Radical and costly changes are needed in aged care but will the Government listen?

21 February 2021

The below article is an abridged version of an article written by Roy Eccleston that was originally published by The Advertiser. Read the full article here.

For a long time, older Australians have been out of sight and out of mind. As the nation has grown more prosperous, many of those who helped build it have been forgotten – mistreated in aged-care homes, ignored on enormous waiting lists for help at home, out of favour in a youth-focused culture, and without a powerful champion.

Now they have one: the Royal Commission into Aged Care Quality and Safety. After 10,000 submissions and hearings across the country, it has been advised by its senior counsel that the system is appallingly inadequate – and must be rescued by sweeping changes.

Just how sweeping will be revealed by commissioners Tony Pagone QC and Lynelle Briggs in their final report due next Friday. An interim report in late 2019 has already described the problem – “a shocking tale of neglect” – so next comes the royal commission’s solution.

They are likely to be radical, and expensive, proposals that will help some of the most vulnerable Australians and create a truckload of jobs. But whether they are politically palatable is another matter entirely for a Federal Government facing massive COVID-19 deficits.

In their final submissions to the royal commission, Mr Rozen and other senior counsel, Peter Gray QC, proposed a very different and much more expensive system. They want independent bodies to run, monitor, investigate and set prices. They also propose a new rights-based entitlement to timely, top care.

Mr Rozen and Mr Gray acknowledge they are calling for a “very significant additional outlay” from the government. Aged care currently costs 1.2 per cent of Australia’s GDP – less than half of some of the Nordic nations – and the counsel assisting’s recommendations would see it rise to at least 1.8 per cent by 2050, according to a Deloitte Access Economics analysis.

The dollar cost for the “four star” system favoured is not specified but looks to rise to close $35bn by the mid-2020s and $44bn by 2030. That would drive a jobs boom, with a forecast doubling the number of home-care packages to more than 300,000 by 2050.

It would also require even more nurses and carers than is already forecast. The staff needed, many of whom would have to be brought from overseas, would rise from current levels of about 319,000 to 621,000 by 2050.

The Deloitte modelling prepared for the royal commission said an increase in the Medicare levy of 0.89 per cent, or income tax by about 1 per cent would be enough to fund it. That would be almost double the Medicare levy for the NDIS – a huge number.

So would Australians pay?

Prime Minister Scott Morrison says no.

“I will await their recommendations but the Australian Government, particularly in the middle of a pandemic, particularly when we are seeking to rebuild our economy … the one way you build your economy back is you don’t hit it with higher taxes,” he said.

“That is not our plan, it has never been our plan.”

But Julie Ratcliffe, a professor of health economics at Flinders University, surveyed Australians on this question and found a different answer.

“We found that almost 90 per cent agreed,” she says. “And the vast majority thought that the government should double its current allocation of income tax contributions – essentially they should double current expenditure.”

Importantly, though, taxpayers need to see what they would get for their money.

Professor Ratcliffe says currently the performance of the aged-care system is impossible to properly measure.

“We need far more public accountability, far more public transparency, we need routine quality of life assessments in aged care and we need public reporting.”

The 300,000-strong Australian Nursing and Midwifery Federation is also vowing a national campaign, right up to the election, to push for an increase in nurse jobs in aged care that have been dramatically cut in recent years.  Read more here.

In the past two decades, governments have managed to ignore many reports urging fixes for aged care. But, with Health Minister Greg Hunt now given carriage of aged care, and the government already pumping billions into the waiting lists, there are signs of change.

What has been missing to date is voter pressure. Older people do have influence, as then-Labor leader Bill Shorten found at the last election when he planned to fiddle with superannuation.

But when it comes to choosing between more money for education, or hospitals, compared with nursing homes, it’s not so clear that the electorate cares.

In the 2020 Eden-Monaro federal by-election, a survey of voters found that while 84 per cent said aged care was in crisis, it only ranked last on a list of seven issues of importance, and only 4 per cent said it was a vote-changer.

The industry and nurses campaigns may change that equation.