Time for a 'forensic' check-up – aged care sector

The shortcomings of our aged care system and how to fix it are the focus of two authoritative analyses by the Australian Health Services Research Institute (AHSR), University of Wollongong, and business advisory firm Grant Thornton.

Staff shortages

In the latest issue of the Medical Journal of Australia, a perspectives article authored by the AHSR highlights the ongoing health care staff shortages in aged care facilities.  

It says more than half of all aged care residents are in facilities that have inadequate staffing levels. In contrast only 1.3 per cent of residents are in facilities with the highest rating that the authors consider best-practice.

To bring Australia up to a three-star standard a staffing increase of 20% across Australia was needed. For all residents to be receiving four-star level of care, staffing would need to increase by 37.2%.

According to the article part of the problem is the increasing trend towards home style residential aged care facilities (RACF) versus the traditional nursing care model.

The Aged Care Act was updated in 1997 and aged care was conceptualised as a lifestyle choice where people were living in a home rather than an institution. However, the people using aged care facilities are different now to those who were 20 years ago the article said.

These days, only 15% of the residents in residential homes are independently mobile, with 50% needing mobility assistance and 35% not mobile at all.

Forensic audit needed

Responding to the article, Professor Joe Ibrahim, Head of Monash University’s Health Law and Ageing Research Unit, called for a forensic examination of aged care homes in order to see through the sector’s lack of transparency for what things cost. RACFs are currently not required to disclose how many staff they have nor how they spend government funding.

“Then we will know where the money is being spent. We will see if they don’t have enough money or if it’s not being managed as well as it can be. Or whether the market forces are such that no matter how brilliant they are, it’s always going to be a struggle. At the moment we can’t really tell which of those scenarios are there,” Dr Ibrahim said.

When compared with international staffing benchmarks, Australia’s aged care homes meet none of the minimum criteria for adequate staffing.

Consumer rights

  1. The AHSR article asserted:
  2. That consumers and their families have the right to high quality and safe services from every provider and worker.
  3. Workers need to be respected for the work they do in caring for the elderly. They are highly skilled and will adapt to a more consumer-centric model that provides pathways for them to learn and grow within the industry.
  4. Providers have a significant role and commitment to make sure the sector delivers the best care possible to the people we support and will not be passive in advocating for a system that delivers it.
  5. Government needs to recognise its role and make an undertaking for systemic reform rather than tinkering around the edges. This will come with increased risk and will require courage, willingness and commitment to change.
  6. Our community needs to better understand the life changes that come with ageing and how services support people through those changes. Our community needs to better understand and accept death and dying as one of those transitions.

New road map

An industry report by Grant Thornton calls for a refresh of the federal 2016 aged care roadmap and a phased approach to transformation with changing funding arrangements along the way to drive change and stimulate reform, investment and sustainability.

The report arose from workshops with provider executives, and what lead author Darrell Price described as the diverse and “sometimes contradictory experiences of the providers”.

“The aged care system in Australia requires structural reform to address the issues experienced by both consumers and providers,” Mr Price told Australia Ageing Agenda.

The report questions whether aged care services could be more effectively delivered in a free market or in a social enterprise with more support and oversight from government.

“At the moment we seem to have a hybrid where the industry has enjoyed the benefits of external capital in the development of new facilities, while the government restricts supply through bed licence and pricing,” Mr Price said.

Right time for change

He said the time is right to have these conversations and change the way the sector is funded and supported.

“The Prime Minister has said that everything is up for review and on the table. Some of the options we’ve put forward could and should certainly be considered as part of the larger reform discussion,” Mr Price said.

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