“Bed Block” is not the failure of the person in the bed, it’s the system that gets them there early and holds them – Blame doesn’t get seniors out of hospital, collaborative reform does

Collective strain

There is no doubt that there is a serious problem surrounding the strain on Australia’s hospital system and RAC capacity but further worrying is the federal government’s position that blame can be chalked up to the sector not building beds fast enough, “the aged care sector is not building the beds at a pace we need them, and we need to do more to make sure that happens.” There is much to be examined about what exactly the shape of “more” will take. The time of blame and ineffective policy is over, for the seniors that deserve to thrive, out of hospital, collaborative system reform must happen now.

As the Federal and state ministers of health and ageing met in Perth on Friday, the worsening interconnected crises of hospital and aged care became front and center. State and Territory Health Ministers came swinging out of the gate with statistics showing that “2,419” seniors were remaining in hospital without anywhere to go. SA’s Minister Picton framed it as, “the equivalent of 880,000 nights every year of our public hospitals taken out of the system”. Coupled with the seemingly consistent new records for ambulance ramping across the country, the cracks of capacity are well and truly displayed from the state hospital standpoint.

Data must lead discourse

Experts are calling for realistic and comprehensive investigation into how bad the situation is. Kathy Eagar, Adjunct Professor at UNSW and QUT puts it starkly, “Bed block is a legitimate issue and a massively growing problem.” The data supported depth of the problem must take precedence over side-stepping, “Let’s not pretend the problem does not exist by using euphemisms to describe and downplay it.”

State ministers have shown an awareness of needing further data to shape the response to these crises, agreeing to improve data collection concurrently with continuing to apply pressure on Canberra to heighten funding and finding solutions. SA’s Picton notes, “So you will be hearing more from us about this data. But Minister Butler, for his part, has agreed to work with us on what urgent actions could happen.”

Systemic reform rather than sector blame

Minister Butler’s comments on recognising State, “frustration that the aged care sector is not building the beds at a pace we need them”, unhelpfully omits acknowledging the environment that many providers are finding themselves in, desperately wanting to build and facing obstacle after obstacle.

Multiple providers are, as Butler comments, trying to “put their money where their mouth was last year”, to “start making plans to build these new facilities,” but the uncertainty still surrounding the government approvals process overarching these builds must be acknowledged.

Juniper’s CEO Russell Bricknell speaks to the situation that a lot of providers find themselves in. While many have started commencing planning, “uncertainty is also impacting on investment decisions.”

“Uncertainty falls into two main areas – firstly a provider does not have any commitment to a facility being approved prior to commencement of a project, essentially the Government is asking for providers to invest significant millions of dollars without certainty that a facility will be approved at the end of the process.”

“Secondly, there has been no movement on the review of the Accommodation Supplement which is legislated to be completed by end of June 2026.  This currently creates a disincentive to construct facilities for supported residents which is also impacting business case viability.”

Uniting’s Tracey Burton has clearly long articulated the terrible position the government’s current policy on the supplement amount versus the RAD has on providers who are tirelessly working to meet standards and daily battling to cover costs. Financial viability and quality care cannot happen independent of each other.

In the logistical sense of being supported to even be physically able to build, providers are also running into limited options, Bricknell shares, “in WA we are seeing quotes between $550K and $650K a bed with a limited number of builders able to undertake the work in a timely manner.”

Confusion of SaH release resistance

Consistently hearing from Government that they understand “need[ing] to do more” has created heightened levels of frustration for those within the sector. Particularly with the coordinated campaign that countless provider leaders, peak bodies and senators were required to wage in order for 20,000 Support at Home (SaH) packages to be released. Seemingly the growing disconnect has reached exasperating levels.

With Minister Butler noting, “We have invested about $600 million over the last period of time to fund different services that ensure that older people are able to be cared for out in the community instead of admitted to hospital in the first place,” aged care leaders are boggled at the resistance to releasing more SaH within that very vein of solve, to help keep seniors at home longer, and healthier for longer.

Bricknell notes that many leaders in aged care are, “unclear [as to] why they made the decision, and would be concerned if they had formed the view that the States could handle the impact on hospitals of that decision.” With the comments from many of the state ministers, they are loudly articulating they are not able to handle the impact.

Pre-emptive solving starts now

Many are calling for a change to referencing back to past growth, Butler noted on Friday, “We’ve got more home care packages than we’ve ever had into the system, about twice as many already as we had only five years ago,” yet aged care leaders are calling for the current situation, and impact on the health care system, to be the yard-stick about whether we are at the ‘right’ amount of packages released across the nation.

Concerningly in a communique from government it was noted that, “the deferral of the commencement [Act and Support at Home Program] followed advice from the aged care sector, as well as advocacy and representative bodies.” Numerous CEOs in aged care directly contradict this, Juniper CEO Russell Bricknell notes, “Juniper, Uniting Care Australia and many other providers all campaigned for there to be no delay to the release of home care packages from the moment that Act was passed in parliament.  Our view was that a delay in package release was unjustified and would result in hardship for older Australians.”

Conducting research into the issue, to underpin their lobbying of the release of more SaH for WA, the Juniper group was able to find that, “there is 3 times the rate of admission to hospital of older people from the community than there is from residential care”, it is likely that seniors, through less support at home, are presenting earlier to hospital.

During the time in hospital, there is also a growing chance of losing their home through either lease loss or even un-supported selling of property. It is pre-emptive, kind and sustainable for seniors and the sector, for Government to pivot legislation and solves to supporting keeping seniors at home longer. This view was clearly articulated in the Royal Commission, Bricknell reminds, “the Royal Commission suggested that home care services should not be rationed, we support that view.”

Pre-emptive policy means keeping seniors out of hospital, mitigating the numbers ending up in a prolonged hospital situation which is deeply wrong for them. Supporting them with access to a range of professionals to increase health in both the physical and mental sense, at home, where they are most happy and comfortable is what the multi-sector crisis needs.

Systemic reform – seniors healthy at home

With the numbers of those in hospital likely to climb, the issue is a present one as well as a future sustainability issue. While the government on Friday articulated wanting to see increased build rates from within the sector, aged care leadership notes this must be seen as likely to yield results in the medium to long term.

Bricknell shares, “We are in the early stages of planning for some new buildings, keeping in mind that from initial planning to completion of construction and fit out can take up to five years.  This means that the Minister’s intent, whilst positive for the sector, will take until the medium term to see the outcome.”

Sharing conversations with peers across the sector, Bricknell notes that, “We are all currently assessing opportunities but the uncertainty in the approval process along with the accommodation supplement issue outlined above is making it difficult to build a business case.”

The government must be willing to come to the table with provider leadership to understand, on the ground, obstacles that are being faced when seeking to build. Commenting within a silo of government, from afar, does not helpfully shape policy or make effective change for those that need and deserve it most.

What is acutely needed is cross-collaboration between government and the sector, to understand the realities of the situation, and so, pivoting to yield results for the immediate and long-term.

Hospital isn’t home. Home is a safe space all your own.

Unhelpful blame games and distance from a sector’s reality means that pivots in legislation cannot be made to help the people that need it the most. Seniors deserve a system that allows them to stay in their own homes for as long as they can, and to be supported to be as healthy as they can. Seniors need and deserve to have options to leave hospital whether to RAC or other options. As Uniting’s leadership team notes, it is not just RAC that should be an option for seniors that are without a home. Independent senior housing or community living must also be looked into as an innovative approach to mitigating the pressures on hospitals and RAC. Both government, providers and the housing sector have avhuge opportunity to pursue social and affordable housing for seniors.

And in all of this discourse and learning, that must be done from all the actors in this crises, the grounding factor must always be the human-beings at the center.

Eagar reminds, “The patient is not a bed blocker. The patient is a frail vulnerable person who is stuck in the wrong place because of a severe shortage of residential aged care beds. The system is the problem, not the patient.”

In a nation of such wealth, seniors must be supported to have a safe home, to stay in it for as long as possible, to being as healthy as possible. And to have options, whether a RAC room of their own or another option that fits better, to never be stuck in hospital. Hospital isn’t home. Home is a safe space all your own.