Quality of aged care: Will you still need me, will you still feed me?

Early this month the Victorian Association of Health and Extended Care (VAHEC) convened a conference involving hundreds of aged care providers from Victoria, New South Wales and South Australia in Mt Gambier. You will be forgiven if you did not notice. Apart from some airtime on Monday March 8, on ABC radio, the conference drew little media interest. Aged care issues, except maybe in an election year or in light of “horror” media stories, fail to capture genuine interest of the community or policy makers. In spite of the importance of the industry, aged care continues to suffer a fragile if not poor reputation. Its funding arrangements are equally as fragile and equally as poor. The industry's inability to pay competitive wages has the potential to undermine recent gains made in quality and service.

Most media interest in health and aged care issues finds expression in bad news stories. Hospital waiting lists, adverse events, a lack of neonatal intensive care beds and sadly, stories about kerosene baths, are genuine headline grabbers. Health related stories come and go but engender little or no long-term interest. Seldom do they generate any momentum for change. They appear as regularly as do stories about successful high school results or toddlers making their way off to school for the first time. They then disappear only to be recycled another time.

Politicians, health and aged care bureaucrats exploit the obviously short attention span of the consumer and usually “weather” these bad news stories unscathed and unchanging. So it is with aged care funding. The election year of 2004 saw some new money flow to the industry. The view of the industry however is that the recurrent funding made available was inadequate and by no means provides it with the capacity to pay reasonable rates of pay.

But in spite of bad press and an extremely challenging funding environment the aged care industry has proven itself to be to be dynamic and resilient. In the 1980s and again in the late 1990s the industry went through two changes. The first change dealt with methods of funding and more closely aligned funds to needs, albeit based on a draconian system of documentary justification. The second more aggressively focused on standards of care and tinkered again with the funding methodology.

Under the influences of these policy initiatives the industry has made great advances. Standards have improved and the industry has moved away from the days when care could be best described as a form of warehousing for our elders. Principles of choice, the preservation of dignity and cultural values and a commitment to continuous improvement are now integral parts of the industry’s practice.

Aged care is under continuous pressure to provide higher and higher standards. The key to high standards of care is in an ability to attract and retain good quality staff. Aged care funding militates against providers attracting the best quality staff as the industry is unable to pay competitive pay rates. In an environment where nurses are becoming increasingly scarce, particularly in rural areas, competition for registered nurses is fierce. In Victoria for example higher pay rates and the existence of higher legislated nurse to patient ratios in the public sector place aged care a poor second in the employment stakes.

It is an anomaly that the Australian aged care industry delivers some of the highest and best forms of aged care services to be found any where in the world, in spite of questionable funding models. So if our aged care is so good how is it that the industry represents itself as being under-funded? The answer is that some one else is paying the price. In part it is the consumer who is now paying in very real terms. But in equal parts it is the nurse and generalist aged care worker at the bedside or on the end of a broom who is underwriting the rest with their poor pay. They do the work, they deliver the standards and they provide the care. As a rule the politicians, boards of management and senior managers lay claim to the improvements and successes. But really it is the nursing and domestic services employees that deliver the goods and often under difficult circumstances.

This relative under-funding in some instances can take its toll on the residents and care recipients. But the staff are similarly affected. They are often tired, over worked and feel that their own personal standards of care and attention to detail are compromised by staffing or equipment shortages: shortages brought about by providers trying to get by on what the federal government offers them.

In most jurisdictions aged care workers are paid substantially less than their counterparts within the acute care and public sector. Some may argue that acute care activity requires higher skill levels and is intrinsically more demanding. Aged care nursing however is equally as demanding and at times more complex, requiring well-developed analytical and practical skills. Indeed, stripped of large amounts of the technological trappings that are sometimes associated with acute care nursing, it could be argued that aged care nursing remains in essence the purest form of nursing given that “nursing” is all that is done: that is, the only real focus of nursing activity in an aged care setting is the person in the bed or lounge chair and not the machines that go “ping!”

A good aged care worker is a valuable resource. But the rates of pay that the industry can afford render any organisation’s mission statement - which might make reference to employees being a highly valued asset - mere rhetoric. The assertion of value is not borne out in the rates of pay we offer those who care for our parents. Like the childcare workers to whom we entrust another of our most precious assets, our children, the pay rates are relatively paltry. Registered nurses are paid less in aged care than their equals in other health sectors and other workers in aged care are paid even less.

It strikes me as ironic that at the beginning of a life and towards the end of a life we entrust those for whom we are ultimately responsible to the care of others. At the same time we seem content not to pay those who care for them what they are worth. It is only when governments see the real value offered by the aged care industry in catering to the needs of our elders that those who deliver the care will get paid at an appropriate level. Realistic funding for aged care that flows through to the workers would represent a real paradigm shift and probably be the start of the next escalation of quality service within aged care.