Clare Bruderlin
Australian Prime Minister Scott Morrison announced yesterday that his government will hold a royal commission into the aged care sector.
The decision is a desperate attempt to win support from older voters in the lead up to the next federal election and divert attention from the impact of ongoing cuts and privatisation of the industry by Liberal-National and Labor governments. The royal commission will not complete its investigation or release its findings until after the scheduled election.
Numerous reports, as well as two federal parliamentary inquiries in the past two years alone, have revealed that neglect, mistreatment and shocking conditions are now an everyday reality for an increasing number of the 259,000 people currently living in residential aged care.
Privatisation of Australia’s aged care sector has led to staff reductions and casualisation, the rationing of basic necessities to residents and a precipitous decline in standards.
Recent GEN Aged Care Data reports by the Australian government’s Australian Institute of Health and Welfare (AIHW) reveal that the number of aged care facilities in Australia managed by the government fell rapidly from 14 percent in 2015-16 to just 9 percent in 2016–17. The number of privately managed aged care facilities rose from 21 percent in 2015–16 to 33 percent in 2016–17. A significant portion (58 percent) of aged care facilities are managed by so-called not-for-profit organisations—i.e., charitable, community-based or religious organisations.
A report released in May and based on an audit of 70 aged care facilities by the Queensland Nurses and Midwives Union (QNMU) contains shocking accounts of mistreatment. These include incidents of residents being underfed and under-hydrated, sores and infections left untreated, continence pads being rationed and, as a standard practice across the facilities, bed-bound residents only being showered once a week.
It also revealed that aged residents on average only received 2.5 hours of care by nursing staff per day, well below the recommended 4 hours, and that just 16 percent of staff in the state’s 70 aged care facilities were registered nurses or degree qualified.
Aged care workers surveyed said that under-staffing had resulted in increased workloads and inadequate time to provide the residents with proper care.
Job cuts continue across the sector. In June this year around 120 laundry and kitchen staff at Christadelphian aged care facilities in Queensland and NSW were made redundant without any prior warning that their jobs were at risk.
Late last year, Blue Care cut staffing at its Queensland facilities, including the elimination of 11 out of 17 enrolled nurses’ positions. Nurses’ working hours were also sharply reduced at the Nubeena and NyMylo aged care facilities.
While a recent Australian Aged Care Charities report revealed aged care charities had combined net assets amounting to $15 billion in 2015, the number of full-time staff in not-for-profit aged care facilities fell by 7.7 percent and casual staff numbers increased by 14.4 percent between 2014 and 2016.
Australian governments claim that aged care providers’ services need to meet “quality standards,” but these standards in many crucial areas are low or non-existent. For example, there are no enforceable staff-to-patient ratios and aged care facilities receive accreditation according to the kind of care that the facility is able to provide—not what it actually provides.
Asked about the accreditation process at a Community Affairs Legislation Committee Inquiry in 2010, Mark Brandon, the then-CEO of the Australian government’s Aged Care Standards and Accreditation Agency, admitted: “We do not measure nutrition levels. We look at the standards which we expect will stop malnutrition actually happening.”
However, according to a recent research paper published in the Australia Nutrition and Dietetics journal, malnutrition affects at least one-in-two residential aged care facilities. The paper also compared overall residential aged care facility economic outlay data and found a 5 percent decrease in food cost ($0.31 per person per day) in 2016, particularly in fresh produce, with a simultaneous 128 percent ($0.50 per person per day) increase in cost for supplements and food replacements.
The crisis in aged care has been further exacerbated by ongoing government funding cuts. While the 2018 budget projected an increase in aged care expenditure of $5 billion over four years, this comes after decades of cuts, including almost $3 billion since the 2013–14 budget and an overall reduction in healthcare funding. This has occurred as the number of people entering aged care has increased by 11 percent since 2014 and continues to rise.
The 2018–19 budget, moreover, only provided 14,000 additional home care packages over the next five years. Home care packages provide the elderly with funding to assist everyday needs, such as showering, dressing, meal preparation, transport and sanitation, allowing them to stay in their home for longer.
The most recent Home Care Packages Program Data Report shows that 108,456 people are currently on the waiting list for home care packages in the 2018 January to March quarter, up 3.7 percent on the previous quarter. This situation could see more elderly people forced to seek residential care.
Overall cuts in healthca re funding have also impacted on the quality of care provided to the elderly. An Australian Medical Association (AMA) survey released at the end of July revealed that 20 percent of medical practitioners planned to decrease their visits to residential aged care facilities. Almost 49 percent cited increasing unpaid non-face-to-face time as the reason while 40 percent said they were working in very busy practices.
The survey also asked doctors about access to particular services for aged care residence patients. Over 48 percent said it was “very difficult’ for aged care residents to access mobile x-ray and ultrasound services; and 27.6 percent reported difficulties accessing secondary support and consultation with specialists.
Lack of access to critical medical treatment and inadequate levels of care has had devastating consequences. A Medical Journal of Australia study in 2017 recorded 3,291 premature deaths in aged care nursing homes from potentially preventable causes between 2000 and 2013. It also found that preventable deaths had increased more than four-fold over a decade.
Labor and Liberal-National governments alike have maintained a systematic attack on aged care provision and the health workers’ conditions in the sector.
Under the Gillard Labor government in 2012, the Australian Nurses Federation (predecessor of the Australian Nurses and Midwives Federation) reported that there was a shortage of 20,000 aged care nurses and that they were paid between $168 and $300 less per week than nurses working in public hospitals.
By 2013, after six years of Labor rule, numerous reports by families, staff and volunteers pointed to ongoing chronic conditions and a plethora of abuses suffered by residents in aged care.
An ABC-TV “Lateline” investigation drew some of these together in a damning report that year. The show provided detailed accounts of residents left for days in soiled pads or bedding; poor nutrition and hydration; incorrectly or infrequently administered medication, and untreated broken bones and infections leading to many incidents of premature and preventable deaths.
“Lateline” declared: “Many elderly people are being left to die unnecessarily or are in great pain because of a critical lack of staff and training in many of Australia’s nursing homes. Only one in five are receiving proper palliative care. Up to 50 percent of residents are malnourished, with some people being left for entire days in soiled nappies.”
The deplorable state of aged care was described at the time by various advocacy groups, politicians and sections of the media as a “national state of emergency.” Five years on the crisis has only deepened.
The Australian Nurses and Midwives Federation (ANMF) and the Health Services Union (HSU), which cover aged care workers, have played a pivotal role in this process.
Like all the other health sector unions, they have worked to contain workers’ opposition to the staff reductions and casualisation, imposing one regressive enterprise work agreement (EA) after another, cutting wages and conditions. The latest EA brokered by the ANMF covering workers at Bupa aged care facilities, is typical. It included a pay increase of just 11.25 percent over five years, a little over 2 percent per year and barely covering inflation. ANMF members had called for a 14 percent increase, pay parity with public sector nurses and the introduction of minimum nurse-to-patient ratios.
The unions are now attempting to divert the widespread anger amongst aged care workers behind the ANMF’s current “Ratios for Aged Care” campaign and the Australian Council of Trade Union’s “Change the Rules” protests. Both campaigns are aimed at the election of yet another Labor government, whose pro-market policies are responsible for the increasing catastrophe in the sector.
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