The crisis of aged care in Australia has many dimensions, however. It is a problem of dire dimensions here and now - not merely “some time in the future”.
Insufficient staff skills and numbers
In correspondence with Charmaine Crowe, the Policy Co-ordinator of the Combined Pensioners and Superannuants Association (CPSA), I was informed of immediate crises in the standard and affordability of aged care.
Ms Crowe explained that one of the most essential elements of quality care are “staff numbers and skill mix”. Apparently “there are no mandatory staff/skill mix ratios”. The lack of trained staff comprises “the number one [reason] behind poor standards of care”.
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Decent wages, subsidised training, recognised career paths, are all necessary to attract the best quality carers to the sector. Studies appear to back up these claims. A report on the aged care workforce by the National Institute of Labour Studies at Flinders University found that (in 2008):
Registered nurses in aged care are reputed to earn $250 to $300 a week less than their colleagues in acute care.
Furthermore, “the number of registered nurses in aged care [had] reduced from 21 per cent to 16 per cent”.
Residents requiring a higher level of care often need to be “turned” on a regular basis to avoid bedsores. And in case of incontinence, nurses need check on the conditions of residents regularly, and must be able to assist in showering and washing residents whenever the need arises. Diligence, and sensitivity to the dignity and humanity of residents is critical.
Against aged care as a business
According to Crowe, “for-profit” aged care is counter-productive. There is a contradiction, here, between an ethic of providing the greatest care and respect, and the motive of maximising profit and share-value. Ideally, there ought to be a mix of public and private providers - where private providers are run on a “not-for-profit” basis - managed by charities, churches and other community organisations.
Whatever the mix, though, measures of accountability and transparency are key.
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Accountability
Crowe, speaking on behalf of the CPSA, condemned the accreditation and monitoring process for residential aged care in Australia. There are many dimensions to the problem: but the inability of vulnerable patients to hold their carers accountable - often because of dementia and other conditions - is a central concern. According to the citizens’ group “Aged Care Crisis”, there is a deep and disturbing culture in areas of “aged care industry” whereby standards of care are often unmet, and even after warnings there is non compliance.
A parliamentary report “on the operation of nursing homes … mentioned 46 nursing homes not meeting standards as at June 30, 2008.” These numbers, however, are deceptive. Originally 199 homes “failed to meet at least one of the 44 standards”. The figure of “46 homes” only applied to “those still non-compliant at the end of the year".
In other words, apparently 7 per cent of homes “had failed to meet at least one of the 44 standards in the last financial year”. In addition, the Department of Health and Ageing, received many complaints. Out of 2,830 nursing homes, there were 11,323 complaints, 66 per cent of which were investigated. Areas of concern included: health and personal care 3,106 cases; physical environment 1,598 cases; communication 1,496 cases; personnel 1,255 cases; abuse 1,117 cases.
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