Regulatory changes and ever more complex regulatory processes can have adverse consequences and much of that burden can fall on already stressed and over-worked staff. Change needs to be introduced incrementally and commenced in regions. Its consequences should be carefully monitored. That has not been happening.
As the Royal Commission has so clearly demonstrated, the free-market model of care has failed staff and residents. The complex reforms recommended and government action make no fundamental changes to this market model. Governments continue to marketise those sections like home care where vestiges of community-led care remain.
The huge uncertainties and the complex changes being made are driving some of the smaller providers out of the aged care sector. They have a low staff turnover and provide better more person-centred and relationship-based care.
In this article we focus on the consequences for home care in Victoria and smaller non-profit providers.
Local councils and state governments have been providing good aged care services, sometimes since the 1950s. As government have underfunded the system and others have reduced payment, councils have supplemented salaries and provided far better working conditions for staff so retaining those who have a sense of vocation.
Victoria has led the way in this. This difference and the superior care was reflected in the low rate of COVID and low death rate in government owned aged care homes in Victoria compared with the competitive private sector. In the face of the planned market driven regulatory changes, many are now vacating the sector. It is government and not local councils who select the marketplace providers who will take over.
The community is being further excluded. This increases the problems created by an unbalanced system where all the power lies with the market. It is the opposite of what is needed to address the “deep and entrenched systemic flaws” that resulted from this and were identified in the Royal Commission’s interim report. They have not been addressed by these reforms.
Smaller non-profits providers of residential care have little appetite for commercial competitiveness and the catchphrases that accompany them. They have provided a better working environment and better more personalised care. They too are finding the new changes too threatening and are vacating the sector.
The linked articles below describe what has been happening. We include extracts that illustrate this.
- At least 33 of 79 local councils in Victoria are planning to leave home care to the market
Source: Local governments are being pushed out of aged care. But at what cost?, Eureka Street, 5 April 2022
Caught between these conflicting objectives are Victorian local councils, where a long- term partnership with the Federal government has been undermined by the process of reform. Since the 1980s — and to some extent even earlier — Victorian local councils have played a central role as providers of in-home aged care.
block funding is being supplanted by a new consumer-directed model, under which clients are allocated a set amount of money and then choose among a selection of competing providers. - - - - Over the last few years, many local councils have decided that there is no place for them in the new structure. - - - at least five had stopped providing home care services in the last five years and six more have announced that their exit this year. - - - Casey City Council - - - -Mildura Rural City Council - - - councils provide better wages and working conditions than private providers - - - - private providers generally paid close to the ‘rock bottom’ industry minimum award wage - - - - superior work conditions at local councils help to maintain a long-term workforce - - - - matching in-home aged care workers to the individual needs of older people is a feature of council provide care
When moving to a private provider "the other company is hard to contact by phone, workers not experienced, charge higher rates and missed services due to staff availability issues,’ - - - -'Most council aged care services are currently too small and inefficient to operate in the Federal government’s regulated market model.
Source: Expanding Aged Care Service | Bayside City Council, 17 March 2022
--- Has decided to continue to operate under the new arrangements.
Private providers (Mecwacare and Bolton Clarke) have taken over from two Melbourne councils (Mornington Peninsula and Booondara) to provide in-home aged care despite lacking the staff to service all the additional clients as low wages and poor conditions fail to attract workers.
Council, aged care staff were paid around $34 an hour, received a travel allowance to get to homes, and were paid to receive training and attend meetings. - - - - - - Mecwacare and Bolton Clarke pay award wages of $24 to $25 an hour and workers have to pay for travel and other costs
23 councils around the state were discontinuing their aged care services or had already done so. - - - former council in-home aged care workers were reluctant to work for private providers due to the lower wages - - - etc, - - - some providers not even paying workers for the time they spend driving from one elderly client to another,
Source: Aged care: Boroondara elderly residents abandoned by private aged care provider after council exit, (The Age 6 August 2022)
- - - - the council’s 60 aged care staff were made redundant.
Elderly residents in Boroondara are without in-home care, after a privatised aged care provider failed to supply staff for the services after taking over from the council. - - - - In a letter sent to hundreds of elderly residents this week mecwacare informed them that care services would not be available for “some weeks” due to staff shortages.
Boroondara said it made the switch because of the introduction of the government’s Support at Home program, which requires providers to offer specialist services such as occupational therapy and physiotherapy. - - - - many elderly residents at the time, who said they were not properly consulted and did not want to change carers.
Source: Aged care services on Mornington Peninsula: Elderly residents left without care (‘Nobody’s checked I’m alive’: More than 1000 stranded as council retreats from aged care), The Age 9 Aug 2022
Mornington Peninsula --- Private providers Mecwacare and Bolton Clarke took over the in-home service, but many residents have been left without care for the past
month. - - - - more than 110 council staff were made redundant.- - - “The council said they are monitoring,” she said. “Pig’s arse they are. Nobody has contacted me to see if I am still alive.”- - - - “Mecwacare has had months and months to prepare for this,” he said. “It is typical of the former federal government they want to give everything over to private enterprise.”
- - - - - - the council decided to “transition” to new providers this year, away from its own staff, to prepare for the federal government’s open-market system. “The peninsula had no provider other than council delivering these services and we needed to ensure our residents had a choice and the advantage of a competitive market environment,” he said. “We did not get a say in the appointment of new providers; that was done by the federal government.” - - - - council was given assurances by both providers and the government that all essential services would continue to be delivered from the July 1 transition date. “We offered to keep some staff on to help with the transition, but that offer was turned down,”
Source: New home care providers appointed | City of Casey, 24 Jun 2022
A positive article from the council itself:
The Commonwealth Government has appointed MiCare, Mecwacare and Uniting AgeWell to deliver home and community care to the City of Casey’s residents in response to Commonwealth Aged and Disability funding reforms.
City of Casey: Council set to shed hundreds of workers, Herald Sun 12 Feb 2022 (Paywall)
The City of Casey will slash more than 200 aged care workers from its roster, in a move a union has called a “scandal”. The City of Casey has been savaged by the Australian Services Union for a “secret” decision to outsource its aged care program — at the possible cost of more than 200 jobs.
Source: Hepburn Shire to Stop Providing Aged Care Services - The Wombat Post, 26 Nov 2021
The recent Royal Commission into Aged Care Quality and Safety showed huge problems - - - - - In response, the Commonwealth is dramatically expanding and rearranging home care. It is likely this will see a dramatic expansion of private and non-government home care.- - - - it is not clear what the impact - - will be on the long term future of aged care services for residents.
Source: Hepburn Shire Council votes to drop home support aged care services after Commonwealth reforms - ABC News, 16 Mar 2022
- - - the council said "significant Commonwealth reforms" had been implemented in the past decade and the changes meant the council would not be suited to continuing as a provider. - - a challenge over the past decade in terms of the uncertainty - - - must now decide whether to transition more than 300 clients to a privately-operated program overseen by the Commonwealth or to shift the services to a not-for-profit provider.
Source: Benetas and mecwacare new providers Hepburn Shire Council.pdf, Hepburn Shire Council, 30 May 22
A positive article from the council itself
All clients will have an uninterrupted and seamless transition of care to the new provider. - - - -the Commonwealth’s aged and health care reforms had made it unviable for Council to continue to deliver these services.
Source: Wesley Mission to close Sylvania, Carlingford, Narrabeen aged care homes over workforce constraints - ABC News, 13 Apr 2023
Last month VincentCare said they made the "difficult decision" to cease their involvement in Home Care Packages in Victoria due to "significant changes" to federal government aged-care funding.
- Smaller non-profit providers of residential care are selling up or closing
Source: Wesley Mission to close Sylvania, Carlingford, Narrabeen aged care homes over workforce constraints - ABC News, ABC News 13 Apr 2023
Wesley Mission has announced the closure of all its Sydney aged care homes due to challenges in attracting and retaining staff. - - - upheaval for nearly 200 residents and their families.- - - - - necessary because of difficulties meeting new national staffing requirements. - - - The aged care sector is experiencing challenges to workforce and flow-on impacts from the national reforms to aged care.
Source: More aged care facilities to close as Labor defends nurse staffing requirements The Guardian, 14 Apr 2023
Brightwater Care Group WA- - - citing problems meeting a new staffing mandate.-- - three of its Perth sites will close in the next 12 months.
Source: Showdown looming as elderly residents refuse to leave Feros aged care facility slated for closure - ABC News 11 May 2023
unable to meet the complex regulations required under law for aged care at that facility.
Source: Sarina Aged Care transfers ownership as regulatory pressures mount, Hellocare, 9 May 2023
Sarina’s Board identified legislative change and increased regulatory burden as two major obstacles for the small ownership group
“The actual viability of the company is not only a financial thing, and luckily we are profitable, it is also in the governance side of things, it is becoming absolutely a different level of difficulty to try to have the right governance for everybody to be able to sleep at night,”
Source: Sarina Aged Care near Mackay, QLD, transfers its operations to Ozcare, The Weekly Source. May 9, 2023
The letter states that “increasing external pressures”, the Australian Government’s aged care reforms and increasing regulatory burdens, and the higher number of residents with complex needs are the reasons behind the decision.