Historically, aged care barely rates a mention in federal elections. Conventional wisdom says aged care isn’t a vote winner, so the spinners and speechwriters get away with shallow platitudes about better care for our elders and politicians are rarely asked to pony up any policy specifics.
This hollowness at the heart of our policymaking has allowed neglect, abuse and poor care to flourish in aged care for decades. In the wake of shocking scandals, various inquiries have been held, committees formed, recommendations handed down and mostly ignored. And each successive government has failed to make Australia’s aged care system safer and more dignified.
This election has been different. The escalating crisis in aged care has been exacerbated by the pandemic, and the community has been profoundly affected and enraged by the harrowing stories flowing from aged care during lockdowns and outbreaks. The public knows that the status quo is unconscionable and expects major change.
The incoming prime minister, Anthony Albanese, has staked his credibility on his capacity to deliver aged care reform. Aged care was the centrepiece of his budget reply, and Albanese campaigned heavily on the issue, making much of of what he described as the Coalition’s “cynical” and ineffectual one-off payment schemes for workers while emphasising Labor’s “plan” to “fix” the aged care crisis.
In contrast to the royal commission’s 148 comprehensive recommendations to overhaul our aged care system, Labor went to the election with a mere five-point plan: registered nurses on site 24/7, more carers, better pay for workers, greater financial transparency and instituting nutrition standards.
These are all critically important issues: round-the-clock registered nurses will improve palliative care and pain relief; an increase in staff numbers and a pay rise will help recruit and retain workers; and measures to address appalling rates of malnutrition and enhance financial transparency are also urgently needed.
But five points alone won’t undo decades of neglect, nor will they encompass the sweeping changes the royal commission recommended.
Complex policy issues get boiled down to bullet points in election campaigns. But now that Labor is in government, it’s time to move beyond the slogans and get into the meat of the complex policy reform that must take place to improve the daily reality for older Australians in care.
While addressing pay conditions and chronic understaffing is critical, the Albanese government must also tackle the training and regulation of aged care workers, in order to professionalise the workforce. At present, personal care workers are not regulated like other healthcare staff; nor are they subject to any mandatory minimum training qualifications.
The royal commission recommended a compulsory minimum standard of a Certificate III apply to aged care workers, in order to ensure a baseline standard of competency. The problem untrained workers pose is particularly acute in home care settings, where workers cannot draw on the medical expertise of nurses as they can in residential care.
Likewise, aged care workers should be regulated so that unqualified or unsuitable workers can be excluded from the workforce – just as they are in other areas of healthcare.
Additionally, the Albanese government must urgently address the vexed issue of regulation – about which the two commissioners delivered divergent recommendations in the royal commission’s final report – by scrapping the present aged care regulator, and creating an empowered and independent body to oversee providers. For too long, providers who repeatedly fail quality standards have been allowed to continue operating – many posting extraordinary profits – even as older Australians experience indignity, neglect and abuse in their care.
The regulator’s light touch during the pandemic as outbreaks swept through the sector – including suspending site visits, reaccrediting providers over the telephone, and allowing providers to self-assess whether they were prepared for outbreaks – further underscores the case for complete overhaul. As the royal commission noted in its interim report, the regulator in its current form is utterly “unfit for purpose,” and without an effective regulator, any of the Albanese government’s other aged care policy reforms will be for naught.
But the most important task in front of the Albanese government is the writing of a new Aged Care Act, which must undo the pernicious myth of the “aged-care consumer” inflecting our current policy settings, which has underwritten so much of the current damage.
This new Act, which the royal commission has recommended come into force by July 2023, will be of enormous consequence to our ageing population: it will determine what kind of system we enter when we need care, what protections we have from negligent providers, and what standards and human rights we are entitled to. After all the rhetoric of the election, these are the words which will count.
• Sarah Holland-Batt is an advocate for aged care reform, a professor of creative writing at QUT, and the Judy Harris writer in residence at the University of Sydney’s Charles Perkins Centre. Her most recent book is The Jaguar (UQP, 2022)
