“A complete and utter mess”
That's what advocates say about Australia’s seismic aged care reforms
Welcome to Care-full, a practical guide to caring for aging parents. Here, you’ll find my tips about how to juggle your caring responsibilities, where to find support, how to navigate government bureaucracy, and how to keep parents safe at home or find the right care facility for them. And – perhaps, most importantly – you’ll realise that you’re not alone during what’s probably your biggest role (reversal) yet!
First up, my apologies. As I write this, it’s Friday morning, and this column needs to be ready for you by Saturday morning but I’ve had a big week, so I’m under the pump. I am working on a really interesting article about the implications for you and your parents if they move to what’s called a “granny flat” arrangement. But today, I am heading back to equally rocky territory – the Australian government’s aged care reforms.
I wrote a lot last year about what the changes to the Aged Care Act would mean for our parents, which you can find on my Substack archive. Since then, there has been an almost universally negative response to the reforms from people receiving this care, from their families and from the aged care sector. If these reports are even half correct, the new act has radically reshaped the landscape for the aged care sector; and the implications for anyone applying for home care or residential aged care funding are huge.
To give you just a taste of the media coverage, the horror headlines include:
—Aged care reforms leave elderly Australians and their loved ones in the lurch
—$107.31 for a shower: Shock list of new Vic aged care service price hikes
—At the algorithm’s mercy: Jean may have to leave her SA home as ‘outrageous’ tool cuts aged care support
Many news stories contain first-hand accounts of what the changes mean for older people. In just about every instance, people are angry, confused and in despair.
There’s been some fantastic reporting by the ABC, and by Guardian Australia’s medical editor Melissa Davey* about the government’s controversial assessment tool for home care support, where an algorithm-driven system determines eligibility for aged care services and funding levels. Aged care assessors - government staff who visit elderly people in their homes to find out what support they need - are being forced to accept classifications determined by this AI tool even when the assessors know the classifications make no sense. I mean, you couldn’t make this shit up!
Beverly Baker, president of the National Older Women’s Network, is an outspoken critic of a lot of the changes. For years, she’s been fighting on behalf of older women, a group so often ignored by policy makers, and who are becoming increasingly vulnerable in great part because of the housing crisis.
In a recent interview with the hosts of podcast She Wasn’t Born Yesterday, Beverley was scathing about the reforms of what’s now called support at home – funding for people who want to remain at home rather than moving to an aged care facility. In theory, the funding covers things such as someone cleaning your home or helping with gardening, helping you shower and dress, driving you to medical appointments, and so on.
“I’m really sorry to have to say that it is a complete and utter mess,” she says, adding that a lot of what the government has told the public about the reforms is nothing more than “spin”.
First off, she says elderly people are waiting a long time for funding after they’ve been assessed and found to be eligible for that funding. In other words, they are getting a green light from the government for the services they need but are kept waiting for the money to pay for those services.
“We’re being told that you’ll be assessed. Terrific. What’s the point of assessing me if I’ve still got to wait for two or three years for a service?” says Beverley.
The decisions you and your parents face about where and how they will live are more complicated and more expensive than they were this time last year
She’s critical of the higher costs now being imposed on pensioners to receive these services – the government is funding less of the cost per person while elderly people are paying more than before the changes took effect. She’s critical too of the confusion about these changes, she’s angry that the government seems to think that all so-called baby boomers are rich, and she doesn’t buy the government’s argument that the reforms are saving taxpayers money.
“I’m old enough and ugly enough to have been around long enough to know when a government says, ‘we’re going to increase the service and it’s going to save us money’, the only way that happens is cost shifting. So, they’re talking about an expanded aged care system that is going to save something like $AUS13 billion. That means that that $13 billion is coming out of someone’s pocket.”
Another issue that fires up Beverley and other advocates is that in theory the reforms have ushered in a much needed shift of focus from what aged care service providers need to what elderly people need – a system based on human rights, empowering older people to negotiate their care and say what they need.
“To have an aged care act that is based on rights is terrific,” she says but although Australia is a signatory to the Declaration of Human Rights “we don’t have a bill of rights” and there’s no underpinning legislation.
“The changes that were made to the [aged care] act exclude any kind of civil action against providers for not delivering the service they are saying they’re providing [to older people],” she adds.
“It’s probably the worst of both worlds, because you’ve got all the right words, you’ve got the empowerment of people, and you’re talking about a generation, our generation, who aren’t going to be pushed around. We’re not going to be subservient and quiet and go along without fighting. We’ve been fighting all our lives.”
But Beverley argues that despite telling people that they will now be able to stay in their own homes for longer – which most older people want to do, and which in theory should save the government huge amounts of funding for a growing number of elderly people entering nursing homes – the government has made home care packages so expensive that some elderly people feel they have no choice but to enter aged care.
It’s not just a slow, expensive system it’s also devilishly complicated. After my experience getting support for my mother last year, I would not have thought it could have got any more labyrinthine. But in one example Beverley provides, some of the contracts elderly people have to sign are 90 pages long!
“We are sending people over to the Senior Rights Service to get them to have a look at the contract because, as you know, with every contract the devil is in the detail. If you sign up you have no idea what your escape clause might be, how much it will cost you if you don’t like that provider any more, and it is predicated on the belief that if you don’t like that provider you being able to change providers.” Try doing that in rural Australia where providers are few and far between, she says.
If you want to listen to the entire interview with Beverley, I’ve provided a link below. At this stage, I don’t intend writing a lot more about the politics around the reforms other than giving you updates about how the new aged care act works. There’s plenty of great reporting in mainstream media and from advocates about what’s happened.
My point is that the decisions you and your parents might have to make about where they live and what kind of support they can get, are more complicated and the services are definitely more expensive than they were this time last year. You need to plan ahead to cope with that.
* I work at Guardian Australia as a sub-editor
More listening and reading
Aged care reforms leave elderly Australians and their loved ones in the lurch - ABC
At the algorithm’s mercy: Jean may have to leave her SA home as ‘outrageous’ tool cuts aged care support - Guardian Australia
Advocacy groups
The Older Women’s Network New South Wales
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Wendy Frew is an Australian journalist, author and community broadcaster whose work has appeared in the Sydney Morning Herald, the Australian Financial Review and the BBC, and on 2SER and Radio Northern Beaches. She is the primary carer for her beautiful nonagenarian mother. She wishes she could fly like a Peregrine falcon.
Thank you for sharing this, Wendy. It's interesting to read about other healthcare systems and legislation. "Labyrinthine", "soundbites", and "90-page long contracts" Ugghh. All sounds very familiar.