My primary intention on these web pages is to stimulate and promote discussion about where aged care could or should go. My interest is in the way patterns of thinking, the individuals who embrace them, and the contexts within which they find themselves interact. This can be in ways that can be very dysfunctional and sometimes harmful.
Introduction
Debating other ideas is an invitation to readers to enter the aged care debate and think laterally. To assist those who are stimulated to think about where we could or should go there are brief notes and links to a large number of reports and web sites. I think these help us to understand what is happening and the many different ways that people are thinking.
The more ways of understanding and the broader the range of ideas about aged care, the better our understanding will be. We can then start synthesising our views and develop a social movement that can move ahead to take control of the agenda and ensure that we, the community, get what we want and need and not what others are telling us we need.
This is not only about aged care, but also welfare services generally and relevant politics in Australia and internationally. It is supplied as food for thought in considering the possible future of aged care and not necessarily to support what I am proposing, although some of it does as do my comments.
Society is not static and to move forward we need to take a good hard look at what we are doing, remove the blinkers, shake off the constraining shackles and develop ideas that open up a road ahead.
The industry have invited us to participate in their debate but they only want to do that on their terms. We need to think about this, look at what is happening and become informed. We need to form our own opinions. We should welcome input from industry, but this care is being provided to our communities and that means that we should set the agenda and decide the issues we want addressed. Other parties have different objectives and different agendas in the sector. This website seeks to start that process and invites the industry and politicians to participate but on our terms.
Academics call for community debate and action
A two-tiered system in residential aged care is emerging with significant consequences for consumer choice, according to Australian researchers who have called for a public debate on the preferred industry ownership structure.
Source: Researchers warn of two-tier aged care - Australian Ageing Agenda (13 Feb 2015)
The group of academic researchers at the University of Technology in Sydney referred to in the quote above are also very concerned about the direction aged care is taking in Australia, the lack of information on which decisions are being made, and the consequences for choice and for care. They are urging public debate and stress the need for accurate information.
They have a different approach and focus on government policy. They have published their research and are calling for more public discussion and for the collection of the sort of data on which sensible decisions can be based. I have given links to their material under the last slider on the first linked page about politics in this subsection.
Approach: My suggestions focus on changing the contexts so that they encourage patterns of thinking that are functional and work for and not against the interests of the community. But as Camilleri indicates in the page about politics, the first step in looking forward constructively is to look back and make an accurate diagnosis of the situation we face. Part 5: Background of Community Aged Care Hub is my attempt to do this and show how the suggested hub would address this by changing the context within which care is provided.
Background: My background is in the experience of the 1990's and early 2000s and after a period of relative inaction I have come back to write this. There are many other ways of looking at things, and the more different and new ways of looking and diagnosing, the better the insight we will have.
In the pages here, I look briefly at some of these and provide links to material where they can be explored. There has been a large amount of very recent material and I cannot pretend to have read much of it in depth but I hope that I have gleaned enough to give you some idea about what they are about.
Relationship to my criticisms: In my criticism of our aged care system, I argue that aged care is trapped within something that has happened and is happening in wider society. It is unique only in the way it might be manifested in each sector. Not only are the problems we are having in aged care global, but they are intimately linked to what is happening in politics in Australia and globally.
My argument is that aged care is the victim of ideas that have been applied in a top down manner. The problems occur at the bottom and the way to deal with this is for the bottom, the community, to take control of those problem areas and initiate a bottom up process pushing back.
Capitalism does seem to be the best system that we have been able to come up with, but it's the lack of insight and the indicriminate way that capitalist markets are being applied that has caused so many problems across several sectors of society. There are "necessary conditions" for competitive markets to work and we should ensure that they are in place before a sector is turned into a market. This was not done in 1997. The argument is that we, the community, need to restore the necessary conditions and so save capitalism from itself. The proposed hub is a first step.
This page and the seven subtended pages look at:
- criticisms of what is happening in politics,
- evidence that challenges current policy and industry's response
- the difficulties and consequences of speaking out and making changes,
- aged care in other similar countries,
- material about aged care in Australia looking at different points of view to mine, at criticisms other than mine and at some issues in aged care that I have not addressed because they do not impact directly on my arguments,
- at developing patterns of social thought that have implications for the discussions and for my suggestions, and
- a selection of articles that show what aged care looks like when you bring it all together and set it in a wider context.
The intention of these linked web pages is to inform and to provide additional stimulus for thought. These pages are intended to stimulate ideas and help readers to come come up with their own ideas and proposals. We need to debate the issues on our terms as a community and empower our members with knowledge. We do not want the framework within which the issues are debated dictated to us by industry or government.
About the linked pages
Background and context for reading these pages
There are large numbers of links on these pages leading to material which may be of interest to different people. There is a vast amount of reading. Once you start following all those links you will never get to Part 5 with its analysis of aged care in Australia and in depth explanation of the many ways in which the proposed community aged care hub would seek to address the issues exposed.
Suggestions:
- Read the brief summaries under the sliders below without going to the linked web pages, or
- If you do go to the pages skim through them and either don't go to the links or do so very selectively
Once you have looked at Part 5: Background of Community Aged Care Hub and seen what is happening in aged care and how the hub proposes to deal with this, you will be in a much better position to explore this section and see how all of this has impacted on health and aged care.
Politics: A public health problem
There is a slightly satirical article in the Medical Journal of Australia with this title which expresses the thrust of the linked page - that our political system needs treatment as it is dysfunctional! This page looks at a number of different criticisms about our political system. Like it or not aged care is trapped in this system and like health care it is affected and we all suffer from the consequences.
On the linked web page, I look at concerns that our judges have about our democracy, at an academic's analysis of the system and the extent that it is trapped by global belief systems, at concerns about the way the country is being run, and at a politician's criticism of the close financial and other relationships between business and politicians.
Then there are criticisms by a number of analysts of the way health and aged care changes are handled in the political system. There are moves to make health and aged care in Australia part of the global marketplace and to sell our health and aged care marketplace "expertise" into other countries.
Learn more: Politics is broken
Aged Care Policy in spite of the evidence
A free market was introduced into aged care by the Howard government in 1997. This was done in spite of a considerable amount of evidence from the USA at that time showing that care would be compromised. Additional funding and other changes were made by the Abbott government in 2014 to encourage the consolidation and increase the competitiveness in the sector. These changes favour for-profit corporations over not-for-profit providers who will struggle to compete.
Academics from the University of Sydney (UTS) have recently reviewed the large amount of international information available showing that for-profit and private equity providers provide inferior care and less staff when compared with not-for-profit. Their own studies based on the very limited information available in Australia suggests that a similar situation exists here. The evidence is that current policy is likely to compromise care further than it has already.
They have published several articles challenging the direction that the government is taking us and are calling for public debate.
The large industry groups have responded to this by forming a lobby group that is urging the government to stay on track with its policies.
The linked web page explores these issues and discusses the relevance of this to my analysis and proposals.
Learn more: Policy and Evidence
Free speech and democracy
We all believe in and are proud of democracy and free speech. We stoutly defend them. At the same time we stand by while democracy is undermined and various forms of censorship are subtly introduced. Each justified by plausible sounding arguments.
The reality is that free speech is dangerous, particularly for those who try it.. People have invested their lives in the current system and are driven to protect it and themselves. Speaking out to expose or criticise always upsets some. If change results then some, particularly those who have invested their lives in the current system, may be disadvantaged or even harmed if they are unable to adjust and change.
Those who speak out as whistleblowers or who express dissenting views are at risk of retribution as powerful figures seek to crush them in order to protect their patch. Change is inevitable and change only comes when people speak out, so this is a minefield we have to navigate. It helps if both recognise and acknowledge the problems.
The linked page explores these issues and their implication for aged care and the proposed community aged care hub.
Learn more: Speak out if you dare
Getting old in the UK and USA
This linked web page looks at some of the recent information coming out of the UK and the USA. It looks at some of the criticisms made there and the failures in their aged care systems. While the UK and the USA started from very different positions in the 1980s when economic rationalism was adopted by Margaret Thatcher in the UK and Ronald Reagan in the USA, the broad similarities in what is happening in both those countries and in Australia is revealing.
These countries are so locked into this increasingly outdated system of thought that none of them are prepared to admit that their thinking is flawed. None are coming up with sensible ways of addressing these problems. As a consequence we simply get more of the same under a new name and it never works.
There have been good but confronting television analyses of the situation in nursing homes in both the USA and the UK and there are links to both.
Learn more: International aged care
Many issues in aged care
This linked page contains a motley collection of issues related to aged care directly or indirectly and looks at many issues that are not part of my argument in Part 5, as well as some I revisit there. Mostly I just give an outline or introduction and supply links to material about the issue. Sometimes I express an opinion.
They include:
- Attitudes to ageing and to aged care
- A range of issues like dementia, medication use and abuse, dental care, infection control and more
- Australian medical opinion about aged care
- Accommodation issues, preventable deaths, reablement
- Economic potential of the aged
- Advocacy and dissent in aged care
- Some non-aged care matters revealing of attitudes and policies
- Some aged care market issues, some of which are revisited in Part 5.
Learn more: Different viewpoints in aged care
More about Advocacy
On the linked web page in the slider above there was a section on advocacy and dissent in aged care. On that I briefly mentioned the government funded and run advocacy service. Since that page was written the department of Social Service has commissioned a review of the government advocacy system by Australian Healthcare Associates, a private contractor.
Aged Care Crisis' (ACC) inquiries revealed that neither the submissions nor the final report are to be made available to the public. We are not going to be given an opportunity to become more informed and to debate the issues, nor will we know whether they have taken any account of our submission. We have subsequently learned by accident that the findings of the review were discussed at a meeting of invited stakeholders - something that those who responded were not told about.
Advocacy is an activity that is critically important for the welfare for citizens in vulnerable sectors yet this advocacy service seems to have been absent in just those situations where it was needed.
Academics have not been supported when they were attacked after they spoke out about failures in care. There has been no one there for nurses when they have spoken out and were then fired. The advocacy service is seldom mentioned by those families who speak out about what has happened to their relatives and about the failure of the complaints system.
These advocates are the people who should know what is happening in the system, yet we don’t hear from them in any of the public debates. It seems that the residents who need them are not aware of them and if they do anything then it is behind closed doors. Essentially it seems to be an organisation that is not working for those who need them so needs fixing. The advocacy in each state is contracted to independent operators in each state. I wonder if, like the nurses, advocates would lose their jobs if they spoke out critically?
ACC has made a submission to this inquiry. It has argued that the current structure is based on outdated 20th century thinking that is not working. It has called for a 21st century solution.
All of the structures protecting vulnerable citizens and maintaining standards are fragmented and organised centrally far away from the nursing homes and the communities where the care is given. ACC has argued that all of these oversight and support activities should be restructured and provided through local community organisations where they would be integrated and work together. The community should be involved in planning and in implementation from the outset. The ACC submission is in effect suggesting something like the proposed aged care community hub.
Advocacy is one of the problem areas in aged care and it needs solving. To counter the secrecy and make this a community issue ACC has decided to create a forum for discussion by making it part of the Solving Aged Care debate. We invite you to read that submission and then comment or if you prefer make a longer contribution to the debate about advocacy setting out your ideas.
We need to have the debate that the government is denying us.
We are particularly interested in getting information and comment from current advocates and from anyone who has had experience of the government’s advocacy system. You can do so anonymously and current advocates may prefer to do so.
Learn more: To read and contribute, please visit Review of Aged Care Advocacy Services
Soliciting feedback
Consumer surveys have become the flavour of the day with a large number of groups either entering this market or expressing their intention to do so. A variety of independent organisations initiated web reviews but were soon followed by an initiative between COTA and the NRMA awarding OWL ratings. A number of other groups serving the industry have offered feedback opportunities and the federal government has promised to open a Trip Adviser for aged care on its myagedcare web site.
The link below goes to a page that describes what is happening in the sector at present and then in turn links to an in depth analysis.
Learn more: Soliciting feedback
Developments in social thought
This linked page looks at some recent developments in social thought that are relevant to aged care. I set the context for this page by outlining the debris left by the 20th century and then examining the 21st century movement for greater participation in political processes at all levels of politics, and particularly in the provision of community services. Here, involvement and control by communities including those most affected by the policies is critical for success.
The evidence points to significant benefits for democracy, for activities in the community, for decision making across all spheres, and for the political process itself. I referred to this on the Community partnership page in Part 2. I give links to some of this material here.
Important theretical and practical work has been done by the Centre for Social Reform in Birmingham in the UK. Their focus on community and on the exercise of citizenship relates primarily to social services for the disabled and marginalised. It is directly applicable to aged care and some of their articles address aged care problems. What they are proposing for the 21st century differs from the 20th century structure that we are still getting in Australia.
Finally a group, The Dragonfly Collection, that has a very jaundiced view about the way the idea of innovation is being appropriated by government and market in order to control it and make it serve their purposes - so that it is anything but innovation. Is this what is happening in aged care?
Learn more: Developments in social thought
Bringing information together
There is a vast amount of scattered information available, but it is only when it is brought together that patterns emerge and you can see what is happening. In writing web pages on my separate web site analysing the system I quote from and discuss many articles and reports relevant to the arguments I am making.
On the linked page I have listed a selection of articles with links when possible. I have arranged them under sliders with brief notes to illustrate the arguments I am making in Part 5 where there are no links or references.
There is too much to read it all but the titles outline the story and the links are there to follow up on.
Learn more: Further reading