Far-reaching reform of funding and services crucial for aged care

The Aged Care Royal Commission had laid down its findings. These should be the source of great shame for the Government. But also for Labor – who failed to prioritise the issue over the decades as well. It now falls to Labor Federal Opposition Leader Anthony Albanese to drop the 'small target, 'no new taxes' policy and promise to fund comprehensive, needs-based Aged Care with ongoing and significant progressive tax reform. Labor could plan for incremental reform over a ten year timeframe, peaking at 5 per cent of GDP in new progressive taxation. But aiming for 1% to 1.5% of GDP in a first term.

After scrutiny from the ABC especially in recent years, It should come as little surprise that the Australian Aged Care system has been found to be subject to appalling neglect. The Guardian reports that after over 20 years of 'efficiency dividends' almost $10 billion a year has effectively been ripped out of the Aged Care budget. This funding – and more – needs to be restored.

The Royal Commission has found that since its inception – with the 1997 Aged Care Act – the aim of the system has been to cap costs rather than ensure quality. Australia spends less than half the amount provided for proportionately in the Netherlands for instance. To improve quality, and wind back inequitable user-pays, funding needs to at least double.

On the understanding that the system has been under-resourced for decades, now, Aged Care has lacked nurse and aged care worker ratios. Many workers lack skills, are under-paid, and are demoralised. Casualised labour is common, and makes it difficult for staff to form relationships with residents. Workers often need to move between several workplaces. Experts informing the Royal Commission have concluded that residents require at least 200 minutes of personalised care a day. (including 40 minutes with a Registered Nurse)

It is also notable that about 25% of elderly Australians (over 70) suffer chronic social isolation ; and this needs to be addressed as much as purely-physical needs.

Further ; physical and sexual abuse affects between 13% and 18% of residents, and much greater oversight is necessary to defend their rights and dignity.

Because of inadequate ratios it is not uncommon for aged care workers to try and dress and shower elderly residents in around 6 minutes: which must surely impact on the quality of care. And involve significant trauma. Food is often cheap and un-nutritious. Dental care and other Allied health services are not always adequate. Often 'life' consists of being sat down in front of a TV in a common room all day.

Sometimes people develop bedsores or lay in their own urine or excrement because there is inadequate supervision. There is a desperate need for more facilitated social interaction, and excursions for those capable. People need sunlight, privacy, pleasant surrounds, gardens, books, things to do and aspire to. Rather than receiving specialist care, those with dementia are often literally 'tied down', or 'knocked out' by heavy application of anti-psychotic medications.

A largely privatised system has faced inadequate government scrutiny. With funding already critically low, pressures to provide profits and dividends have driven a culture of 'cutting corners' in the industry, to residents' detriment.

Many who require Aged Care would prefer to stay at home with assistance packages. (this is also more efficient in terms of necessary funding) But waiting lists have hovered at around the 100,000 mark. Many thousands die every year waiting for care that is never delivered. This is also unfair for Carers.

Scott Morrison has injected almost half a billion into the system in response to the Commission's findings. But this is only a small fraction of what is needed. He claims reform will take 'years' ; but in fact the government is still focused on containing costs as opposed to fixing the system. They hope that – with time – people will 'forget' – and pressures for tax reform will recede. Their 'low tax credentials' are more important to them than our vulnerable elderly. Over the long term, Labor is partly to blame as well. If Aged Care was prioritised as much as Covid, reform could be implemented more rapidly.

Aged Care 'for profit' is part of the problem ; but not-for-profits have a hard time sustaining the necessary staff, infrastructure and services also. Profiteers should be driven out of the system. Government and not-for-profits should step in to fill the void.

A robust, dedicated and progressively-structured Aged Care Levy could raise at least $16 billion to be redirected into the system ; enhancing health and social services, improving ratios of aged care workers and nurses , ensuring more personal attention for residents and those requiring care-at-home. Capital should also pay its share, with Company Tax rising by at least one per cent.

Overall, progressive tax should rise as soon as possible (over the short term) by over one per cent of GDP – maybe even 1.5% of GDP. (ie: somewhere between about $16 billion and $24 billion a year) The Morrison Government needs to be pressed to implement these reforms immediately ; but otherwise a new Labor Government needs to implement such change in its first term.