Having recently returned to working at the coalface in aged care, I was starkly reminded of the continuing crippling impact of the mandatory reporting and compliance regimes that overwhelm this “industry”.
The string of recent Royal Commissions into all forms of “Care”, (Ageing, Disability, Mental Health, NDIS, Robodebt to name just a few) have ended up magnifying the problem. Because the only way commissioners, bureaucrats and politicians can imagine ensuring “reform” is by mandating compliance measures, which put added pressure on already strained and under resourced providers.
Meanwhile, the for-profit providers have worked the tick box reporting system to perfection, so they can keep creaming off margins, knowing that no one gets caught, just as occurred after the Robodebt Royal Commission. Friends at the top remain gatekeepers of who gets held to account and who avoids scrutiny.
The whole sorry business rests on a destruction of a basic human foundation of decency, exercising trust in the discretionary judgment of local service providers. This is true in all fields of human endeavour, from the justice system where so-called “Truth in Sentencing” legislation threatens the role of magistrates and judges to be able to reflect real human discretionary decisions, to all forms of health and human services, where compliance has become more important than person-to-person caring.
It’s time to call out the Emperor’s New Clothes and the current replace compliance mechanisms with a whole new approach built on trust.
It is estimated that up to 60 per cent of organisational resources are now invested in meeting mandatory compliance reporting and accreditation requirements. This is Orwellian madness.
Just because shonky providers abused clients and staff shouldn’t mean that honest providers have to reduce care to invest in reporting in order to pass their next accreditation audit.
My recent exposure to the aged care industry reinforced that compliance needs to be reduced to a quarter of what has grown to. And the industry needs to shift to a trusted provider model, where passing an accreditation audit can secure a five-year approval, allowing more resources to be focused on person-centred care.
“Spot audits” could still be used to check on any organisation suspected of rorting, but most organisations should be able to reduce their anxiety about compliance, and increase their involvement in giving their clients and communities excellent care.
At the same time, the ludicrous game of public liability and risk-averse management should be replaced by more human-centred and local discretionary judgement-based management of community Involvement in aged and disability care services. It’s time we got over the COVID era jitters.
Volunteers have abandoned these places for fear on both sides of their liability if something goes wrong. And children can’t visit elders without an encyclopaedic risk assessment being completed first, which discourages anyone from trying to bring the generations together.
This whole disaster goes back to the neoliberal, economic rationalist game that first developed in the 1980s. As the cowboys in the boardrooms of the banks, stock markets, Robodebt consultants, and other non-accountable backroomers all know: “keep them all busy fearfully reporting upwards, and we can get away with anything we like”.
And even if the NACC comes after us, our mates at the top table will look after us.
One simple decision would remove this nightmare. Replace current compliance regimes with a quarter of what’s required, continue spot checks, but give five-year approvals to good providers and allow them to be more creative and community responsive and interactive in how they serve their clients and communities.
Robbie Lloyd
Dr Robbie Lloyd has been a national journalist, public affairs director, education and community health reformer for over 50 years. He works with First People and those with Lived Experience of mental health challenges, disability, alcohol and other drugs, DFV, ageing and trauma.
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