As our population continues to age, aged care will be a very real part of all of our lives eventually. Government projections predict that by 2050, the portion of the population over the age of 85 will increase from the 0.4 million we have now, to 1.8 million. The expected increase is often attributed to the ‘baby boomer’ generation being so large, and suggestion is made that it will decline as the generation dies out. However, Australia has a consistent growth in life expectancy which may lead to longer stays in aged care facilities than before, and thus, continued increase in demand. Luckily, the government has begun to implement much needed reform and regulation to the industry.
The past 18 months has seen the sector under a metaphoric microscope due to the introduction of Covid-19. As aged care homes typically house the most medically vulnerable members of the population, it is no surprise that the virus spread rapidly within facilities. Throughout Australia, the aged care homes have made up three quarters of total numbers of deaths. Of those deaths, a vast majority were from private facilities rather than the government funded ones. Australia has an estimated 3,000+ aged care providers, 59 per cent of which are privately owned and mostly geared for profit. Many would expect that with larger out of pocket expenses for the residents, that these facilities would result in better quality and care. However, the publicity aged care has received due to Covid has shed a great deal of light on many cases of negligence across the private sector. Public facilities are governed by strict requirements and regulations, private facilities are not. As a result, many of these private providers get away with drastically lower standards including a dangerously low ratio of staff to residents.
As these privately-owned facilities are regularly understaffed, it is not uncommon for hygiene practices to also be sub-par. Due to this diminished cleanliness, and lack of funding allocation for PPE, cases were able to easily spread. This resulted in large clusters of ICU grade cases, putting a strain on resources. Covid-19 increased the pressure on many Victorian hospitals throughout the larger outbreaks. At the time, concerns were high with regard to the availability of many types of equipment. Items such as ventilators and anaesthesia required an additional piece of equipment; an air compressor. Hospitals were previously able to meet temporary surplus’ in requirements with an air compressor lease, however, Covid related demand was larger than the number of devices available. There has been speculation that these shortages may have impacted the number of deaths recorded. Had these private aged care facilities been held to similar standards as the public system, we may have seen fewer cases, and subsequently, fewer deaths.
For elderly people and their families, a private facility suggests a higher level of care to go with the higher price tag. However, unlike the not-for-profit public facilities, there is a requirement to make profit. Therefore, a proportion of the fees paid by residents is siphoned out as revenue and less is spent on the cost of providing the care. Reports on Covid cases also became reports of residents receiving poor quality and quantities of food, facilities with no 24hr medical personnel at hand, and even cases of medical neglect. Aged care equipment suppliers provide facilities with a number of essential items, not least of which is the bed alarm. This can be used by residents to call for assistance when they are in need. However, residents reported using these alarms and having heavy delay in responses if one is received at all. For residents who are in a fragile or compromised state, this could be catastrophic.
In 2018, Australia launched a royal commission into the aged care sector in order to assess current conditions and spending. The review was designed to ensure elderly citizens are receiving the best care as well as improvement and preparation for expected growth. A total of 148 recommendations were made ranging from requests for a National Disability Insurance Scheme (NDIS) review to the wages and training of its staff to be increased. All in all, the recommendation required extra funding of $10 billion a year. The 2021 budget has allocated a total of $18 billion over the next four years and the government has committed to 123 of the 148 recommendations including the creation of a new aged care act.
While the act is estimated to be around two years away, it is expected to deliver many reforms. We can expect to see the homecare waiting list cleared by the time the act is complete. The reforms will also see a minimum mandate for time spent with residents for staff and a minimum requirement for access to an on-site nurse. Nutritional quality and quantity of food provided to aged care residents will be closely monitored with requirements to report expenditure. Perhaps the biggest reform to come from the new act will be a push to make staying in your own home more realistic. The government package commits to raising the number of home care packages by 80,000 over the next two years. Many residents would prefer to remain in their own home and maintain some independence. The increase of home care is expected to greatly benefit the sector as accommodation cost is one of the biggest allocations of limited government funding.
In the coming two plus years, we will see many changes in the aged care system. The extra funding and enforcement of an industry wide standard will ensure our countries most vulnerable are kept safer and given a better quality of life. The only remaining concern of industry workers and families alike is the lack of pledge to improve numbers of staff and quality of wages and training. It will be close to impossible for many of the changes to be effectively implemented – without pushing existing staff to breaking point – unless the workforce is increased. As an industry that is already underpaid and under-appreciated, it is likely these new changes will see many leave the industry, and a serious decline in recruitment.