It’s an awful death too many Australians are facing: losing the battle to breathe against a relentless disease, alone but for medical staff, prevented from seeing and touching family and friends, unable to say farewell.
That’s been the fate of 71 people so far in aged care facilities, and likely many more before the Victorian outbreak is finally suppressed. It’s a number that represents over 40% of Australia’s COVID-19 death toll.
The outbreaks in more than half-a-dozen aged care facilities in suburban Melbourne involving nearly 700 patients come months after the deadly Newmarch House outbreak in Sydney that claimed 19 lives despite lockdowns of facilities.
The failure of Newmarch House managers to send ill residents to hospital has been raised as a key reason why the outbreak was so much deadlier there than in other facilities. The families of victims also complained they were banned from removing their ailing relatives from the residence.
Now the focus in Victoria is on aged care staff working at multiple facilities spreading the virus.
Last week, Minister for Aged Care and Senior Australians Richard Colbeck announced a funding package to enable operators to pay staff to work at single sites, and said the Victorian industry had begun “an urgent process to ensure aged care workers work in a single aged care facility where possible”.
“The industry will commence a cooperative process to identify existing workforce sharing and negotiate safer arrangements across the sector to minimise the risk of COVID-19 transmission in aged care.”
But one industry peak body claimed 20-30% of the aged care workforce work in more than one facility. For a sector employing around a quarter of a million people across Australia, that’s at least 50,000 people nation-wide.
Industry sources are telling the media they remain unclear about exactly how the scheme to end multiple work environments will work, while Colbeck is adamant that no worker should be working at more than one site now.
If the 20-30% figure is correct, it represents a large increase on a decade ago, when a Department of Health study of the aged care workforce identified 10% of the workforce as holding more than one job.
Notably, for around half of those who had more than one job, their other job wasn’t in residential care — it was in community care or outside the sector altogether, meaning the challenge for the industry isn’t merely consolidation of existing positions.
This is a heavily part-time workforce — in 2010, more than 90% of aged care workers other than registered nurses were part-time or casual; even 80% of nurses were part-time or casual, reflecting the heavily female composition of the industry.
At least one of the sites of the current outbreaks has serious questions over its compliance with standards, and has been evacuated, as have others, but workers brought in by the federal government were also apparently unqualified.
That is, once again the aged care workforce is at the centre of major concerns about the failings of the aged care system. The workforce is a recurring feature of the many inquiries that have been held into aged care over the last 20 years and more, including the horrific interim report from late last year of the aged care royal commission currently underway.
The issue has not been the lack of funding being pumped into aged care — that has expanded significantly, and gone into both residential care and home care. But private providers have been the main beneficiaries of that increased funding, and have increased their role in the sector at the expense of facilities run by religious groups.
There is now an Aged Care Workforce Industry Council, which has been up and running for over a year, and a two-year-old workforce strategy. The strategy identifies many of the issues also identified in the interim report around the aged care workforce, including high turnover, “poor employee engagement and enablement”, difficulty in attracting talent (a huge problem for regional aged care facilities) and “key capability gaps and skills and competencies misalignment”. It also identifies “casualisation of the workforce” as a problem.
The challenge of improving the aged care workforce and making it a better fit for the kind of care that we want for our seniors has been known about for many years, and government processes have been under way for the last couple. But now seniors in Victoria face having to pay the highest price for our failure to get it right. And minister Richard Colbeck is insisting major reforms happen, literally, yesterday.
This isn’t a problem so much of funding, or even of non-profit versus private providers: it’s a complex policy problem about effective linking of the vocational training system, service provision, consumer empowerment and aged care funding mechanisms so that the sector can attract and retain people with the right competencies.
It’s a national scandal that we have known about the challenge for so long but have failed to respond to it, and it’s one we all share the blame for, not just one government or one provider.
How can we improve the aged care system? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication in Crikey’s Your Say column.
It is not a matter of how we can fix our aged care system. We have deliberately broken it. All we need to do is to revert to what used to work. Some thirty years ago, we had nursing homes run by skilled registered nurses and allied health, supported by GPs who routinely visited, often run by state governments. The professional knowledge was such that infection control and other essential expertise were built in, readily able to deal with a crisis. Sadly, political decisions were made it that the complex skilled work could be done on the cheap by dispensing with professional expertise and oversight, and replacing this with casual attendants with minimal training. The consequences should come as no surprise.
Well & truly said Chris…the taking of years for all that good works to be undone, must be one of the most horrible social ironies ,considering the ‘old age conservatism’ that has helped vote in & maintain the neo-liberal ‘creative destruction’..
This is just so closely linked to 4Corners last night, where the profit motive is totally at odds with proper care as the primary motivator.
If billions of dollars are needed to fix aged care/workers comp/tafe/uni/jobseeking etc then that money should be used to start nationalizing those institutions and begin doing the work properly and kindly, and employing ful- time decently paid staff at the same time.
Private enterprise is not always the holy grail, and we do not need any more Thatcherism as multiple crises engulf our societies.
Chris, whilst there may have been some very well run facilities 30 years ago there were also many many hell holes. As someone who was required to enter these private Nursing Homes it was simply disgusting how the forgotten people were treated. Many of these homes were owned and operated by Medical Practitioners. Old three story mansions in Sydney’s inner west in such disrepair and fire traps without lifts. Sometimes the good old days weren’t that good. It was just dependent where you looked.
Naturally not all was perfect back then but if the question is how do we fix things, we do have knowledge and experience of models that can care for the frail elderly (and support their loved ones) with skill and compassion. Those models have largely been abandoned for financial, ideological and political reasons, with the pretense that bureaucracy and nominal standards will miraculously substitute for consistent hands on expertise.
I d think there is a role for PCAs in Aged Care and that not all staff have to be nurses. Most of the needs of low care residents can be met by well-trained and experienced PCAs – showering, dressing, helping with eating, social activities and social support, etc but the key is the well-trained, and experienced and having a core of staff in each home who have been there for a while and know the residents and can mentor and supervise new staff. We need to go back to having the majority of staff as permanently employed working 8 hour shifts and supported by casuals, for example on night-shift when most of the residents are asleep. I am speaking of my parents’ experience and they were only ever in low care, before low and high care were consolidated (or I think this is what happened). High care (i.e. nursing home) residents. will need a more intensive standard of care.
I also think that the idea of ‘choice’ is an illusion. Like most families when we had to make a decision about our father when our mother couldn’t cope, we didn’t know anything about aged care. Fortunately back then there were groups such as Carer Support who could support and guide you to finding somewhere for your parent to live and give information on the rules. ‘Choice’ often brings out the snake-oil salesmen (and women) and as in disability care destroys the funding for the large, experienced organisations with experience in delivering services and fragments the money and the services.
We deliberately broke it because, of course, privatised care is “always better”. We can see how that has worked. We really deliberately broke it because our backers in the private sector could make money from it.
It’s happened at both ends of life, the only way it can be profitable is by minimising standards and minimising care, and the only way that can happen is ‘deregulation’ by a complicit Government.
We voted for it, it’s both Coal-ition and ALP policy.
Part of it is that aged care is not integrated into the health system.
Surely it is about money? Even the better ones use as low priced a worker they can get away with and pay them poorly. But the regulations and awards allow them to do this. Not saying the people who do work there aren’t good at what they do but the chase for profits with chronic understaffing and poorly trained staff and old vulnerable people makes for a dangerous cocktail.
Another spectacular social failure caused by leaving it to the market. It beggars belief that the media allows right wing winks from the IPA, BCA etc to continually push for cutting red tape without ever calling them to account for market failures of which we have experienced many – the banks, superannuation funds, building regulation, aged care, NDIS, electricity generation and retail, public transport, child care – on and on and on. Every market is perverse and ineffective it seems but we are only ever told that by serial royal commissions. And when the state does anything for social good (eg child protection) the states strangles its own capability with inadequate funding, it seems to demonstrate that it should be privatised. And all this is only one aspect of the social carnage neoliberalism has unleashed. Yet we have a treasurer lauding the success of the ‘heroes’ of neoliberalism. How stupid and greedy we have become in our atomised individualism indoctrinated into us by the political retreat from responsibility engineered by the warriors of neoliberalism. And with one dimensional morons like #ScottyFromMarketing and #JoshFromAccounts it seems we are now going to dive deeper into this quagmire of social failure until the whole illusory structure of neoliberalism blows up in our face. It just has, yet we have not recognised it for what it is.
BA, exactly. Aged care – Another industry privatised by Howard this time, proven to be an absolute failure. All your other industry examples cited show there should be a national conversation in our media about why privatisation has failed, and in this case, is killing people.
Where is the analysis of the failed management of these sectors, and the failed regulatory gestures and policies by previous and current governments?
Private sector aged care Management is responsible for striving for profits, cutting costs and removing experienced, more costly staff. Management in this sector is responsible for perfecting funding mechanisms and deteriorating, pathetic quality care practices and standards.
It is annoying to see various industry apologists and Colbeck focus on staffing issues, deflecting focus from the management that has taken billions of taxpayer money, without investing in improving quality care.
This could also apply to security guards involved In hotel quarantine. While it is clear that Victorian Government didn’t do their due diligence on the companies involved, if the private sector is so much more efficient and that is why as many services as possible should be outsourced, why is the spotlight not focussing on the companies which provided the workers? If they have government contracts, surely they should be providing the services to the highest standard . . .
It is unacceptable that staff have to work at more than one facility as this could cause infection in multiple facilities. This does not just affect Covid 19, but all ailments including flu etc.
We need to go back to what worked with State owned and run facilities with prifessional nurses and regular doctors backing up the system.
Another major private enterprise fail.