Coronavirus explainer: How does Australia’s aged care system work?
Australia's aged care system has been an ongoing issue – even before the coronavirus hit our shores. Photo: TND
A dramatic spike in coronavirus outbreaks at aged care homes in Victoria has shone the spotlight on a sector marred by allegations of mismanagement and neglect.
On Wednesday, the state recorded 295 COVID-19 cases and nine more deaths – seven of which are linked to the crisis unfolding in aged care homes.
Victorian Premier Daniel Andrews and ministers in the federal government have traded barbs over the aged-care problem, both blaming each other for the unfolding coronavirus emergency.
So how does aged-care work and where does the responsibility lay?
Aged care is a federal responsibility, but as Prime Minister Scott Morrison pointed out on Tuesday, “public health is a matter for state governments”.
“We have seen some very distressing and concerning situations arise in a handful of those facilities,” he told reporters on Wednesday.
Federal chief medical officer Brendan Murphy predicted more deaths in nursing homes to come.
“We will see deaths every day,” he said on Wednesday.
“That is a tragedy.”
If you’re an older Australian who is ready to move into a nursing home, you can choose between a:
- Government-subsidised aged care home; or a
- Private aged care home.
They both receive government subsidies, and are regulated in the same way by the Commonwealth.
The only difference in Victoria is the state government own and operate a number of aged care services, but it does provide some top-up funding too.
In those facilities they have minimum staff ratios and minimum qualification requirements.
As federal Labor MP and former nurse Ged Kearney pointed out on Twitter, nearly all of Victoria’s aged care outbreaks have occurred in private aged care homes.
Of 769 cases of COVID in Vic aged care only 5 are in public sector aged care. So what’s the difference? There's no minimum mandated staffing levels or ratios in private aged care. I am so frustrated – aged care workers & their unions have been raising this for years.
— Ged Kearney (@gedkearney) July 28, 2020
So what is going wrong in private aged care homes?
Residential aged care is big business in Australia.
Companies like Regis Aged Care, Estia Health and Bupa each operate more than 65 aged care facilities around the nation, raking in millions of dollars.
Without proper oversight, there is a lot of money to be made – and potential corners to be cut.
What are the key problems?
The privatisation of aged care has been blamed for a casualisation of its workforce.
A casual workforce presents several key problems in the context of COVID-19:
- Staff members are not paid sick leave or annual leave, so it’s likely they will choose to go to work when feeling ill;
- To make ends meet, many of them will take up shifts across multiple aged care homes, potentially carrying the virus from one facility to another; and
- Staff members are on low wages, so they are more reluctant than others to get tested and isolate because they don’t want to lose money.
Another key issue is that unlike childcare centres, hospitals and schools, there is no mandated staff-to-client ratio in private aged care homes.
This means that managers who need to meet profit targets often do so by reducing staff.
As a result, staff members often complain being worn out and overworked, racing from one resident’s room to another during a single shift.
Not only is this bad news for the staff, it also means elderly Australians are left waiting for longer periods of time to receive the attention they need.
The early signs of the coronavirus, like a cough or a scratchy throat, might go unnoticed.
What’s being done about it?
In 2018, a Royal Commission into Aged Care Quality and Safety was established to get to the heart of the problems facing the sector.
After months of hearings across Australia, the commission published an interim report last year titled ‘Neglect’.
The commissioners shone a light on an under-resourced system where failures to deliver good-quality care to our elderly was disturbing and widespread.
They said a culture of silence was rampant across the aged care industry, where the voices of older people, their families and carers were being swept under the rug.
The commissioners also noted a lack of accountability and transparency by governing, regulatory and provider organisations.