- two of the residential aged-care licences allocated to Central Highlands and administered by Ouse District Hospital have been given away by the Department of Health and Human Services to a private residential aged-care facility in Hobart.