Opinion: The demise of Australian residential aged care

The year 1997 presented the Australian aged care sector with a promising future moving away from a disjointed cottage industry to a professional social services sector with the introduction of the Aged Care Act 1997 and an accreditation regime that promoted excellence and continuous improvement. This was reinforced with the Ministerial Awards for Excellence and annual Better Practice conferences held by the Aged Care Accreditation Agency. 

Given the findings of the Royal Commission into Aged Care Quality and Safety (2018-2021), it is abundantly apparent that the sector has changed dramatically, and not always for the better. As the sector lurches from disaster to disaster and media scrutiny continues to highlight repeated and seemingly more serious shortcomings, it is important to critically analyse what has gone wrong.

While the pre-1997 cottage industry had its own fair share of issues, is the corporate, property development focused “consumer” sector any better? I would argue we have actually gone backwards, and the benefits previously gained through a community based, small scale sector have been lost in the mass production, mediocre inspiring, economies of scale driven market. 

Over a career spanning 30 years, I can identify two major failings that contribute to the majority of issues that have plagued the sector – the abject failure of the regulatory framework and Australia’s prevalent absence of respect and value for our Elders. 

The regulatory system has moved from one that rewarded excellence and actively encouraged innovation and improvement to one where reaching the basic minimum standard has become the goal, a goal that is regularly and repeatedly unattained by many providers.

As a Director of Nursing, failure of even a single accreditation outcome was a personal failure that was followed by a deep sense of embarrassment. Now there is almost an expectation of failure in this new world of learned helplessness which has become a self-fulfilling prophecy.

I regularly now hear senior executives dismiss the failure of 5, 10 even 20 of the 42 requirements of accreditation as nothing more than a minor aberration, almost an expected outcome. 

Previously, homes that failed their accreditation were placed on strict timeframes to address the concerns and the regulatory agencies and appointed sanctions advisors worked together to ensure the safety of those in care.

Sadly, those days are long gone and now homes can sit in a “monitoring” holding pattern for months and years, remaining non-compliant with the minimum standards yet able to continue operating unfettered by regulatory action. Where timeframes are set, these can pass without compliance being reached and are simply “archived” to the bookshelves of a forgotten land. 

The failure of regulation is the single most destructive force that has contributed to the widespread failures of the sector. But how has this been allowed to happen? 

Unlike many cultures around the world, our elders are not revered and served and despite the steady influx of migrants from these countries, our prevalent dismissal of older australians continues unabated. 

The other thing that hasn’t changed is the overwhelming ‘whiteness’ of our politicians and the SES of the public service, especially in health and social services. Maybe the lack of cultural diversity, particularly from cultures who have a deep respect for their Elders is something worth exploring further.

I certainly did not experience the same level of disconnection when working with the Muslim communities of Sydney or the many CALD communities who have engaged my consulting services over the decades. Each of these communities had a prevalent ‘Elder First’ philosophy that was evident in everything they did, and which is conspicuously absent from the rest of Australian culture. 

Australia could learn a lot from these communities. How is it that Australia deinstitutionalised people living with mental illness and disability following the watershed richmond report in 1983, yet in 2023 we continue to institutionalise our citizens simply because of their age? 

Even following the strengthening of community-based disability support with the introduction of the National Disability Insurance Scheme 10 years ago and public pledges by politicians that Australian living with disability will not be forced into nursing homes once they hit the ripe old age of 65, we continue to see this occurring through opaque and clandestine policy enacted by the NDIA. 

The current Aged Care Minister, Anika Wells, will have us believe the Albanese government’s package of reforms will fix the ailing sector. I don’t doubt she herself believes that. I also don’t doubt that the people advising the Minister, the same people who have been sitting at the decision-making tables for the past 20+ years agree with her because dissenting views are not welcome in this country.

The fact that I am delivering at four intentional conferences this year but have been silenced in Australia for more than five years is testament to the power of the aged care cartel. 

Minimum staffing ratios that ignore key groups of employees and which have been introduced without thought of the actual practicalities of implementation will not automatically improve the delivery of aged care services. A star rating system is so woefully inconsistent that, the home where 95-year-old Mrs Clare Nowland was tasered by police for walking with a walking frame carrying a knife and died as a result, is still rated with 4 stars.

This shows that the facility is supposedly of higher quality than the vast majority of homes in this country. If this is what the Minister believes is transparency and empowering consumers, then God help us all. 

Given we spend approximately half that of comparable OECD nations of the care and support of our ageing population, and spent nearly double on incarcerating criminals than aged care, isn’t it time we seriously stopped tinkering around the edges, fund the sector appropriately, openly encourage non-institutional models and simultaneously put into place a regulatory body and system that is objective, consistent, experienced, knowledgeable, competent and which drives excellence beyond substandard mediocrity so our vulnerable Elders are supported, cared for and respected? 

Dr Rodney Jilek is a former Clinical Advisor to the Department of Health and Ageing and has over 30 years’ experience in managing and delivering aged care services in Australia. Community Home Australia is the country’s first non-institutional specialist younger onset dementia service located in Canberra, ACT. He regularly contributes to the international ageing community through publications, consulting, research and conference presentations.