Consultation on the draft National Aged Care Advocacy Framework

Following the Review of Commonwealth aged care advocacy services, the Australian Government announced consultation on the draft National Aged Care Advocacy Framework (the Framework). The feedback form questions are detailed below, along with our responses (submitted on 28 Oct 2016).

QUESTION 1.  Is the purpose of the Framework clear?

There are issues of concern that are not clear:

1 (a)  Lack of consumer participation:  Failure to publish submissions so that the views of those with experience making contributions are not available to the community who are to be the recipients.  Public debate and the ability to advance discussion by the community are stifled.

1 (b)  Data collection:  It is far from clear who will collect, access and control the data that is proposed to be collected.  Whilst data is intended for government and for service improvement, it is critically important that data be transparently collected and assessed and that this data be publicly available to researchers, community (civil society) and those engaging in advocacy.  It is not clear that this will happen.

1 (c)  Increased assistance and protection:  As the report indicates, the marketisation of aged care will result in a greatly increased need for assistance and protection.  This data is likely to expose the serious deficiencies in government policy.  NACAP is funded by government and its funding will be at risk if its reports challenge policy.  Both NACAP and government will be at risk of confirmation bias and tempted into massaging data or even indulging in outright censorship.

1 (d)  Funding of advocacy services:  The allocation and funding of advocacy services is consequently critically important and should not lend itself to becoming a tool for securing compliance and crushing criticism.  There should be no conflicts of interest created for them.  Close links with government aged care departments as advised is worrying when we consider that government also funds NACAP.  If this cooperation was directed through a community controlled service (of which advocacy was a part) working with government, this risk would be markedly reduced. Closer cooperation with an autonomous system of independent advocacy would be important.

1 (e)  Quality and transparency of data:  A good example of how easily data reporting can be distorted is the previously “independent” Accreditation Agency which since 2014 has become the government run Quality Agency.  Data has been reported out in a way that creates the impression that there are many fewer failures than actually occurred and where the manner of reporting conceals information that reveals major differences in performance between different sorts of providers - a finding that challenges government policy.

There is clear international as well as local evidence that profit driven enterprises indulge in greater cost cutting and as a consequence have fewer less qualified staff and a greater number of failures in care.   It is therefore critically important that to inform policy the structure of the provider should be included in all data collected so that problems can be identified early and policy adjusted.

While much is made of cooperation, there is a danger that this data may become another silo.  Integration at a central level may help financial or broad analyses, but in in a sector where ideology plays so large a role, the way this is integrated will be at high risk of confirmation bias.

1 (f)  Partnering with the community:  In our submission we advocated an integrated local service for managing aged care in which advocacy would be included.  Data collection locally would explore why situations arise and integrate that with other information being collected so that a much broader understanding is developed.  When brought together it would give a far deeper insight into how services are being provided. 

The community, family members, those receiving care and providers would all benefit immediately as adjustments to services would follow.  When collated it would give NACAP, government and systemic advocacy from the community a far broader view of the services being provided.  Many problems that individual advocates encounter will be a consequence of systemic problems needing systemic advocacy.  Our approach would identify where they were and then work closely with systemic advocates.

QUESTION 2. Is the proposed process for the design and development of the Framework sufficient?

No.  The intentions are good but we have some reservations.

2 (a)  Risk of becoming irrelevant: While flexibility is a prime objective there is a real danger that, like the funding, complaints and accreditation systems, this will become complex, centrally structured and controlled, process driven, and so inflexible and often impersonal.  This approach has not served the community or aged citizens needing care well.  Many are disillusioned and very critical of all three services. 

2 (b)  Choice as a mantra: We are concerned by the strong focus on choice.  Despite attempts to demedicalise and pretend that aged care is not about health, most elderly have a multitude of health issues and their frailty is a direct result of tissue degeneration of one sort or another which health practitioners seek to hold at bay.  For example, no health professional will agree to provide treatment that is not beneficial even if a patient chooses it.  The emphasis should be on guiding and helping people so that they make the sort of decisions that are in their best interests.

The mantra of choice for choices sake is an advertising strategy adopted in the marketplace and has been used to con the vulnerable into buying services that they may not need, may not be beneficial for them, or may be downright harmful.  The prominence it receives gives the marketing of snake oil a legitimacy it does not deserve.

QUESTION 3. Does the proposed content of the Framework include key elements that will support the future delivery of nationally consistent advocacy services?

No.  There are funding risks.

3 (a) Risks in funding system:  Government funding is high risk funding which can be withdrawn for ideological reasons or in order to divert funding to more popular projects that will win votes.  A far more stable service can be provided by involving and including far more community volunteers to provide advocacy.  They provide a resource that will take up the slack when politicians abandon advocacy and will recruit their friends when there is a need.

3 (b) Risks that the system will be overwhelmed: We have studied market failure in vulnerable sectors and we think it likely that if advocacy is provided in sufficient quantity to hold profit pressures in check and to all those who would benefit from it then the need for advocacy will increase dramatically and the system may not be able to cope.   But without a local trusted contact many will not access the system.

It would not be difficult to build a strategy that would support and encourage the formation of local government and community structures and then progressively delegate these services and responsibility to them as these groups develop skills and confidence.

3 (c) A better and fairer way: We believe that a broad strategy of community involvement could be included in the framework in order to encourage politicians, bureaucrats and citizens to start thinking about something better than the present system.  This is failing far too often and is proving far too costly.  Advocacy would be better provided by people closer to the bedside.  There would be a larger number of people with diverse skills – a resource to drive innovation.

QUESTION 4. Are there any other comments?


Short contributions

We have had a number of people making short contributions and comments suggesting changes but not exploring them in depth. These are not suitable for a separate web page and do not fit into one of our web pages.  We think that we should make these available and encourage debate and discussion.  We will place these here. We will not place critical comment that belongs on one of our other web pages or complaints about the system that do not contribute to a debate about changes to aged care here.

If you want to comment on what others say here please do so at the foot of this page and indicate which contribution (number) you are referring to.

Contribution 1: Suggestion for change from a carers perspective

By Carer A: Professional status for PCs (Personal Carers) and accountability

It is also noted that due to the Federal Government’s decision to provide greater in-home support to aged persons that the people entering our facility are more and more requiring greater physical and psychological support – a requirement that is not reflected in current PC training programs, thus impacting on the care provided.

I believe that the time has come for the Federal Government to recognize the professional status of PCs and stop treating such as unskilled labor and adopt a national certified training program with minimum standards and registration. If this requires an increase in the Medicare levy, then perhaps this should be placed on the agenda.

Organisations need to be more accountable for the way in which Commonwealth funds are deployed throughout their organization and rewarded financially when best practice has been detected by independent auditing.

Comments on Contribution 1:

Thank you for your contribution. PC's certainly need professional status and a professional regulatory system that ensures standards and promotes professional conduct.  Accurate data and full accountability are core components of the local Community Aged Care Hub changes that we are pressing for in aged care.


Contribution 2: Government is not going to save us

By #1 Michael

I think we need to go back roughly 100 years and see how the sector was financed and run in terms of organisations and to what extent government was involved.

Government is not going to save us or the elderly, they will only promise, debate and mainly tax to save themselves in the coming years. Just a fact and history repeating itself.

One must realise the world is in a stage of great change and Age care is not the only troubles within the system, the system being that of a socialism style since the great depression as government took a much larger responsibility of running society, we are now back to a spent and over sized bureaucracy that will confound any real solutions as they will threaten their very existence.

Other problems that will present themselves in the coming few years is that of superannuation /pensions crisis which is also not just confined to Australia. This is a global mess not only in Age care but all aspects of life which are now overseen by government.

I have worked in various healthcare /age care institutions and have only come across self-interest within management, with the added pressure of listed companies/shareholders and very senior management(with 7 figure wages) of age care providers the outlook is very grim for any positive outcome.

Any personnel within the sector whom may point out possible solutions or other matters relating to improvements will most likely be met with reporting of non compliance, be it within organisation or by government.

We will see change but only after a crash and burn situation, then and only then will you see real solutions and change.

Comment in reply to Contribution 2

Thank you for your comment #1-Michael. It’s the sort I really welcome and like to engage. Agree with all of your concerns.  I think that the extremes of socialism and capitalism are a threat and that neither government or markets should be in charge. They ignore their failures and that is what is happening with the neoliberal movement today. As you indicated what we have now is not working in spite of the best efforts of dedicated people like yourself.

Expanding on the history: I would like to expand on your history. The explanations go back 250 years when market theory originated. It was realised that successful markets required informed and effective customers and communities who were wary of “that order of men ... who have generally an interest to deceive and even oppress the public”.

These are the necessary conditions required for an impersonal market mechanism to work effectively for society - responsible capitalism. When they are absent markets fail society which is what the evidence indicates is happening in multiple sectors.

Free markets dominated the 19th century resulting in vast misery, the rise of the labor movement and instability which culminated in the great depression of the 1930’s. The horrors of the poorhouse were the reality for a large number of citizens.

The plight of the aged and the ill in poorhouses gave rise to community charitable endeavours. The community raised money and provided care to the sick and the suffering establishing institutions to do so. Over the years these became not-for-profits and a smaller number of socially responsible (fit and proper) businessmen joined them making a reasonable living.

After the 1930s depression we entered an era of more responsible capitalism rudely disrupted by WW2. By the 1950s it was clear that the community could no longer meet the more sophisticated needs of modern care or educate those who were born into poverty. It was the Menzies liberal government that started to fund education and the Fraser government who followed.

During the late 1960s governments both in the USA and Australia developed funding systems like Medicare that sought to fund services for those in need or if socialist provide the services themselves. In both countries entrepreneurs saw the opportunity to make money from this largesse. In Australia they were restrained by restrictions on the sort of person operating in sectors that did not meet the necessary conditions.

The 1970s saw a re-emergence of free market ideology arguing that social responsibility was socialist and that the responsibility of corporations was to serve their shareholders above their customers. The new ideology abandoned the theory on which markets were based and, in the face of history and evidence, claimed that unrestrained markets were universally beneficial and not harmful. The dogma of competition, efficiency etc. underpinned this and the managerialist approach compounded the bureaucracy that socialism had introduced.

In the late 1980s labor moved to occupy the middle ground and the liberals swung radically to the right adopting these new ideas. These were imposed on aged care by Howard in 1997 and the multiple market failures that government seeks to play down are the consequence.

Looking for a way out: My proposal is simply an attempt to find a way of short-circuiting the crash and burn which will cause vast suffering. My experience is that occasionally this is possible. It seeks to create the necessary conditions (customers and effective community in control of itself) for the aged care market to work by rebuilding responsible capitalism in vulnerable sectors where it is failing. I am hopeful because many others are beginning to think this way (see Developments in Social thought).

Another web site: These issues are too complex for a web site that requires a single simple paradigm to motivate people. I have written another web site quoting extensively called Inside Aged Care in which I explore all of these issues in depth. I look at them from different points of view going far deeper into the issues hoping to engage the industry and its supporters.

If you can find the time I would love you to look at its and criticise because I am sure I have made some mistakes. Please persuade any colleagues whatever their views to contribute and argue. So far no one from the industry has criticised and if they don’t put me right then I am in due course going to very loudly proclaim that they have no answers to what I have said there.

Michael Wynne

Contribution 3: A lack of staff-to-resident ratios is at the root of substandard care

By: Aged care employee

I have been working in residential aged care for a number of years now. First as an Assistant Nurse whilst studying my Bachelor of Nursing, and now as a Registered Nurse. I learnt quickly that ALL nursing homes are grossly understaffed (an average of 2 Assistant Nurses to 20 residents and 1 Registered Nurse to 40 residents) and this is the main cause of substandard care.

When you have these ratios, people are left waiting to go to the toilet and people are left suffering in pain waiting for pain relief to arrive. I have heard countless times staff express that residents can ‘go to the toilet in their pants’ as they are wearing a pad. The first time I heard this, I was appalled. People have no choice but to go to the toilet in their pants because there simply aren’t enough staff.

On the other hand, some residents will get sick of waiting for help to arrive and will try to walk to the toilet themselves, having a fall and often fracturing a hip or sustaining some other form of injury. Injuries would be reduced with more adequate staffing levels.

At mealtimes, if 10 or 15 residents need assistance to eat their meal, how do you think 2 Assistant Nurses achieve this? It certainly doesn’t make for a relaxed meal. When residents’ family members and friends come and visit in nursing homes and criticise the level of care, it is immensely frustrating as the staff are NOT to blame.

We are doing the best that we can- we are overworked and overstretched. The government needs to step in and introduce mandated ratios. Only then will your loved ones receive the care that they are entitled to and paying for. We wouldn’t even treat a dog the way in which we treat our elderly.

Comment in reply to Contribution 3

Thank you for your contribution. Aged Care Crisis has been listening to staff and advocating for this for over 10 years. I first wrote about nursing issues on my original Corporate Medicine web site when I wrote many pages about aged care in 2006. Despite extensive advocacy nothing has happened and the present system will not do this. We have advanced a plan suggesting how this can be done and are looking for suggestions from anyone who has alternative suggestions or can suggest ways to improve on ours. That is what we are really looking for here.

I have written a detailed analysis of the reasons for failure on “Inside Aged Care”. I would like to invite you to visit the page “Those who know” where you can contribute your experience to that of others to show that the system is failing.

The issue of mandated and minimum staffing ratios is explored in depth and supported with international data because there is none in Australia on the page Minimum staffing levels. Australia is not the only country where the power of the corporate lobby has blocked this. The way our proposal might address this is explained. Feel free to comment there too. We want to see staff, families and community working together on this. Together we can force the changes we need.  Our criticism is not of the staff or even management.  We are all trapped in this and need to work together but it is up to individuals in these groups to start talking to each other locally.  Get your friends in the community involved as that is the first step towards forming groups, linking with others then forcing change.

Michael Wynne

Contribution 4: WA facility - poor care/staffing and complaint system

By Susan

 Staffing the main concern - 2 Carers for 17 clients. Most are bed bound & hand fed meals. Since May 2015 - Mainly wet (continent), thirsty, not showered, shave or teeth brushed. Family visit up to 4 hours each and every day - to attempt fill the gap. This week - no shower, teeth not clean, dehydrated, raging scrotal penile rash. The Commissioner - rude, dismissive closed the case.

Comment:  Thanks Susan.  This is an ongoing problem at far too many facilities.  We feel that aged care should be overseen locally  with strong community involvement. Why not comment on some of the proposals for change.  Have you got better ideas.  Michael

Soliciting feedback

Getting feedback from residents, families and visitors to nursing homes has become a rapidly growing aggressively competitive market place.  There are three broad groups competing in what has recently become a  very complex and confusing system for both the not-for-profit providers and the community.

  1. The family as represented by government and members of NACA,  They are responsible for designing this complicated market and they have done this behind our backs.  They have a vested interest in protecting it.
  2. Consultants of various sorts serving the sector.  They have seen additional opportunities in servicing the confused and struggling customers of this system.  They could have a vested interest in maintaining its complexity.
  3. Independent groups comprising:
    1. Individuals who are concerned at what is happening and are motivated to help prospective residents find suitable facilities as well as providers willing to address problems and wanting feedback to guide them.
    2. An entrepreneur who sees web feedback as a potential global market.
    3. An international not-for-profit providing web feedback in health and aged care in the UK expanding into Australia.
    4. A multinational US web feedback company focusing on the tablet and smartphone market that also provides feedback on aged care facilities.

My interest is in the problems in this system and what the proposed Community Aged care Hub could do to address them.

The family

The family are promoting a positive image of aged care by associating aged care with going on holiday, finding accommodation and dining out.  They are porting the sort of reviews done when going out for a good time and applying them to aged care which is a trifle different.

COTA/NRMA/Gallup polls

COTA the seniors group that is a member of NACA and works with the government in structuring our aged care system, has joined with NRMA to develop an OWL rating of 1 to 3 in which nursing homes, which are good enough and pay enough, can display in much the same way that hotels, caravan parks and restaurants do.  It is rather more suited to retirement villages than nursing homes, but both are included.

It is interesting that this project went ahead when all of the submissions to the ACCC assessment of the application to certify the OWL ratings logo came from state residents associations that were critical and opposed to the scheme. Although others were invited by letter only three submissions were made.  It suggests that this was more about serving providers than residents - or perhaps about creating positive stories to counter the widespread concern about what is happening in the sector.

I am critical at the way the Gallup surveys which have merit are being organised. The OWL ratings promote and encourage the good homes to improve their performance. It concerns me because it is voluntary and those homes that perform poorly are automatically excluded. These facilities are where the problems lie.  As the submissions indicate the questions are skewed and do not addequately reflect what prospective residents need to know when they make life changing decisions.

From a consumer point of view, it is more important to know the bad ones to stay away from. Many want to be near family and the local homes may not be rated by these surveys. Once you are in a nursing home, it is too late.  It is simply too difficult to move. It is not like other services.  This caters to the very rich rather than to the average person looking for somewhere safe near family and friends.

I am also worried that the providers will be supplying the names and details of the people to be interviewed.  This creates a situation where there is a strong temptation to game the system by selecting those who will give positive feedback and excluding those who have complained.  This has been a major problem in survey systems.

MyAgedCare offers trip adviser services

The Government has carried the image of holiday time one step further.  Since 2014, it has been promising to offer a trip adviser service on its heavily criticised MyAgedCare website.  While that has been met with some enthusiasm by a few, serious critics in the UK and Australia see the application of this complex and relatively unreliable system to aged care as ridiculous  and inappropriate.

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Industry consultants and advisers

Aged Care Ratings and Aged Care Online

A director of a consulting business advising providers, a director of a business in the “Placement Industry” (which helps potential residents find a nursing home), and a director from Aged Care Online, (a company publishing information about aged care and about individual nursing homes) have founded Aged Care Ratings.

Facilities rate themselves on a 5 star system and if they want to put this on their websites and letterheads with a logo then they pay a fee to have it verified and then certified by Aged Care ratings. The rating does not include standards of care or quality of life.

Aged Care Online invites short reviews from residents and families on its web site. It publishes a listing of all the aged care facilities in Australia with any information the facility has provided including beds on offer and pricing. It the facility has been rated, the star logo is displayed and if any reviews are available they are displayed. Contact details are provided.

DPS publishing

DPS publishing works with the industry and publishes information brochures that the providers use. In December 2015, they indicated that they were considering “implementing user reviews” on their web site.

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Independent web based feedback sites

This more limited system does not collect nearly as much information as the Gallup poles collected by NRMA and COTA.   Although they do not collect as much information, I think that these sites could serve the bulk of people looking for an aged care facility much better.

These sites are already popular in the UK where they have had more experience. There is a rating system and feedback is supplied anonymously on the web sites.  It is often structured to get comment on specific issues but also allow free comment.  Providers of care are supplied with this information so that they can respond, take remedial action and address community concerns. This is an excellent idea and potentially very helpful for providers committed to improving their services. The feedback supplied is also a valuable resource for those deciding which nursing home to enter.

There are currently or soon will be, several competing groups in Australia asking people to go to their web sites to give feedback. The number of competing sites is going to markedly reduce the number of people responding to each web site and so the validity and usefulness of the information for consumers.

Some of these sites are community focussed and driven by dedicated individuals.  My impression is that genuinely concerned individuals worried about what is happening in nursing homes have started some of these web sites. Some have experienced problems themselves.

Others profess the same concerns but are primarily focused on this as a market. They are commercial entities and driven by market principles -  wanting to grow and make large amounts of money out of it.  Some are multinationals.

Not all the sites are fully transparent about their backers and funders.  With at least 5 groups, it looks like a competitive marketplace.  I can't help asking why we need so many and whether this is something that should be profit driven. The monney for all this has to come from the aged residents either directly or indirectly and will only push up the total cost of aged care further.

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Potential problems for all these sites

There are multiple issues :

  • Because negative information is challenging and costly for providers and recruitment of feedback will depend on support from providers, I am worried that pressure may be put on the websites to help keep some of the feedback in 'the family' and not publish it.
  • If they are to get sufficient numbers under the present system, all of these websites will depend on the cooperation of providers in directing residents, family and staff to the web sites.  The providers can decide which website they will support and this may not be the one that serves the consumers best.
  • My worry is that providers will feel threatened by the public availability of adverse comment and may prefer the Gallup pole surveys where they have more control and where adverse feedback may not be published.
  • Poor providers are less likely to cooperate, but if there is a clear single system that consumers are directed to, then there will be strong pressure on them to go there.
  • There are many ways that less motivated providers can game these systems by filtering who they recruit to provide the feedback. Alternately, they might support those that provide advertising opportunities and who will exert more control over what is published. Those that don't do what the providers want, may not succeed.  The feedback sites themselves are in a position to manipulate results in order to boost advertising and extort money from providers.  All of these things have, or are alleged to have happened elsewhere.

When the sites were examined in April 2016, two independent sites dominated and the others were not doing very much.  Both of these require reviewers to register with them and give details so are in a position to monitor and vet inappropriate use.  The number of reviewers can be influenced by how carefully they vet and select reviewers. I looked through the site collecting several hundred reviews from each.

The extent to which the aged care sector is covered by reviews was not obvious, but it is clear that the bulk of facilities in Australia have not been reviewed.  About two thirds of reviewed sites were only reviewed by one person and of those reviewed, only 5 to 8% had more than 3 reviewers rating the system.  This can only mean that providers are not supporting them and are not encouraging people to review their facilities.

Aged Care Report Card has the most sophisticated web site, has an advisory panel drawn from a seniors group, nursing bodies and some independent businesses.  They are sponsored by similar groups and use some of these groups to help them recruit reviewers.

Aged Care Reviews is a commercial enterprise started by entrepreneurs and with a board of businesses directors.  It is funded by investors.  While the figures are unreliable, they suggest that it has a larger share of the feedback business and this may be due the additional funds they have available to market their services.

Rorting: Web feedback sites have become very popular in the wider marketplace and large numbers of people use them to evaluate services or products before buying. These systems are being extensively rorted in the USA, in the UK and in Australia. Providers themselves, or commercial entities they employ are providing a flood of positive (for their employer) and negative (for the employers competitors) feedback reviews. These distort the services and render them valueless and deceptive. I give examples on the linked page.

It has probably happened in health care in the UK, but I could not find confirmed reports of this happening in aged care. Comments by community groups in the UK and by one provider in Australia who has withdrawn from the process suggest that it may already be occurring.

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The Community Aged Care Hub

The proposed hub would be working in the nursing homes in each region helping them to collect objective data transparently.  The major weakness in the system that allows rorting is in the openness for anyone to participate.  The other weakness is the vulnerability of the sites to commercial pressures and their ability to vet or censure critical comments because of this.  Their dependence on advertising sits poorly with their intention to provide information objectively.

The hub, rather than the providers could assume responsibility for collecting formal feedback by supervising surveys or by recruiting people to go to a web site to give feedback, so ensuring that the sample is representative and fair.

This would ensure that both satisfied and dissatisfied people were encouraged to do reviews and that a balanced selection of people participated. It would support those web sites that serve providers wanting to improve and it would work with providers in doing this. There would be little prospect for gaming the system. It would be important for the site to please the community as well as the providers. There would be more pressure on providers to participate.  Because a community organisation would be selecting and working with the websites, the leverage and potential control by providers would be eliminated.

The hub would support websites that supply families and researchers with accurate and unbiased information. They would use this information and would integrate it with other information when giving advice and support to families making decisions. They would be cooperating with researchers.

Because this information would be important for the hub in advising and helping families they will ensure that sufficient numbers participate to make the information accurate and useful.

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This page is a summary of a much longer and more detailed review.  Because I am particularly interested in the potential failures of the system and of the contribution that the proposed community aged care hub would make, I have written a much longer in depth analysis looking at all of the information I could find.

Learn more: Aged care consumer reviews

Continuity of care

As a Planned Activity Group Supervisor for 15 years in Independent Community Health Services, one of the most difficult things is that when our clients have to leave their home and go into Residential Care or a Nursing Home, there is a crossover time of a couple of weeks then because of funding parameters and policy, we are unable to have them attend our groups anymore.

The effect this has on the person can be devastating.

One example of many clients this happened to ... we will call her Joan (not her real name).

Joan had been attending my group for over 10 years.

Joan lived in a unit with her son, they cared for each other.  Joan’s mobility was poor, her son slight mental health issues, but they lived happily together.

Joan woke one day to find her son had passed away in his sleep. She of course, was devastated and shocked like all of us, as this was never anticipated.

She came back to the group almost immediately, her friends, her support, was the group.

She had a platform of trust and was able to work through this very difficult time.

Joan made very good progress and we watched her become happier and healing.

Eventually, Joans daughter felt worried about Joan living by herself, and found a lovely supported residential care place for her to move into.

I knew what this meant.

Joan would not be able to come to the group anymore.

One of the hardest things I have ever had to do, was to explain to Joan that because of Policy and the way funding was set up - that she would not be able to attend the group anymore.

Her first reaction was, but I pay, I can pay more, I can get a taxi ...

It's heartbreaking for all concerned.

My solution to this: change policy, change the funding structure, change whatever has to be changed, so that this does not keep happening.  For a person leaving their home to go into care, it is such a huge adjustment, and grieving process, but for any activity that they can realistically continue to take part in, don’t set things up in such a way that they have to totally cut off from everything and everyone they know, this is not helping the person at all but only adding to their already difficult circumstances and huge life change. 

There is much that could be done to help the person stay connected to parts of their life outside of the care facility that they go into.

Solving Aged Care

Aged Care is broken

Aged care is broken. It is costing a lot of money and it is not providing the sort of care that it claims it will provide. Politicians are unable to face the fact that what they have done is not working. They are under pressure and are responding with more of the same and that is not going to make much difference.

It is not that those who are providing care are not trying hard or that all care is bad. It is that it is obviously failing far too often. Too often those responsible for running the system and providing the care do not realise this.

The pressures in the system are towards cost cutting and profit and too often this is at the expense of care. Good care is occurring in spite of the system and not because of it. We need a system where good care is provided because of the system and not in spite of it - where care is the best that can be provided with the resources available.

Lets stop complaining and do something about it

Complaining and expecting something to happen: Many of those who have been failed by the system or who have studied it have, and still are, complaining bitterly. There have been multiple reviews and inquiries and vast numbers of submissions have been made. In spite of that, we have not come up with a diagnosis of the problems and have not done anything effective to control them. Until we come up with an agreed diagnoses and some idea of what we need to do we won't be able to move forward.

As a worried community we have looked to politicians and their reviews for solutions but we have looked in vain. Nothing effective has been done. It is definitely not only about more money. Under the present system, more money will probably not improve care.

The biggest problem we have is that:

  • there is no useful information that enables us to accurately assess how good or bad our aged care is,
  • what the quality of life is,
  • how our money is spent, or
  • how much is really needed.

So we really have very little to work with. That is one of the main problems that we need to confront.

A way forward: Aged Care Crisis believes that it is time for us all to stop complaining and instead to start thinking about what has and is happening to aged care. We must come up with alternate diagnoses to consider. Then we can evaluate them and plan a way forward that will enable us to reach a diagnosis  more clearly and deal effectively with our findings. This will require debate and argument in order to lead to some consensus and then action.

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Opening the debate

In the "Solving Aged Care" section of the Aged Care Crisis website, we are asking everyone - including providers, politicians, staff, allied health and medical professionals, academics, senior's organisations, and members of the community to interact by identifying key problems and making proposals for change.

Please indicate what problems you see and how your proposals will solve them - and importantly, why that change will make a difference. We need a reasoned argument rather than gut responses. Comments and proposals that do not contribute to this debate will be published in other sections of the web site. 

Academics working at UTS in Sydney have recently published a study showing wide discrepancies in the care provided in different parts of the country and by different sorts of providers with some types of provider being sanctioned for poor care more than twice as often as others.  They have pointed to the lack of available data in the sector and the difficulties this created for them in exploring the reasons for this. 

They have also indicated the absence of a coherent government policy.  They have called for a wide ranging public debate about the direction aged care is taking.

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Initiating the debate - the first contribution

Dr Michael Wynne, a retired surgeon, has spent over 20 years examining the health and aged care systems in Australia and internationally. He has agreed to open this debate by setting out his diagnoses and his proposals for a way forward, not only for resolving issues in our current system, but for creating a responsive system where further change will occur as the need for it emerges. It is essential that the system be flexible and not be trapped by inertia again.

Thesis: His thesis is that the failure of aged care is an example of a failed market and that it is the inability of politicians and their inquiry appointees to accept and confront this that has resulted in paralysis of the system. As a nation we have tried to impose simplistic global solutions onto a very complex world and not surprisingly, they haven't worked in all sections of society.

This is a problem for those markets where the basic requirements (called necessary conditions) for a free market to work are not present. The most common reason for market failure in service industries is the absence of a knowledgeable and effective customer. It is not isolated to aged care and it is not a local Australian problem. It manifests in different ways in other sectors including banking and financial advice.

It is not limited by national boundaries.  Identical problems have, and still are, occurring in the USA, the UK and probably many other countries. In each sector they manifest in similar ways.  Because each of these sectors is different they will need to find their own way out of the problems they have.

Michael argues that this is part of a wider social phenomenon and is not limited to markets. It occurs where cultures, including those adopted by nations and subcultures within sections or even institutions, develop and apply ideas that don't work. Too often people try to hang on to these ideas when they are not working. In spite of often well-motivated intentions, citizens are harmed rather than helped. In extreme cases millions have died.

Aged Care needs its own solutions: The problems for aged care are the most urgent because people are so vulnerable and unable to fend for themselves, and because of the rapidly increasing numbers of older citizens. The system we have is ruthless and impersonal. It frustrates rather than encourage the humanitarian attributes that are needed in the sector. When we behave with empathy we do so in spite of the system and not because of it. That is a recipe for ongoing problems.

Michael proposes changes that will:

  1. result in the ongoing regular collection of accurate information about care, quality of life and finances.
  2. create the necessary conditions to make this market work and require it to foster and support our humanitarian values.
  3. create a permanent forum within which aged care issues would be continuously examined, debated and responded to so that a similar stalemate does not happen again.

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Outline of Michael's pages

The "Solving Aged Care" pages are arranged in 5 sections:

  • Part 1: How do we solve aged care? - introduces the basic problem in simple terms
  • Part 2: A big change to aged care - sets out the main changes that he believes are needed to create a knowlegeable customer who has access to accurate data,  and who has the market power to insist that the service is what is needed and wanted.  The intention is to ensure that the aged care market works for citizens and serves society.
  • Part 3: Past, current and future - brings the ideas together looking at how we got to where we are and where we want to be.
  • Part 4: Debating other ideas - is intended to inform.  It provides links to informative material and to a variety of different views.  The focus is on what is happening elsewhere and what others have been saying and doing that is relevant to aged care. This section is intended to start readers on the path to thinking and analysing. It is there to stimulate them so that they can come up with their own ideas and also criticise Michael's.
  • Part 5: Background of Community Aged Care Hub - is a different and more detailed analysis of our current aged care system and the political beliefs that are impacting on it. He looks at what is happening in different ways showing where, how and why it has failed and why Michael thinks his proposal might work to control the problems that have occurred there and provide a sustainable way forward.

    This page is based on and links to one of Michael's web sites where he explores these issues in much greater depth illustrating what he feels is happening with figures and extracts from a large amount of publicly available material. Those who feel challenged and don't agree with his analysis or who want to explore more deeply, will want to look at his reasoning and the examples he gives.

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Michael invites you to comment, criticise, modify or suggest better alternatives. This is intended to be a work in progress and not a final solution.

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