The aged care royal commission may well be a waste of taxpayers’ money in terms of bringing about real change, writes Mark Sheldon-Stemm.
Having observed the aged care royal commission output over almost two years, one must ask whether the commission will result in any tangible real changes to the way aged care will progress.
In discussions with many aged care providers there is now a view emerging that the royal commission has gone past its use by date.
Obviously the COVID-19 pandemic has been a major distraction but it has yet again shows the government’s machine –for both the commonwealth and states – is far from well operated. As a result, providers have been left to sink or swim.
From my observations, the five main reasons many providers now think the royal commission has lost its relevance are:
- There is recognition that the royal commission was initially called as a political response to the ABC program on aged care. Therefore, it is impossible to separate the politics from the commission itself.
- The process of publicly purging those who have provided poor care has been achieved and providers are truly focused on overcoming the shortcomings identified.
- The royal commission seems determined not to listen to those who understand the aged care industry but rather rely on academic or so called expert advice from those who have never run an aged care service and who have little or no idea of the challenges faced by providers. So far, its recommendations are either impractical or irrelevant.
- The government direction in aged care has already been set out in the Aged Care Roadmap and everybody understands this is the direction the sector is headed.
- Finally, as Australia enters a recession, there is a realisation that the Government does not have the funds to meet the true cost of aged care. A higher level of contribution is required from those who access the services, and this must be fair and equitable. This is a political decision over which the royal commission has no control.
Obviously, the Government will receive the final report and consider the recommendations made by the royal commission.
Unfortunately, as we know after countless reviews and studies into aged care over the past 20 years, the royal commission’s final report will probably be bound into a set of nicely covered volumes and placed in the archive.
This begs the question: Will aged care profoundly change?
That is not up to the royal commission but truly lies in the hands of proactive aged care providers.
Mark Sheldon-Stemm is principal at Research Analytics.
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What a great article, well said and summed up, unfortunately I think it is very accurate, a lot of us hoped that it wouldn’t be another cash cow for lawyers, I still hold out some hope though.. A very tough business to be in, well done to those trying their best for our elderly with all the ridiculous red tape and lack of funds.
Agree that the Royal Commission is going in the wrong direction and engaging with the industry, academic economist and government. These are the same people responsible for the 1997 aged care act and the Aged Care Roadmap that have both failed us so badly. They must be abandoned.
The problems are firstly the powerful perverse incentives created by a competitive market in a sector where there is no effective customer and where caring communities have been pushed aside. Care is too individual and too complex to be managed. Central federal management and regulation has not and will never work.
Markets depend on self-interest for its benefits. Care depends on humanity, community values and altruism. The problem this creates has been recognised in care for 2500 years (Hippocrates) and in the market for over 200 years (Adam Smith).
Care of our vulnerable members is the responsibility of every citizen, of every society and of every community. What is required is a decentralised system based in local governments working with local community organisations in close contact with families and residents. It is governments role to build local capacity not erode community as has happened. It should operate with and through local services supporting them. It should be there when it is beyond their capacity.
Local communities working with families and older citizens should assess past provider performance to assess their probity and licence or contract with the ones they choose to provide aged care services. It must be easy to replace those who do not operate within community values and don’t meet their expectations. That is what makes markets in vulnerable sectors work.
Four major reviews in the 1970s and 1980s recognised these problems and advised decentralised management with community involvement and central integration. Reforms along these lines were abandoned when free-market and top down managerial ideologies were introduced by Keating and then Howard in the 1990s. The system has gone steadily downhill very since. The late Professor Hal Kendig has been advocating for decentralisation for 20 years and Aged Care Crisis has done so for the last 12 years.
We agree that a government appointed Commission is very unlikely to challenge prevailing ideology and we note that it is carefully avoiding these issues. We agree that this still has a long way to go. It will continue until the roadmap is gone and we have a market that is directly responsible to and accountable to the citizens and communities where it operates.
“The royal commission seems determined not to listen to those who understand the aged care industry but rather rely on academic or so called expert advice from those who have never run an aged care service and who have little or no idea of the challenges faced by providers. So far, its recommendations are either impractical or irrelevant.”
So providers made no submissions to the RC, nor appeared as witnesses?
The issue of younger people in aged care is irrelevant?
The issue of chemical restraint is not relevant?
The lack of community aged care packages is irrelevant.
“The process of publicly purging those who have provided poor care has been achieved and providers are truly focused on overcoming the shortcomings identified.”
You reckon?
Thank you Robyn, Michael and Barry for your comments. The article was designed to get a conversation going about the Royal commission and its short comings. You all make good points. Robyn, we need to get rid of the red tape and let the person receiving the care be in control. The same with your comment Michael we need to let the person decide. Barry your comments are interesting as each of the points you raise have been discussed for over 20 years in aged care and nothing has changed. I have listened to the evidence and read the reports and testimony from the commission and most of them I have been found to be factually incorrect or over emphasized by the person giving evidence to push their own barrow. Such as, the only person qualified to shower a person with dementia is a Registered Nurse or that a huge percentage of people in aged care are on chemical restraints. Both these and many more I know these are factually incorrect. As for the current providers, I don’t disagree that many have a long way to go, but there are those who are on their way. The problem many current providers have is, they are trying to change the old system into a new system by putting band-aids on the old system. This simply won’t work and when they fail they will leave the industry over the next little while. It has already started to happen. As for the community packages well the extra numbers are great but the system is so screwed up it will never meet the need of the community.
Mark thank you for raising the issues and for responding. You fail to address the issues that I raised. The first is the profound conflict between the patterns of thinking that are required to be successful in this marketplace and those required to provide good care. The second is the perverse incentives that success depends on.
I agree that good care is sometimes provided but that is in spite of the system and not because of it. There is a profound ‘paradigm conflict’ introduced by the ideologies of the late 20th century. It is not that those responsible are deliberately evil or bad it but that the things they believe in are not universally applicable. Similar situations have risen multiple times in the many ideologies of the 20th century. Challenging beliefs that we have built into the fabric of successful lives is confronting and very difficult.
The third issue is the impossibility of a successful free market in a vulnerable sector where, as in aged care, the customer is vulnerable and frail, the issues are complex, knowledge is controlled by industry and decisions are made under extreme stress. In 2003 the industry was criticised for not collecting data. It promised parliament it would do so. It never happened and that is one reason why it has lasted 20 years. It is unlikely to happen until that is done independently
In logic theory your argument is called a ‘category error’. This is because the ‘necessary conditions’ (eg. effective customer) for a market to operate are absent. This means that the market will fail and that has been happening for the last 20 years. We need the community to have knowledge and so some control. It can then become the effective and responsible customer working with families. There are precedents where surrogate customers who are part of the system but with a strong interest in the welfare of the vulnerable have been effective.