Privatisation, cost-cutting behind aged care crisis

July 26, 2013
Many elderly people living in aged care facilities are grossly neglected.

Anyone with even superficial experience with how aged people are treated would be disgusted and outraged by the standards of most nursing homes, a result of neoliberal policies in Australia.

An investigation by ABC TV’s Lateline on July 15 found many elderly people living in aged care facilities are grossly neglected. Advocacy groups have called it “a national human rights emergency”.

The issue typically gets mentioned in the media only when a spectacle is involved, like a fire in a nursing home that costs lives.

An undercover investigation by the Sunday Telegraph in 2010 found: “Elderly patients in nursing homes are being fed cold and inedible food, left sitting in urine and faeces and subjected to cruel and at times inhumane treatment from overworked and under-resourced carers.”

After Lateline aired its report, the Minister for Aged Care, Jacinta Collins, denied there was widespread neglect.

She told Lateline: “We have to look at the situation in context, not putting aside the very concerning images that are part of tonight's presentation. There are roughly about 220,000 Australians in aged residential care, and in most cases those people are well looked after within accredited services that are doing their job properly.”

If these were isolated cases, they could have been quickly dealt with. But they are not.

The work of many generous and dedicated staff keeps nursing homes going, and provides desperately needed care. But there is a limit to the sacrifices they can make before the personal toll overtakes them.

The aged care industry is one of the fastest growing sectors in Australia. By 2020 there is expected to be 1.6 million Australians aged over 65 who will require some form of

However, there is a shortage of skilled nurses who can provide the level of care that is needed.

One of the reasons for this is that nurses are expected to work long hours for less money compared with work in other sectors.

A 2011 budget submission by the Australian Nursing Federation said: “Registered and enrolled nurses and assistants in nursing earn up to $300 a week less than their counterparts in the public health system.”

Chronic under-staffing and grossly inadequate budgets, such as a reputed $6 allocated for food per person per day, increase the stress on staff.

This is a humanitarian crisis, in a country whose wealth should make this situation unthinkable.

Brian Martin, a professor of social sciences at the University of Wollongong, has blown the whistle on the aged care crisis.

He says that Australian governments are ignoring the crisis, not listening to those warning them of the consequences of their neoliberal policies and actions.

When it comes to deregulation, Martin is unequivocal: "A policy of relaxing standards has led to relaxed standards.” He explains that a "free market" is incapable of providing guidance to aged care because the primary consumers are aged, by definition in poor health, often confused, and very vulnerable.

There is a shortage of nursing home places. The costs, which residents bear and often meet in part by a substantial "up-front" payment, prevent their "marching with their feet".

Relatives and others concerned for the welfare of residents are frequently ill-placed to assess the quality of care being given.

For these reasons, and the fact that they are major providers of funding for aged care, governments have a duty of care to such residents, answerable to both the residents of nursing homes and the wider community.

In contrast, the private sector's primary aim is to maximise profit. With this logic, patient care is a cost to be minimised.

Martin compares the Australian situation to that of the US. There the true believers in the "free market", faced with having failed to provide genuine care, shout louder for greater adherence to "free market" principles.

The Australian federal government’s policies of deregulation and an embrace of the "free market", have led to an erosion of standards of control over aged care in nursing homes.

Martin examined the adequate rates of pay of today's carers and said the traditional altruism and integrity of carers are eroded once aged care facilities are placed in the hands of private capital.

"It is a low-paid job which depends on the dedication and altruism of staff. In a market system the focus on profits comes at the expense of dedication and altruism. It is hard to maintain motivation in a system where your dedication is exploited not for residents in need but to provide management with large bonuses and uninterested shareholders with large profits ...

“A radical restructuring is long overdue. Care and the community should be at the heart of any new system. The farming of our seniors for profit must be stopped by marginalising the market in this sector."

A big overhaul of the system is long overdue.

In response to a productivity commission inquiry into aged care, the federal government released a reform package last year called "Living Longer, Living Better".

This proposal, which promises to redesign Australia’s aged care system, contains no strategy for easing the current crisis, but proposes more neoliberal policies, paying lip-service to "an appropriate standard of aged care".

The report states its recommendations are "based on business models", promoting the quest for private dollars, and the further deregulation it deems necessary to achieve that.

Regulation is caricatured and denigrated as "bureaucratic red tape". The proposed solution to the current crisis is "consumers" having "greater choice", not the provision of adequate numbers of qualified staff and proper nourishment and care for patients.

The fact is that, under "free market" conditions, it is not possible to make a profit from those who require high level of care. To make a profit, the private sector depends on high government subsidies and protection. Now, about 70% of the cost of aged care is provided by the government.

Bruce Bailey, from accounting firm RSM Bird Cameron, wrote enthusiastically about the "new era" where aged care facilities will be run more like “resorts” in an analysis of the shift.

Bailey admits the public will pay more for care and said: "The public will vote with their feet. This may mean a shift in demand from residential care to community care, or it may mean a shift between providers."

Few, if any, of the aged, who can no longer care for themselves on a day-to-day basis, are in a position to seek and find alternatives, to arrange the legal and practical aspects of relocating.

An article in The Courier Mail in March reported the plight of an aged man left alone for hours on end without help. Unable to reach his buzzer, he used his mobile phone to dial 000. It was only after the police arrived that he was put to bed.

The man had paid $450,000 for the room and was paying an additional $50,000 a year.

How could he "vote with his feet"? He couldn't even walk to his bed. He had invested in care years earlier after being assured that paying such a large sum would ensure he was properly looked after.

Government deregulation provides tremendous opportunities for the private sector. An analysis by aged care consultant John Coxon lays out the emerging opportunities for the industry. His report said greater deregulation will mean "freedom of choice", which organisations can capitalise on "whenever it is profitable".

Further deregulation will end the "minimum standards of safety and care", which government legislation has mandated.

Coxon welcomes the prospect of a shift in power to occur once consumers are given the power of choice. The power of marketing will provide understanding and knowledge to “customers".

He said: "It is possible marketing for aged care services will commence at birth" and technology will play a significant role in caring for people.

"Humans are a very accommodating species and will cast aside their initial scepticism of machines doing the work of humans once they see that Mum and Dad are safe and that these machines will reduce the cost to the family."

As this glimpse behind the facade shows, what matters in neoliberalism is not concern and care for others, especially the most vulnerable, but what can be bought and sold at "the market place", with maximum "value" for your dollar.

Humans are not commodities to be traded. Those needing care, especially the aged, cannot have their needs met by neoliberal measures and "reforms".

The aged care system, along with health care in general, should be publicly funded and accessible to all Australians.

A government that was committed to putting people before private profits would end government subsidies to private healthcare providers and redirect the money to boosting the numbers of aged care staff and ensuring they were paid adequately for the work they do.

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