Evidence supports mandatory COVID vaccination for aged-care workers. But we need to make it easier too


Holly Seale, UNSWNational cabinet yesterday announced it will mandate COVID-19 vaccination for residential aged-care workers, with the aim to ensure all aged-care staff have received their first dose by mid-September.

A support package worth A$11 million is intended to facilitate this, by enabling aged-care facilities to provide their staff with paid leave to be vaccinated.

Health department figures released to The Age showed two-thirds of Australian aged-care staff were yet to receive one dose as of last week. Of 263,000 workers, just over 88,000 (33.6%) had received their first shot and about 43,000 (16.3%) had received both doses.

Given the current community transmission across parts of Australia, and the low vaccination rates in this crucial group, it’s perhaps not surprising we’ve seen this policy shift.

Vaccine mandates for Australian health and aged-care workers exist

In Australia, this is not the first time we’ve moved to mandates to improve vaccine uptake among the health- and aged-care sectors.

Many health- and aged-care workers are required to show evidence they’re protected from a range of vaccine-preventable diseases. For example, annual flu vaccines are mandatory for those working in high-risk clinical settings, including staff in NSW Health aged-care facilities. With the introduction of these mandates, we have not documented mass departures of staff.

That said, as Prime Minister Scott Morrison correctly pointed out:

Imposing on a person the requirement to have a vaccine or not be able to work in a particular sector is something that no government would do lightly.




Read more:
Should all aged-care residents with COVID-19 be moved to hospital? Probably, but there are drawbacks too


Did we do enough to get to this point?

While Aged & Community Services Australia, the industry peak body, has welcomed the mandate as “the right decision”, others are questioning whether the government has made sufficient efforts to ensure on-site or priority off-site access to vaccination for aged-care staff across all states and territories.

To support vaccination access for the sector, the federal government announced 13 clinics in multiple locations for aged-care staff. But as of May, only three of these pop-up clinics had been established, all of which were in Sydney (in areas covered by the mass vaccination hubs).

Aged care provider peak bodies Leading Age Services Australia and Aged & Community Services Australia had previously called for more on-site vaccination for aged-care staff, as opposed to having staff members seek vaccination appointments via mass clinics or their GP.

In the aged-care sector, the delivery of vaccination is complicated by variations in staff working hours. Providing the COVID vaccine at their place of work can potentially addresses issues around access to vaccination.

Seeing coworkers getting vaccinated may also help build confidence in those who are sitting on the fence.

Studies have found workplace provision of vaccination plays an important part in the decision to immunise among aged-care workers, with higher vaccination rates in facilities providing on-site vaccination.




Read more:
It’s crucial we address COVID vaccine hesitancy among health workers. Here’s where to start


What we can do alongside the mandate

To support the introduction of this policy, it’s critical we support conversations within aged-care facilities to ensure staff members understand why the shift in policy has occurred, to address any misinformation and to support them to take up the vaccine.

Importantly, Australia’s aged-care workforce reflects the make-up of the broader Australian population. So English may be a second language for a portion of workers.

While efforts have been made to ensure information sheets are available in other languages, booking systems, including the one used to support the pop-up vaccination clinics in Sydney, are only available in English.

We need to be mindful to adopt best practice to support engagement with vaccine services for people from culturally and linguistically diverse communities. Information sessions should be held which allow for questions, and staff should have the opportunity to talk to an immuniser who speaks the same language if needed.

Previous surveys of aged-care staff have also identified some workers have limited computer skills, which may be a barrier to using online booking systems. Support should be available to assist those staff in booking their appointments.

An aged-care worker with an elderly woman.
Research has shown workplace provision of vaccination makes aged-care staff more likely to immunise.
Shutterstock

Concerns have also been raised about the level of funding allocated to support staff members to to take leave to have the vaccine. Australian Nursing and Midwifery Federation federal secretary Annie Butler calculated the A$11 million would give each unvaccinated worker about $A30 per dose.

As Butler noted, this would be nowhere near enough to support time off from work. So this issue needs to be addressed immediately to ensure aged-care workers can take time off if needed to access off-site vaccination appointments, and ideally to recover if they experience any adverse reactions.

Mandates work

The introduction of this mandate aligns with what has been recommended previously to improve influenza vaccination of aged-care staff. Internationally, mandates have been shown to increase vaccine coverage for health workers including for influenza.

It also aligns with our past research on mandatory vaccination of aged-care staff, where we found positive support from stakeholders, including those responsible for developing policy and delivering vaccination programs to aged-care staff.




Read more:
Mandatory COVID vaccines for aged- and health-care workers could increase uptake, but we need to exhaust other options first


Beyond aged care, there may be a need to extend mandatory COVID vaccination policies to other health workers including those working in community or disability care, or to staff in hospitals.

However, it’s critical we understand the coverage levels for each of these groups before moving forward, as other strategies including the opportunity for paid time off to receive a vaccine or incentives may assist here, before we need to consider further mandates.The Conversation

Holly Seale, Associate professor, UNSW

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

National cabinet makes jabs compulsory for aged care workers and AstraZeneca will be available for all who want it


Michelle Grattan, University of CanberraAll workers in residential aged care facilities will be required to have at least a first COVID vaccination by mid-September under a decision at an emergency national cabinet meeting on Monday night.

And in a major move to speed up the lagging rollout, the AstraZeneca vaccine will be available to anyone who wishes to have it.

This effectively makes vaccinations immediately available to the whole adult population.

At present the Pfizer vaccine, which is in limited supply, is administered on health advice to those aged 40 to 59, while the under 40s are not yet being vaccinated.

To encourage the wider take up of AstraZeneca, the government will bring in a new no-fault indemnity scheme for general practitioners who are providing advice on COVID-19 vaccines.

Scott Morrison, addressing a news conference from The Lodge where he is in quarantine, said the medical advice talked about AstraZeneca being preferred for those over 60. This is because of rare blood clots in younger people.

“But the advice does not preclude persons under 60 from getting the AstraZeneca vaccine. And so if you wish to get the AstraZeneca vaccine, then we would encourage you to go and have that discussion with your GP.”

National cabinet met against the threatening backdrop of outbreaks in five jurisdictions and more than 270 active cases nationally. There is particular worry about NSW, where greater Sydney and certain other areas are in lockdown, and now Western Australian premier Mark McGowan has ordered Perth and Peel into lockdown.

Morrison said it was “important to get feedback from all the states and territories on the measures that they’re putting in place and to essentially get everybody on the same page in terms of their understanding of the situation, the impact particularly of the Delta variant.

“The Delta variant is proving to be a far more difficult element of this virus than we have seen to date,” he said.

The mandatory vaccination of residential aged care workers comes after the latest figures show only a third of this workforce has had a jab, and many fewer are fully vaccinated.

The federal government will partner with the states to ensure compliance, and provide $11 million for facilities to give staff time to get vaccinated or deal with side effects.

“We want to make sure that this won’t have a negative impact on available workforce,” Morrison said.

He said this was the third time the mandating for aged care workers had been before national cabinet.

Previously the proposal has run into resistance from the national cabinet’s health advisers, who have worried that compulsion could lead to people leaving the workforce.

But Chief Medical Officer Paul Kelly said the Australian Health Protection Principal Committee had on Monday unanimously supported the decision.

Morrison said there would be a “risk-benefit assessment” in early August.

He said: “This has been a difficult group to get vaccinated, and this is why I have been fairly constant and determined to ensure we got to where we are tonight.

“I would have preferred to have been here a little while ago, but nevertheless, our determination has paid off.”

National cabinet is getting further advice on making vaccination compulsory for disability care workers.

In other decisions, vaccination and testing will be mandatory for all quarantine workers including those involved in the transport of quarantined individuals. Morrison said this would be a state responsibility and there would be no Commonwealth funding program such as with the aged care workers.

This follows an unvaccinated transport worker triggering the Sydney outbreak.

It will also be mandatory for returned travellers and close contacts to get tested two or three days after the travellers finish quarantine.

National cabinet agreed to ensure that international quarantine residents and other high risk people were kept separate from low risk people such as those crossing state borders.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.

At last, health, aged care and quarantine workers get the right masks to protect against airborne coronavirus


Shutterstock

C Raina MacIntyre, UNSW; Benjamin Veness, CQUniversity Australia, and Michelle Ananda-Rajah, Monash UniversityAlmost a year ago, in July 2020, our calls for the government to urgently upgrade the guidelines to protect health workers from airborne SARS-CoV-2 fell on deaf ears.

The existing guidelines said health providers working around COVID-19 patients should wear a surgical mask. It restricted use of the more protective P2 or N95 masks, which stop airborne particles getting through, to very limited scenarios. These involved “aerosol-generating procedures”, such as inserting a breathing tube. This was expanded slightly in August 2020 but still left most health workers without access to P2/N95 masks.

More than 4,000 Australian health workers were infected by COVID-19 during the Victorian second wave. Health authorities denied the importance of airborne transmission and blamed clinical staff for “poor habits” and “apathy”. Health workers expressed despair and a sense of abandonment, cataloguing the opposition they faced to get adequate protection against COVID-19.

Last week, 15 months after the COVID-19 pandemic was declared, the Australian guidelines on personal protective equipment (PPE) for health workers, including masks, were finally revised.

What do the new guidelines say?

The new guidelines expand the range of situations in which P2/N95 masks should be available to staff – essentially anywhere where COVID-19-infected people are expected to be – and remove all references to “aerosol-generating procedures”.

This recognises that breathing, speaking, sneezing and coughing all generate aerosols which can accumulate in indoor spaces, posing a higher risk than “aerosol-generating procedures”.




Read more:
Which mask works best? We filmed people coughing and sneezing to find out


“Fit testing” is an annual procedure that should be done for all workers wearing a P2/N95 mask or higher grade respirator, to ensure air can’t leak around the edges.

But this was previously denied to many Australian health workers.

The new guidelines unequivocally state fit-tested P2/N95 masks are required for all staff managing patients with suspected or confirmed COVID-19. This means health workers can finally receive similar levels of respiratory protection to workers on mining and construction sites.

The new guidelines leave ambiguity around which workplaces are within the scope by stating that health care:

may include hospitals, non-inpatient settings, managed quarantine, residential care facilities, COVID-19 testing clinics, in-home care and other environments where clinical care is provided.

The guidelines also allow employers to decide what comprises a high risk and what doesn’t, allowing more wiggle room to deny workers a P2/N95 mask.

N95 and surgical masks on a table.
N95 masks (top) protect against airborne transmission, while surgical masks (bottom) don’t.
Shutterstock

The guidelines say when a suitable P2/N95 mask can’t be used, a re-usable respirator (powered air purifying respirators, or PAPRs) should be considered.

But the guideline’s claim that a PAPR may not provide any additional protection compared to a “well-sealed” disposable P2/N95 mask, is not accurate. In fact, re-usable respirators such as PAPRs afford a higher level of protection than disposable N95 masks.

The new guidelines should also apply to workers in hotel quarantine – both health care and non-clinical staff. This will help strengthen our biosecurity, as long as they’re interpreted in the most precautionary way.

That means not using the wiggle room that allows workplaces to deem a situation lower risk than it actually is or that their workplace is exempt. When working around a suspected or confirmed COVID-19 case, all workers must be provided with a fit-tested P2/N95 mask. Otherwise they are not protected from inhaling SARS-CoV-2 from the air.

In aged care and health care, where cases linked to quarantine breaches can be amplified and re-seeded to the community, the new guidelines go some way towards better protecting our essential first responders and their patients.




Read more:
What’s the Delta COVID variant found in Melbourne? Is it more infectious and does it spread more in kids? A virologist explains


Guidelines miss the mark on ventilation

The guidelines fail to explicitly acknowledge COVID-19 spreads through air but nonetheless recommend the use of airborne precautions for staff.

Airborne particles are usually less than 100 microns in diameter and can accumulate indoors, which means they’re an inhalation risk.

The old guidelines focused on “large droplets”, which were thought to fall quickly to the ground and didn’t pose a risk in breathed air. This was based on debunked theories about airborne versus droplet transmission.

The new guidelines fail to comprehensively address ventilation, which is only mentioned in passing with a reference to separate guidelines for health-care facilities. This may not cover aged care or hotel quarantine.




Read more:
This is how we should build and staff Victoria’s new quarantine facility, say two infection control experts


We must ensure institutions such as hospitals, hotel quarantine facilities, residential care, schools, businesses and public transport have plans to mitigate the airborne risk of COVID-19 and other pandemic viruses through improved ventilation and air filtration.

Australia could follow Germany, which has invested €500 million (A$787 million) in improving ventilation in indoor spaces.

Meanwhile, Belgium is mandating the use of carbon dioxide monitors in public spaces such as restaurants and gyms so customers can assess whether the ventilation is adequate.

Cleaning shared air would add an additional layer of protection beyond vaccination and mask-wearing. Secondary benefits include decreased transmission of other respiratory viruses and improved productivity due to higher attention and concentration levels.

No updated advice on hand-washing

The United States Centers for Disease Control and Prevention (CDC) now acknowledges exposure to SARS-CoV-2 occurs through “very fine respiratory droplets and aerosol particles” and states the risk of transmission through touching surfaces is “low”.

Yet this is not acknowledged in the latest Australian health-care guidelines.

Australians have been repeatedly reminded to wash or sanitise their hands, wipe down surfaces and stand behind near-useless plexiglass barriers.

The promotion of hand hygiene and cleaning surfaces is not based on science, which shows it is the air we breathe that matters most.

Revised public messaging is needed for Australians to understand shared air is the most important risk for COVID-19.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Benjamin Veness, Adjunct Professorial Fellow, CQUniversity Australia, and Michelle Ananda-Rajah, Consultant physician General Medicine & Infectious Diseases, Alfred Health, past MRFF TRIP Fellow, Monash University

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

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


Shutterstock

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.




Read more:
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.




Read more:
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.
Shutterstock

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.
Shutterstock

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.”




Read more:
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.




Read more:
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



Shutterstock

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.




Read more:
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.
Shutterstock

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.




Read more:
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.




Read more:
Grattan on Friday: Six issues on Scott Morrison’s mind over summer


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.




Read more:
Is Canberra having a #metoo moment? It will take more than reports of MPs behaving badly for parliament to change


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.




Read more:
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.




Read more:
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.




Read more:
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.