A working class answer to healing the broken aged care system

Workers have long raised problems in the sector, including their demand for mandated staffing ratios. This protest by members of the Australian Nursing and Midwiferey Federation took place in 2018. Photo by Penny Stephens.
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On 31 October 2020, the Royal Commission into Aged Care Quality and Safety released its interim report. With its single-word title, Neglect, the report does not mince words. The Commissioners declare, “the aged care system fails to meet the needs of its older, vulnerable, citizens. It does not deliver uniformly safe and quality care, is unkind and uncaring towards older people and, in too many instances, it neglects them.” 

While the preliminary findings are a shocking indictment on the treatment of seniors, they are actually not news! There have been more than 30 major enquiries into aged care since 1997. All found essentially the same thing — a system in crisis! Neglect and abuse of residents is prevalent; the sector is under regulated with no mandated staffing ratios; and the predominantly casual workforce is overworked, low-paid and under-trained for its responsibilities. 

Frontline workers in aged care are grossly under-valued. These members of the Health Services Union in Lithgow stopped work on 24 June 2020 to demand a 5% pay increase. Photo by Alanna Tomazin.

Ninety-six percent of Australian aged care providers are privately owned — a mix of big corporates and not-for-profits. The six largest — BUPA, Estia Health, Opal, Regis, Japara and Allity — are responsible for more than 20% of aged care beds. In 2018, the Australian Nursing and Midwifery Federation commissioned a report by the Tax Justice Network. Titled Tax Avoidance by For-Profit Aged Care Companies: Profit shifting on public funds, the report found that the largest players benefited from massive taxpayer subsidies while using complex tax avoidance schemes to minimise their tax liabilities. Similarly, “care” is delivered solely to serve the needs of the balance sheet, with reports finding as little as seven dollars per resident per day spent on food, and workers complaining of personal protective equipment being rationed. 

Faced with the challenge of COVID-19, the shortcomings of the system were not only glaringly obvious, they also made news headlines night after night as residential aged care bore a disproportionate impact of the virus. The combination of vulnerable community members, and staff without leave working multiple jobs, resulted in the virus tearing through aged care homes with devastating results where it got inside. Three quarters of all COVID deaths have been linked to the aged care sector. 

The litany of horror stories just kept on coming — dehydrated and malnourished residents; people with untreated bed sores; seniors sedated to make them compliant and easier to manage; physical and sexual abuse, plus inadequate infection control. Workers spoke out about speed-ups and their frustration with being unable to provide the care the residents deserved. 

Merle Mitchell, activist and advocate who is now 85 and lives in aged care, continues to be a powerful voice for residents. Speaking with Fran Kelly on the ABC in mid-December, Mitchell described the many unnecessary restrictions which strip people of control over their lives. In her home she was told there’s a two-hour limit on visitors on Christmas Day. Mitchell noted the mental health of residents deteriorated during lockdown, describing a lack of mental health support. She makes common cause with the workers, declaring that COVID made things worse for both residents and staff: “the staff are becoming absolutely exhausted, we don’t have enough staff,” adding that understaffing is especially noticeable when there’s a need to deal with the unexpected. 

Let the market rip. The system is governed by the Aged Care Act legislated by the Howard government in 1997. Faced with the need for increased funding for aged care, the government had the choice to either provide more resources directly for building and maintenance or to intensify user-pays. It chose the latter, introducing a regime of extortionate bonds and fees. It also changed the rules around how money could be used by diluting the protections in place, which had required a minimum portion of fees to go towards care. The new regime allowed lower spending on care, granting owners the choice to spend fees on improving their assets and paying dividends. 

These changes also stripped crucial regulations, including mandatory staffing ratios. One result was nursing homes having no requirement to have a nurse on duty! This led to deskilling and opened the floodgates for mass casualisation, which is a central feature of the system today. 

The last two decades saw business and government team up to wage war on the so-called “red tape” of regulations, which were actually measures to protect the public. The aged care sector has been part of this massive program of deregulation, allowing decision-making  to be driven by a focus on the bottom line of profit. The broad approach by the government is to let the market deliver with just a little light-touch oversight. 

A federal accreditation system is supposed to assure the quality of aged care, but providers fail to deliver again and again. A recent study by the University of Queensland found that 79% of aged care providers did not meet the full list of accreditation standards. This lack of preparedness had devastating consequences in Victoria. A damning independent review into two Victorian nursing homes, where 83 people died from COVID during the second wave, was released on 21 December. It found inadequate emergency planning and poor infection control. The accreditation regulator is the Aged Care Quality and Safety Commission. But, like the rest of the public sector, it is understaffed due to the imposition of an arbitrary staffing cap. The Community and Public Sector Union reports that staff struggle with high workloads, and casual workers are employed to help get jobs done. 

A warning message unheard. As COVID-19 unfolded, it quickly became clear that for workers engaged in casual and other forms of precarious work, the appeal to stay home when unwell is not easy. Many workers feel that non-attendance would put their job at risk, or they do not have leave entitlements. Up to 80% of COVID transmissions happened in the workplace, and more than a quarter of the workforce is employed in insecure work — that’s 2.6 million people! Again and again public health officials reported on workers being exposed to the virus in one unsafe workplace, and then attending a shift at another workplace, including aged care homes. 

This problem became widely visible in 2020, with many characterising insecure work as a dangerous social virus which must be combatted. In March, Treasurer Josh Frydenberg said, “I’m very conscious that Australians in employment, be it casual or permanent, will be concerned about their job security.” While briefly adopting an empathetic tone, he continued to reaffirm the government’s commitment to “flexibility” for business. The government established a series of roundtable discussions between business and union peak bodies to discuss industrial relations. 

In December, the government released its plan, the Industrial Relations (IR) Omnibus Bill, which is a kick in the guts for workers. If legislated, it will lead to a growth in casual work, drive down wages, strip working conditions and introduce more measures to muzzle unions. The changes will allow employers to declare any job casual if they choose to do so, even if the employee is engaged on a regular shift pattern. The bill also makes agreements possible even if they do not meet the Better Off Overall Test (widely known as the BOOT). This could see workers locked into long-term agreements that are worse than the minimums specified in the Award. 

The measures in the IR Omnibus Bill are a disaster and must be fought. The Australian Council of Trade Unions has launched a petition appealing to the Prime Minister around the slogan, “You can’t heal the economy by hurting workers.” This slogan misleads workers. It is not the job of the union movement to “heal” the capitalist economy. Making it the responsibility of workers to try to revive a flagging economy risks contributing to the narrative peddled by employers that workers need to make sacrifices. The job of the union movement is to lead collective resistance, to mobilise workers to fight in their own interests to defend pay, working conditions, job security and the broader interests of working people. Healing the economy, will not help the ever-expanding army of desperate and insecure workers, including those in aged care. 

Necessary measures.  Working people — including retired, working age and those in training — are in a fight for our lives. No one would argue that it is easy to build the fighting movement we need to reshape the aged care system, defeat the IR Omnibus Bill and assert our collective rights. To forge a united and powerful movement it is essential to make a case for what we need and start organising to build collective resistance. Union democracy is a key ingredient to rebuild union power. 

We need safe, secure and well-paid jobs for all, including in the aged care sector, with quality training funded by employers. Unemployment, under-employment and precarious work should be addressed by reducing the working week with no loss of pay, providing permanent jobs for all. 

The aged care sector needs a complete overhaul. All facilities should be brought into public hands. Homes need to be staffed by culturally-appropriate and integrated teams of nurses and other healthcare professionals, recreation workers, social workers, nutritionists, cooks, and well-paid and trained care workers, cleaners, gardeners and maintenance staff. Staffing levels must be mandated to provide quality care that provides dignity. Residents need control over their lives. Decisions about how these homes are run should be made by residents and the workers who support them. 

The revamped aged care sector will be funded through eliminating profit from the sector and through taxing big corporates by closing tax evasion loopholes. Most aged care residents have paid taxes all their working lives and should expect quality aged care provided in their home or in a residential facility based on their needs and choices. 

This is just a start — imagine healing society by replacing the system that gave us the COVID crisis with one based on planning rather than profits, and that has the needs of working people at every stage of life at its very centre.

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