New Aged Care Act fails to deliver meaningful improvement

April 1 marked six months since the full commencement of the Aged Care Act, and the date passed with barely a whimper.

In February, data from the Productivity Commission showed that older Australians are waiting for almost a month to even be assessed for services. They will then wait for over 200 days after assessment to access those services.

Other recent reports focus on the older Australians ‘blocking’ scarce hospital beds as they wait for aged care placement, threatening to drive government care spending skyward. The system is under severe stress and demographic shifts will continue to increase demand for the foreseeable future.

While there are undoubtedly aged care operators and care workers doing their utmost to care for our parents and grandparents, loneliness and depression still remain rife in the sector.

Within aged care services, particularly residential aged care, care recipients are distracted with colourful robots, video game consoles and iPads; inane distractions billed as loneliness-busters and quality of life boosters. Still, stories continue to seep from the sector about cases of abuse and neglect.  

This is happening at the same time as the sustainability of services is in decline. News of acquisitions and amalgamations have dominated industry headlines. Local community-owned services are being subsumed within expansive, growth-centred corporations, many of which operate as for-profit businesses.

Commentary from both aged care operators and older people accessing (or attempting to access) services highlights how operating and living conditions have either stagnated or diminished under the new Act. Peak bodies are warning that conditions are straining further under the weight of the ongoing fuel crisis.

The free market fiction

Working for a decade in the sector, I empathise with these significant challenges. From frontline caring to various administrative and policy roles, I’m familiar with aged care’s complex web of workforce, funding and infrastructural intricacies. But we need to seriously ask: where is the sector improvement?

Aged Care Minister Sam Rae, his predecessor Anika Wells, and Minister for Health and Ageing Mark Butler have overseen the system on its downward trajectory.

In the same spirit as governments before them, they continue to insist that aged care should be legislatively framed as a commodified product – a free market in which consumers and providers freely tussle in a spirit of good-willed competition. All their proposed interventions have followed this market-driven framing: injecting cash, deregulating beds, and establishing charters of consumer rights.

But this framing is a foundational fiction. In fact, it is the underlying failure of aged care in Australia.

Aged care’s so-called ‘market’ is doomed to consistently fail and, in doing so, it jeopardises the well-being and flourishing of older Australians.  A person will only access aged care services because they have some degree of dependence (they require some form of ongoing personal or clinical care), and they will near certainly do so in a time of duress (such as seeking access from a hospital bed). This basic premise undermines market operation from the word go.

To attempt to build an aged care sector around ‘consumer rights’, as the new Aged Care Act has insisted upon, is pre-destined for failure. The person receiving aged care services cannot be reduced to being a ‘consumer’ without damaging all other aspects of their life.

A person who is receiving aged care is necessarily dependent on those care services. Because of that dependence, aged care institutions and organisations will necessarily influence all facets of the person’s existence.

Without properly designed supports and safeguards that recognise these truths, and without active engagement from other parts of society, people receiving aged care will languish and be unable to flourish – as we have consistently seen.

Rather than being spaces and services where human beings are empowered to flourish in connection with society in the later years of their life, much of aged care remains overly clinical, a market-dominated distraction, intended to occupy older members of our community until they die. So, what is to be done?

Keeping close and connected

Policymakers need to think beyond the market paradigm with aged care. It’s not enough to keep fiddling around the edges; the sector needs meaningful foundational change.

Policy and regulation need to reflect the significance of this sector’s human impact. Instead of insisting on doomed market-based interventions, we need to see quality aged care as a matter of justice – as we do for healthcare and education.

In the absence of government action, the sector needs more courageous aged care operators and innovators willing to rise above the status quo, moving away from thinking of themselves as ‘providers’ in transaction with ‘consumers’.

Community groups, families, and other members of society should consider how they can better engage with aged care, ensuring older members of our communities are kept close and connected.

Unless we can do away with the current damaging foundations of aged care in this country, the sector will not improve. We’ll return at every subsequent milestone or anniversary to observe the continued spiral until it’s time for another Royal Commission.

---