Joseph Ibrahim: More money alone will not transform the sector
We are all looking forward to the federal budget with an expectation of signs that indicate substantive reforms of the aged care sector. We must be mindful of the realities. The budget is framed for the next 12 months with long-term projections which are guesses into the future. Each year brings a new budget; past promises are broken, and new ones made.
A windfall for aged care is likely, but not necessarily cause for hope for two reasons. First, the additional funding into the sector will be needed to cover an expansion of the existing system, for example more home care packages, more audits from the regulator, more support for approved providers to maintain operations and more for advocacy agencies. Second, more money alone will not transform the aged care sector. The underlying issues require massive systemic changes in legislation, regulation, enforcement of standards, workforce recruitment and training, better models of care, and integration of health care into aged care.
The reforms needed for aged care will take time to implement. Aged care needs better long-term resourcing, not just one big year of increased funding. While we do need a cash injection upfront to make up lost ground and ensure all providers are achieving the basic minimum standards of care, the long-term plan is the most important.
We should look at the budget to see whether it indicates a thoughtful, transparent approach to planning for a better aged care system. It is more important to consider where and how the funding is allocated, not just how much.
So, do we really want a government to be spending money when it has not even finished thinking through the strategic plan for reform? No matter what happens on budget night, remember, the official government response to the royal commission is due on 31 May – three weeks after the budget is delivered. True change will only occur if the community holds governments accountable.
• Joseph E Ibrahim, professor and head of Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University; Victorian Institute Forensic Medicine; affiliated faculty, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
Sarah Holland-Batt: Financial transparency is needed
After the appalling human rights abuses exposed by the royal commission, aged care must be the cornerstone of the federal budget. Most critically, the budget must address the chronic understaffing plaguing the sector. To lift the standard, we need budget measures dedicated to establishing national staffing minimums, ensuring residential nurses are on site in facilities 24 hours a day, enhancing staff skills – including dementia and palliative care training – and adequately remunerating the casualised, undervalued aged care workforce, who presently earn less than retail workers.
The unacceptably high home care waitlist – which sees thousands of older Australians dying each year while waiting for care – must be cleared by the end of 2021. To achieve this, the government will need not only to fund the remaining packages, but also develop measures to attract quality providers into the market, which the royal commission heard is dominated by “bottom feeders”.
And in order to ensure meaningful consequences for providers who repeatedly fail care standards, the budget should plan for a complete overhaul of the floundering aged care regulator. While the commissioners were divided on whether there should be an independent body overseeing aged care or a new regulator, both agreed that the current oversight mechanisms are a dismal failure. The budget must respond to these calls.
Pre-budget leaks indicate that the government intends to commit $10bn to the sector over four years. Economic forecasts indicate this is a fraction of what is required to cover the royal commission’s recommendations. However, unless the government introduces financial transparency measures, the exact figure it allocates to aged care is meaningless. We know that under current funding arrangements, an increase in taxpayer funding does not necessarily equate to an increase in staffing or improved care.
The same intransigent profiteering and cratering care standards we have seen for years will continue unless the government introduces financial transparency measures to ensure funding goes to care provision. Only then will the public have confidence that the federal budget’s investment in aged care will benefit the vulnerable older Australians who so desperately need it.
• Sarah Holland-Batt is an associate professor of creative writing at QUT and an aged care advocate
Sarah Russell: Workforce the highest priority
Private providers of aged care, on whose watch thousands of elderly Australians have experienced appalling neglect over many years, are unimpressed by the Morrison government’s reported plans to give an additional $10bn over four years to the sector.
The budget’s highest priority should be the workforce. The aged care sector needs to employ more, and better trained, staff for both residential and home care. These staff need to be paid decently. There should also not be a gap between wages paid to aged care staff and those paid to hospital staff. As the royal commission final report noted: “Successive governments have made several failed attempts to address that gap by providing additional funds to providers in the hope [my italics] that they would be passed on to aged care workers by way of increased wages. They were not.”
We need specific accountability measures for aged care providers to ensure extra government money is spent on the things that lead to better care for residents and support for recipients of home care packages.
Before the government hands out more home care packages, mechanisms must be put in place to prevent potential rorting in the system. The costs for administration and case management vary enormously. There are also significant differences in the hourly rates providers pay support workers.
The budget must include transparency and accountability from providers and government on all funding. The Department must not claim commercial-in- confidence. This is taxpayers’ money and the public has a right to know.
• Dr Sarah Russell is a public health researcher and aged care advocate