Intense criticism about staffing led to the 2016 Aged Care Workforce Inquiry which revealed that there were indeed major deficiencies in the number and training of staff. Much of the criticism was that the industry was putting profits before care and that they, and the managerial culture were largely responsible for what had happened.
These were the organisations whose influence led to the removal of all nursing requirements in 1998 and then to the Work Choices legislation that that prevented the unions from resisting staff cuts.
Incredibly, the government then set up an industry driven Aged Care Workforce Strategy Taskforce (the taskforce) to develop a policy to address the problem. They brought in John Pollaers to lead the industry driven process. He is a very successful businessman who had experience with Pacific Brands and then made his name in the global business world. He has helped government on a number of occasions. The taskforce was stacked with industry, government and other supporters of the system.
This faith in industry managers, boards and consultants is a reflection of the way the sector has been run for 20 years. These are the people who have consistently been appointed to advise government and help them make decisions. The vast majority have management, market and financial qualifications and experience.
Few have any experience in actually providing care particularly aged care. These are the people that the discourse sees as credible and effective.
This is entirely consistent with neoliberal thinking. These are the people they see as credible and on whose advice they rely. They turn to them whenever they have a problem they can’t deal with themselves. This inability to think outside a particular pattern of ideas is called 'paradigm paralysis'. That this paradigm paralysis lies at the root of our political and regulatory failures across society is readily apparent. As a consequence, our citizens are ready to move on into the 21st century while the political process is locked into the 20th century and its obsolete ideologies.
An exercise in public relations
The process commenced with a summit meeting to which advocacy groups including Aged Care Crisis were invited. It was disturbing that the first discussion session started not with data, but with a motivational and branding exercise.
It was led after the introductory session by a “Global business strategist and cultural anthropologist” and a “global brand strategist” who addressed “the cultural phenomenon of branding and its power to unite, define and dramatically dictate people’s behaviours within companies and communities”.
This effectively countered any tendency on the part of participants to be truly introspective, to look critically and in depth at what was happening and challenge the neoliberal discourse on which policy and corporate success depended.
Many of those attending were young and would have had limited experience, yet no basic data about current staffing levels was supplied nor did anyone give information about the history of aged care and the way it had developed.
Data should have been available from the nursing unions and from StewartBrown and Bentleys who both collect it. This would have shown the extent of the problem and led to a discussion about what was actually required.
As a consequence, the sessions dissolved into the sharing of often feel good opinions and did not come to grips with the issues. Those advocacy groups like Aged Care Crisis who were critical of the process were not invited back to the second summit.
We are left with the impression that all of the real discussion took place in the taskforce itself and that these summits were feel good publicity exercises to show that they had discussed widely and everyone had input and felt good about it.
2017/18: The taskforce report
The taskforce report was interesting because it did write about many of the problems in staffing and it did propose a large number of processes for retraining, recruiting and addressing its objectives. It also spoke about providing good care so was also a motivational document.
Developed with and for industry: We think the problem with the report is that this is an industry led and organised “reform” process and it is doing it for the industry. It starts off by indicating at the start of the second paragraph that "This strategy - developed with the industry, for the industry". That is its problem. The report at one point even indicates that it is “working for the collective good of the industry” (page 98). It has “identified a shared and unifying belief for the industry”.
We are not persuaded that the collective interest of the residents, their families and the community received as much attention.
The report carefully avoids giving actual staffing data and ratios for Australia or comparing them to show how poorly they compare with the USA and Canada. This data had been sent directly to Pollaers. There was no attempt to develop any sort of formula to calculate what would be required in different situations, or to collect the sort of data that would allow anyone to evaluate whether it was adequate. So it takes us no further in the debate about how to regulate staffing.
It skates around the issue of ratios and like every industry body, it rejects them. We must remember that the profitability of the sector depends on its ability to save money on staffing. This is what attracted many of them to the industry and without it their shareholders will not get the profits they are used to - or the managers their bonuses.
A number of small points illustrate the problem:
- The report refers uncritically to 55 to 60% of provider expenses as being employee related, whereas 70% or more would probably be needed for good care given the increasing acuity of the residents over the years. To a businessman, this is efficiency and not understaffing.
- It uncritically adopts the industry argument that the sector is “experiencing rising consumer expectations and other significant changes, much outside its direct control”. For 20 years industry and government have been advertising their ‘world class’ system. Glossy brochures, magnificent websites and television advertisements have been promising an impossible lifestyle and experience – and of course the unrealistic “wish for greater choice” when the residents who are lucky enough to have made a good choice have no choice about who they will be sold off to as the industry consolidates. If this is a problem, then they created it.
- There are the usual claims to a “tightly regulated market” when it is clear it is anything but.
- There is no attempt to even consider the possibility that the “negative societal attitudes to ageing and public portrayals of ageing” are well deserved because the problems in the system are systemic and closely tied to the marketised structure and the neoliberal ideology on which it is based.
The report does create processes and multiple committees to implement its reforms and drive the processes.
The major and most critical reform and the one it all depends on is "A voluntary aged care industry code of practice".
"An expert with extensive experience in drafting and consulting on industry self-regulatory codes was commissioned to assist the taskforce in preparing a principles-based code for the aged care industry".
Following the recent scandals exposing the exploitation of vulnerable citizens in multiple failed markets in Australia, particularly the exposure of banking self-regulation by the Royal Commission, we are expected to accept self-regulation in aged care. Surely we are not as gullible as that.
This is the same industry that:
- persuaded government to remove financial accountability in 1997, remove the final vestiges of staffing requirements in 1998, and then were reluctant to invest in 2005 until the Unions fighting to improve staffing were disempowered by "Work Choices"; and
- has been denying failures and understaffing for 21 years - an industry whose failures have just been exposed on 4-Corners. They have shown that they cannot be trusted and they have the nerve to come back and ask us to trust them once more.
This is a managerialist report. There are many good ideas (working and career opportunities are very important), but they are set within the wrong context.
The possibility of a competitive profit driven industry adopting voluntary codes in order to achieve the lofty goals must be small. One wonders whether there will be funding left over for staff when the costs of the management structures and processes being put in place are added to this expensive taskforce exercise.
Who is responsible for aged care and what drives it?
Aged care is every person and every community’s responsibility and it is through involvement and “ownership” that citizens build their values and learn to empathize. Staff are drawn from these communities. They are motivated by the altruism and values in those communities. They are rewarded by the relationships they form in caring. This is not the language of managerialism or how business thinks. It gets little attention in this report. Values are ignored and altruism languishes.
Increasingly we are learning that social services are better when local communities have sufficient control to give them a sense of ownership. Remote aboriginal communities get token involvement and perhaps some ownership. The rest of us are denied this.
Comment - 2017/18 Taskforce Report: This is a report for the large corporate providers, for large nursing homes, and for a government that supports consolidation in the face of evidence. Both large corporatised businesses, and large nursing homes are generally associated with poorer outcomes.
Pollaers is well meaning and used his business experience and knowledge as best he could, but his was the wrong experience for the job. It is not his fault but the government’s because they picked the man who would give them what they and their backers wanted.
Source: Extract - ACC Submission to Inquiry into the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018