The senior investigative Fairfax journalist Michael Bachelard started asking readers to report to him problems in aged care in April 2017 and has since been a regular writer. Last Monday he posed 15 questions the Royal Commission should ask, “but may not”. Read it here.
a) Whether the profits of up to $25,000 per bed per year, which the top-tier private aged-care companies and some of the big not-for-profits are making, on margins of 20 per cent, is coming at the expense of care;
b) Why, when the bulk of their funding comes from taxpayers, are the big, for-profit nursing home companies aggressively minimising tax?
c) Are staff numbers in nursing homes sufficient since there is no minimum legal ratio of staff to residents, no minimum training requirement and no statutory requirement to have a nurse on duty at all times? Should there be minimum requirements, since nurses now make up only 24 per cent of staff (and shrinking), and “personal care assistants” are now almost three-quarters of all staff?
d) Is staff training and pay good enough, when the bulk of the students for the Certificate III qualification in aged care are doing courses that are shorter than the minimum 33 weeks full time recommended by the vocational education regulator, the Australian Skills Quality Authority, and when they earn about $18 to $19 per hour?
e) Are we providing enough hours of care per day, when nursing home residents in Australia receive just 2.8 hours, compared to 4.1 hours recommended by the US Centre for Medicare and Medicaid Services?
f) What can be done about food, when, according to industry auditors StewartBrown, the “best” homes also spent just $6.08 per day on food for each resident
g) Why are 70,000 people subjected to “chemical restraint” – that is, drugs used to calm dementia sufferers rather than activities, distraction and human contact – when only 10,000 to 15,000 get medical benefit from it.
h) Why are nursing homes not required to publish any information about the number of direct care staff per resident, their qualifications, the home’s record of care, or its food and activities?
i) Should the government funding for nursing homes be devoted entirely towards care? As it stands, nursing homes can use public funds for any purpose – care, infrastructure, or executive salaries and dividends for shareholders.
j) Are the accreditation standards sufficiently rigorous, and rigorously enough policed?
k) Should we hold managers and boards of nursing homes personally accountable when standards are not met..?
l) Why is that complaints reports are not made public and the complaints commissioner is prevented by legislation and the Privacy Act from naming and shaming nursing homes that do the wrong thing?
m) Is the push for more market reform the way to go in future? The government’s Aged Care Roadmap suggests removing regulation from nursing homes to create “diversity and choice … competition, innovation and responsiveness” in the system;
n) Is the market approach to the home-care industry for aged-care services working?
o) Is the legislation that underpins Australia’s nursing home industry adequate?