The Australian government’s Royal Commission into Aged Care Quality and Safety recently released its final report. The inquiry held 23 public hearings over two years and received more than 10,000 submissions from aged care residents and their families, staff, providers and government agencies.
The submissions revealed a catastrophic crisis. Virtually no aspect of the aged care system is accessible, transparent, affordable and adequately funded or staffed. Yet the report conceded that its findings are fundamentally no different to those in numerous previous inquiries.
Commissioner Tony Pagone stated: “The problems in the aged care system are neither new nor unknown. There have been more than twenty substantial official inquiries into aspects of the aged care system over the past twenty years. Many of these inquires have made similar findings and offered similar recommendations for improvement to those that we make in this report. The responses by successive governments have failed to tackle the underlying problems.”
Prime Minister Scott Morrison announced the inquiry in September 2018, in an effort to quell public anger over media revelations of the abuse, malnourishment and neglect of many elderly residents of nursing homes, and to divert attention from the impact of ongoing cuts and privatisation of the industry by Liberal-National and Labor governments alike.
As with the previous inquiries, this one acts as a cover for those responsible for these conditions. In its final hearing, it stated: “Now is not the time for blame. There is too much at stake. We are left in no doubt that people, governments and government departments have worked tirelessly to avert, contain and respond to this human tragedy.”
The final report, entitled “Care, Dignity and Respect,” made 148 recommendations. Whilst these were characterised as a “call for fundamental reform of the aged care system,” they were predominately administrative measures that do not deal directly with the quality of aged care services.
Many of the recommendations centred around the adoption of a new Aged Care Act, which should be aimed at “ensuring the safety, health and wellbeing of people receiving aged care,” and include a “universal entitlement for high quality and safe care based on assessed need.” The commissioners recommended that the new Act list “rights of older people receiving aged care,” but these only “may be taken into account in interpreting the Act.”
Moreover, a proposal for National Decision-Making Principles to guide the drafting of relevant federal, state and territory laws was made in 2014 by the Australian Law Reform Commission (ALRC). The same recommendation was repeated in a further 2017 ALRC inquiry.
Other recommendations included the creation of an “independent office of the Inspector-General of Aged Care to investigate, monitor and report on the administration and governance of the aged care system,” a “review of certificate-based courses for aged care,” and a “review of aged care quality standards.” Previous inquiries have made similar calls for reviews.
The recommendations are not enforceable or mandatory, nor is a five-year time frame set for the government to implement them. There was also disagreement between the commissioners on 43 recommendations, primarily on questions of funding and governance.
In a press conference, Morrison signalled that the government has no intention of taking any action to address even the “urgent and short-term” priorities set out by the report. He stated: “I thank the commissioners because they know there are no easy fixes… It will take quite considerable time to achieve the scale of change that we want to and need to.”
Likewise, opposition Labor Party leader Anthony Albanese said: “Labor will take time to digest and work our way through the recommendations of the Royal Commission.”
According to the report, in order to implement its recommendations, government funding would need to increase by $10 to $20 billion a year. Morrison announced a meagre $452.2 million package—less than the $537 million pledged in response to the inquiry’s interim report in November 2019.
This is in line with the government’s response to the coronavirus pandemic, which resulted in the deaths of more than 600 aged care residents and the infection of over 1,700 aged care workers. Just $1.8 billion was pledged to aged care services to cope with COVID-19, a fraction of the hundreds of billions allocated to bail out big business.
Professor Joseph Ibrahim, Head of the Health Law and Ageing Research Unit at Monash University, commented: “Saying it will take five years to get anything done means another 200,000 older people will have lived and died in aged care before we see a change. The $450 million that has been allocated now is less than 3 percent of the total annual budget for aged care, so it’s really just, it’s not very much at all.”
The report outlined four concerns for immediate attention: food and nutrition, dementia care, the use of restrictive practices and palliative care. But the recommendations, even if implemented, would do nothing to significantly improve the lives of those in aged care.
The commissioners recommended an immediate increase to aged care residents’ Basic Daily Fee of $10 per resident per day, to pay for living needs “including nutrition.” This was described as an “urgent need for action,” yet it is only proposed to be implemented by July 1.
Submissions from the public showed that despite the extraction of 85 percent of the aged pension from every resident, the average amount spent on food in these facilities is just $6.08 per resident per day. The single aged pension is $944.30 per fortnight, 85 percent of which amounts to $802.66. Of this, just $85.12 is expended on food, meant to cover three meals a day and morning and afternoon tea.
The inquiry heard that widespread understaffing means that many aged care workers do not have the time or training or provide adequate care for residents, particularly for those with high-care needs like dementia.
Yet the report only recommended that by July 2023, the government should “establish a dementia support pathway to provide a comprehensive, clear and accessible post-diagnosis support pathway for people living with dementia, their families and carers.” In the same time frame, it recommended that the government should merely “review and publicly report on,” the state of specialist dementia care services.
Despite commissioning a report by the University of Wollongong’s Centre for Health Service Development which found that, on average, each resident in a residential aged care facility receives 180 minutes of care per day, of which just 36 minutes are provided by registered nurses, the inquiry’s recommended time frame to address this is 2022.
By 2022, the report recommended an abysmal 200 minutes, or around 3.5 hours, of care per resident day—an increase of just 20 minutes—of which 40 minutes would be provided by registered nurses. By 2024, it recommended an increase to 215 minutes of care per day, with 44 minutes to be provided by registered nurses.
Also by 2024, the standard would require at least one registered nurse on site at each residential aged care facility at all times. But no staff-to-patient ratios were proposed.
The trade unions welcomed the report. They have facilitated the privatisation of aged care and the attacks on workers’ wages and conditions by suppressing strike action and enforcing regressive enterprise bargaining agreements for decades.
The Australian Nurses and Midwives Federation called on the government to “urgently respond” to the report’s “recognition that staffing levels in aged care are too low and that staff ratios should be introduced.”
The Health Services Union (HSU) said its members were “hoping this report will finally provide the impetus to change the system for good.” It claimed that government and opposition members were “open to another HSU suggestion,” a possible aged care levy. It insisted: “The future looks brighter.”
In reality, the appalling conditions in aged care, which have worsened during the coronavirus pandemic, can be explained only as a result of the capitalist system, which subordinates everything, including life itself, to the interests of private profit.
Unless the working class undertakes independent political action in defence of the elderly, which means fighting for a workers’ government to expropriate the corporate health empires and major banks and corporations, these conditions will continue to deteriorate.