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The labor government has been lying low on aged care but at the same time has been quietly conducting a number of inquiries into the sector and in matters relating to it. There seems to have been a subtle shift in the focus away from a preoccupation with markets and towards a focus on community and not-for-profit organisations.
A new inquiry by the productivity commission has been announced. This seems to be the culmination of a process. The commission has been asked to examine the several previous reports, identify the issues and come up with a blue print to take the aged care system forward.
It is critical that those of us who have been concerned about the direction that aged care has taken should make sure that our opinions, views and arguments are before this committee.
To see what this was all about I decided that the first step was to look through
a selection of past reports, select parts that I thought relevant and annotate
them. I have turned this into a number of web pages in the hope that they may
be helpful to others from the community wanting to make a submission. This
is my selection and these are my comments. The quotes are not all in context
and are used to make points so interpret it
with care and if you want to use it check the original.
Caring for our elderly has traditionally been something that each community and each family has done. We have nurtured and tried to make the last years of life worth while. Changing circumstances in society, less time, increasing complexity and greater cost have meant that we have delegated our responsibilities to the church, to government and to the market.
My argument is that it is still our responsibility. It is our responsibility to see that what is being done in the nursing homes on our behalf meets our requirements, and that what is being done with our taxes provides the sort of care that we want. If there is not enough money then we need solid evidence to show what is needed, what is provided and then discuss what we should do about it.
Aged care is being rationed and that is probably necessary - but we want to know about it, be sure that it is not being rationed in order to provide rich pickings for entrepreneurs and uninterested shareholders, such as superannuation and other managed funds. We need to be in a position to decide if we want government to spend more of our money to alleviate this. åÊ To do this we need information and it is clear that we are not getting it.
The answer is simple of course, the best possible physical care and the best possible quality of life, that our resources can provide, for the older members of our community, for our parents and ultimately for ourselves. We probably have a number of different perspectives on how we can ensure this, but there are a number of things that those of us in the community all probably agree on. åÊ åÊWe need
Years of frustrated experience tells us that we are not going to get any of these things while government, the market or some other closed entity, guarding its interests, collects and controls the information. åÊ åÊ Oversight and complaint resolution will not be really effective while the bodies responsible reside elsewhere and visit infrequently.
I argue that collection of information, oversight of standards, and resolution of complaints should all be addressed locally. The responsibility should be shared between local community, and a centralised supervisory organisation that would collate and analyse information reporting back to local communities and to government.
Before putting pen to submission, it is worth looking at some of the multitude of past inquiries to see what they investigated and what they advised. I cannot pretend to have read all of these but I have tried to see what some were about.
The first thing that strikes you about government (mostly senate) inquiries is how they divide around party lines producing majority and minority reports. A party is unlikely to be critical when it holds power in the house of representatives.
Useful criticisms of government proposals come from reports dominated by opposition
parties whether they be a majority or a minority in the senate. At the same time these carry the bias of their particular ideological position and the imperatives of the Australian political system.
Inquiries conducted by the productivity commission do not share this bias but
generally by their very nature have tended to focus on the economic implications
of policy, on productivity and on efficiency, relying on regulation and oversight,
rather than the structure of services, to address the possible adverse human
and
societal consequences of their proposals.
The new productivity commission is specifically directed to examine the structure of the system and its societal impacts. If the interesting 2010 report on not-for-profit organisations in Australia is a guide then we can hope for more from the productivity commission this time.
In examining Productivity Commission reports we should be aware of the guidelines set out in the Productivity Commission Act 1998. These are summarized in the 1999 report on nursing nome subsidies.
Amongst other things, these require the Commission to have regard to the need to improve the productivity and economic performance of the economy, reduce unnecessary regulation, encourage the development of efficient and internationally competitive industries, facilitate adjustment to structural change, recognise the interests of the community generally and all those likely to be affected by its proposals, and promote regional employment and development. Collectively, the guidelines require the Commission to give due regard to social, regional and environmental concerns as well as to economic performance.
Some of the reports are briefly examined on this web page. Those I have devoted more attention to are on separate pages. Only a short summary is on this web page.
1997
REPORT ON FUNDING OF AGED CARE INSTITUTIONS
Senate Community Affairs Committee JUNE 1997
Summary
The 1996/7 budget and the 1997 aged care act were referred to the Community Affairs Committee for a review by the labor dominated senate.
The review advised against the introduction of accommodation bonds but if they were introduced then it urged multiple protections. They warned that this would result in a loss of accommodation for family members and Cherry Picking of residents who came with more profitable bonds.
The review warned that the changes would result in deskilling as well as understaffing, that care would be compromised, and that the accreditation process would not be able to prevent this. Because of this they urged legally enforceable user's rights, that advocacy groups be strengthened, that an independent external complaints system be set up, and that the proposal to abolish financial accountability be abandoned.
The minority report did not address the issues raised in the majority report. Instead it aggressively attacked the labor party.
In retrospect it is clear that the majority of the issues raised were valid and much that was predicted has come to pass. The problems remain 13 years later.
CLICK HERE to go to a web page critically examining matters raised in this report.
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/1996-99/aged/report/index.htm
1998
REPORT - AGED CARE AMENDMENT BILL 1998
Senate Community Affairs Committee April 1998
There was a public outcry about the accommodation bonds and the government backed down by replacing the accommodation bonds for high care with a capped payment for accommodation. The bill was referred to the Community Affairs Committee. Twenty six submissions were made and a public hearing held. The senate was by now controlled by a coalition party majority and the majority report reflects this change.
The majority report noted the concerns expressed by some of the submissions and at the public hearing. It made only one recommendation.
The Committee reports to the Senate that it has considered the Aged Care Amendment Bill 1998 and recommends that the Bill proceed. (Section 4. 1)
The labour minority report was an opportunity to criticise the original reforms and the "ad hoc and rushed" way it was done claiming that "the removal of millions of dollars from the system and the inability of the user pays system to replace those dollars in either the short or long term will mean a drop in the levels of care to which aging Australians are entitled". The criticisms followed the same pattern and drew attention to many of the same or similar issues addressed in the 1997 majority report.
The Democrats minority report reinforced these criticisms and doubted that the changes would address the problems in the new system. They blamed the failure of the reforms to gain community support on the labour opposition which they believed had conducted a scare campaign.
Several witnesses told the Committee that the Government's ad hoc approach to residential aged care policy over the past six months has resulted in a policy package which is inconsistent, uncoordinated and lacking in long term vision.
--------------------------
We suspect that the Prime Minister's back flip on accommodation bonds for nursing
homes last November was driven, not by a desire to produce a `better' policy
package, but by a desperate need to minimise the political and electoral backlash
associated with its failure to successfully sell its original aged care reform
package.
------------------------
- - - a desperate need to counteract a series of negative opinion polls on the Government's original aged care package.
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/1996-99/agedcare/report/index.htm
1999
Nursing Home Subsidies
The Productivity Commission 31 March 1999
The subsidies for high care residents differed between jurisdictions and the government planned to move these to nationally uniform rates. The inquiry was asked to advise as to whether this coalescence of rates should proceed and if not then suggest a funding method. It received 120 submissions and conducted hearings in capital cities.
The report emphasises equity of access as the main criterion but also the need to promote efficiency and transparency. To do this they wanted the funding linked to the standard of care, but how this was to be done was not addressed.
It found that costs between jurisdictions did not vary greatly but, because they might do so in the future, they should be monitored. Nationally uniform subsidies were supported subject to some conditions. It did not support the planned method of doing so. Instead they advised a subsidy regime linked to standard of care, and to movements in the industry's costs.
They advised that providers should not be required to account for the way they spent the subsidies, which should be paid to providers and not residents. They advised that there be greater opportunity for residents to purchase "extra services" and some regulations relating to this be abolished.
My Comment:-
This is a long document reviewing funding of aged care in Australia. I have not studied it in any depth but it seems to take a strong non-regulatory economic rationalist position. It seems to be out of touch with the realities of the aged care sector and I fail to see how some of its suggestions could be successfully applied. How for instance could funding be linked to standards of care in a system where the available information did not actually monitor the outcomes on which standards of care could be assessed. I do not know to what extent these recommendations were accepted by government.
The government implemented some of the recommendations and made $148 million available to states that needed supplementary funding for this.
The full report can be found at
http://www.pc.gov.au/projects/inquiry/nursehom/docs/finalreport
2000
AGED CARE AMENDMENT BILL 2000
Senate Community Affairs Legislation Committee November 2000
Background
That the new system was not working and that there were many problems and many problem nursing homes seems to have been apparent to those familiar with the system but the authorities were in denial. The problems erupted with the exposure of disturbing practices when a massive scandal surrounding the Riverside nursing home broke. This was a home that had been a constant problem for 12 years without any effective action being taken. This was the first of many dramatic exposures. The ignorance and ineptitude of the minister, the lack of utility of the regulations, as well as the incompetence and lack of morale in the accreditation process was exposed for all to see. A succession of blunders compounded the problems.
A relative of one of the residents put it well claiming "Riverside has definitely been the scapegoat. Before this, no one ever paid any attention to the plight of elderly people. "
The government refused to accept this as a red flag, minimising the failures and claiming this as an exception. They introduced a bill to give the agency greater powers over recalcitrant owners and managers, and to make it easier to impose sanctions and close down nursing homes. They targeted the suitability of "key personnel" as revealed by criminal convictions, insanity and bankruptcy. The onus was placed on corporations and not the department to monitor this and act.
The "Selection of Bills Committee" referred this to the Senate Community Affairs Legislation Committee to examine the provisions of the bill and its possible consequences for residents and providers. Six submissions were made. These generally supported increased powers but made many criticisms. No hearings were held. Instead the department's opinion on the issues was sought.
The majority report
The three liberal members acknowledged the concerns in the submissions including the one which suggested that the lack of transparency in the approval process for allocation of aged care places would negate its effectiveness by allowing criminals in. The majority accepted the departments explanations. They recommended the bill be passed.
The minority report
The two labour members seized the opportunity to highlight that the bill was a response to the Riverside debacle and the extent to which the current regulations had failed to protect residents and had aggravated the situation. åÊ åÊ It drew attention to the many problems in the new system, the systemic nature of the problems and the far too limited nature of the bill in response to these. The pattern seen in Riverside had been repeated in other homes showing that the monitoring system was incapable of ensuring proper care standards. They recommended that the failed standards monitoring system be urgently reviewed. They claimed that the departments response had not adequately dealt with the issues raised by the submissions.
The government should urgently examine the efficiency of its system to ensure that residents are not left at risk for such lengthy periods when problems are identified.
They saw serious problems for residents when homes were forced to close and were no longer financially viable,They supported the criticisms that the law was bedeviled with a lack of definition of key concepts and that this led to subjectivity in decision making. Putting the onus on providers to take action would not work when the department had itself failed badly when this was their responsibility.
In smaller organisations the owner was not going to properly assess their own suitability. The processes set in place for the appointment of an administrator would take far too long leaving residents at risk.
The lone democrat in her dissenting submission also argued that the bill did not go "sufficiently far to tighten up the compliance provisions".
The full report can be found at
http://www.aph.gov.au/senate/committee/clacctte/completedinquiries/1999-02/agedcare2000/index.htm
2001
Nursing labour force 2001
National health labour force series no. åÊ26
Australian Institute of Health and Welfare
The section on aged care gives the figures for the number and skills of trained nurses in aged care across Australia between 1994 and 1999. Overall there was a 20% drop in the number of nurses working in aged care. In nursing homes this was 17%. The fall off was greatest in enrolled nurses. There was also progressive ageing of the nurses with a drop in younger staff entering the profession.
The full report can be found at
http://www.aihw.gov.au/publications/hwl/nurslf01/
2002
Senate Inquiry Into Nursing
Senate Community Affairs References Committee June 2002
Summary
This very long report received a record 988 submissions. It reviewed every aspect of nursing across the country. Aged care was only part of a massive problem identified.
The report paid particular attention to the more extensive nature of the problems in aged care as well as the particular problems and deteriorating situation there. It made many recommendations.
CLICK HERE to go to a web page examining matters raised about aged care in this report.
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2002-04/nursing/index.htm
2003
Aged Care Enrolled Nurse Working Party
A Report to the Minister for Ageing March 2003
This was a report from a working party set up by the minister following another report "Review of Nursing Education, 2002:Our Duty of Care" . It was directed to examine previous reports relating to inconsistencies in training, in legislation and in the duties of enrolled nurses in Australia. A particular focus was on their role in administering medication and the supervision required. The 12 members were drawn from a number of interested groups.
They reviewed 8 inquiries and reports dealing with these issues from across Australia, all of which identified similar situations. They made recommendations and directed which authorities should address the issues. They were unable to recommend on medication although this was desirable. They advised further reviews.
The review reveals much about the cumbersome bureaucratic process and the difficulty in getting things done - particularly when responsibilities are spread across multiple states.
The full report can be downloaded as a pdf file
http://www.latrobe.edu.au/acebac/assets/documents/ACENWPFinalReport.pdf
Managing Residential Aged Care Accreditation
The Aged Care Standards and Accreditation Agency Ltd
The Auditor-General Audit Report No. 42 2002-03 Performance Audit
Australian National Audit Office May 2003
Summary
This was the first and as far as I am aware the only audit ever conducted of the performance of the agency itself. It had only been in operation for a short period of time. The main thrust of the criticisms was the failure to collect useful data to assess whether accreditation had any impact on care, monitor its own performance, measure quality of life. Concern was expressed about the conflicting roles of educator and supporter on the one hand and regulator on the other.
These criticisms are much the same as those being made 7 years later. The agency agreed to implement the recommendations made but it is clear that at least some of the advice has not been embraced.
Click Here for comment and to examine some of the main findings
To download the audit report go to
http://www.anao.gov.au/uploads/documents/2002-03_Audit_Report_42.pdf
REVIEW OF PRICING ARRANGEMENTS IN RESIDENTIAL AGED CARE
The Productivity Commission
WP Hogan 2004
Summary
Hogan was commissioned to examine efficiency and productivity in the aged care system and his process was exhaustive. There are however multiple concerns about the way he did this and his market based approach to aged care. His recommendations must be seen in this light.
Because there was insufficient information about financial input and output Hogan did his own investigation. There must be concern that the economic data he collected was not representative and that his analysis did not control for the many variables. He looked at inputs and outputs using this data in order to calculate efficiency and productivity concluding that the system was still 17% inefficient.
He did not comment on the fact that there was no reliable information about the outcomes for the residents. It would not have been too costly to employ staff from the agency to enter a random selection of homes to record the incidence of readily measured markers of care. He made no attempt to assess the quality of their lives. Instead he accepted the accreditation findings.
Hogan ignored the humanitarian inputs which play a critical role in care. He considered aged care as if it were a commercial service rather than a community mission. In examining outputs he looked at profits and the number of beds to see how many more beds could be provided if there was a 17% increase in efficiency. He did not examine the care provided, justifying this on the basis that the flawed accreditation and complaints systems were effective and because almost all homes got full marks.
Hogan carefully avoided supplying information and considering issues which might reveal deficiencies, support criticisms of the market, or indicate that excessive pressure to be more efficient and productive would affect care adversely.
Issues that emerge are the need for much better collection of data and of regular analysis of this data. He made some recommendations to the department but these fell a long way short of requiring that providers disclose the information needed. He advised far greater public transparency. Although Hogan did not refer to the deficiencies in the accreditation system he was aware of the inadequacies of their reporting and urged a more meaningful star system.
CLICK HERE to go to a web page critically examining matters raised in this report.
The full report can be found at
2005
Economic Implications of an Ageing Australia
Productivity Commission Research Report 24 March 2005
This is a wide ranging, 469 page review of the consequences of ageing for Australia. There were 74 submissions. It was carried out at the request of the Council of Australian Governments
I have only examined the Overview of this 469 page report. It examines the aging of Australia's population and the impact of this on the labour force, on the economy and on the future funding of health and aged care. The figures showing the long term picture is enough to scare any government. The projections of a steadily growing number of aged, and a falling number of carers to care for them will disturb those now entering the cohort of aged citizens who must wonder what will happen to them.
The report softens this scary picture by indicating that the changes will be gradual and provided they are addressed they can be managed. Only if they are ignored will it become a catastrophe.
Government expenditure on aged care is projected to increase from around 0. 86 per cent of GDP to around 2. 24 per cent in 2044-45. Residential care remains the largest area of expenditure. (Page 175)
The full report can be found at
http://www.pc.gov.au/projects/study/ageing/docs/finalreport/
FUTURE AGEING : Report on a draft report of the 40th Parliament
Inquiry into long-term strategies to address the ageing of the Australian population
over the next 40 years
House of Representatives Standing Committee on Health and Ageing
41st Parliament
March 2005 Canberra
This report from a government controlled house of representative committee examines the broad area of aged care with particular emphasis on the community and on what I have called its nurturing role. It explores this thoroughly and takes a generally positive approach to what some are already doing, but recognises that there are problem areas and much more needs to be done.
The problems with nursing staff in nursing homes were recognised and some attention given to what needed to be done. Many statements were relevant.
CLICK HERE to go to a web page examining matters raised in this report.
The full report can be found at
http://www.aph.gov.au/house/committee/haa/strategies/report.htm#fullreport/
Quality and equity in aged care
The senate Community Affairs References Committee
June 2005
Summary
This review was undoubtedly a response by the labour controlled senate to the rather bland self-congratulatory report "Future Ageing" from the government controlled House of Representatives' Standing Committee on Health and Ageing. The senate review gave a voice to those who were unhappy with the aged care system.
It drew attention to the parlous state of nursing in aged care, and the adverse effect this was having on care. This was in spite of 34 reviews addressing the issue over the previous 7 years. Some providers were finding excuses to discriminate against nurses. In addition it emphasises the shortage of doctors and other health care workers in the sector. Geriatricians felt marginalized and discouraged.
The report was very critical about the accreditation process and the agency, quoting a nursing association claim that the process was a farce. The committee questioned the effectiveness of accreditation and made many criticisms of the process, concluding that it was not effective.
The review was also very critical of the complaints mechanism finding multiple deficiencies. It documented the fear of intimidation felt by those who complained. It recommended whistleblower legislation to protect them. This has not happened.
CLICK HERE to go to a web page examining matters raised in this report.
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2004-07/aged_care04/report/index.htm
Productivity Commission Research Report
January 2003
22 December 2005
This is another 435 page exhaustive review. åÊIt was commissioned by the Council of Australian Governments (COAG) in June 2004 and released in January 2006. It examined Australia's workforce needs for health care then and into the future.
The Commission considers the study can best add value by focusing on the fourth approach - addressing systemic impediments in workplace arrangements that reduce efficiency, effectiveness and responsiveness. Notably, this has also been the focus of reform programs in many other sectors.
The review proposes multiple changes to the way all sectors of the health workforce are structured, organized, trained, accredited and registered. It makes multiple recommendations for major changes.
While this report did not deal specifically with aged care, aged care is a part of it and aged care planners will have to plan within the context of the proposals that have implemented. Many of these were based on the prevailing competitive market paradigm. Some would have been poorly suited to the health and aged care sectors and so need attention.
The full report can be found at
http://www.pc.gov.au/projects/study/healthworkforce/docs/finalreport/
The welfare of the aged and the prevalence of elder abuse has been recognized globally and is reflected in United Nations policy and in global declarations. Australia has been part of this. Some states, particularly Victoria have been active in pursuing Elder Abuse programs. Elder abuse occurs both in the community and in residential care facilities.
Our particular concern to me here is abuse that occurs in nursing homes, principally by carers and managers; including sexual abuse. Several reports in the press are likely to be pointers to a significant problem and if the press is a true reflection then Victorian homes seem more susceptible.
There are a number of factors which are likely to contribute to this lack of caring. Work stresses, the quality of staff, the nature of management, deskilling and cultural differences. I argue that the cultural effects of strong market competition, exerted through management places large additional stresses on workers. As a consequence their frustrations are likely to spill over into a lack of tolerance. They employ such strategies as compartmentalization and rationalization to separate themselves from their human charges. Anger, roughness, physical and emotional violence, vindictiveness or impersonal attention to duties can all harm residents - the latter by denying them the nurturing they need.
Relief from stress will sometimes be obtained by demeaning pranks, teasing or other inappropriate activity at the expense of residents. Group behaviour of this type has occurred in Australia. These problems are compounded by the labour shortage, the recruitment and limited training of people "off the street", (some of whom will have antisocial personalities), and staff from other countries so that there can be a lack of cultural cohesion and cultural restraint.
The current shortage and deskilling in our nursing homes must pose a considerable risk of events such as these occurring. Frustration and disillusionment is widespread and residents will inevitably trigger some of that resentment. The Victorian government has published the following papers which explore elder abuse in the community in detail. I could not find any reference in these papers to abuse by staff in nursing homes.
Elder Abuse Prevention Project Office of Senior Victorians
The Mismanagement & Misappropriation of Older People's Assets: How can the Financial Service Sector help?
A 'Roundtable Discussion', 3 November 2005
Preventing elder abuse through the health sector
A background paper by the Victorian Community Council Against Violence
November 2005
Office of Senior Victorians
Victorian Government Elder Abuse Prevention Strategic Implementation Plan 2006-09
August 2007
Rights, Respect, Trust, Victorian Government Elder Abuse Prevention Strategy April 2009
These and other reports and articles dealing with Elder Abuse in Victoria can
be found at
http://www.seniors.vic.gov.au/web19/osv/dvcosv.nsf/headingpagesdisplay/elder+abuse+prevention
A submission from the Aged Care Crisis Centre can be downloaded below
http://www. dvc. vic. gov. au/Web19/osv/rwpgslib. nsf/GraphicFiles/ACCT/$file/ACCT. pdf
2006
Aged Care (Bond Security) Bill 2005
Aged Care (Bond Security) Levy Bill 2005
Aged Care Amendment (2005 Measures No. 1) Bill 2005
The Senate Community Affairs Legislation Committee
March 2006
These three bills were introduced into parliament in December 2005 in order to "strengthen the existing protection surrounding aged care residents' accommodation bonds by establishing a scheme to guarantee the repayment of bond balances if a provider defaults and by introducing new prudential regulatory arrangements" It was referred to the committee by the senate in February 2006 because "the residential aged care provider sector is unsure of the potential liability arising as a result of these Bills".
Hogan had recommended greater protection of bonds in 2004. As he predicted the government was embarrassed when providers were unable to repay bonds and the government had to do so. I recall that the prime minister was forced to step in and guarantee the repayment of the bonds using taxpayers funds. The bill planned to ultimately pass these costs on to the industry but I am not sure that that ever actually happened.
The committee accepted the assurances given by the department and approved the bill without amendment.
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2004-07/aged_care06/index.htm
Aged Care Amendment (Residential Care) Bill 2006
Standing Committee on Community Affairs
October 2006
The committee approved the bill.
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2004-07/aged_care_resident_care/index.htm
2007
Funding and operation of the Commonwealth State/Territory Disability Agreement
The Senate Standing Committee on Community Affairs
February 2007
This 171 page review of disability services in Australia covered a large sector and made multiple recommendations. It was initiated at the request of labor Senator Mc Lucas because of wide spread criticism in the community. It received many submissions and held 7 days of public hearings. One of its briefs concerned the ageing of those with disability and their access to aged care services.
an examination of the ageing/disability interface with respect to health, aged care and other services, including the problems of jurisdictional overlap and inefficiency;
This is another sector in which services are provided largely by the states but jointly funded by state and commonwealth. While the needs and services for this sector are different it overlaps with other services in the community, in hospitals and in institutions.
In addition to this those with disability grow older earlier and develop age related disabilities and diseases. They require care from both disability and aged care services but, as they could not be funded from both under the current legislation, they fell between the cracks.
The committee dealt with these issues and made recommendations. They favoured an ageing in place strategy whereby aged care services were provided at the same time as disability services. Only when necessary should they be transferred to nursing homes.
The AIHW report Disability and Ageing identified a number of groups at risk of falling within the 'grey areas' of the disability and aged care services interface and potentially not being able to access appropriate services. (Page 105)
The AIHW noted that because of their changing needs, or changes in their eligibility for certain services, it may be appropriate or necessary for people ageing with a disability to transfer between service types - for instance from specialist disability to generic aged care services. This transition is most likely to affect people with an early onset disability in their later years. (Page 105)
Recommendation 22
That funding arrangements and eligibility requirements should be made to allow supplemental aged care services to be made available to people with disabilities who are ageing, allowing them to age in place. Administrative funding arrangements should not impede access to aged care services for people with a disability who are ageing. (Page 117)
The second issue raised in this review was the plight of the aging person caring for someone with a disability - someone seeking to make arrangements for the care of a family member when they themselves became too frail or were no longer there. The need for a gradual and progressive transition was emphasized.
An ageing population means that an increasing number of unpaid carers will require aged care services themselves and will no longer be able to act as carers. The people with disability for whom they care will need to be transitioned to alternative paid care. The uncertainty surrounding the issue of future care was a critical issue for informal carers and people with disabilities. (Page 121)
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2004-07/cstda/index.htm
Aged Care Amendment (Security and Protection) Bill 2007 [Provisions]
The Senate Standing Committee on Community Affairs
March 2007
Summary
This bill was the response of the coalition government to the nursing home rape scandal in 2006. This response was a host of draconian police checks and mandatory reporting requirements. With the coalition in power in both houses the outcome was predictable. No attempt was made to examine the underlying problems in the system although the democrats tried.
There were however a number of issues discussed. There were concerns that the wishes of the victim would be ignored under the mandatory reporting requirements. A particularly contentious issue was the limited nature of the whistleblower protection provided. Even the majority wanted it to be wider. Both Labor and the Democrats wanted it to be much wider. There was some concern about the independence of the aged care commissioner. There was some concern about the limited nature of the bill as only limited forms of elder abuse and no forms of elder neglect were included.
CLICK HERE for more about this
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2004-07/aged_care_security_protect/index.htm
Aged Care Amendment (Residential Care) Bill 2007 [Provisions]
The Senate Standing Committee on Community Affairs
May 2007
The intention of the review was to replace the Resident Classification System (RCS) as the instrument for determining funding with a new Aged Care Funding Instrument (ACFI). This was a system where the resident was classified according to the care needed by the resident. It had been under trial since 2005. This was in keeping with recommendations from an RCS review in 2002/3 and the Hogan review released in 2004.
Both this one and the related previous bill were largely dependent on a third bill, the proposed Classification Amendment Principles 2007. Full details for this were not available and some felt that they could not properly assess these bills. Six submissions were made and there was a public hearing.
The submissions were generally in favour of the changes but there were a number of issues raised about its implementation and the impact it would have on some providers. The committee made some recommendations
The full report can be found at
Private equity investment in Australia
The Senate Standing Committee on Economics
August 2007
Summary
The rapid growth of private equity investment was causing some anxiety. The issue was referred to the senate standing committee on economics. Two submissions were made describing the extent to which profit focused private equity groups had entered the health and aged care sectors. The potential risks to this sector were stressed.
The committee did not see private equity as a threat to Australia or to these sectors. Some weeks later the New York Times published an expose of private equity practices in aged care in the USA.
CLICK HERE for more about this
The full report can be found at
http://www.aph.gov.au/senate/committee/economics_ctte/completed_inquiries/2004-07/private_equity/index.htm
House of Representatives Standing Committee on Legal and Constitutional Affairs
September 2007
This was a wide ranging 292 page investigation. It received 200 submissions and 170 exhibits. It held public hearings in 8 cities and made 48 recommendations
Its brief was
To investigate and report on the adequacy of current legislative regimes in addressing the legal needs of older Australians in the following specific areas:
䮣 Fraud;
䮣 Financial abuse;
䮣 General and enduring 'power of attorney' provisions;
䮣 Family agreements;
䮣 Barriers to older Australians accessing legal services; and
䮣 Discrimination.
This was a very broad ranging inquiry looking at the vulnerability of older Australians to several types of fraud and financial abuse. It examined various forms of power of attorney and related matters such as health care directives and family agreements. It looked at the problems the aged had in accessing legal services, at discrimination against them and at the difficulties they experienced. These difficulties were experienced with their contracts and in conflicts with management in the facilities There were a number of matters about which it received submissions but which were excluded as they were not part of the brief.
Three themes ran through the report. The first was the legal problems created across all of these issues by the differing laws in each state. Many recommendations related to ways of overcoming this.
The second theme if there was one was the underutilization of the various legal documents like power of attorney, health care directives, family agreements as well as the underutilization of legal services for example in drawing up retirement village contracts. Recommendations mostly related to informing and educating both the public and the legal profession.
The third theme was a lack of hard data in several of these areas and recommendations suggested further data collection or detailed exploration.
The full report can be found at
http://www.aph.gov.au/house/committee/laca/olderpeople/index.htm
Evaluation of the impact of accreditation on
the delivery of quality of care and quality of life
to residents in Australian Government subsidised residential aged care homes
Final Report
Campbell Research & Consulting (CR&C), DLA Phillips Fox Lawyers & Monash University. October
October 2007
Summary
Accreditation had been heavily criticised by the June 2005 senate review of aged care and by those at the coal face. While this 2007 review did not claim to be addressing these criticisms and did not do so, this long, jargon laden and dense report would be seen as such by many. It attempted to assess whether accreditation as a process improved the quality of care provided. As no hard data recording failures or successes in care had ever been recorded by the agency they were unable to assess its success objectively. Instead they resorted to interviews and questionnaires with those participating in the accreditation process. The conclusion that it is beneficial in improving care is not unexpected, nor do I want to contest it.
The issues are whether accreditation is effective in doing the many other things asked of it and whether it is effective in containing aberrant operators. Is it of any value as a regulatory tool? At the outset the review tells us that the accreditation process does not have the sensitivity or the scale and so does not do much of what it should do and is claimed to do. We do not get any answer to other issues. This report must be seen in the context of the audit of the agency carried out in 2003 when the department agreed to collect data to evaluate the impact of accreditation on quality of care and on quality of life. This review was careful not to mention that earlier audit and that the department had agreed to collect this sort of data. Perhaps no one told them.
Particularly worrying is the report's support of the agency's refusal to collect hard data documenting standards of care (ie performance) rather than processes. By "indicators" the quote below is referring to failures in care like pressure sores, weight loss, contractures etc.
The purpose of the indicators should be confirmed to the sector - the basis for the indicator development was the clear understanding that they were being developed not to measure performance, but as tools to assist aged care homes to monitor and improve the quality of their care and services;
(Page 99)
Other things that did emerge from this report were that almost all of those interviewed considered that time spent communicating with residents was critically important, not only for quality of life but for quality of care. Staff consistently found the accreditation process extremely burdensome.
CLICK HERE for more about this
To see the full report go to the following web page
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-iar-final-report.htm
2008
A decent quality of life: Inquiry into the cost of living pressures on older Australians
The Senate Standing Committee on Community Affairs
March 2008
This was a review into the wealth of older Australians. It examined their resources and the context of their lives to see how well they were able to cope and contribute. I have only looked at sections.
The committee received 260 submissions and held 3 public hearings.
The committee found that although the wealth of aged care Australians had increased
this was unbalanced. Many had not benefited from our prosperity.
"For a significant minority, cost of living pressures are placing them in increasing financial stress. These older Australians do not enjoy a decent quality of life. "(Page xi)
These poorer seniors were disproportionately affected by cost increases. This was compounded by a decline in the value of concessions and the trend towards user pays. Pensions did not permit an adequate standard of living. Those most at risk were single pensioners, particularly women.
Older people with severe disabilities or chronic illnesses and those in residential aged care are also particularly sensitive to cost of living pressures. (Page xi)
Older Australians play an ever larger role in society by involvement in charitable activities and as carers.
More and more, older Australians are taking on caring responsibilities - caring for their partners, grandchildren and sometimes their own parents. At the same time, the level of participation of older Australians in voluntary work is comparatively high. These activities are insufficiently recognised and supported in government policies and yet they unquestionably benefit the broader Australian community. (Page xii)
The committee looked at superannuation , at pensions, at the cost of living for
older Australians and at the contributions they made. It made a number of recommendations.
These are matters which have relevance because they have a major impact on the number of people able to assist others; and so on the number able to age in the community. It has relevance for the resources and contributions which those entering nursing homes will be in a position to contribute. Health is closely related to economic well being. Those who do not enjoy a decent quality of life are more likely to need nursing home care. When they do need a nursing home they will be discriminated against by those who cherry pick the most profitable.
To see the full report go to the following web page
http://www.aph.gov.au/senate/committee/clac_ctte/older_austs_living_costs/index.htm
Aged Care Amendment (2008 Measures No. 2) Bill 2008 [Provisions]
The Senate Standing Committee on Community Affairs
November 2008
Summary
In 1997 probity provisions for aged care providers had been replaced with a corporate friendly approved provider process which took no account of ownership and allowed unsuitable purchasers to become approved providers simply by buying a nursing home. I had been writing about this and challenging it since 1999. The information supplied by the minister suggested that the bill would go some way towards addressing this. My reading of the information was that the bill would not go nearly far enough. I made a submission in which I welcomed the bill as the first small step but made the point that it was much too limited and gave examples.
I suggested that it be structured to accommodate future changes and made some suggestion as to what they might be including changes to the complaints system and accreditation process by moving them locally and by making the processes transparent to the local community.
The bill was passed. I later lodged a test case complaint to see how far the legislation had changed. The department did not have the power to deal with it.
CLICK HERE for more about this
To see the full report go to the following web page
http://www.aph.gov.au/senate/committee/clac_ctte/aged_care_amend_2008_measures_no2/index.htm
2009
Residential and Community Aged Care in Australia
The Senate Standing Committee on Finance and Public Administration
April 2009
Summary
This report examining the costs of aged care degenerated into an argument by providers, on the one hand, that they did not have enough money and that the system was in crisis, and the department, on the other, arguing that there was enough money in the system and that efficient operators were doing well. The department apparently were not cooperative in responding and were heavily criticised by the committee.
What the report revealed was that the information on which to base opinions and decisions was simply not there. Each protagonist snatched snippets from various reviews done by commercial agencies and used them to support its position.
The providers called for reform of the aged care system. As a community we should see that as both a threat and an opportunity for us to make sure that we get the sort of changes we want. If providers want more money then we want accountability as regards staff numbers and expenditure on staffing etc.
Issues addressed included the need for reform, the lack of information, funding levels, building new facilities, problems with accreditation, reduced services, and the indexation formula. Very concerning for the community are the revelations that cherry picking is occurring.
The next step in this competitive marketing process is for providers to start paying incentives (kickbacks) to assessors and then link these to the size of accommodation bonds. This is not illegal in Australia (except for doctors). Financial advisers have for example given those referring customers payment linked to the investment package customers accept. It is only a small step from there to hiring bounty hunters to go out into the community to find wealthy seniors who can be persuaded that they would be better off in a nursing home than in their own homes. That would be illegal in Australia. Sections of the market can see such business practices as legitimate. They have been used to target vulnerable groups in health care.
The committee recommended the formation of an ongoing national aged care forum drawn from all interested parties. That forum it was suggested should be responsible for collecting information and planning reforms to the system. It was recommended that most of the unresolved issues be referred to that forum. I believe that as a community we should set up the sort of not for profit community structure that can represent the community at any such forum.
CLICK HERE for more about this
To see the full report go to the following web page
http://www.aph.gov.au/senate/committee/fapa_ctte/aged_care/
A Healthier Future for all Australians
National Health and Hospitals Reform Commission
Final report June 2009
This 292 page report is a comprehensive overhaul of our health care system.
While it only touches on our aged care system, it deals with an ageing
population and the health problems they have. There are recommendations
that are
applicable
to aged care and the aged care system will have to be integrated with it. I have
only looked at the Executive Summary to see what the general thrust was.
The report reinforced the need to integrate the aged care system into the broader health care system. It talks of redesigning "to connect and integrate health and aged care services for people over the course of their lives". They find that the needs of people with "chronic diseases, people with multiple complex health and social problems, and older, increasingly frail people are less well met". They stress the need to access "the right care in the right setting".
They seek to accomplish this by strengthening "primary health care services in the community" as " the 'first contact' for providing care for most health needs of Australian people", and by providing greater access to multidisciplinary and specialist services in the community. They want specialists to share in the community management of people with "complex and chronic health needs" many of whom will be elderly.
They recognise the importance of the local community and of those working locally and seek to replace an excess of regulation with a devolution of responsibility to the local community. They sought a shift to local governance. Those on the ground know what is happening because they are in the loop.
Their recommendations on aged care focus on connecting and integrating health and aged care services by promoting informed decisions when making choices, protecting older people in need, and creating a robust and sustainable aged care sector.
Of particular relevance are the recommendations on eHealth. While it is not explicitly stated these clearly should apply equally to nursing home care and community aged care. With records no longer tied to an office they can be readily linked. Aged care services should be seen as an integral component of the critical recommendation that "the patient (should be) the locus around which health information flows" and that broadband networks be available for all Australians. Clearly this must include nursing homes.
Digital records are vital to measuring and monitoring the health of our population . As all of the reviews illustrate the recording of good information about all aspects of aged care is essential. Reviews since 2004 have been complaining about the lack of this and so have the community. The recommendations made for proper health performance reporting is as applicable for aged care. The emphasis on research activities "across hospitals, aged care and primary health care settings" is welcomed so that it is "valued and enabled as a normal part of providing health services". There is a lot to be welcomed.
To see the full report go to the following web page
http://www.health.gov.au/internet/main/publishing. nsf/Content/nhhrc-report
Productivity Commission Research Report
December 2009
The aged care system must integrate with both public and private hospitals so this 425 page report is peripherally relevant. It starts off by admitting that it does not have the information needed to compare the two systems. There are differences in the way data is collected and its accuracy. The two sectors don't provide the same services, and the sort of patients and the complexity of their illnesses differ. The distribution in terms of size and remoteness between the groups is considerable. The type of hospital and the services provided are affected.
The basic message from the overview which is all I read was that they were not comparable and that their findings were therefore very tentative. Once again the recommendation was for more data and standardisation of methods for collecting. There is one other message which it was good to see coming from the productivity commission. That is a big admission for the productivity commission. It is even more applicable to aged care.
This report also discusses measures to improve data accessibility, which could ultimately facilitate improvements in health care, especially as competitive markets only have a limited role in the health sector.
This report differs from the 2004 Hogan report in that it recognises this and
works within this constraint rather than seeking to force as much as it can
into market mode. That is a major step forward!
What is not in the commission's brief and is much more comparable is the difference between for-profit and not-for-profit private hospitals. They operate in the same places and compete to provide the same services. This is the question those who go to private hospitals want to know. It also has important policy implications which might be embarrassing. That is why this question is never put to any body, and no body has tried to be independent.
I did a search on "not-for-profit" to see what comment was made. The principal comments relate to not-for-profit tax benefits (which were compensated for) and to the Fringe benefits of up to $17000 which public and not-for-profit hospitals could offer to staff. This made them both more attractive for staff than for-profit hospitals. They were likely to be more able to recruit and train staff. The implication was that they could offer better staffing. For-profit and not-for-profit spent about the same amount of money (about 50% of total recurrent expenditure) on staff so it is likely that not-for-profits staffed better. Potential patients might be influenced by this.
Private for-profit hospitals treated the least morbid patients with an average Charlson score of 0. 42 compared with 0. 55 for public hospitals and 0. 72 for not-for-profit hospitals.
Many not-for-profit hospitals have a mission of services so were skewed to a wider range of less profitable treatments such as more palliative care than might be the case than if the hospital was purely focused on profit maximisation. Others are located in geographic regions which might not necessarily be attractive to for-profit operators .
In examining other studies of technical efficiency international studies suggested that not-for-profits were more efficient, whereas Australian studies suggested for-profits were.
After making many qualifications as to possible inaccuracy the report said
Across all hospital size groupings, public hospitals have a mean efficiency score of 0. 797 and private hospitals 0. 750 suggesting slightly superior performance by public hospitals (table 8.5 - there was virtually no difference between the scores for for-profit and not-for-profit private hospitals). (Page 399)
As regards relevance to aged care, the geographic difference, and service to less wealthy and remote communities by not-for-profit nursing homes has been demonstrated. One can only speculate as to whether a study of aged care would reveal greater comorbidities in not-for-profit nursing homes and perhaps some other comparable findings. åÊ åÊ
If, and I assume it is likely, not-for-profit nursing home providers are able to offer fringe benefits tax benefits to staff then this would make them more successful at recruiting and retaining staff. Because staffing is so critically important in caring for the aged this would be very good reason for preferring a not-for-profit nursing home - quite apart of course that most (but not all) have a mission of care rather than a mission for profit and growth.
To see the full report go to the following web page
http://www.pc.gov.au/projects/study/hospitals/report
Review of the Aged Care Complaints Investigation Scheme
Assoc. Prof. Merrilyn Walton
October 2009
Summary
This was a very thorough review. It found that, in spite of good intentions, the complaints system (CIS) run by the department of health and ageing did not operate effectively. Professor Walton went to the heart of the matter and made many criticisms. Essentially the department was trapped in regulations and obsessed with natural justice rather that resolution for the distressed resident and family.
Walton recommended that a separate independent complaints unit be set up. That will be very welcome if the government agrees and I think it is essential. In my submission I had urged her to advise that the complaints system be sited in the local community who should oversee the process. She stopped short of advising this.
In the linked page I look at Walton's report and argue for a more community based system.
Click Here to go to this web page
To see the full report go to the following web page
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-review-cis.htm
2010
Review of the residential aged care accreditation process
for residential aged care homes
Department of Health and Ageing (DOHA)
Submissions closed July 2009
Report due end June 2010
Summary
In May 2009 the Minister for Ageing asked the department of health and ageing to carry out a review of the accreditation process (not the agency's performance). This is due by the end of June 2010 and hopefully it will be expeditiously released in time for those making submissions to the productivity commission by the end of July to utilise it.
I made a submission in which I highlighted the disenfranchisement and disempowerment of the community, conflicting roles for the agency, a failure to collect useful information, and an almost total lack of transparency.
I urged the splitting of the accreditation agency, re-enfranchising and re-empowering the local community, and collecting the sort of information that is useful to the community. This should indicate when problems are developing, and should form the basis for accreditation, ongoing debate and research.
When I heard that 5 of the 12 members of the agency's board were also providers I made a supplementary submission showing how this conflict of interest compromised the accreditation process and the imposition of sanctions.
Click Here to look at some of the points made in submissions and download them
For information about the progress of the accreditation review go to
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-quality-accreditation-review-submissions.htm
Contribution of the Not-for-Profit Sector
Productivity Commission Research Report
January 2010
Summary
This review is another small step away from hard line economic rationalism. It reviews the width and breadth of the not-for-profit sector in Australia. It acknowledges its large economic footprint and at the same time recognises the enormous contribution which the sector makes to the community. The major contribution to social capital is acknowledged. It recognises that the vast majority are focused on service and community activities and not on profits. This means that they focus on the the use of their economic resources for the benefit of members or of the community.
In many instances their financial behaviour is not relevant to the wider community. Where a not-for-profit group is in receipt of government or community funds or volunteer assistance, then their financial conduct and effective operation is relevant. They are expected to be accountable. They must show that they are using the funds prudently and for the purpose they were provided for.
The problem for this review is that ever more strongly profit focused entities have entered some sectors such as health and aged care. While the review does not address this many have come to see themselves as competing for customers rather than cooperating in the provision of a needed service.
Because of the vulnerability of those served competitiveness was in the past controlled by a system of ethics among providers and by regulations (eg. probity requirements) that sought to constrain the market and shield these sectors. Private operators were expected to adopt not-for-profit and community values and were subjected to strong community pressure.
After 2. 5 thousand years of shielding care from self interest by making it illegitimate to exploit the vulnerable, and in the face of disturbing evidence from the USA, Australia adopted a National Competition Policy.
In 1996/7 health and aged care were turned into a market and regulators sought to control undesirable conduct by focusing on the way selfinterest of participants could be manipulated (eg. Hogan review in 2004). They made it legitimate. Not-for-profit organisations were expected to conform but many had difficulty. Some could not bring themselves to do so and vacated the sector. Others brought in managers from the market accommodating to the new culture and strategies.
I argue that the consequences of this have been profound for the morale of staff, for the trust in and the trustworthiness of providers, and for the large contribution to social capital that the sector once made. The community has been disenfranchised and disempowered so permitting an unrestrained market culture to dominate the sector. As a consequence cherry picking is not frowned on and, as it is not illegal, it seems likely that kickbacks are being paid to give better paying seniors preference.
It is reassuring that the review recognised the difficulties faced by not-for-profit operators in these sectors. While it examined the relationships between not-for-profits and the market, the sections I read did not suggest ways of restoring a not-for-profit focus and culture to the sectors. In fact these matters were not fully confronted.
Once again in this era of an information highway we find that the review is limited by the lack of collected information. The review examined the difficulties experienced by not-for-profits and suggested reforms which would benefit them.
Click Here to go to a web page commenting on this report
To see the full report go to the following web page
http://www.pc.gov.au/projects/study/not-for-profit/report
Report on Government Services 2010
Volume 2: Health; Community Services; Housing
Steering Committee for the Review of Government Service Provision
Section13 Aged care services
This report gives a vast amount of information about the costs and utilisation of aged care services. Anyone wanting to make submissions relating to costs and usage will need to delve into this in more detail.
To see the full report go to the following web page
http://www.pc.gov.au/gsp/reports/rogs/2010
INQUIRY INTO PLANNING OPTIONS AND SERVICES FOR PEOPLE AGEING WITH A DISABILITY
SENATE COMMUNITY AFFAIRS REFERENCES COMMITTEE
TERMS OF REFERENCE
This matter was referred to the committee on 25 November 2009 and the report is due by 2 September 2010. It will not be available to those wishing to make a submission to the productivity commission review in regard to these issues. To use the final report you will need to seek an extension or else include references in a supplementary submission after the draft report is released in February 2011.
The brief
Access to planning options and services for people with a disability to ensure their continued quality of life as they and their carers age, and to identify any inadequacies in the choice and funding of planning options currently available to people ageing with a disability and their carers.
Fifty four submissions made to the Senate Affairs References Committee can be found on the committee's web pages.
Conclusion: A time to change all this.
What the reviews reveal about the 1997-2010 era
Summary of linked web page
A vast amount of effort has been devoted to multiple reviews and reports. Although many of our concerns have been raised and remedies sometimes advised fundamental flaws in the system remain and recommendations have not been implemented.
Many of the problems can be traced back to the aged care act of 1997. This attempted to turn aged care into a marketplace and at the same time ensured that the sort of information which might show that this was not working was not available. The system has become opaque so that no one knows what is really happening.
The tragedy of this ill considered legislation was not only its impact on the morale and manner of operation but even more tragically the steps it took to prevent anyone from accessing the sort of information which would have shown that this was not working and that change was needed.
Politicians have had to rely on incomplete and probably flawed financial data that a reluctant industry was prepared to disclose to an investigative body that was going to tell government how much to pay them. This large and complex report was filled with impressive figures and complicated modeling by impressive academic institutions. This made it look highly credible. On that basis far reaching recommendations were made. How many of those politicians who accepted and voted on those recommendation had actually read the body of the report and how many had asked how that data was obtained and questioned its integrity?
The community have had to rely on whistleblowers, prepared to risk their careers and that of their families for the public good, and on newspapers prepared to send their reporters into nursing homes run by two of our most credible and powerful operators. Only because a reporter went disguised as a voluntary helper to find out what was actually happening did we find out. These are the groups that a lowly accreditator, assessing the nursing home would think twice about censoring. If one of the senior staff from these groups was not on the board of the agency then his or her mates would be. Assessors would be well aware of what had happened to nurses who blew the whistle and would think hard about their own careers and what was best for their families.
Core problems then are, serious understaffing and deskilling of nursing and medical staff, a loss of morale, radically different perceptions of care in the sector, so little information about finances and standards of care that rational decisions cannot be made, broken accreditation and complaints systems, cherry picking of wealthy residents, an approved provider system that does not protect, a lack of protection from excessive commercialism, a lack of transparency and the disengagement, disenfranchisement and disempowerment of the community.
The time for change has come. Lets make sure that selfinterested grandstanding and obfuscation by our politicians does not derail it. They may stab each other in the back to gain power but lets make sure they don't do it to us.
The productivity commission has asked for input and every citizen has the right to do that. Those of us who are worried should write to them and tell them what we think. Go to http://www.pc.gov.au/projects/inquiry/aged-care
Click Here to look at these issues and what we might do in greater depth.
445 SUBMISSIONS TO THE PRODUCTIVITY COMMISSION
A record number of submissions have been made to the Productivity Commission Inquiry.
I made a submission along the lines suggested on these web pages. This tracked the history of aged care in Australia explaining where I thought we had gone so wrong. To address the problems that have resulted I suggested a fully transparent oversight system based around a community centred organisation with strong central integration.
CLICK HERE TO DOWNLOAD MY SUBMISSION
I have not had time to read most of the submissions.
Among the many industry submissions I note a number looking at the issues from a community perspective. Below are links to submissions from two groups that have canvassed these issues to past inquiries. Click to link to their submissions.
The School of Management, University of Technology, Sydney
All 925 submissions to the inquiry, my submissions, final report and critique
The Commission received 925 submissions and held public hearings across the country. 487 of the submissions were received initially and another 438 after the release of a draft report.
I worked with tha Aged Care Crisis Centre and between us we made 5 submissions, 2 to the first stage of the inquiry and then another 3 after the release of the draft report. I have also written a critique of the final report which I believe is still seriously deficient.
A linked web page gives a brief overview of the 5 submissions we made and also of the critique I wrote of the Final Report. On this page are links to all of the submissions and the critique.
Click Here to go to this overview page
ALTERNATELY
Click Here to go a full list of the 925 submissions on the PC's web site to download them
Click Here to go to the Commission's web page and download the Final Report
The Critique
To set the stage for an examination of the report from an alternate point of view I wrote an introduction introducing the concepts and the ideas I used to examine the report. Many would be familiar with these concepts so I put them into a separate document titled "A Basis for Criticism" and then summarised this in short bullet form in the introduction to the Critique. This summary should be sufficient for those to whom these ideas are familiar, but available for anyone wanting to explore the ideas further.
Click Here for the introduction "A Basis for Criticism" (for those wanting to explore these)
Click Here for the critique of the Final Report (pdf file) "Caring for Older Australians" (which summarises the above)
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