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Issue #1930      August 31, 2020

Australian Aged care standards a disgrace!

More than 125 aged care centres have been hit by the pandemic and more than 1,700 elderly residents were infected (at time of writing). 350 of them have lost their lives, most of them in Victoria as the number continues to rise, albeit at a reduced rate.

These alarming statistics are about people, human beings who lost their lives in the most tragic of circumstances and without their loved ones by their side. For their grief-stricken families it was a traumatising experience.

These infections and deaths were avoidable.

The second wave in Victoria, is believed to have been triggered by a serious breach of quarantine security by a private contractor not meeting safety obligations. If ever there was a lesson in contracting out to labour hire firms, this is surely one.

The federal government has responsibility for funding and regulation of aged care services, which it subsidises to the tune of around eighty per cent. The unpreparedness of aged centres, lack of training of staff, lack of availability of appropriate equipment, and understaffing compounded the tragedy that was unfolding.

The workforce is highly casualised and low paid, with many staff working across a number of centres which contributed to the spread of the virus between centres. These workers have copped a lot of flack. They should not be blamed. They are victims of a system in crisis.

Dedicated health workers and other centre staff put their lives on the line as they courageously worked all out to care for residents and save the lives of some of those most at risk in the community.

The images of relatives of the residents have been heart-wrenching as they have been unable to make visits. Horrific stories have emerged of families unable to locate an elderly relative or not even being able to ascertain if that relative is well or has passed away.

The second wave in Victoria has seen the health sector stretched beyond its limits, to the point where there has been a complete breakdown in some aged care centres.

Residents have been found to be in the most appalling conditions, not always fed or receiving the basic care they require, as staff cannot physically attend to their needs.

COVID-19 exposes fault lines

An ongoing Royal Commission into Age Care commissioned by the Morrison government in 2018 continues to expose decades of neglect and failings in the system. The horror stories of abuse, malnourishment, over-medicating, and other serious issues paint an appalling picture of a system that was in crisis well before the pandemic hit. The pandemic has magnified many times the issues, bringing them to the fore.

The aged care system is chronically under-funded, under-resourced and under-staffed.

ANMF demands for regulation

The Australian Nursing and Midwifery Federation (ANMF) has been fighting for years for a regulated system, with mandated minimum staffing levels. This has been achieved in Queensland and Victoria where Labor governments have mandated staffing levels.

The ANMF has adopted a five-point plan to address the pandemic in aged care. This plan demands:

  1. A stop to any further cuts to nursing and care: Inexplicably, throughout the COVID-19 pandemic, sixty-four per cent of ANMF members (in a survey conducted by the union), reported staff cuts and nursing and care hour reductions in some nursing homes, diminishing care for residents and putting the lives of the elderly at further risk during the pandemic.
  2. Additional staffing with the right skills: Ensure sufficient numbers of qualified staff with the right skills mix and mandate minimum nursing/care hours, to properly prepare a suitably-skilled workforce in the event of further infection outbreaks.
  3. Personal Protective Equipment (PPE): Ensure sufficient supplies of PPE and clear guidance, education and training for all aged care staff from an infection control expert and ensure infection control expertise is available at every nursing home.
  4. Paid pandemic leave: Guarantee paid pandemic leave for all workers who need to stay home because they need to get tested and self-isolate due to exposure to COVID-19 or feeling unwell. This is a critical measure in preventing further spread of COVID-19 in workplaces across the community.
  5. Accountability/transparency for government-funding: Ensure that aged care providers are actually using additional taxpayer funds for its intended purposes – providing additional staff and skills, guaranteeing PPE and other critical resources and that incentive payments intended for aged care workers are reaching them.

The Morrison government has ignored repeated requests from the ANMF to discuss these demands and how to address the pandemic in aged care.

Lessons not learnt

The response, or lack thereof, by the federal government demonstrates that the lessons from a cluster in Newmarch House in Sydney, where nineteen people passed away, were not learnt. The federal government still had no plan in place when the second wave hit in Victoria, despite having several months to prepare!

In fact, the centres were mostly ill-equipped at the commencement of the second wave. Instead of transferring patients with COVID-19 to a hospital, they were kept locked up in their rooms, a mistake made at Newmarch, no doubt risking further spread of the infection.

Prime Minister Scott Morrison repeatedly denied that the federal government is responsible for aged care while never hesitating to blame Victorian Labor Premier Daniel Andrews.

Eventually, Aged Care Minister Senator Richard Colbeck came clean when questioned by the Senate’s COVID-19 committee that the federal government has responsibility for regulating and funding aged care services.

It was an embarrassing appearance before the Senate inquiry for Colbeck who was unable to indicate how many lives had been lost.

Even more incredibly, the so-called Aged Care Minister said: “We did not anticipate that the entire management structure and the office structure, cleaning, catering staff would all be regarded as close contacts as part of an outbreak.”

Has he ever visited an aged care centre?!

Morrison, rushed in to defend his Minister, saying that he had confidence in Colbeck, that the number of lives lost could have been much worse!

Deregulation

Only ten per cent of the centres are state-run, with the remainder being for-profit or not-for-profit private providers.

Apart from the public sector centres in Victoria and Queensland, the aged care system is largely deregulated. The exception is where unions have managed to recruit members and negotiate agreements specifying such matters as staff to resident ratios or the mix of staff skills.

Deregulation and funding cuts took off in earnest under the Howard Coalition government. The federal government cut the aged care budget by $1 billion and removed a number of regulatory requirements such as the minimum proportion of government funding that had to be spent on patient care. Minimum staffing numbers required were also reduced.

This increased the potential for profit-making and made the sector attractive for private outfits including foreign investors to move in. Deregulation accompanied by lucrative government subsidies was like a magnet to large corporations and private equity firms who saw the potential to make large profits.

Many of the private for-profit institutions are notorious for taking short cuts to maximise profits. There is a tendency for them to employ fewer, less qualified staff; fail to provide a nutritious diet; and to not always provide basic services to residents.

Today there is virtually no accountability, no transparency as to how government subsidies – around eighty percent of their income – are spent. In the case of the large private operators, the subsidies appear to fund the private profits, not resident care.

Perhaps then, it should not come as a surprise that ten per cent of the aged care centres are state-managed with one in 900 residents having contracted the virus. In the private sector, one in twenty-three have contracted the virus. These figures confirm the need for the sector to be publicly owned and managed.

Federal govt failed to act

The government has responsibility for infection control in aged care, regulation, and accreditation of aged care centres through its Aged Care Quality and Safety Commission (ACQSC). It uses a “proportionate, risk-based approach” to achieving its regulatory objectives.

The Royal Commission heard criticisms of the Commission that is also responsible for assessing compliance with the requirements of the Act. The system is largely based on a process of self-assessment – that is, by the centres themselves! There are provisions for site inspections, but assessors from the Commission or approved private assessors all too often give advance notice of an impending inspection!

This conveniently gives centres time to change the menu, hire additional casual staff, organise programs for residents and take other measures to pass muster. The Commission announced on 24th August that surprise inspections will be carried out. This should have been the case all along for all inspections.

Nationalise aged care

If any good is to come out of the pandemic then it is recognition of the need for nationalisation of aged care and all health care services. The private system could not cope with the pandemic and without massive subsidies could not stand on its own feet.

The COVID-19 health crisis has brought to the fore the pre-existing crisis in the aged care system, a result of decades of neglect by successive governments. The deregulated, unaccountable system is beyond repair. Aged care is a service, and those being cared for should not be treated as commodities, nor should aged care workers be exploited for private profit.

With the removal of the profit motive, with a fully accountable system, run democratically by the public sector it then becomes possible to provide services that are designed to meet people’s needs.

Such a system should be funded through a progressive, centralised taxation system where large corporations are forced to pay their share. Introducing another special levy like the Medicare levy to raise additional revenue for aged care is not the way to go. It lets companies off the hook, as it is only paid by individuals.

Aged care should be free as should all health care services. Workers in the sector should receive the necessary training and be paid according to their skills and the responsibility they carry in the important work they do. Full-time and permanent work should be available for all who want it, with full entitlements.

Even then, under capitalism, such reforms would only be temporary, as seen by the Howard government’s deregulatory roll-back and successive funding cuts and freezes. Far reaching change is required by a society that respects and treats their elderly with dignity, not as disposable commodities as seen during the pandemic. It’s called socialism – a system that puts people first.

Next article – Editorial – Hammer & Sickle – A symbol of freedom

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