Government’s response to Royal Commission interim report won’t solve decades of Government aged care neglect

Article published 26 November 2019

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Successive Governments have neglected aged care and turned it into the mess it is today. The measures announced by the Prime Minister on 25 November 2019 only seem to take the waiting list for the Home Care Packages program seriously, while announcing token measures to reduce the use of chemical restraints in nursing homes and to get younger people out of nursing homes.

Home Care Packages program

The Prime Minister’s media release says there are 150,412 “available” Home Care Packages “this financial year”.

150,412 packages exceed the projected 144.912 packages in the forward estimates for 2019-2020 by 5,500. So, do the 10,000 additional packages which “will be rolled out from 1 December 2019” bring the total by the end of 2019-2020 to 154,912 (144,912 plus 10,000) or to 160,412 (150,412 plus 10,000)?

Neither is the answer.

It is fair to assume that by the end of 2019-2020, there will be 150,412  “available” packages. That number is up 5,500 from the projected number of 144,912 in the forward estimates, not 10,000.

Now, bear in mind that packages to be “rolled out” are going to be “available” at first. The language is important, because an “available” package is not necessarily an “active” package, that is, a real package which is actually being used by a real person.

The number of “active” packages at the end of 2018-2019 (30 June 2019) was 99,110. The number of available packages, according to the forward estimates for that year by year end, was 124,032.

So, on 30 June there were 24,922 (124,032 minus 99,110) packages “available” but not “active”. That’s at least 20 per cent of packages sitting idle.

The reason why so many available packages are not active is that these packages have been offered to applicants as interim packages. In other words, these Packages are at the wrong level and are being offered as an interim solution. They are for people waiting for an “available” and “active” package to become inactive and therefore available to them, as Sir Humphrey might have put it.

The difference between the number of “available” packages  and the number of “active” packages is accounted for by the number of people approved for level 3 and 4 Packages (the heavier levels) refusing, or still considering, offers of interim level 1 and 2 Packages. At the end of 2018-2019, there were about 25,000 of those people, as we saw.

This gives rise to two questions.

First, why is the Government creating more packages ”strongly weighted towards level 3 and 4 Packages” rather than upgrading level 1 and 2 packages, which are not needed and sitting permanently idle?

The answer: probably because 150,000 sounds like a lot and the alternative, upgrading level 1 and 2 packages to 3 and 4, would not increase the overall number of packages. The Government would look like it was doing nothing.

Second, why at last count are 25,000 people who have been approved for level 3 and 4 packages knocking back these interim level 1 and 2 packages? Wouldn’t you accept any help in their circumstances, even if that help is not enough?

The answer: level 1 and 2 package refusers are mostly getting help equivalent to what’s on offer as part of level 1 and 2 packages under the Commonwealth Home Support Program (CHSP) and they are getting it more cheaply. Anyone on a package pays at least the Basic Daily Fee, set at 17.5 per cent of the full single’s rate of the Age Pension, while CHSP services are charged at the discretion of providers, often small charities operated by volunteers and on a local-community basis.

The stated aim of Government policy makers is to “merge” the CHSP into the Home Care Packages Program. Problem is, the CHSP works well and the Home Care Packages program doesn’t, beset as it by all the familiar problems that come with marketising social services.

All up, making “available” 5,500 additional mainly level 3 and 4 Home Care Packages is better than nothing, although nowhere near enough.

Medication management and dementia training

The $25.5 million measure announced by the Prime Minister to reduce the reliance on chemical restraints in nursing homes is a case of blithely ignoring the real problem while focussing on a side issue.

The evidence at the Royal Commission is that something like half the population of nursing homes is being restrained. The vast majority are restrained because there are no staff to manage their anxiety, wandering, aggression, or otherwise disruptive behaviour.

In other words, the right response to over-reliance on chemical restraint is to put more staff on. But it’s cheaper to increase use of physical restraints, that is, tying people down.

Unless staffing numbers are increased, the Government can ban prescribing pills all it likes, but it will be ignored, especially since physical restraints have also largely been banned.

The Government’s medication management measure to spend $25.5 million training staff in how to manage people with dementia will be a waste of money, because those staff are not going to have the time and opportunity to put into practice what they learn during training.

Younger people in aged care

This is not an aged care problem as aged care is understood at the moment, but a problem for the disability care system. What this problem does point to, though, is the crucial importance of housing in care. Regardless of age, anyone living in a nursing home but able and wanting to live independently should be able to do so.

The Government has announced some impressive targets. No people under 65 entering residential care by 2022 and no people under 45 living in residential aged care by 2022 with the whole problem solved by 2025.

The Government is wasting $.7 million developing a strategy and an action plan and finding suitable accommodation for people with disabilities.

This problem has existed and has been identified and analysed to death for decades. The solution is simple: build accessible social housing.

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