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