We are trying to care for our elderly on the cheap. What an indictment that we seem willing to spend more on defence than we do on the elderly.
There is no market in aged care. That there was a “market” that brought together buyers and sellers to make considered, rational decisions was the justification to privatise the aged care industry about 20 years ago. But it was always a false assumption. Buyers had little choice and sellers were always in a powerful position. The number of older people overall, the numbers with urgent medical needs, and the numbers with dementia are increasing fast and will continue to increase as the community ages.
This market failure is especially so for poorer folk in need; even for the affluent the market is limited. The buyers (older people, their families or frantic social workers in hospitals) find too few available facilities and take what they can. It is not possible to pick and choose – to take what is better and reject what is worse. That is how a market should work. But demand exceeds supply, which puts providers in a powerful position.
It was a mistake to privatise aged care. Private providers who operate for profit too often have scarce regard for the welfare or needs of older people.
We have now a hierarchy of care. “For profit” homes are sometimes awful. Food is poor, personal care is poor, infections spread like wildfire, and support is minimal, while recent television footage has even shown the abuse of some older people. One friend said her husband described his home as a “hell hole”.
“Not for profit” homes are better. More money is available for food and staff wages. The Masonic movement in NSW, for example, operates 22 homes and (properly) made a lot of arrangements to obtain personal protective equipment in light of the pandemic. This was responsible and expensive action.
We have a society where people no longer try to keep the elderly living with them. Smaller houses don’t have space for another generation. Children might not even live in the same district as their elderly parents. If they do remain with their children, they are in loving families, there is a healthy inter-generational mix, while the experience of life that the elderly bring is valuable. Many less-developed societies continue to do this.
But people do get old and emergencies do happen. Older people need care and sometimes relatives with good intentions do not know what to do.
We under-pay workers in aged-care homes and should not be surprised that some of the people who are employed go on to abuse their elderly charges.
Sadly, there is too often “inheritance impatience”, with some people waiting eagerly for their parents to die. A solicitor friend says she spends too much time protecting elderly people from avaricious relatives.
Meanwhile, recommendations made by successive committees of inquiry are ignored regularly and government sanctions are weak.
Aged care providers know they are in the box seat and that they can, and do, operate sub-standard homes. Imagine the furore if older people were suddenly evicted from a home that didn’t measure up. For sanctions to be effective there needs to be a sufficient supply of places and a choice for potential buyers.
We are trying to care for our elderly on the cheap. Poor care is the result. If we want a Rolls Royce system, it will be expensive. And we seem to be ready to spend more on defence than we are willing to spend on the elderly.
It speaks eloquently of our values and priorities.
Peter Erne Baume AC is a retired Australian doctor and politician. He was a Senator for New South Wales from 1974 to 1991, representing the Liberal Party. He served as Minister for Aboriginal Affairs and Minister for Education in the Fraser Government.
Comments
One response to “It was a mistake to privatise aged care”
Recent publicity, including this article and some comments, suggest that private aged care residences are a relatively recent innovation (“the justification to privatise the aged care industry about 20 years ago”). In fact, private aged care residences have existed with government subsidy since nursing homes were introduced as a form of non-acute hospital care more than 50 years ago. Their subsidisation and associated regulation has always been problematic with the profit motive causing some less scrupulous operators to minimise costs with little regard to the impact on quality of care. Government subsidies should never be provided without regulation of outcomes, i.e. assurance of proper care and proper accountability for the expenditure of public money. Current regulation is demonstrably inadequate particularly, but not only, for private operators. The aged care sector needs greater resourcing but the prior questions are the very nature of that care, both home care and residential care, and whether the role of the private sector can be adequately monitored to ensure proper care and proper accountability. The current Royal Commission must answer those questions and identify proper resourcing needs and outcome controls, and the federal government must act on its recommendations.