A number of articles and presentations suggest that family members have "unrealistic expectations" in aged care.  However, there are major problems in the aged care system and too many residents are suffering as a result.  

Claims about "unrealistic expectations" are a cop out.  If some have unrealistic expectations, it's because of the branding and marketing by the aged care industry and the unrealistic image of a "world class system" promoted by government.  

For the last two decades, industry and government have been advertising their ‘world class' system. If they want world class, have a look at Norway, Sweden and the USA for theirs is truly world class.

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 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.

Confronting problems with illusions, not solutions

Instead of confronting the root causes of the problems, the aversion to "negative" accounts of aged care are countered with positive image campaigns and marketing. Problems are seen in terms of images and perceptions and too often are addressed by trying to create positive images. These serve to obscure the real situation.

Voluntary code of practice and a public relations campaign: The antidote recommended by the Aged Care Workforce Strategy Taskforce was for a "voluntary industry code of practice" along with a "social change campaign" to "change negative attitudes to ageing".

What could be more destructive of trust and ultimately result in more disillusionment?

Negative stories are important because they expose the unacceptable things that are happening and that is why people focus on them.  Without that, the system would continue down the same path. What is needed is structural reform and we are pressing strongly for that.

Sadly, systems that are built on illusions and obtain their objectives by illusion have very real consequences for some and in this case it is not only the frail residents, but the newly trained and naïve school leavers who can very soon find themselves trapped in the sort of facilities the submissions to inquiries describe and then suffering from the psychological consequences of the stress and disillusionment.

Claims to "world class" or even good care, need to be validated.  Major changes are needed starting with the collection and comparison of accurate data about failures in care, staffing and expenditure. Further funding must be based on accurate and verifiable data and full accountability to the public.

In the absence of accurate objective data we need to listen to those at the bedside. Worrying are the many allegations of poor care, cost cutting, profitability of some corporations and diversion of resources from care to meet the demands of a competitive market. 

Structural reforms needed

Since 1997, there has been extensive rhetoric and impression management to create the perception that aged care has been improving. The changes in 1997 left the community, the elderly and their families ill-informed and ineffective so creating a large imbalance of power between providers on the one hand and anxious family on the other. The community could no longer contribute to policy. Minister after minister has become minister for the industry, not for the community.

Luxury facilities have been built and glossy advertising brochures and impressive websites developed. Most have accepted this claimed improvement uncritically.  At the same time, staffing levels and skilled staff have declined.

Increasingly, industry conferences have been dominated by business consultants and like presentations, revealing how far the discourse has changed from care to profits.

'We are the best in the world'

" ... The Australian aged care system is a global benchmark for best practice, thanks to strong government funding, a robust framework for accreditation, quality and regulation, and a long history of cooperation between government, service providers and the community ... "

Source: Industry Capability Report - Aged Care, Introduction, Selling Australia's ‘world class' aged care system
Australian Trade and Investment Commission (Austrade), Australian Trade Commission

The Australian Government's Austrade website proudly boasts of our aged care systems 'Industrial Strengths' claiming "The aged care system in Australia is one of the most thoroughly regulated in the world and is used as a model by many other countries".

Our claim to be able to provide good care in Asia (and elsewhere around the world) under our trade agreements rests on this rock. It was made of papier mache and is now a sodden mess. It is time to stop pretending and fix the system rather than paper over it again. The Netherlands, Finland and Sweden spend the most. As for the most thoroughly regulated? The evidence speaks for itself.

The real situation in Australia: Regulation, particularly accreditation is a process that has failed consistently and repeatedly since the late 1990s. It has been extensively criticised in the Senate and the House of Representatives inquiries, by nurses and by those families whose complaints have resulted in an accreditation whitewash. This has had little impact and the fundamental problems have been ignored.

It is now clear that all of the assurances we have been given were invalid. We need to question the performance of the entire aged care sector much more widely. For years, any form of accountability has been rejected by industry. Since the Productivity Commission 2011 report into aged care, industry does not even want to disclose how much staff actually looks after residents.

Their campaign against having staff to resident ratios they have called on ABC's 4 Corners: a "blunt instrument". Yet, they would not even let us know if they have any staff at all looking after your loved ones.

It has become so ludicrous, that one South Australian MP, Rebekah Sharkie, has presented a Bill (now an Inquiry) for Disclosing Staffing Ratios before Parliament. The suggestion that homes should disclose their direct care staffing information has been met with stiff opposition by the sector. What are they hiding?

Industry receives 70% of its income from government - us taxpayers - yet they do not even want to let us know how much and what type of people are employed looking after our own parents or loved ones.

The simple question is: how many nurses do they have on one 24-hour shift looking after how many residents? The answer from industry has been a total shut down. They are only required by legislation to have "adequate care" which is a misnomer if any.

This is the tail wagging the dog.

Selling us snake oil

"Choice" as the guiding principle in aged care (the Aged Care Roadmap): As is clear from the Aged Care Roadmap "choice" and sometimes with "control" added is the rationale and justification used by the neoliberal believers who designed the roadmap. This is the carrot being sold to the public.

This framework is based on the misconception that most, if not all aged care residents, are capable of being effective customers or 'consumers', who make informed 'choices', take 'control' of their lives and hold the market to account.  They often must do so at times of great stress.  This has not and will not work for frail patients in aged care.  It did not work for those at Oakden.

It uses these words to cloak the vulnerability and ready confusion of the elderly, as well as the aggressively competitive market and the confusion of options that the elderly will be cajoled to buy from the multiple franchisees attracted by the potential profitability of the sector. While options to meet different needs should be available, residents are at greater risk from competitive commercial pressures and from companies selling snake oil choices.

Some choice: The choice residents and their families may have exercised to carefully choose a home and/or provider are not a consideration when residents are traded, bought and sold with their nursing homes by aggressively competing companies.

They become in effect, depersonalised profit vehicles being managed for profit and when market forces dictate, traded on an impersonal corporate market. Businesses are sold to the highest bidder, the one who feels they can extract the most profit from these vehicles who - despite all the rhetoric about choice, still have no say in this. Staff must also learn to cope with a revolving door of managers, policies and corporate cultures.

The primary need in residential care must be in staffing because it largely determines the sort of care provided, comfort, palliation and so quality of life.

Impersonal markets that exclude the vulnerable

The market that is selling commodities and services is highly structured and well organised. It has consolidated and there are large highly organised and powerful groups. They are all focusing on making us buy whether we need it or not. Our economy depends on our doing so! But it is no longer a level playing field for the individual customer. When it comes to services in vulnerable sectors this is a big problem.

Real need: What senior citizens do need is good care to keep them functioning as well as possible, then stability and control, which of course includes choice. But they often do need assistance to exercise choice effectively.

What they are being given instead is instability, complexity and the confusion of multiple choices marketed to them by those who want their money. Residents are at risk from competitive commercial pressures and from companies selling snake oil choices.

We can see this as another of the basic conflicts in a system where inappropriate marketplace discourse and a system built on them have been imposed on a sector where they don't fit.

As with the banks, participants have to say one thing to create an image and look credible to be successful, but then must behave very differently in order to compete successfully. Those who can't handle the mental gymnastics go under.

Trust and the Aged Care Workforce Taskforce

For example, the major and most critical aged care workforce taskforce 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 ... "

Source: Aged Care Workforce Taskforce Strategy Report, pg 8, Department of Health

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".

This is the same industry that has been denying failures and understaffing for 21 years - - - an industry whose failures have just been exposed at Oakden in South Australia and countless other homes, and then on ABC's 4 Corners two part program "Who Cares".

They have shown that they cannot be trusted and they have the nerve to come back and ask us to trust them once more.

Making a choice without information

Accurate information: Information on the MyAgedCare website is of limited value for anyone requiring real information about local services. It provides little more information than costs, contact details, a link to the service's website and whether the facility is compliant or not.

Families are faced with performing the impossible task of sourcing information directly from the provider and/or their websites. The glossy brochures and impressive websites seeking their custom can be deceptive.  They may also search through various commercial websites who offer guidance and reviews about aged care facilities, although we are concerned about whose interests some are serving.

This is often done at a time when families are under extreme pressure from hospitals to vacate beds or after an adverse event. Hardly anyone volunteers to live in aged care unless absolutely neccessary.

Trusting in "Choice" and "Control": The government is urging us to shop around and to choose wisely. "Choice" has become the new buzzword. In this system, government and industry cannot logically offer us choice and at the same time urge us to trust the system. In a competitive market with vulnerable customers, choice and trust are very uncomfortable bedfellows.

We think trust and trustworthiness are important and it is what the elderly and their families expect in this sector. But that is not the sort of market that government and industry insisted we have 20 years ago. The data shows that 'buyer beware' must replace trust. It is sad that it has come to this, but we cannot have it both ways.

A sector where trust and trustworthiness have always been important has been turned into one where success in obtaining services depends on a healthy distrust. Yet government and industry are encouraging us to continue to trust the system.

Conclusions

In our society, our trusted banks have been exposed by the royal commission as ruthlessly exploiting the vulnerable.  A multitude of franchising businesses like 7-Eleven stores, pizza companies as well as many others, have exploited vulnerable students, tourists and visa holders. The banks including AMP, the worst offender, have invested heavily in aged care. Multiple franchising companies are entering aged care to offer us "choices".

Is the aged care market really different? Are we still going to believe the confident businessmen, managers and politicians isolated in their offices? Would we be wiser to believe the anxious staff providing care --- the families who know enough to identify problems and the available data about staffing?

Politicians and businessmen have invested their lives in aged care reforms including the Living Longer Living Better reforms and the Aged Care Roadmap and have much to lose.

Could it be that the policy of "there will be a strong focus on positive images of aged care" has been too pervasive and gone much too far? Only blind believers and the gullible are persuaded. The Aged Care Roadmap was the industry's policy and not our policy and the illusions they marketed at us were enticing.

After 20 years, it is time to look at the warnings that were ignored, to throw out this failed roadmap and work with the caring professions to develop a more sensible aged care system. Government is not capable of doing it alone. The community will need to lead the way.

 

Comments  

#1 Helen 2018-12-09 22:37
Thank you for writing about this issue. As a daughter of parents in an Aged Care facility my concerns have been treated as though I am a complaining relative, it is my problem not the facilities. The issues I have been raising are;
Severe and constant bruising,
people being left to sit for hours with inadequate activities and staff care,
inadequate personal care leading to extreme, painful excoriation, inadequate wound care leading to infection,
sedating with medication in absence of any attempt of behaviour management or investigation of what is causing behaviour such as; staff communication / empathy, untreated scabies etc etc etc
Hardly unrealistic expectations! I work in health and human services this would be completely unacceptable treatment in any other industry why is it allowed within our Aged care system!!!
We will potentially all need to access these services in future!!!
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