The local Hub and its central representation would be active in advocating for improvements and changes in aged care. It would keep the community informed and foster community debate about aged care issues.

Staffing is a key area for advocacy, but there is an advocacy role in dealing with issues involving providers, politics, community and nursing staff.

Example: Staffing issues

Staffing: Staffing is a critical issue in aged care. Staffing levels, expertise and motivation are the most important determinants of care. Staff salaries are by far the most costly item, accounting for in excess of 60% of the costs of nursing home care. Other costs are relatively fixed so that staffing is the first to suffer when funding is cut or when profits are taken.

There is no basic staffing level for "best care". The better the staffing the better the care that is possible, although other factors might impact the actual care provided. Currently there is no way in which families or the community can find out the actual levels of staffing. It is a sensitive issue for providers and the government.

There has been ongoing concern that care is being compromised because money is being taken from care (namely staffing) to fuel profitability and financial performance in far-away markets.

There has been strong advocacy for minimum staffing levels as we have in childcare but this has been tenaciously resisted. Governments have all refused to consider this option, reinforcing community suspicions that staffing is seriously deficient and that the government knows this but won't spend more money.

In a functioning democracy, unimpeded by silos hiding information, it would be the community who would debate the need for more money and indicate to government whether they would be prepared to pay more in taxes to provide more staff or not. They would decide where the line should be drawn.

Nursing homes themselves do not publicly disclose their staffing rosters and are not legislatively required to do so.

Other advocating by the hub

Role of the hub: The hub would be well placed to monitor staffing, to remonstrate when profits are excessive because of under-staffing, and to support local managers in lobbying the corporate owner for better staffing. When funding is inadequate to allow acceptable staffing then the community, through its hub, would join with their provider partners to open community discussion and, if the community was willing, then to press for relief.

Politics: Budget pressures and the nature of political process ensure that those sectors where budget cuts will have fewer political consequences suffer most, or benefit least, when available funds are allocated. Our two-party system has strayed a long way from the Athenian democratic ideal where citizens debate and vote on each issue. Many voters feel disempowered and uninvolved.

We are not able to detach single issues from the package of political policies that we are offered. There are practical reasons for this, but the nearer we get to the Athenian ideal the better we would be served. Modern technology makes a more dispersed decision-making process a practical possibility. The politicians who we elect to serve us and respond to our views have not fully embraced this sort of technology.

Community: Ultimately it should be an informed public that discusses, listens to opinion and makes the way it wants the money divided up clear to government. The aged are not entitled to an excess of resources, but it is the community that must indicate how much of our money should go to staffing, and what should be cut instead - or whether taxes should be increased to make up any shortfall.

The hub and its representatives would play an important role in combating ill-informed political rhetoric and in bringing issues about aged care, like funding for staff, before the public. They could facilitate the sort of informed discussion that would send clear messages about the community's priorities.

Supporting staff: The Community, encouraged by its hub, could go a long way to help in staffing by giving positive feedback to staff, involving, encouraging and rewarding them, and making their efforts worth while. These staff are a valuable part of a community endeavor. They are much more than an employee of a commercial provider.

The community could push for career paths, help in recruiting staff to local facilities, and promote aged care as a rewarding and worthwhile career. They could give it status.

Government Advocacy Services: The government does have an advocacy service. It contracts this to operators in each state. It operates by advocating for individuals who have difficulties with the aged care system. It seems to be relatively low key and for one reason or another, has not been used or not there in most of the examples of failure that Aged Care Crisis is aware of. Its advocates do not participate in the public debates about staffing, CDC and other issues.  Their primary role is helping individuals with issues involving providers or the system. These are matters on which they should be well positioned to comment - yet they are silent.

That service could be considerably improved if it were to operate through and mentor advocacy by the proposed aged care hub.

Asking for feedback: Submissions to a Review of Commonwealth Aged Care Advocacy Services closed on 4th September 2015. The department confirmed to ACC that neither the submissions nor the report will be made public and so available for discussion.

Aged Care Crisis has made a submission arguing that advocacy would be much better provided through the agency of local community groups that would also be responsible for all of the other services proposed on this web site - in other words the proposed aged care hub. This would ensure that all of the oversight processes protecting and supporting consumers are integrated and work together.

Aged care Crisis is concerned that once again submissions and the report are not to be made public. I will say more about this submission in Part 4. Information and a link to ACC's submission can be found on the contributions page where we invite comment. The debate about advocacy is opened up on that page as part of the wider Solving Aged Care discussion

We would love to hear your thoughts on the direction aged care should take in order to make life worth living and working in Australian nursing homes: Join our conversation  Author: Dr. Michael Wynne, Copyright 2015