Aged care divided cannot score its goals – part 2: exhaustion and playing by the rules ending in penalties

Exploring the headwinds that aged care leaders are facing is to acknowledge the real gusts that hard-working and conscience-led professionals have been striving against for decades. 

Russell Bricknell, CEO of Juniper in WA shares a candid view, echoing peers known and unknown, on the playing field. Without rose-tinted glasses but in conviction and commitment to score the goals of excellence in care, naming points of exhaustion is to honour those that have played by the rules only to feel the penalties mounting. Parsing out compliance cost, in the form of well-intentioned reactive task layering is a spotlight of reform on the ground. 

For the thousands of teams reeling from a rapid regulatory pace of change, the gap between intentioned reform and operational hurdles is not what seniors, staff and those on the ground accept as progress.

A widening gap

Bricknell frankly shares the team story, likely mirrored across the nation. Compliance implementation, now 9 months on, has had a cost on teams.

Team members of all roles have seen, “reform and money going too far into regulation, where burden is the impact, not viability of excellence in care, the investment the Commonwealth has made into aged care, [much of] the money has gone into regulation, paperwork, bureaucracy, and the system has forgotten it’s actually about caring for people”.

Teams are feeling the gap between “realistic” and “funding”. And while, “we’ve seen some real improvements to care as part of the reform, the gap remains that we all haven’t yet identified and been satisfied in knowing how much care should have been delivered from all the reform”.

Compliance cost – the penalty of improving performance in harder conditions

Bricknell is candid, “we’re still trying to improve our performance under the new reform”.

“We’re needing to work really hard to prove we’re sustainable in the long run because we know that if we can’t demonstrate that we can’t afford to borrow the money we need to build the facilities, if we can’t put forward business cases that stack up”.

He shares that boards are now in a position where it’s bravery or go home. 

“Recently new business went to the board for approval, to go to the DA, the board has been great, and brave enough to approve it, but our return rate on that property, that build, which is an aged care facility, was 6%, it should be 10 or 11%, by the government’s own numbers, and our own internal parameters”.

“If we can’t wiggle that extra, can’t make it stack out, it doesn’t happen, which means we don’t increase the number of beds in the state, that’s the challenge for us”. This frustration is echoed in the offices of providers across Australia. This is the reality faced by many who are rearing to go and build more beds to meet demand.

“So for us, it’s always the question of how do we run more efficiently so we can generate better outcomes, so we can build more at a time when there’s expected of us by ministry”.

Exhaustion from the efficiency race

He nods to the team story, “we’re now 9 months after the reform of the new act in place, so there’s a whole lot of new things that have been added to us”. This is the stark reality providers and teams are operating. It isn’t an excuse, it is the factual environment.

There has been a cost to compliance, “none of us have really had the time to get the efficiencies out of the responses to reform, that teams needs to be hitting for optimal efficiency”.

On the ground, in the halls and floors, this has meant break-neck reaction. “What we’ve done is we’ve added tasks on top of tasks, so they’re inefficient and now people are exhausted, and we’re starting to [be able to] want to make some changes to make that better”.

It should not be a blame-game towards the sector. Bricknell agrees, there has been a gargantuan change; growing pains and response must be couched in the sincere convictions of those trying to adjust caring for the vulnerable in real-time.

Over-regulation has real-world implications, many times taking resources out of hands-on excellence in care.

“The government must give the sector more tools, more certainty, it is incumbent on government to facilitate bed builds, their programs must run smoothly, in line with how ready the sector is to partner and break ground”.

No speed interest for low-interest

And so it is particularly galling, touted as breakaway progress by the WA government that not much has moved on the $100 million low-interest scheme it announced last year to help build beds.

“In January we applied, in April we were asked questions and answered, and haven’t heard anything since. It’s just really unclear what’s going on, and the problem with it being unclear is you have no certainty”. Provider heads are acutely aware, the investment appetite for uncertainty is utter fasting.

Bricknell highlights the position numerous boards and heads find themselves in. They’ve played by the rules, and the referee isn’t providing clarity or communication, “we’re needing to make big decisions, we are extremely keen to build beds and be a part of the solve to the huge issue of capacity”.

“But if you think about it, in WA it’s about $700,000 a bed, we’d love to build a 100 bed facility, that’s $70 million, you don’t make those decisions lightly as an exec, as a board member, so you’re not going to commit to $70 million that may or may not be affordable”.

Damaging democracy

Bricknell names what many within have thought and seen with frustration. Inactivity from those with policy levers has no excuse, “I joined the sector in 2001, the demographic data has been clear from that time, it’s been around with profound clarity ever since”.

And yet the conversation of aged care must wrestle with the very real, good, complicated and at times, limiting nature of Australia’s electoral system. Democracy has shaped aged care and not always to its betterment.

“I think, the problem we have, is that we’re driven by an electoral cycle, it has a biased government towards short-term decision making”, Bricknell shares.

“Rather than a long-term view [it’s been short] and to be fair to Rae and Butler, they’re the ones that have been left holding the can. That can has been kicked down to them by many governments of all persuasions over the last 20 years”.

Bricknell affirms, conversations with peers shows a cohort of aged care leaders needing to thread an approach under a system. “I’ve talked to a few people about this, sometimes it’s not clear how to push, we’ve got this changeable democratic system, there’s a sentiment sometimes of ‘let’s not shake that tree too much’”.

But now, what’s before leaders, hard-working front-line staff, and seniors all wanting excellence of care, you have a headwind decades and decades in the making. “Now, we have a decades-long built-in problem of demographics, and it’s going to hit more and more each year”.

Part three to follow next week: Exhaustion from leaders in aged care has and is causing significant loss. Those exiting to other sectors or early retirement means an increasing brain-drain of seasoned leaders and a loss of mentors. Dignity of risk, Bricknell notes, of changed aged care approach from policy-makers, sector and society may be the hard conversation to win long-wished for and illusive sustainability.