“For purpose, not profit” sounds noble. Dr Darren Coppin says it teaches the public that purpose and profit are opposites. He shares the phrases aged care leaders should retire, what to say instead, and why words change how decent people inside the sector actually behave.
Two groups of people sit down to play the same game. The rules are identical. Only the name is different.
In Liberman, Samuels and Ross’s study of the classic prisoner’s dilemma, players told they were playing the “Community Game” cooperated about two-thirds of the time. Players told it was the “Wall Street Game” cooperated only about a third of the time.
“Words do not just describe a sector,” says Dr Darren Coppin, founder and chief behavioural scientist at Ethyx. “They change how decent people inside it behave.”
For aged care, he argues, that matters more than most leaders realise. Every customer arrives at one of the hardest moments of their family’s life, so every word about money lands on people who are already primed to suspect they are being exploited.
“Language matters so much,” he says. “It triggers immediate impressions in the minds of people.”
Stop saying, start saying
The sector’s best-known slogan is a good place to start. “For purpose, not profit”, Dr Coppin says, tells everyone that purpose and profit are opposites. Here is the language he would retire, and what he would say instead.
The internal vocabulary matters just as much. Phrases like “occupancy optimisation” and “rostering efficiency”, he says, make decisions that are really about “how many minutes of human attention Mrs Patterson gets this afternoon” feel purely technical.
Tenbrunsel and Messick call this “ethical fading”: once a decision arrives labelled as a business decision, the ethical side drops out. Dr Coppin concedes it isn’t easy to escape, since legislation and procedures push providers towards measuring the measurable and talking in the language of efficiency.
Price the inputs, never the need
When it comes to fees, Dr Coppin says the public applies a simple rule, first identified in the 1986 fairness study by Kahneman, Knetsch and Thaler: “You may protect your margin against your costs, but you may not harvest my bad luck.”
So every dollar a family pays should be visibly attached to a cost, and every dollar of surplus visibly attached to something it built. He offers admissions staff a line to use: “You’re not paying for her frailty. You’re paying for a room, a bed and the people who look after her.”
Prices should be published and identical for every family, “whether they are planning a year ahead or arriving from hospital on a Friday afternoon”. Increases should come with their cause, in writing and in advance. In the same study, 75 per cent of people accepted a landlord raising rent to cover documented cost increases.
The way a surplus is explained matters too. “Our result came from a better roster and lower borrowing costs, and it is paying for forty new places in Dubbo” passes the public’s fairness test. “Our result came from strong occupancy” does not, “because it sounds as though you profited from demand, which in this sector means from misfortune.”
And providers should show what the family bought, not only what it cost. Johnson, Zhang and Keil found people instinctively assume a seller wins and a buyer loses, because they follow the cash. Simply prompting people to think about why the buyer wanted the thing reduced that bias by around a fifth.
The default trap
The admission meeting is where trust is most easily lost. A daughter admitting her mother is usually exhausted, guilty, grieving and short of time. Mullainathan and Shafir’s research on scarcity shows that this kind of pressure imposes a “bandwidth tax” on decision-making. In that state, whatever is already selected tends to stick.
In Johnson and Goldstein’s study, Germany, which asks people to opt in to organ donation, had a consent rate of about 12 per cent. Neighbouring Austria, which asks people to opt out, was close to 100 per cent.
“So when a provider hands a stressed family a list of extras with boxes already ticked, it is not offering a choice,” Dr Coppin says. “It turns one of the strongest tools in behavioural science against the very person it is meant to care for.” Richard Thaler calls this “sludge”. “Families probably just see it as a rip-off.”
His version of a fair admission process:
- Nothing is pre-ticked. If the family does nothing, they pay nothing extra, and they are told so clearly.
- Separate the move from the menu. The rules already say higher everyday living agreements cannot be made until after the person has entered care, with a 28-day cooling-off period. Good providers should not raise extras at all until a settling-in review around six weeks later.
- One page, in plain English. What government pays, what you pay, what is optional, and the caps. Most families don’t know the family home is only counted up to a capped value, or that non-clinical care contributions stop at a lifetime limit. “Telling them costs nothing, and it takes the fear out of the room.”
- Daily and annual totals, side by side. “‘$5.50 a day’ sounds trivial. ‘About $2,000 a year’ is the honest figure.”
- Use it or lose it, in the resident’s favour. If a paid service hasn’t been used for a month, stop charging and tell the family.
- No sales targets in admissions. “If the person sitting with the family is rewarded for selling extras, the family will sense it, and they will be right.”
His test for any CEO is the one most ministers live by: “If your paperwork and policies were shown on national television tomorrow, would you stand by it?”
Don’t talk about EBITDA. Talk about Elsie.
There is a well-known and slightly uncomfortable finding about human generosity. People give far more to help one identified child, a seven-year-old girl called Rokia, than to help millions of starving people described in statistics. Paul Slovic calls it “psychic numbing”.
Aged care, Dr Coppin says, reports its finances in exactly the form the human brain cares least about.
“‘Our operating surplus enabled $2 million of investment in infrastructure’ means nothing to anyone. ‘Because we ran well last year, Elsie now has a garden she can reach on her own, a room she chose, and carers who have been with her for three years.’ Now that means a great deal. Nobody falls in love with an EBITDA margin. They fall in love with what it makes possible.”
To keep that from sounding like brochure copy, he says, the stories need to be specific and checkable: a named resident, with consent, a named change, a date and a dollar figure. They should come from residents and staff rather than the CEO. “A carer explaining that new lifting equipment means she no longer goes home with a sore back is worth 10 pages from the CEO.” And they should include what didn’t work, because admitting a weakness makes the rest of a message more credible.
There is a deeper point. “We have built a system in which older people can only receive: care, help and invoices. In a one-way relationship, any surplus looks like something taken.”
In Langer and Rodin’s classic nursing home study, residents given a plant to look after reported happier, more active lives, and eighteen months later significantly fewer of them had died.
“It turns out that what keeps us alive isn’t being cared for,” Dr Coppin says. “It’s having something to care for.”
Publish what families buy, not just what it costs
Occupancy, care minutes and compliance are what regulators ask for, but Dr Coppin says they measure the avoidance of failure. “We have built a sector that publishes what it costs and never publishes what it buys.”
He would add a handful of measures families actually care about: quality of life in the resident’s own words, function kept or regained, how often each resident did something they chose and valued, and a simple reinvestment ledger showing what was earned per resident per day and what it bought.
Above all, continuity. “How many different carers looked after Mum this month? If I had to choose one number that tells a family whether to trust a home, it would be this one.”
One letter, next month
So if an aged care CEO could do just one thing next month, what should it be?
Send every family and every staff member a one-page letter, Dr Coppin says. In plain English, it would set out what the organisation earned last year per resident per day; what it cost to care for their mother, what government paid and what the family paid; and exactly where the surplus went, “with names, places and photographs: the night nurse we added, the garden we rebuilt, the new places we are building and where.”
“It costs almost nothing and needs nobody’s approval.”
What the sector is short of, he says, is “a sentence in which the words ‘return’ and ‘dignity’ can sit side by side without anyone feeling awkward or affronted.”
“Words are the cheapest thing in the whole system to change. We have spent thirty years being careful not to say the wrong thing about money in aged care, and it has cost us beds, and hope. If we spend the next thirty saying the right thing, I think the sector can have a realistically optimistic future.”
Dr Darren Coppin is founder and chief behavioural scientist at Ethyx, which focuses on predicting and preventing staff burnout and turnover to improve continuity of care.
