Delving into fairness – Uniting’s NSW.ACT outgoing CEO urges honest national conversation on how aged care is funded

If any conversation about fairness is going to stand a chance, transparency and collaboration have to be its bedfellows. Tracey Burton is Uniting NSW.ACT’s outgoing CEO and as she looks to retire from the sector, she showcases a trend that has become apparent for the many who have poured themselves into aged care. Burton has a passion to do what she can to step into conversations that are difficult and sensitive, that challenge and change to help land unfinished reform. For Burton, leaders, and staff like her, being on the ground of aged care means seeing it all, the cracks and unfinished business, yes, but also the sacrificial attitude and work that hundreds and hundreds of aged care workers commit to every day. Burton speaks of change, not just from quarterly cost reports but the stories of staff and seniors she can’t get out of her head. When Burton speaks about reform that must happen, from government funding, to normalising co-contributions by people with means in contributing to the cost of their aged care, it is not from a prescriptive podium but an offer of partnership pairing. Conversation, not command, must be at the centre of earning change in hearts and minds when it comes to landing aged care reform.

Substance

When tackling the topics of funding and reform, too quickly, the conversation can miss those at the sector’s heart. Burton saw staff at Uniting show up day-in and day-out through seemingly relentless setbacks to deliver the best care they could.

Burton shares that through severe weather events, fire and floods, the COVID-19 pandemic, the Royal Commission and the new Aged Care Act, she has witnessed incredible, and most importantly, consistent, acts of selflessness and professionalism, “staff showed up and gave their all.”

“Residents were supported. Families relied on us. Through an incredibly challenging time we were guided by Uniting’s values: to be bold, imaginative and respectful, and always show compassion. And when tested by extraordinary circumstances, we did our best for the people we serve.”

Burton shares the stories of two Uniting staff members, Hannah and Elise, who, “started what became a Flying Squad of approximately 100 Uniting employees who packed bags, left their own families and volunteered to travel into outbreak sites to deliver care where it was needed, including in other providers’ homes when they were so desperate for help.”

The start of the conversation of reform, of paying staff like Hannah and Elise to do the incredible work they do, is to honour the substance of the aged care sector. Rarely seen, and even more rarely recognised, Burton highlights that acts like theirs are occurring across aged care services every day.

When speaking about funding sustainability, when talking about quality of care, when talking about landing reform, the full picture of who makes up aged care, not just salacious headlines, must be given weight.

“They were extraordinary times [and staff] that should not be forgotten with an “oh yes, there was Covid.”

Unfinished

As advocates and aged care leaders have publicly noted, the work to land true reform is not yet finished. Burton affirms, “the Royal Commission set out a vision that still demands follow-through.”

For the conversation of change to earn trust and buy-in, all collaborators, from government to sector, must step into naming reality, and honouring transparency. Trust starts from recognising that the intention of the new act is still being worked through on the ground.

Burton is clear, “the funding of quality and equitable care remains the unfinished business of the Royal Commission.”

As countless leaders in aged care have vocalised, while there have been improvements for residents, clients and staff, the financial model of aged care remains unstable, volatile and worryingly immediate. For aged care leaders that have remained in a sector, frequently tumultuous, their heart and vision for the sector extend further than the current year. Like Burton, numerous CEOs are calling on the government, on the sector, on the Australian people to partner with them to make a sector that will thrive now and well into the future.

Aged care, heart-felt leaders say, must work for the seniors of now, and the seniors of fifty years hence.

Burton looks to open space for all parties to lean into making changes that support a sector that is robust for the long-run.

That means seeing the full-picture, the selflessness of those that make up the staff of aged care, protecting the most vulnerable, recognising those with means, and supporting national buy-in about the validity of fairness.

Cross-sector funding analyses

Burton has worked in hospitals. When she arrived at Uniting in 2018, she, alongside numerous other leaders, were thrown by the fact that Canberra had decided that indexation for aged care funding would be zero.

Calculating the annual revenue in RAC she found the value to be a third of what hospital bed pricing was receiving. She was “truly shocked”.

Industry leaders continue to seek to have collaborative and open conversations with the government about “honest and sustainable funding”. To land reform well, the reality and challenge of price caps needs to be recognised across the sector. There was significant expectation last October surrounding the increase of ANACC, but for many, the rise did not cover the cost increases providers experienced sector wide, particularly for the necessary and deserved pay lifts for staff like Hannah and Elise.

Burton notes, “it’s critical we don’t see inadequate indexation return as a means of government containing costs”. Provider leadership are offering up transparency of where money is needed, for many, they want to raise pay-rates for staff but the money must come from somewhere.

Analysts and industry leaders are frank, fairness must extend to indexation rates for funding. Being between a rock and a hard place means seniors and staff suffer, and care is compromised.

The most vulnerable

Burton also sees the conversation of how aged care is funded as needing to know, front and centre, those who are most vulnerable.

She shares about Lynn. Lynn lives alone in a rented apartment in Newcastle and relies on a full-pension to pay her way. After a career as a high school teacher, TAFE and eventually Sydney University, she was most happy in facilitating spaces so the minds of the young could thrive.

At 82 years old, she hasn’t lost that desire to plug in and be a part of supporting others. She volunteers a few days every week with the Salvation Army, she paints and loves to chat and spend time with her younger neighbours.

Lynn was diagnosed with cancer, her son had to move interstate, and so with less support and growing needs, she has come into contact with the system, receiving home care support from Uniting. The three hours of personal care each week to shower safely, and one hour of domestic assistance, has helped her stay at home.

But one of Australia’s other crises has impacted Lynn. Her private rent has increased twice since her son moved out, and she has shouldered the rent alone. Lynn has never been reckless; she has budgeted carefully but her reality is this: buying her monthly medications, covering her rent, this has meant that something has to give, that’s been reducing her food for the week.

Burton, and advocates attest, Lynn’s case is not unique.

“For someone living on the full pension and paying private rent, co-contributions come directly out of money needed for food, medication and basic living costs. It is crystal clear in my mind – full pensioners who rent should be automatically exempt from co-contributions”, Burton shares.

When it comes to fairness, when it comes to what funding should cover, advocates and sector leaders are championing change, “they should not need to apply for hardship or navigate additional complex administrative processes.”

“If they receive the full pension and are eligible for Commonwealth Rent Assistance, the system already holds the relevant data. Automatic protection would be targeted and consistent with the intent of reform. We’ve calculated it would only cost an extra $50 million per year.”

Burton, and other sector leaders have vocalised the implications of getting this wrong, further and further pressure on hospitals and residential aged care, that don’t have the available beds to receive seniors entering unnecessarily and early, “we must get these settings right.”

“There are genuine fears that poorly designed co-contribution arrangements will lead vulnerable people to forgo essential support. This will not only undermine dignity, but it will also risk avoidable deterioration and greater pressure on hospitals and residential care.”

Super – balance and fairness

For balance and fairness to land, particularly when it comes to gaining traction, all must be invited to the conversation.

Burton advocates that when it comes to aged care’s future, in protecting that very future, in safeguarding quality care for all, there is the unavoidable, non-negotiable need to be able to pay for it, that means, “people with the means to do so should contribute more to the cost of their aged care.”

But it is in substantiating this, in inviting government, sector leadership, the Australian people to engage with this sentiment, that Burton highlights that progress still needs to be made.

She shares that the conversation around super, and what it should be used for, must be at the forefront of government and sector education and messaging: “Australia now holds more than four trillion dollars in superannuation savings.”

“We have built one of the most successful retirement savings systems in the world, designed to support Australians in retirement, including the cost of their care.”

Burton highlights that it is vital that, alongside fair indexation of funding from government, such as ANACC increases, there must be partnered, societal buy-in of the fairness of contribution by those with means.

Anthropologists affirm that deep in Australian society there is a passionate sentiment of fairness. This psycho-social bedrock has a part to play in shaping the health of Australia’s aged care future. Burton advocates that education, transparency and conversation on super, and contributing to aged care by those that have a lot, is integral to protecting care for those that don’t.

Far from lining the pockets of ‘greedy’ providers, industry leaders are working to share the narrative of reality. The stories of Hannah and Elise, the story of Lynn and countless others. These are the selfless, kind and community-minded people that are aged care. They are the full-picture of framing fairness, and how to pay for excellent care, and the people that deliver it, for the most vulnerable that can’t pay for it, and those that can.

Burton is clear, “contributions from those with means is what will allow the system to deliver what they expect in aged care and protect those without it.”

“Uniting has consistently held this position”, Burton says, “for many years we have argued that a sustainable system requires contributions from those who can afford them, alongside strong protections for people of limited means.”

Burton sees recent media coverage of HELF as highlighting a key omission in conversation with the Australian people, “the Australian community must be brought on this journey.”

“There’s been no education or leadership on helping Australians to understand – if they want the quality, equitable aged care system the Royal Commission articulated, we need to find the way to pay for it.”

Changing minds

Burton doesn’t just talk the talk, she walks the walk. Sitting down with friends and family who have different opinions to her is important. It is through sitting through difference, through listening and sharing that trust can be earned, and opinions substantiated.

She caught up with a friend who is comfortably retired. He said to her, “’I paid my taxes my whole life. I don’t get anything.”

She replied, “You receive Medicare rebates. You receive PBS subsidies – the government will even pay for all your clinical care in aged care, just not your daily living choices you have made and paid for yourself your whole life.”

Burton points to healthcare, and how the Australian health system relies on other streams of revenue, not just government funding. Private health insurance and private savings from those with means contribute to its sustainability, she notes.

Burton asks, “why do we see aged care differently – as a taxpayer funded entitlement?”

She advocates, “contribution is how we protect equity.”

“Every additional dollar contributed by someone with the means to do so strengthens the system’s service offering and its ability to protect someone without means.”

It is here the work to showcase the transparency of the sector can be seen in its full importance; The workers like Hannah and Elise, who left their partners, and small children for months during a national pandemic, to care for seniors, when there was no protection of vaccines is a powerful truth. These are the staff who deserve to be paid fair wages. 

It is the people like Lynn who poured themselves into their work to build up the next generation, to equip them to thrive in the world and be confident and thriving human-beings but now rely fully on a pension but find themselves paying eye-watering Australian private rent and co-payments to shower and safeguard against hygiene-related decline. 

It is within this that Burton says, “those with the means to contribute to the cost of their care must expect to do so. Not because providers are seeking excess, but because the system requires more funding than the diminishing taxpayer base can possibly afford – if it is to deliver rights-based care for all older Australians.”

Change requires transparency and trust

Burton sees trust as paramount, for any change to how super pays for aged care, and co-payments, “trust must be built with the Australian public.”

While, “there were serious failures that required scrutiny and reform”, work by the sector, by media, by the government must go further to highlight the substance of aged care. The reality of staff like Hannah and Elise, and the thousands of others who show up without fanfare or breaking-news stories. This is the full picture of aged care.

The full-picture, built of the true and transparent stories of selfless front-line staff, managers and aged care executives, must be the foundation to conversations about change and high contributions of those with means, about using large super amounts to contribute higher co-payments.

Burton, alongside other leaders, shares, “many Australians still believe aged care providers are motivated primarily by profit over care. It is just below the surface and bubbles up, especially as we move towards more co-contributions by people with means.”

She endorses, “we need to have an honest national conversation led by government, with active engagement by the media, advocacy groups like COTA and OPAN and providers to help shape the national conversation about what fairness and sustainability in aged care truly mean.”

Burton shares, “every year around 60,000 Australians turn 80. Demand for aged care will continue to rise sharply in the years ahead.”

“We need to build trust and adopt the right mindsets and policy settings to fund it. The alternative is to return to an under-resourced sector that will disappoint us all.”