Rising COVID-19 infections and the high mortality rates in private aged care facilities in Victoria have shocked the country. These are in large part due to the failings of the largely privatised aged-care sector, the consequences of which are deadly.
As people live longer, the number of people needing care in their older age is rising. According to The Tax Justice Network (TJN), between 2015–2016, 214,000 people entered aged care. It reported that on average, older people spend three years in permanent residential care, just over two years in home care, and one and a half months in respite care.
Our taxes contribute around 75% of federal funding to aged care and around 96% of the total aged care funding from federal and state governments. The deregulation of the aged-care sector in 1997 opened the way to privatisation of the sector. It quickly became a lucrative market: the six largest for-profit aged care companies continue to grow, attracting billions of dollars of federal government funding as they do.
In 2009, the Australian Nursing and Midwifery Federation (ANMF) launched an ambitious campaign, “Because We Care”, to push governments to hold private aged care providers to account. The union could see that the for-profit model was allowing resources for nurses and carers in the aged care homes to be swindled.
An ANMF-commissioned report put forward an economic case to stop the haemorrhaging of staff, which covered the recruitment, retention and retraining of aged care staff. The union focussed its attention on: fixing the wage gap; minimum staffing levels; retraining; transparent and accountable funding and the licensing of staff. An average weekly pay difference of $300 between the public and private sector meant that nurses were less likely to work in aged care or less likely to stay working there.
Understaffing the norm
Once, aged care was considered by nurses to be a good job to transition to before retirement. Now, many nurses refuse to work in a sector where understaffing has become the norm, large pay differentials continue, high workloads are commonplace, onerous documentation takes precious time away from direct patient care and the increased litigious nature of the work is forever on nurses’ consciousness.
There are no minimum staffing levels and no minimum educational requirements for carers. The 2009 ANMF report recommended a minimum qualification of Certificate 3 in Aged Care to be tied to licensing through the Australian Health Practitioner Regulation Agency (AHPRA).
To date, this has not been implemented even though there is a mountain of evidence to show that poor outcomes for residents in aged care are directly related to the inadequate staffing and skill mix. The system is heavily weighted towards an unqualified workforce.
The report also recommended that $750 million over four years was needed to improve the wages gap, and a further $376,724,400 was needed to fund 30,500 more nurses to properly staff nursing homes.
No accountability
However, the problem all along has been that private nursing homes appear to have carte blanche to do what they want with the federal funding they receive — 72% of their total revenue according to the TJN.
This lack of accountability is astonishing.
In 2009, the ANMF called on the federal government to force private aged care owners to show how much they spent on direct care, including nurses/carers’ wages, with proof that all care subsidies were spent on direct care.
Fast forward 10 years and nothing much has changed.
In February of last year, the federal government announced a $320 million funding boost to residential aged care. Council of The Ageing CEO Ian Yates said he was disappointed that the funding was not tied to improving staffing numbers and training in private aged care facilities.
The ANMF commissioned the TJN to investigate the private aged care sector in 2018. It found that in 2017, the six largest for-profit companies were given more than $2.17 billion in government subsidies. Their total revenue was $3 billion. Between 2016-2018, the companies reported profits of $210 million.
At the same time, the aged care providers were using sophisticated tax avoidance accounting methods while simultaneously crying poor. In 2018, it was revealed that some private providers were spending less than $6.08 per day on total food costs for three meals for each resident.
The ANMF’s Because We Care campaign finally started to gain traction. Former federal minister for ageing Mark Butler announced in March 2013 that the Labor government would commit $1.4 billion over 4 years to close the wages’ gap for workers in the sector — The Workforce Compact.
That promise was subsequently dumped by Tony Abbott’s newly-elected Coalition in September 2013. This was a missed opportunity to reform the sector, the repercussions of which are being felt today by the most vulnerable people who are bearing the brunt of the broken, private aged care system during the pandemic.
Labor had every opportunity to implement The Workforce Compact, but failed to do so in the lead up to the 2013 federal election.
After years of campaigning, the Victorian branch of the ANMF finally won nurse-to-patient ratios in the acute public sector and Victorian-run nursing homes, which was legislated in the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015.
Previously, the state government had only legislated for minimum nurse staffing levels within private hospitals and private nursing homes. This was removed in the 1990s by the Jeff Kennett Liberal government.
Action needed
In response to the COVID-19 pandemic, the federal ANMF is now pushing another five-point action plan with strikingly similar demands to the Because We Care campaign. It is pushing for: the immediate cessation of funding cuts to aged care; additional staffing with the right skill mix including mandated nursing/care hours; sufficient Personal Protection Equipment (PPE) and education on use of PPE and infection control; paid pandemic leave and for private aged care providers to be forced to show accountability/transparency for government-funding.
The aged care system is showing all the signs of just how a degraded privatised sector works. After years of neglect from major party governments unwilling to hold large profit- making corporations to account, it is unable to cope with a pandemic and our elderly folk will continue to pay the price.
[Katherine Davis is a health worker.]