The problems in residential aged care are a product of a much broader issue, namely the failure to fund publicly subsidised comprehensive multidisciplinary community care.
Little children cannot speak up for themselves, advocate for their healthcare, protect themselves against abuse or lobby for funding for basic services—in response, Australians have developed a framework of laws and policies that protect children and their rights. We strictly enforce these through various measures, such as the protection through “Working with Children Check (WWCC)”.
Whilst not equating senior Australians with children, it is important to recognise that, with about half of them suffering from cognitive decline, many have limited ability to speak up for themselves, advocate for their healthcare, protect themselves against abuse or lobby for funding for basic services—in response, Australians have next to nothing in place to protect seniors and their rights.
We have well documented the crisis in aged care through the findings by the Royal Commission into Aged Care Quality and Safety. The Royal Commission did not stop at documenting the crisis in residential aged care but suggested multiple solutions. However, the federal government has halted at admitting the problem, without creating and funding a regulatory framework that equates to that which works so well for our children.
The problems in residential aged care are a product of a much broader issue, namely the failure to fund publicly subsidised comprehensive multidisciplinary community care. This care needs to include not only GP services, but also comprehensive community and home-based clinical allied health and nursing support. This support should focus not only on maintenance of the status quo, but a proactive health and well-being optimisation program across the lifespan.
Such a program would require investment in subsidised dental care, dietary care, exercise, physiotherapy, pharmacy and occupational therapy. In addition, community nursing, child and family health nursing, mental health nursing, nurse practitioners and geriatricians would be needed to deliver comprehensive supportive care. Models of care include home visiting, community-based programs in local facilities, virtual health and telehealth. This focus would shift the emphasis from federally funded private enterprise in aged care (whether for profit or not) and enable the considerable subsidies provided to the private sector to be reinvested into public community care.
Where in-reach to residential aged care is necessary, it needs to be adequately funded for allied health, nurse practitioners and GPs to make it a financially viable option that would reduce emergency department presentations for minor in-home manageable issues and reduce potentially preventable hospitalisations. It is essential that there are adequate staffing levels for registered nurses 24/7 in all residential facilities and that there are also registered nurses on call 24/7 for all home-based aged care. If this is not implemented, after hours emergency presentations will simply continue to accelerate, with ever more burden on busy hospitals.
While most voters have children, or know someone with children, all voters expect to grow old. A government that can demonstrate effective, efficient and affordable measures that ensures the comprehensive healthcare and protection of seniors will win the confidence of the voters.
If a fair and just, compassionate and ethical society is to be judged on the manner in which all citizens are treated, the evidence is overwhelming that we, Australia, are failing that key test because we continue to neglect and disrespect our elderly. Fix the problems in our Aged Care system, and many of the problems in our health care system will also dissolve.
This Federal election is the perfect time to send a message that we expect our government to do more, do it better and do it soon.
(This article has been endorsed by the Health Reform Group, a multidisciplinary alliance of 35 health professionals (including allied health, nurses, doctors and dentists, health economists, health policy experts and consumers who, over the past 18 years, have met regularly to discuss, debate and advise on Australia’s healthcare system)
Mary’s career spans 40 years both in the United Kingdom and Australia. Mary is Professor Emerita, Susan Wakil School of Nursing at the University of Sydney. In 2003/04 she was the Chief Nursing Officer, NSW Health Department and prior to that was the Foundation Professor of Nursing in Corrections Health, with the University of Technology, Sydney.
Mary is a Board member of Northern Sydney LHD and chairs their Health Care Quality Committee. She also serves on the Health Ethics Advisory Panel to the NSW Minister for Health and the Clinical Governance Advisory Committee to Healthdirect Australia.
Mary was awarded an AM for significant contributions to nursing and midwifery education and healthcare standards in June 2019.
Professor Heiko Spallek serves as Head of School and Dean of The University of Sydney School of Dentistry. Professor Spallek’s research has as its focus the development of computerized clinical decision support tools.
Professor Brad Frankum is conjoint Professor with Western Sydney University's School of Medicine and a previous President of the Australian Medical Association (NSW).
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