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.
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.
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:
- result in the ongoing regular collection of accurate information about care, quality of life and finances.
- create the necessary conditions to make this market work and require it to foster and support our humanitarian values.
- 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.
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.
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.