Budget package doesn’t guarantee aged-care residents will get better care


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Stephen Duckett, Grattan Institute and Anika Stobart, Grattan InstituteThe big investment in aged care announced in last night’s federal budget – an extra A$17.7 billion over five years – is a welcome response to the Royal Commission into Aged Care Quality and Safety. But even an investment of this scale does not meet the level of ambition set by the royal commission.

The government has committed A$6.5 billion for more home-care packages (about A$2.5 billion more for home care per year when fully implemented), and A$7.1 billion for residential-care staffing and services (about $2.4 billion more for residential care per year when fully implemented).

But the government has failed to outline a clear vision of what older Australians should expect of their aged-care system.




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Fewer hard hats, more soft hearts: budget pivots to women and care


Immediate fixes with no guarantees

The budget includes funding for 80,000 extra home-care packages over two years. The current home-care packages program has numerous problems, including nearly a 100,000-strong waiting list.

But the government has not explicitly promised to clear the waiting list and bring waiting times down to 30 days, as the royal commission called for.

The budget has some good news for people in residential aged care. The Basic Daily Fee (for services including food) will be increased by A$10 per resident per day, as called for by the royal commission.

And there’s more funding for better staffing, with mandates for an average of at least 200 minutes of care for every resident every day (40 minutes of which must be by a nurse) by 2023.

This is a good start, given nearly 60% of residents presently get less than this. But residents will have to wait two years – not one, as recommended by the royal commission – before they get more care hours.




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If we have the guts to give older people a fair go, this is how we fix aged care in Australia


The budget also provides additional funding to improve the aged-care workforce. The government will subsidise the training of new and existing aged-care workers, including 33,800 places to attain Certificate III.

But the government has not gone far enough in supporting the workforce. It stopped short of guaranteeing that every staff member providing care for older Australians will be trained to a minimum Certificate III level, and that all residential aged-care facilities will have a registered nurse on site 24 hours a day.

The budget commitments appear to be a once-off, with workforce funding plummeting to only A$86.5 million in 2024-25, compared to A$293.3 million in 2022-23. And there is no commitment to lift carers’ wages.

Residents won’t have access to a registered nurse 24 hours a day.
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Small steps towards a better system

The royal commission made it clear the aged-care system needed to be reformed from top to bottom. The government’s announcements foreshadow a shake-up of the system over five years. But the extent of reform is yet to be determined.

The budget papers show funding will be up by about A$5.5 billion per year once most reforms are in (see the chart below). That’s not enough to create a needs-driven, rights-based system, called for by the royal commission and the Grattan Institute.


Federal budget paper 2

The government has committed to a new Aged Care Act, to be legislated by mid-2023, though the details are yet to be filled in. This Act must put the rights of older Australians at its heart.

The government has also committed to designing a new home care program and will provide a single assessment process for both home care and residential care.

More home-care packages will be available but there won’t be enough for all those currently on the wait list.
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A local network of health department staff will be embedded in the regions, and there will be a network of 500 “care finders” to help older Australians get the support they need.

But the biggest risk to achieving real structural change is governance and transparency. Here, the government has fallen short.




Read more:
4 key takeaways from the aged care royal commission’s final report


The government does not support the establishment of an independent aged care commission. Most disappointingly, it is pumping A$260 million into the Aged Care Quality and Safety Commission, which the royal commission found had demonstrably failed.

While some transparency will be provided through public reporting of staffing hours and star ratings to compare provider performance, clear transparency measures will be needed to ensure the additional billions don’t end up boosting providers’ profits.

The good news from budget 2021 is that the journey has begun. The government has made a substantial down payment to allow development of a new aged-care system. We must hope that more will follow, so the neglect ends and every older Australian can get the care and support they need.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute and Anika Stobart, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Budget splashes cash, with $17.7 billion for aged care and a pitch to women


AAP/Mick Tsikas

Michelle Grattan, University of CanberraThe Morrison government has brought down a big-spending, expansionary budget that forecasts Australia’s unemployment rate will fall to 4.75% in two years time.

But Australia’s international borders won’t be properly open for at least a year, according to the budget’s assumptions.

“Australia is coming back,” Treasurer Josh Frydenberg told parliament on Tuesday night.

“Employment is at a record high, with 75,000 more Australians in jobs than before the pandemic.

“This budget will help to create more than 250,000 jobs by the end of 2022-23,” Frydenberg said.

“This budget secures the recovery and sets Australia up for the future.”




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Frydenberg spends the budget bounty to drive unemployment down to new lows


The deficit for next financial year is expected to be A$106.6 billion, with cumulative deficits of $342.4 billion over the forward estimates.

As the government continues to spend to underpin the recovery, net debt will increase to 30% of GDP at the end of June, before peaking at 40.9% at June 30, 2025.

Aged care centrepiece

The centrepiece of Frydenberg’s third budget – which had been largely pre-announced by the government – is a $17.7 billion aged care package, spent over five years and including 80,000 extra home care packages.

Frydenberg said this would make a total of 275,000 packages available. The present waiting list is 100,000.

The aged care package is designed as long term structural reform after the royal commission found the system in a parlous state and needing a comprehensive overhaul.

“We will increase the time nurses and carers are required to spend with their patients,” Frydenberg said.

“We will make an additional payment of $10 per resident per day to enhance the viability and sustainability of the residential aged care sector.

“We will support over 33,000 new training places for personal carers, and a new Indigenous workforce.

“We will increase access for respite services for carers.

“We will strengthen the regulatory regime to monitor to monitor and enforce standards of care.”

In other major initiatives, there is $2.3 billion for mental health, while the earlier-announced adjustment to the JobSeeker rate will cost nearly $9.5 billion over the budget period.

Tax cuts and a focus on women

Some 10.2 million low and middle income earners will benefit from the extension of the tax offset for another year, at a cost of $7.8 billion.

As Morrison seeks to repair his image with women, there is a range of measures on women’s safety, economic security, health and wellbeing totalling $3.4 billion.

This includes $1.7 billion for changes to child care, $351.6 million for women’s health, and $1.1 billion for women’s safety.

There will be another $1.9 billion for the rollout of COVID vaccines.

Quizzed at his news conference on the future of Australia’s closed border, Frydenberg hedged his bets. “When it comes to international borders, it’s an imprecise business.”

The budget papers assume a gradual return of temporary and permanent migrants from mid-2022, and small arrivals of international students, starting late this year and increasing from next year.

“The rate of international arrivals will continue to be constrained by state and territory quarantine caps over 2021 and the first half of 2022, with the exception of passengers from Safe Travel Zones.

“Inbound and outbound international travel is expected to remain low through to mid-2022, after which a gradual recovery in international tourism is assumed to occur,” the papers say.




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Budget 2021: the floppy-V-shaped recovery


The budget is heavy on continued help for business, with more than $20 billion extra in support.

With the country facing a skill shortage and skilled workers not able to enter, Frydenberg said the government would create more than 170,000 new apprenticeships at a cost of $2.7 billion.

“We will help more women break into non-traditional trades, with training support for 5,000 places,” he said

There will be 2,700 places in Indigenous girls academies to help them finish school and enter the workforce.

More STEM scholarships will be provided for women.

Another 5,000 places are being made available in higher education short courses.

Housing and support for retirees

The budget’s housing package includes another 10,000 places under the New Home Guarantee for first home buyers who build or buy a newly-built home. It will also increase the amount that can be released under the First Home Super Saver Scheme.

From July 1, 10,000 guarantees will be provided over four years to single parents with dependants to build or buy a home with a deposit as low as 2%.

Retirees will benefit from a measure to encourage them to downsize.

Older people will no longer have to meet a work test before they can make voluntary contributions to superannuation. People aged over 60 will be able to contribute up to $300,000 into their superannuation if they downsize.

Given the housing shortage, this is aimed at freeing up more housing for younger people.

The government will also enhance the Pension Loan Scheme by providing immediate access to lump sums of $12,000 for single people and $18,000 for couples.

Although modest, one measure that will help women, who retire on average with much less superannuation than men, is that the government will remove the $450-a-month minimum income threshold for the superannuation guarantee.

Frydenberg said the government was committing another $15 billion over a decade to infrastructure, including roads, airports and light rail.

There is also $1.2 billion for multiple measures to promote the digital economy.

Labor says it’s ‘just more of the same’

The opposition was dismissive. Anthony Albanese said, “Australians have endured eight long years of flat wages, insecure work and skyrocketing cost of living under the Liberals and Nationals – and this budget does nothing to change that.

“It’s just more of the same from a tired old government.”

The Business Council of Australia welcomed the budget, saying it “strikes a prudent balance between growth and fiscal discipline by making sensible investments in the levers of growth”.

But the ACTU said while the Coalition’s rejection of austerity was welcome, “the government has failed to use the spending in this budget to tackle the underlying problems of low wages and insecure jobs”.

Instead, it was “handing billions of dollars to business including in the critical areas of aged care, mental health and vocational training, with little accountability or strings attached”.

The Australian Aged Care Collaboration, which represents more than 1,000 providers, congratulated the government on agreeing to implement most of the royal commission’s 148 recommendations.

AACC representative Patricia Sparrow said “after 20 government reviews in 20 years, this budget, and the government’s response to the royal commission’s recommendations, finally addressed many of the challenges facing aged care”.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

4 key takeaways from the aged care royal commission’s final report



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Stephen Duckett, Grattan Institute and Anika Stobart, Grattan Institute

The Royal Commission into Aged Care Quality and Safety’s final report into aged care has laid out an extensive plan to overhaul Australia’s aged-care system.

Among the 148 recommendations, the report calls for a new system underpinned by a rights-based Act, funding based on need, and much stronger regulation and transparency.

Over two years, through more than 10,500 submissions and 600 witnesses, the two commissioners heard extensive evidence of a system in crisis. Australians might have expected the commissioners to provide one streamlined blueprint for reform.

But the commissioners diverged on a number of large and some smaller recommendations. This makes the already complex path to reform even more confusing. It reduces the power of the final report. More disappointingly, it gives the government room to pick and choose recommendations as the cabinet likes.

Nonetheless, if the major recommendations are adopted, Australia will get a transformed aged care system over the next five years.

Here are our top four takeaways from this landmark report.




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Paid on par with cleaners: the broader issue affecting the quality of aged care


1. Australia needs a rights-based aged-care system

In its recommendations, the final report highlights Australia needs a new Aged Care Act to underpin reform. The new Act should set out the rights of older people, including their entitlement to care and support based on their needs and preferences.

This would be a significant shift away from the current ration-based system, and would bring aged care more in line with the principles of Medicare.

Practically, this would mean the number of people in the system would no longer be capped — the long waiting lists for care would disappear over time. The current aged-care programs, such as home-care packages and residential care, would be replaced by a single program.

Under this new program, all older Australians in need of support would be independently assessed, and allocated care according to their personal needs and preferences — whether at home or in residential care.

This is a huge step forward, and, with the right support, would enable older Australians more choice and control over their care.

2. The system needs stronger governance

Ineffective governance and weak regulation of aged care must end. The final report calls for much stronger governance, regulation of the quality of care, prudential regulation, and an independent mechanism to set prices.

These changes would ensure the “quasi-market” aged-care system, as commissioner Tony Pagone described it, was much better regulated, holding providers to a higher standard of care, and better able to address any service gaps in the system. We might see the introduction of home care in locations where home-care services were not previously available, for example.

This change would require all aged-care providers to be accredited against the new standards. We hope that process would weed out some of the poorest performers in the sector. The new system would have offices across the country, to provide on-the-ground support to older Australians and providers.

Unfortunately, the commissioners diverged on the exact mechanisms for these changes. Pagone wants an independent commission to be responsible for aged care, at arms-length from the health department. Meanwhile, commissioner Lynelle Briggs wants governance to remain with a reformed department, but with quality regulation managed by an independent quality commission.

Given the department’s poor track record on managing aged care, we need to see a major change of culture. We urge the government to accept commissioner Pagone’s recommendation.

3. We need to improve workforce conditions and capability

The final report makes numerous important recommendations to enhance the capability and work conditions of formal carers. It calls for better wages and a new national registration scheme for all personal care workers, who would be required to have a minimum Certificate III training.

Residential care facilities would need to ensure minimum staff time with residents. By July 1 2022, this would be at least 200 minutes per resident per day for the average resident, with at least 40 minutes of that time with a registered nurse.

The facilities would be required to report staffing hours provided each day, specifying the breakdown of residents’ time with personal care workers versus nursing staff.

While these measures are good, they are the bare minimum, and would only give facilities a minimum 2 or 3 star rating. But coupled with recommendations for stronger transparency, including the publication of star ratings and quality indicators to compare provider performance, providers might be incentivised to go above this minimum standard.

4. A better system will cost more

The final report makes a series of complex recommendations about fees and funding, with the commissioners diverging in view as to the specific arrangements. But essentially, the proposed new funding model would provide universal funding for care services, such as nursing.

This means there would be no requirement for aged-care recipients to pay a co-contribution, like public patients in public hospitals. Instead, the expectation is people pay for their ordinary costs of living, such as cleaning, subject to a means test and up to a maximum amount in residential care.

A carer holds the hand of an elderly person.
A rights-based system means funding is determined by each individual’s needs.
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These changes would coincide with the phase-out of the burdensome refundable accommodation deposits, which some residents currently pay as a lump sum to providers when they enter residential care. This approach is a shift away from the current muddled set of means-tested arrangements, and may help offset some of the additional spending needed to pay for a rights-based system.

Unfortunately, the report does not touch on how much the recommended changes would cost. Australia should be prepared to pay the price of a better aged care system.




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View from The Hill: royal commission confronts Morrison government with call for aged care tax levy


The government has been underspending on aged care. Most Australians agree the government should provide more funding for aged care. Commissioner Briggs has the more persuasive proposal for funding the new system. She wants the government to introduce legislation by July 1 2022 that establishes an aged-care improvement levy of 1% of taxable personal income.

Commissioner Pagone is weaker on this point. He wants the Productivity Commission to investigate the establishment of an hypothecated aged-care levy (meaning the money raised by the levy can only be spent on aged care).

Either approach will be politically difficult, but Australians should demand their government lock-in a secure funding supply. That will help produce an aged-care system that protects the rights, upholds the dignity, and celebrates the contribution of all older Australians.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute and Anika Stobart, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

View from The Hill: aged care to cabinet, Tehan to trade in Morrison’s modest reshuffle



Lukas Coch/AAP

Michelle Grattan, University of Canberra

The most important changes in Scott Morrison’s limited reshuffle are centred on two vital and controversial issues – aged care and trade – that will severely test the government in coming months.

Aged care has been elevated to cabinet and put in the safe hands of Health Minister Greg Hunt, who has performed strongly during the pandemic.

The current Aged Care Minister, Richard Colbeck, retains responsibility for aged care services, including delivery of residential and home care packages and the regulation of the sector.




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With the royal commission due to deliver its final report in February, Hunt will spearhead the policy response. Importantly, he will carry the government’s public case as it works through one of the most difficult policy challenges of early 2021.

The choice of Dan Tehan for trade is logical. He comes with an extensive background in the area before his parliamentary career, including serving in the Foreign Affairs and Trade Department, and as an adviser to a former trade minister, Mark Vaile.

Tehan arrives in the portfolio – shed by Simon Birmingham who is now Finance Minister – when trade tensions with China are an all-time high, and Australia is looking to negotiate trade agreements with Europe and the United Kingdom.

Tehan’s education portfolio goes to Alan Tudge, who will also have responsibility for youth (previously under Colbeck). The recent Four Corners expose about Tudge’s private life hasn’t affected his ministerial career. Questioned at his news conference on Friday, Morrison said those matter related to years ago.

Morrison has also elevated some spear carriers of the right.




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Queensland senator Amanda Stoker is promoted from the backbench to become Assistant Minister to the Attorney-General. ACT senator Zed Seselja moves from being an Assistant Minister to become Minister for International Development and the Pacific.

Rewarding the Liberal party right might be politically useful next year, if Morrison needs the conservatives’ forbearance for a shift on climate policy.

Andrew Hastie is also from the Liberals’ conservative wing, but his move up from the backbench will be seen through a foreign policy prism.

He has been an outspoken hawk on China and the Chinese will be particularly noting his appointment as Assistant Minister for Defence.

Hastie has been well respected on both sides of politics as chair of parliament’s influential intelligence and security committee.

A former soldier in the SAS who served in Afghanistan, he will potentially be able to help manage the fallout from the Brereton report on alleged Australian war crimes, which is proving difficult for the government.

The new Immigration Minister will be Alex Hawke, Morrison’s strong factional ally. This position has been in limbo for a year, in the hands of an acting minister, while David Coleman has been on personal leave.

Coleman is to become Assistant Minister to the Prime Minister for Mental Health and Suicide Prevention, an area Morrison has given high priority in the pandemic.

It is notable Ben Morton, who is very close to Morrison, has not been moved up to the junior ministry. He stays as Assistant Minister to the Prime Minister and Cabinet, where he can have a bird’s eye view on many matters, as distinct from the narrower focus demanded by a ministerial portfolio.

Morton formally takes over from Hunt to become Assistant Minister for the Public Service — a role he has had anyway while Hunt has been preoccupied with the health crisis. A former Liberal party director in Western Australia, Morton will also have the politically-sensitive position of Assistant Minister for Electoral Matters.




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Grattan on Friday: China plays reverse ‘poke the bear’


Jane Hume moves up from assistant minister, with expanded responsibilities as Minister for Superannuation, Financial Services and the Digital Economy.

Communications Minister Paul Fletcher adds urban infrastructure and cities to his responsibilities, but loses cyber safety.

Morrison emphasised key portfolios relating to the economy and security remained unchanged, as did the positions held by the Nationals, and the number of women in cabinet.

He said the changes reflected a “very strong focus on stability in key portfolios, together with a commitment to bring forward some new talent”.

The new Morrison ministry list can be found here.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Morrison likely to elevate aged care to cabinet, as government boosts its funding by $1 billion


Michelle Grattan, University of Canberra

The government will inject a further $1 billion into aged care, most of it for home care packages, in Thursday’s budget update.

Prime Minister Scott Morrison is also likely to elevate the troubled policy area to cabinet, in his imminent ministerial reshuffle.

Some 10,000 home care packages will be provided, costing $850 million, in the latest funding – 2500 packages will be released across each of the four levels of care.

The funds – announced Wednesday and included in Thursday’s Mid-Year Economic and Fiscal Outlook – come ahead of the final report of the royal commission into aged care due in February. An interim report more than a year ago was scathing about conditions in the sector.

Aged Care Minister Richard Colbeck is in the outer ministry and struggled during the pandemic. COVID’s largest death toll was in the residential aged care sector – approaching 700 deaths out of the total Australian deaths of just over 900.

Colbeck, a Tasmanian senator, was with Morrison in Tasmania on Tuesday and it is understood the Prime Minister went to Colbeck’s Devonport office after a function.

The reshuffle is expected to be modest, with most interest in who gets the trade portfolio, presently held by Simon Birmingham who took over finance when Mathias Cormann left parliament.

Trade is high profile with the attacks by China on a range of Australian exports. Education Minister Dan Tehan has been widely speculated for the post.

Tehan has experience in the area. He served in the Foreign Affairs and Trade Department; in 2002 he was seconded to the office of trade minister Mark Vaile as trade adviser. Later he worked for the Australian Chamber of Commerce and Industry as director of trade policy and international affairs.

If Tehan moved to trade, that would leave the education portfolio open – with the new incumbent facing the problems of a higher education sector that has taken a beating from the pandemic, which has blocked overseas students’ entry to Australia.

David Coleman, who has been on leave from the ministry for personal reasons for a year, is expected to step down from it in the reshuffle.

There is some room for backbench promotions to the frontbench.

The government said the new aged care money would bring to nearly 50,000 the number of home care packages funded since the commission’s interim report, at a cost of $3.3 billion.

In September more than 100,000 people were waiting for packages. The government says 99% of people on the home care waiting list are already receiving some level of support package.

The latest funding also includes $63.3 million for increased access to allied health services and improved mental health support for people in residential aged care.

An extra $57.8 million will be provided for aged care under the National Partnership on COVID-19 Response. This will strengthen protection, including training and and support in infection prevention and control.

There will be $8.2 million to extend the Victorian Aged Care Response Centre until June 30.

The budget update will show the projected deficit not to be as large as forecast in the budget only two months ago.

The update is expected to adopt conservative assumptions about the iron ore price which has skyrocketed recently.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Aged care isn’t working, but we can create neighbourhoods to support healthy ageing in place



Image: Kathleen Brasher, Author provided

Melanie Davern, RMIT University; Geoffrey Woolcock, University of Southern Queensland; Kathleen Brasher, Charles Sturt University, and Rachel Winterton, La Trobe University

This article is part of our series on aged care. You can read the other articles in the series here.


In 2020, the coronavirus pandemic has exposed issues and inequities across society. How we plan for ageing populations and older people is one critical issue that has been neglected for decades. Fresher-faced youth and families have become the demographic focus of increasingly short-term electoral cycles, reinforcing a deep-seated prejudice against ageing and older people.

If Gandhi is right, and the true measure of a society can be found in how we treat the most vulnerable, then Australia has a lot to learn from the 683 deaths from COVID-19 in residential aged care this year. Australia needs a radical shift to policies that better support ageing in place — that is, in their own homes — rather than relying so heavily on underfunded and poorly resourced residential aged care.




Read more:
Despite more than 30 major inquiries, governments still haven’t fixed aged care. Why are they getting away with it?


Residential aged care populations are growing, with 70% of facilities located in major cities and 30% in regional areas. These facilities and current policies are failing our older people as identified by the current Royal Commission into Aged Care. Reform is needed now.

However, residential aged care is only part of the problem of failing to plan adequately for ageing. Neoliberal policies have turned the ageing population into a growing consumer market while filial piety or family caring becomes rarer as economic and social pressures on working families (their adult children) become greater.

Old and young women sit together in a garden
Caring for older family members is becoming rarer in Australia, but remains common practice in Asia.
Chayatorn Laorattanavech/Shutterstock



Read more:
Asian countries do aged care differently. Here’s what we can learn from them


These trends have reinforced health inequities. More than 100,000 people are on the waiting list for in-home support package funding. Over the past two years, 28,000 people have died before receiving any funding.

Older women are particularly vulnerable. In 2007, 75% of women aged over 70 had no superannuation (with superannuation beginning in the 1980s). Two-thirds of residents in aged care were women.

Being age-friendly makes cities more liveable

We need to shift the conversation on ageing to healthy ageing and creating environments that better support ageing in place. Age-friendly places aren’t just good for older people. They also support the needs of children, people with a disability and everyone else in a community.




Read more:
‘Ageing in neighbourhood’: what seniors want instead of retirement villages and how to achieve it


The 50-year-old child-friendly cities movement has increasingly emphasised how the features of a city that make it safe, healthy and accommodating for its most vulnerable citizens can also make it much more liveable for everyone.

In recent research we looked at how the World Health Organisation’s Global Age-Friendly Cities Guide can be applied in local planning. The aim was to develop practical tools to help policymakers and planners assess the age-friendliness of local neighbourhoods. This included the use of spatial indicators to measure the eight domains of the Age-Friendly Cities framework.

Spatial indicators investigating the relationship between health and place are created using geographic information systems (GIS) to map the presence of features within a local area. We have suggested key indicators that can be created and mapped using desktop analysis to understand how age-friendly local spaces are.

Table of key indicators for assessing age-friendly cities

Author provided

One of the most striking features is that many of these suggested measures are important for everyone living locally and not just older people. Examples include good walkability, public open spaces, public transport, affordable housing, local services, cafes, doctors and internet connectivity. Others are age-specific such as in-home aged care.

Most importantly, all of these factors are essential ingredients of healthy and liveable communities. Together, they support better health and well-being outcomes for all. We have mapped many of the suggested measures of age-friendly communities in the Australian Urban Observatory.




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How do we create liveable cities? First, we must work out the key ingredients


The use of additional technology such as sensor and robot technology should also be considered in future community and housing design, but this depends on household internet access. That can be a problem, particularly in regional and remote areas where populations are ageing rapidly and fewer aged-care places are available.

Some of these indicators might not necessarily be feasible for all regional and rural communities. Many regional communities have reduced access to services. However, these indicators still provide an important starting point for discussions with diverse rural older people about what is important and what constitutes reasonable access within their community.




Read more:
The average regional city resident lacks good access to two-thirds of community services, and liveability suffers


If we have learnt anything from this difficult year, then post-COVID recovery must include a broader approach to ageing that extends beyond residential aged care to a focus on healthy ageing. That means better support for people to age in place.

Age-friendly communities enable older people to continue to make significant economic and social contributions to families and communities. However, this can’t occur unless local places plan for all ages and abilities from the beginning.The Conversation

Melanie Davern, Senior Research Fellow, Director Australian Urban Observatory, Deputy Director (Acting) Centre for Urban Research, RMIT University; Geoffrey Woolcock, Senior Research Fellow (Regional Community Development), Strategic Research Projects, University of Southern Queensland; Kathleen Brasher, Assistant Lecturer, Charles Sturt University, and Rachel Winterton, Senior Research Fellow, John Richards Centre for Rural Ageing Research, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Despite more than 30 major inquiries, governments still haven’t fixed aged care. Why are they getting away with it?


http://www.shutterstock.com

Eileen Webb, University of South Australia; Christie M. Gardiner, University of Newcastle, and Teresa Somes, Macquarie University

This article is part of our series on aged care. You can read the other articles in the series here.


Australia’s aged care sector has been the subject of more than 30 major inquiries and reviews since 1997.

It is fair to say the findings have been highly critical of the way aged care is run in this country. Many of these concerns have been brought to light again — along with new issues raised — in the ongoing Royal Commission into Aged Care Quality and Safety.

Yet, as the royal commission has noted, successive Australian governments have shown a “lack of willingness to commit to change”.

Responses often come years after the review and recount what has been done in an almost tangential way.

Even the establishment of the royal commission was not based on previous inquiries or recommendations, but in response to media exposés of the appalling conditions in some aged care facilities.




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Aged care failures show how little we value older people – and those who care for them


From these dysfunctional circumstances, three questions arise.

First, what are the ongoing issues with aged care in Australia?

Second, why have successive governments been comfortable making do with piecemeal solutions rather than truly “fixing” aged care, once and for all?

Finally, and most perplexingly, why have Australian voters let them get away with it?

What’s the problem?

It is important to emphasise that aged care is predominantly a federal government responsibility. The 1997 Aged Care Act is the main law covering government-funded aged care. This includes rules for funding, regulation, approval of providers, quality of care and the rights of those in care.

Elderly woman looking out a window.
The Royal Commission released a damning interim report into aged care in October 2019.
http://www.shutterstock.com

Since 2019, the federal Aged Care Quality and Safety Commission Act regulates complaints, sanctions and enforcement, but has been criticised for lacking teeth.

The 1997 act diluted many preexisting regulatory protections, such as strict financial accreditation and staffing requirements, and opened the sector up to privatisation. At the time, concerns were raised the new regime could compromise standards of care in aged care facilities and disadvantage older people on lower incomes.

The concerns were raised again and amplified in subsequent years. For example, in 2011, a Productivity Commission report noted Australia’s aged care system needed a “fundamental redesign”.

Here is a brief summary of the recurring issues raised in multiple reports:

  • the huge difficulty people have navigating the aged care system, including finding accurate information about facilities

  • failure to meet the needs of vulnerable older people

  • poor quality care, especially for those with dementia and other disabilities

  • the use of chemical or physical restraints

  • inappropriate staff ratios and poor training

  • the rising cost of care, especially in light of an ageing population

  • adherence to accreditation standards

  • ineffective complaints mechanisms.

Why haven’t these problems been fixed?

One of the major hurdles to real reform is the relationship between the aged care industry and the federal government.

The government funds the sector and provides a relatively “light-touch” oversight, while the providers attend to the day-to-day running of the facilities.




Read more:
Federal government did not prepare aged care sector adequately for COVID: royal commission


However, there is concern this alignment has meant successive governments are not as involved as they should be and proposals for change are diluted by the influence of industry lobbyists.

Another reason for governments’ reluctance to intervene is many of the providers are “too big to fail”. A facility’s licence and government funding can be withdrawn if standards are not met. Yet this rarely happens.

Why? Because if a licence is revoked, residents need somewhere to go. The issues here can be seen in the closure of the Earle Haven nursing home in July 2019. Here, 68 elderly people were left homeless and had to be moved to hospitals and other aged care facilities.

As a further example, Bupa, one of Australia’s largest providers, continues to operate, despite sanctions or failing fundamental assessments.

Why isn’t aged care a vote winner?

After so many inquiries and so many horror headlines, the problems in aged care are well and truly common knowledge. But do Australians care enough about aged care for it to influence their vote — and so, influence the way governments respond?

If we cast our minds back to the 2019 federal election campaign, the hot button issue concerning older people was the potential demise of franking credits and negative gearing.

Australians voting at a polling booth.
Aged care issues did not feature prominently in the 2019 federal election.
http://www.shutterstock.com

In-home and residential aged care barely rated a mention in the campaigns of the major parties.

Even now, despite the publicity surrounding the royal commission, if an election was held today, would this issue actually influence voting intentions? Sadly, it seems unlikely.

During the July 2020 Eden-Monaro byelection, a survey of nearly 700 voters showed while 84% believed the aged care system was “in crisis”, this influenced the vote of less than 4% of respondents. It also ranked last in a list of seven issues of importance.

When heartfelt concern does not translate to winning votes, there is little incentive for the federal government to provide meaningful solutions to well-documented problems.




Read more:
The budget must address aged care — here are 3 key priorities


We only need to look to the record spending in the 2020 Budget, which provided only 23,000 extra home care packages and deferred consideration of funding for residential aged care until the royal commission’s final report next year.

It comes back to voters

Why does concern for the plight of people in aged care fail to generate public action?

We suggest it is because many Australians consciously or unconsciously have ageist attitudes — that older people are inherently not important. On this front, look no further than arguments made by prominent commentators about the fate of older people during COVID-19.

Yes, most fair-thinking Australians care about our older citizens, yet until either we or our family members are directly impacted, we do not prioritise it.

If we don’t care enough or care about other things more, nothing will change. And, while this remains the case, the government will have no reason to do more than just tinker with an unsatisfactory status quo.




Read more:
If we have the guts to give older people a fair go, this is how we fix aged care in Australia


The Conversation


Eileen Webb, Professor of Law and Ageing, UniSA: Justice and Society, University of South Australia; Christie M. Gardiner, Associate Lecturer of Law, University of Newcastle, and Teresa Somes, Associate Lecturer, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Aged-care facilities need accredited infection control experts. Who are they, and what will they do?



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Philip Russo, Monash University and Ramon Zenel Shaban, University of Sydney

The Royal Commission into Aged Care Quality and Safety last week released a special report looking at the sector’s response to COVID-19.

Finding the federal government did not adequately prepare residential aged care to deal with a pandemic, the commission made several recommendations designed to safeguard residents moving forward.

One was that the federal government should arrange with states and territories to deploy “accredited infection prevention and control experts” into aged-care facilities to better prepare for, and assist with, management of outbreaks.

But who are these accredited infection prevention and control experts, and what will they actually do?

First, why do aged-care facilites need this?

Infection prevention and control is well established in hospitals and acute care facilities. In Australian hospitals, there’s an average of one full-time infection prevention nurse for every 152 beds. Hospitals typically have an infection control committee, which is ultimately accountable to the hospital board.

By definition, aged-care facilities are not considered to be health-care facilities. Rather, they are social-care settings designed to mimic a home environment as much as possible.

While this is important for residents, this difference can present a range of challenges from an infection control perspective. Unlike hospitals, aged-care facilities typically have various communal areas for socialising, dining and activities, where groups can gather and come into close contact.

Two elderly men talking over a cup of coffee in an aged-care setting.
Aged-care facilities have a range of communal spaces for residents.
Shutterstock

Recent research found while Australian hospitals are guided by different national and state-based standards and guidelines, aged-care facilities generally manage infection control arrangements themselves.

Only 23% of Australian aged-care facilities surveyed had a dedicated infection control committee. More than half reported a lack of staff with specialised qualifications and experience in infection prevention and control.




Read more:
Federal government did not prepare aged care sector adequately for COVID: royal commission


Enter infection prevention and control experts

The royal commission report noted high-level infection control expertise was needed:

  • to assist with the preparation and implementation of outbreak management plans

  • to provide training to staff on the use of personal protective equipment (PPE) and infection prevention and control

  • to provide assistance on day one of an outbreak.

An elderly woman sits in a wheelchair, while a cleaner cleans the floor of her room.
COVID-19 has highlighted the importance of infection control in aged care.
Shutterstock

Besides the accredited infection prevention and control experts, the commission recommended all aged-care facilities should have one or more trained infection control officers as a condition of accreditation.

This could be a registered nurse who has specific training in infection prevention and control. Importantly, they should have access to expert resources and be capable of implementing infection prevention programs.

Employers would be required to support these nurses to take the infection prevention “champion” role, and under the close supervision and guidance of the accredited experts, they could prepare plans for outbreaks like COVID-19.

These plans would include ongoing education around the use of PPE, procedures regarding how to manage residents who become infected, and trigger points for escalating responses.

The COVID-19 crisis in residential aged-care facilities, particularly in Victoria, has shown us how important it will be to have strong and experienced leaders overseeing these plans, and the management of any ongoing and future outbreaks.




Read more:
Poor ventilation may be adding to nursing homes’ COVID-19 risks


So how are the experts accredited?

The Australasian College for Infection Prevention and Control (ACIPC) is the peak body for infection prevention and control in the Australasian region. It provides “credentialing” for professionals who want to become accredited infection prevention and control experts.

There are three levels of credentialing: primary, advanced and expert. Qualifications and experience determine the level a person attains, but the system is designed so those commencing at the “primary” level can progress to “expert”.

A panel of existing accredited infection prevention and control experts reviews all applications.

They evaluate whether the applicant meets several criteria across five domains: relevant vocation, prerequisites, knowledge, attitude and practice. Criteria include professional qualifications, awards, experience, continuing education, professional activities, and research.

Once credentialed, each member must apply for their accreditation again every three years.

Right now, there aren’t enough

The relationship between certification status of health professionals and the quality of patient care they provide is clear.

In particular, hospitals with infection control programs led by certified or credentialed infection control practitioners have fewer health care-associated infections when compared to those led by non-certified infection control practitioners.




Read more:
Older Australians deserve more than the aged care royal commission’s COVID-19 report delivers


According to the ACIPC database, there are currently around 62 accredited infection prevention and control experts in Australia, of whom 42 are at expert level. All are nurses.

The royal commission acknowledged this small number as a limitation. It reflects the fact employers so far haven’t generally required their staff to attain this accreditation — so there’s been little incentive.

But COVID-19 has necessarily changed this. In the short term, facilities must establish a relationship with a local accredited infection prevention and control expert who can support their staff.

Looking forward, employers and providers should be incentivised to support staff to seek higher infection prevention training, and ultimately undergo credentialing.The Conversation

Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash University and Ramon Zenel Shaban, Clinical Chair and Professor of Infection Prevention and Disease Control at the University of Sydney, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Older Australians deserve more than the aged care royal commission’s COVID-19 report delivers



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Joseph Ibrahim, Monash University

Amid the ongoing disaster in Victorian aged-care homes, the Royal Commission into Aged Care Quality and Safety yesterday released its special report into the COVID-19 pandemic.

This report finally states who is responsible for aged care — the federal government — finding its actions were “insufficient” to ensure the aged-care sector was prepared for the pandemic.

But the report doesn’t offer us a clear picture of what went wrong and why.

Importantly, its recommendations largely fall short and come too late.

5 main recommendations that don’t go far enough

The report’s first key recommendation addresses the vexed issue of isolating residents from family and friends during lockdowns. The commissioners have asked the government to fund providers to ensure adequate staff are available to facilitate loved ones to visit.

This addresses the universally recognised need for a humane and proportionate response to lockdown, and the need to reduce the mental and physical harms associated with isolation.

But a better approach would be to introduce a mandatory code for visits to aged-care homes during COVID-19, rather than the voluntary code we currently have. We’d also need a way of enforcing this code, including a process to address family concerns immediately.




Read more:
Federal government did not prepare aged care sector adequately for COVID: royal commission


Second, the commission recommends the government create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to aged-care residents.

While this will assist to some degree, a better recommendation would be instituting structured rehabilitation plans for residents with support from care workers. This would ensure the allied health advice provided through these new Medicare items is followed.

This recommendation also fails to address the fact many allied health staff work across multiple services, which increases the risk of infection spread.

The third recommendation requires establishing a national aged-care plan for COVID-19, including setting up a national aged-care advisory body. This is the most obvious step in any emergency response.

The commission indicates the plan should establish protocols between the federal government and states and territories, which may reduce some confusion around who is responsible for what. The plan should also set up procedures regarding who decides whether residents with COVID-19 are transferred to hospital.

As part of the plan, significant outbreaks in facilities are to be investigated by an independent expert, and any lessons promptly disseminated to the sector.

But the commission doesn’t provide any detail on what constitutes an independent expert, a major oversight. Ideally, the experts shouldn’t be directly involved with government departments, the regulator or affiliated groups involved in the pandemic response.




Read more:
4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes


Perhaps most disappointing is the commission did not highlight that multiple outbreaks in aged-care homes reflect systemic issues rather than individual organisational failures. The most useful information is obtained by investigating every aspect of the sector as a whole. This is a missed opportunity and does not serve the best interests of older Australians.

As for the advisory body, the commission was clear the group Prime Minister Scott Morrison established in August was not sufficient — it lacked the right skill mix and was temporary.

But it’s extremely disappointing the commission has not directed that senior nurses, family members and residents (ideally supported by human rights lawyers) be appointed to the group. The people who will be most affected by the decisions should be directly involved in making them.




Read more:
Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers


The fourth recommendation stipulates all aged-care homes should have one or more trained infection control officers as a condition of accreditation.

The fifth is for governments to deploy accredited infection prevention and control experts into aged-care homes to provide training, and assist with preparing for and managing outbreaks.

These are sound recommendations, but should have been in place more than a decade ago, had we learnt from Hong Kong’s experience with SARS.

The challenges with implementing these recommendations will be having the human resources for such a workforce, including addressing the longstanding issue of health professionals’ willingness to work in regional and remote areas.

Some key omissions

The report’s recommendations are worthwhile, yet all are late in arriving and incomplete. Each recommendation provides a solution to an entirely foreseeable problem.

Notably, there’s an absence of strategies to address the known structural problems in aged care. These are issues the commission itself has previously described, around workforce limitations, widespread neglect of residents, and regulatory failures. They represent barriers to implementing the recommendations.

An elderly woman walks down the corridor of a nursing home using a frame.
Dedicated staff will be deployed to enhance infection control procedures in nursing homes.
Shutterstock

The commissioners also fell into the trap of inappropriate comparisons. References to Australia faring better than selected European and North American countries fail to acknowledge our advantages of being an island continent with lower community transmission and an extra three months to prepare. This provides false reassurance to the public.

We should judge our performance on the disparity between what we could have done and what we did do, rather than against countries in different situations.

There’s more to uncover

It’s not surprising the government has accepted all the recommendations, as each of these initiatives should have already been in place well before the second wave hit Victoria.

The commission has recommended the federal government report on the implementation of these recommendations no later than December 1.




Read more:
The budget must address aged care — here are 3 key priorities


Ultimately, this report was not designed, nor did it deliver, an understanding of what went wrong in aged care, and why.

Similarly, the recommendations do not go to the heart of the information gleaned from the appalling and tragic lived experiences of residents, families, aged-care workers and health professionals.

With so many outbreaks, many still ongoing, and tragically, several hundred deaths in aged care already, there remains much we need to uncover.The Conversation

Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Federal government did not prepare aged care sector adequately for COVID: royal commission


Michelle Grattan, University of Canberra

The royal commission into aged care has said government did not prepare the sector well enough for the pandemic.

In a damning report the commission rejected the government’s repeated claim it had a plan for aged care, which is a federal responsibility.

The commission said that now “is not the time for blame” for what happened in aged care, where most of the Australian deaths have occurred – as at September 19, 629 out of 844 total deaths. The latest number of deaths from residential aged care is 665.

But, the commission said, it was clear the measures implemented by the federal government on advice from the Australian Health Protection Principal Committee “were in some respects insufficient to ensure preparedness of the aged care sector”.

It called for immediate action on infection prevention and to ensure residents weren’t cut off from visitors.

In its special report into COVID, the commission said the government should establish a national aged care plan and a permanent aged care advisory body.

Under pressure from evidence to the commission, the government belatedly set up an advisory committee in August but made it clear it was temporary.

As soon as the report was tabled on Thursday, Aged Care minister Richard Colbeck said the government was accepting all its recommendations.

But he continued to insist the government did have a plan for the sector.

“Never before has the aged care sector in Australia faced a challenge like COVID-19,” the report said.

It said the government should fund providers to ensure there were adequate staff available to deal with visits from family and friends.

The understandable restriction of visits “has had tragic, irreparable and lasting effects which must immediately be addressed as much as possible”.

“Maintaining the quality of life of those people living in residential aged care throughout the pandemic is just as important as preparing for and responding to outbreaks,” the report said.

“Funding to support increased visits is needed immediately.”

The commission recommended the Medicare schedule be changed to increase the provision of allied health and mental health services to residents during the pandemic, and the government should “arrange for the deployment of accredited infection prevention and control experts” into facilities.

Announcing $40.6 million as an initial response, Colbeck said the government was already well progressed in delivering some of the recommendations.

The commission said that “confused and inconsistent messaging” from providers, the federal government, state and territory governments had been themes in submissions to it.

“All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge?

“At a time of crisis, such as this pandemic, clear leadership, direction and lines of communication are essential”.

The commission said much had been made during its hearing about whether there was an aged care specific plan for COVID.

“There was not a COVID-19 plan devoted solely to aged care. But there was a national COVID-19 plan that the Australian Government sought to adapt and apply to the aged care sector.”

However “there is a clear need for a defined, consolidated, national aged care COVID-19 plan”.

The commission said the recommended plan should be established through the national cabinet in consultation with the aged care sector.

The plan should establish federal-state protocols, maximise the ability for residents in facilities to have visitors, and establish a mechanism for consultation with the sector about the use of “Hospital in the Home” programs.

It should establish protocols on who would decide about transfers to hospitals of residents with COVID, and ensure significant outbreaks were investigated by an independent expert, with the results disseminated to the sector.

The commission said the government should report to parliament no later than December 1 on the implementation of the recommendations in its report.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.