Aged care minister Anika Wells is spruiking federal Labor’s new aged-care reform package, introduced to Parliament on September 12, saying it shifts the focus from service provision to users’ needs.
However, while the proposed reforms, with a focus on support at home, are an improvement on the marketised system in place, they still fall short of what the elderly and their families need.
Responding to about 60 recommendations from the 2021 Royal Commission into Aged Care Quality and Safety, Labor argues its Aged Care Bill 2024 addresses 17 recommendations, including the sector’s “operational challenges”, with $5.6 billion to be spent on systemic reforms, including a $4.3 billion investment in Support at Home.
While the aged care bill is promoted as a “rights based” approach, it falls short by failing to adhere to human rights standards under the Universal Declaration of Human Rights.
It does not remove the use of physical or chemical restraints from aged care. The bill thereby violates the legal prohibition against “torture and cruel, inhuman or degrading treatment or punishment”.
Restrictive practice is a recognised form of torture and, while the new bill says restrictive practices are a last resort, they are not banned.
The bill’s Statement of Rights and Principles responds to the royal commission’s identification of widespread abuse and neglect in aged care.
While it sounds good, these rights are fairly tokenistic, as the bill does not allow legal redress for people when their rights are breached.
To gain the Coalition’s support for the bill, Labor removed the right for users to litigate against services providing poor care. They will be able to make a complaint, but not enforce their rights through the legal system.
If peoples’ rights are not enforceable by law, they do not exist in reality.
The other main way in which the “rights based approach” is more spin than anything else relates to users’ contracts with service providers.
Under the bill, when a person signs a contract to enter aged care, they become captive to that system. The proposed reforms do not afford the same level of consumer protection, or other legal rights, to people in aged care as they would have in the broader community.
Those signing service agreements will agree to a closed system of arbitration, with limited legal capacity to pursue compensation, or redress, for anything that goes wrong.
The proposed reforms also fail because of their continued minimum standards approach to providing services.
While the bill goes some way towards improving minimum standards, it does not spell out what a high quality aged-care system looks like.
Good care is different from minimum care and, while raising the minimum standard of care is important, it does not address quality-of-life issues.
Minimum care does not provide a stimulating and respectful environment, or a good quality of life.
Unlike other public services, such as state schools, public health services and community welfare services, which are fully funded, Labor has rejected the royal commission’s recommendation and implemented a user-pays system instead.
The final report from the government’s Aged Care Taskforce recommended against the royal commission’s suggestion that 1% Medicare-style levy could raise around $8 billion a year.
According to Deputy Chair of the Bendigo Kangan Institute Hal Swerissen in The Conversation Labor spent $25 billion on aged services for around 1.2 million people aged 65 and over in 2021–2022. Around 60% went to residential care (190,000 people) and one-third to home care (1 million people).
With costs likely to double over the next 20 years, Labor has opted to impose larger means-tested contributions on a highly vulnerable cohort of people.
The government will pay for clinical care, such as nursing and occupational therapy, but the elderly, including those on full pensions, will have to contribute to the care they need to live at home. This includes help with showering and dressing, as well as cleaning, gardening and meal preparation.
Labor wants to reduce the cost of aged care from 1.5% to 1.4% of gross domestic product (GDP), a miniscule amount of the federal budget. By contrast, Labor spends around 2.02% of GDP on defence ($55 billion over the financial year).
Having to pay the new cost of 17.5% of their income for services will have an enormous impost on those living on a full pension of, currently, $572 a week. Services will become inaccessible for pensioners paying private rent.
The Coalition under Prime Minister John Howard deregulated and privatised aged care in 1997. It opened the door for this vital health service to be driven by profiteers, while the quality of care deteriorated.
The royal commission found ample evidence of those, particularly in aged care facilities, being badly treated, or worse, in understaffed and under-resourced settings by underqualified staff. Malnutrition, abuse and neglect were common.
Just 4% of for-profit aged care providers were identified in 2022 as providing high quality care.
A better and more equitable solution would be to return aged care to a public system of service delivery, with free services funded by a levy, or through other government savings, with proper accountability and oversight.
There needs to be an actual human rights model of care, within which services are truly responsive to the users’ needs, respectful, with opportunities and support for elders to make real life choices and to live fulfilling lives.