Aged care ‘failing’ older Australians and in need of major overhaul, report finds

An old man looking at camera, covering his mouth with his hand. Black and white photo.

The country’s aged care system is “failing” older Australians and their families and needs a major overhaul, a new report by the Grattan Institute has found.

The report argued ageism as a key part of the problem and emphasises the human rights of older Australians in need of care and support should shape how a new system is designed.

Led by Dr Stephen Duckett, the Rethinking aged care: Emphasising the rights of older Australians report describes Australia’s aged care system as a “mess” and says horror stories that have emerged from the Aged Care Royal Commission, coupled with mounting deaths in non-government residential aged care facilities in Victoria from COVID-19, must stop.

More funding and better regulation are both essential to overhauling the system but won’t be enough to fundamentally change culture, the report says.

“Unless Australia fundamentally changes the culture of its aged care system – by changing legislated underlying principles, governance and financial incentives – the Royal Commission’s report will be added to the pile of previous reports which haven’t led to the necessary, transformative change.”

The report says that over the past few decades the aged care sector has become a more and more privatised and marketised system dominated by for-profit providers who run increasingly larger facilities, and that regulation has failed to keep up.

Successive governments have put the interests of providers ahead of the needs of older Australians, it states.

“Rather than ensuring an appropriately regulated market, the government’s primary focus has been to constrain costs, entangling assessment of need with assessment of eligibility, resulting in many older Australians missing out on the support they need. And all this despite the fact that Australia spends less than other similar countries on aged care.”

The report suggests the government’s insufficient commitment to aged care and supporting older Australia’s stems in part from ageism across broader society and has resulted in a top-down, provider-centric aged care system that is underfunded, poorly regulated and failing older Australians.

“Older Australians, particularly those seeking aged care and support, are often seen as a burden and no longer valuable or contributing members of society. They are pushed out of sight and out of mind.”

“The result is an aged care system that is underfunded, poorly regulated and often unable to give older Australians the support they need to live meaningful lives.”

Access to adequate care is limited and care is often substandard, the Grattan Institute report highlights.

To fix the system, it proposes a major overhaul, starting with the development of a new rights-based Act that places the rights of older Australians at the forefront.

It says having carers and workers who are adequately paid, trained and supported is a pre-requisite for a rights-based approach.

“Staff should have the time to treat people with dignity in every interaction, and to build relationships with the individuals they are caring for.”

The report identifies five key principles which should shape system design:

  • Independence, self-fulfilment, and participation in community
  • Informed and supported choice and control
  • Universal access to reasonable and necessary supports
  • Equity and non-discrimination
  • Dignity, including dignity in death

“A new system, based on the rights of older people, will look very different from the provider-centric system Australia has now,” the report says.

“Older people would be more empowered and assisted to make informed choices. Older Australians would be better able to participate in the community and fulfil their goals and aspirations. This would then, over time, reshape the system to better meet the desires and aspirations of older Australians.”

The Grattan Institute report on aged care sets an overarching framework for reform. A second report will soon follow and detail how Australia can build a rights-based approach system and provide practical reform proposals so that older Australians can live dignified and meaningful lives.

“Australia needs a new approach to aged care,” the report concludes.

“The pandemic has been another tragic reminder that the current system fails older Australians. We need to abandon the top-down, market-driven, provider-centric approach. Instead, we need a system that does not regard older people as passive recipients of care. The new system should support older people to participate in society as much as they can, and give them as much autonomy as possible.”

Read the full report here

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