Aged care divided cannot score its goals – part 1: exhaustion and the speaking out tightrope

It starts with the goal. At least for Russell Bricknell, CEO of Juniper Care in WA, it does. And while it isn’t ‘the world’s game’ it may as well be. Caring well, for Australia’s seniors, has been his goal for over 25 years. Since entering the sector in 2001, Bricknell has experienced the ‘weather’ events driven upon the sector, from funding drought to regulation rainfall, simply put, the playing field and scoring has had its challenges. And that has come at a cost. 

To the conscience-led leaders, from clinical, office, care managers to CEOs and all in-between, showing up daily, to provide care, above and beyond just words in legislation, has reached a point of exhaustion. That’s because the prevailing headwinds don’t seem to be letting up. He shares a team story, of trying to kick the ball where it needs to go, and in aghast perplexity, seeing it often roll backwards. Bricknell, in wry candour, faces into those gusts.

Speaking out – a tightrope

For many conscientious leaders in aged care, there’s a white elephant in the room that has been parading and prancing. To not announce it, or at least paint it with some neon dashes, is to ignore a prevailing headwind. Part of the exhaustion coming from the sector is that when it comes to voicing the problems on the ground, many can’t. Issues lived in implementing distanced reform, albeit well-intentioned, particularly for providers who receive large portions of public funds to sustain operations, often are not in a position to boldly, and truthfully, offer up earned critique.

This hesitancy is not from lack of care or insight, it is often from prudence, wisdom and realism. To care for the most vulnerable, particularly seniors who do not bring sizable RAD contributions with them is to rely on funding from the public purse. This dynamic is a reality and truth that Bricknell understands and appreciates.

“In senior roles we’re quite careful of what we say and to some extent, we’re [ending up] not saying anything”.

He shares, “if I look around my field, I know a lot of my peers have similar views, and they’re going through the same issues”.

There is a difficult choice on the table for aged care leadership, “it’s about the choice you make about whether or not we speak up about issues”.

Bricknell names what needs to be named, there are headwinds of where the money comes from, the consequences of providing feedback to ‘the hand that feeds’, there are sensitive but no less real factors at play in the game of trying to land the best possible care for Australia’s seniors.

“We [at Juniper] have the luxury of being able to do that because we have a position in a client group in WA that’s unique, whereas others may feel they don’t have the same privilege”.

And yet after decades of conversations with leaders, of seeing proof in the pudding of perseverance, not the reward of rhetoric, he invites in a nuanced narrative and yardstick of Australia’s aged care leaders. 

Far from the ease of low hanging tropes of the “big bad” aged care manager, doing professional life with leaders of all backgrounds and providers he confidently shares, “we’ve all got the same priority at heart”.

“We’re not in this game to make money because that’s been proven time and time again, it’s about providing services that care for people”. 

MBAs to good use

Being in a position to speak out, Bricknell, in mirth and mathematics shares that good conscience and an MBA can do much good. This combination can see trends and consequences that are damaging care for Australia’s most vulnerable. As tropes of Australia’s aged care leaders deserve nuance, so too how its seniors are assessed. A far cry from the blinkers of wealthy boomers, Bricknell highlights a growing challenge to scoring the goal of consistent quality care for all. 

The underlying premise of how aged care is set up is skewed to those that can pay. The figures are stark and the system is ignoring it.

“I think at the moment we’re running an argument nationally that we’re going to get there from a user pays basis. The user pays basis is [now] the way aged care ‘should’ be delivered, assuming that everyone can pay”.

And so Bricknell, in his privilege, lifts from the first headwind of frustrated and sensible silence and points to the next, “I don’t think everyone can pay. More and more people simply cannot pay”.

“With the baby boomer population bulge coming through, it now means we have many more people who can’t afford [RAD spots] care”, Bricknell shares alongside peer Tracy Burton of Uniting NSW.ACT.

“The user pays model has shifted towards everybody paying, except for a very ‘small’ proportion, except what the government hasn’t realised is that this very ‘small’ proportion is a big bucket of people. The government keeps willingly underfunding that big bucket of people”.

Intelligence and conscience merge here for many leaders, in an acute pain-point, “providers are increasingly going to be faced with choices about who they target [RAD or supplementary], and providers like ours and Burton’s make very conscious decisions about access rights for people who can’t afford things, based on our mission and values”.

And providers are left with a cost, “the problem we have is that the sustainability argument now sits across both residential and home care at the moment, and it’s putting pressure on boards, on it all”.

Heading to the stars in a cardboard rocket ship

Rights based and person-centred care has been supported by the sector’s leaders. So too the need to respect mathematical realities in substantiating that care.

“The government has shifted the responsibility to the consumer, which works for those that can pay with RAD but in our case, half of the people in our facilities fall below the government’s own testing threshold, it means [the difficulty of] those people to get services widens, and the Feds aren’t funding that right”.

“As the gap widens between what the government will pay for a supplementary spot per day, and actual cost. Funding is one of the issues as a leader, your mind [consistently] goes to, ‘where are we going to get the money from because money doesn’t grow on trees’”.

A government divided

Bricknell points to the tension that has been building between Canberra and itself, “policy framing out of Treasuring is driving this”.

“If you go back and read the executive summary of the Royal Commission, the commissioners made a really startling observation. They said aged care has been funded on a cost-contained policy for years, and so, the funding input hasn’t matched, by any sense, the costs of delivery services”.

Back five years, “the report said aged care was $9 billion underfunded, government commissioner commentary was then that cost containment is clearly not working because it’s ended up in worse outcomes for seniors”.

“These are the policy settings seniors and the sector are currently being made to run with at the moment”.

He highlights that this means multiplying problems, “shifting costs on to consumers doesn’t work for the vulnerable, for the sector trying to provide excellence to them. In trying to limit the spend, that’s the way of ‘safeguarding’ policy, instead of trying to understand what’s the most efficient way of spending the money to get the best benefits for seniors”.

In short, cost containment may persist in being a cop-out in preventing the harder and deeper work of efficiency from inside Canberra, alongside the sector that is wanting the best in reality and impact on the ground, not in theory and legislation.

Viability vacuum

As to being ready for the prolific influx of seniors already starting to enter the sector, Bricknell points to how the pitch was slanted, at an incline over a decade ago. “The whole problem around supply started in the mid 2010 when the government started stripping cash out of the aged care sector and so people stopped building things”.

“And we still haven’t got the aged care sector back since, into a position where it’s got a reliable return rate so we can stack up business cases to build beds”.

“Boards, provider heads, executive teams, we can’t fix the problem until we are viable, and government is doing a lot to bring uncertainty which feeds unviability”.

Bricknell is clear, “we know we can fix the problem of beds, we can build beds cheaper than the government can, just look at the Victorian government’s owned projects, they have just been built at an extraordinary cost per day, and we can build at a rate a fair bit less”.

Part two to follow next week – Bricknell explores the cost of compliance and how reactive operations policies in response have resulted in inefficiencies driving down returns. The case and need for return is central and valid to aged care investment, uncertainty surrounding low-interest schemes is hampering earnest desire to meet build rates from within the sector.