The Four Corners exposé into the state of aged care in Australia shocked many of us. While it was not the first time such graphic evidence has been presented, few of us will forget the sight of inedible food, residents waiting hours in bed for assistance, or the high use of anti-psychotics in residents with dementia.
This was the impetus for the federal government to announce yet another investigation into the sector – this time a Royal Commission. It also led to the Australian Nursing and Midwifery Association (ANMF) launching the “It’s Time to Act for Ruby” campaign for mandated staff ratios in aged care.
As the ANMF correctly point out there are currently no mandated ratios for nurse to patient care in the privatised sector. A single registered nurse might be on a shift covering 40 residents!
The private aged care sector has grown by 6.4% in the last ten years, while government-run nursing homes have shrunk by 4.9%. Not-for-profit homes have decreased by 1.5%. As The Socialist has previously noted, increased privatisation has led to a decrease in quality of care as cost-cutting is used to maximise profit.
Private nursing homes receive around $12 billion dollars in government funding. An additional $25 billion dollars, in the form of refundable deposits that residents pay, is in the hands of these private operators. While this money is refundable when the residency has finished, in the meantime it is invested by the private operators, earning them interest!
This cash cow combined with loose regulation has led to the intolerable living conditions many now experience in residential aged care.
The increased use of Personal Care Attendants (PCAs) in nursing homes over the last decades has also contributed to the problems. Between 2003-2016 there was a 13% reduction in trained nursing staff in the sector (that’s 1701 full time nurses). At the same time, an aging population means there has been a 40% increase of residents that require specialist nursing care.
PCAs only need to complete a 12-week training course to start working in a home. The registered nurses that work in aged care homes are often so busy just giving medication that they have no time to assess or review pressure sores, care plans and general health needs.
It is certainly not the PCAs themselves that are to blame for the situation. Many PCAs would jump at the opportunity to become nurses. Unfortunately, a myriad of obstacles stands in their way, including expensive university fees and unsupportive workplaces. This is why free education also needs to be fought for.
The government and many of the rogue private operators often say that PCAs are needed as it’s difficult to attract and retain registered nurses. What they don’t say is that they pay aged care nurses around $200 per week less than their colleagues in other sectors!
The call by unions for ratios in private care and to improve the skill mix is a good start, but much more is required to really fix this broken sector. For a start, a much stricter set of standards, and a regime with teeth, needs to be put in place to monitor the quality of all aged care facilities. Rogue operators need to be driven out.
The billions of dollars in funding already allocated to the private sector, if redirected, could begin to transform the public aged care sector. A major funding boost, paid for by increasing taxes on big business, would revolutionise things.
Any rogue operators who refuse to adhere to best practice standards should be immediately nationalised and run as public institutions so that they can be properly controlled.
A plan should be put in place to remove the profit motive from the whole sector and for it to be controlled and managed by workers, patients and residents themselves. We need to ensure that genuinely free healthcare is available to all from the cradle to the grave.
If the unions ran a public campaign along these lines, they could win widespread support and even wring some immediate concessions out of the government. Workers must organise from below to put pressure on their trade union leaders to adopt this sort of fighting approach.
The root cause of the problems in aged care is the profit motive. Only socialist solutions have the potential to really deal with the problems capitalism has created, and to return some dignity to the lives of people who have spent decades contributing to society.
By Denise Dudley