Aged care failures show what NDIS changes could be to disability sector

There has to be a radical change in thinking to address failures in aged care. Moreover, the same failures must not be allowed to befall disability services.

The government’s anticipated spending announcement about aged care in next month’s budget looks to be well short of what is needed to deliver the changes identified as necessary by the aged care royal commission.

In what looked like an actual scoop rather than a traditional budget drop, Nine’s James Massola reported at the weekend a plan to increase aged care funding by $10 billion over four years. But how small $2.5 billion a year is in the face of the sector’s problems was demonstrated by a report from the Grattan Institute yesterday.

Stephen Duckett and his colleagues accepted the figure put forward by the royal commissioners that aged care was $9.8 billion a year worse off than it should have been because of funding cuts by successive governments, and argued for that funding to be restored.

That would allow the home care package backlog to be cleared, home care services to keep people out of residential care as long as possible to be upgraded, the workforce to be increased by 70,000 people to establish minimum levels of care in residential facilities, and a network of “care finders” to be established to help seniors navigate the system.

That reflects the report’s emphasis on delivering on the royal commissioners’ goal of a rights-based system and commissioner Lynelle Briggs’ recommendation for “care finders”, which Duckett and co say “is absolutely fundamental in ensuring a rights-based system”.

Care finders should provide face-to-face help to older Australians as they try to navigate the aged care system. They should be agents or independent advocates for older people, not for government. They should train older Australians and their families in what human rights means for their care … [They] should be qualified, independent from service providers, and locally based in a regional organisation rather than operating out of a distant centralised body … [They] must have some level of independence, employed by independent regional organisations.

The report also urges that aged care workforce training includes a substantial component of competencies in human rights. This re-foundation of aged care on a rights-based philosophy is the crucial test of the government’s response since so much else in the royal commission report flows from that.

A failure to properly centre the system on individual rights, even with a substantial increase in funding, would perpetuate existing problems and the historical approach of recent decades: seeing quality aged care as a service to be rationed out with an eye to balancing fiscal restraint with political imperatives, rather than a basic right to which seniors are entitled.

Such fundamental changes, and such massive funding increases, are required because aged care is a policy tragedy created by successive governments and generations of policymakers at the political and bureaucratic level — all reflecting an indifference to senior’s needs.

It should demonstrate to both decision makers and voters what can happen to the National Disability Insurance Scheme (NDIS) if the same mentality of cost minimisation is allowed to dictate the fundamentals of the system.

If the NDIS is being run with an emphasis on avoiding cost overruns — with a unit within the National Disability Insurance Agency operating under a former McKinsey consultant to slash costs, prevent growth in participant numbers and impose “sustainability” rather than being founded on the rights of disabled Australians to receive quality care — it means disability services will track the same institutional path that aged care has over recent decades.

That means underfunding, poor governance and, inevitably, occasional political firestorms prompting short-term fixes, along with the rights of clients and carers being sidelined.

These will inevitably end up being addressed in the disability care royal commission of 2034, with similar recommendations to similar problems that the government must deal with in aged care in 2021.

The government has an opportunity for a fundamental overhaul of aged care. Prime Minister Scott Morrison isn’t responsible for what’s happened to aged care, but he has a blueprint to address it if he’s willing not merely to throw more money at the sector but to re-base the entire system — its funding, workforce planning and governance — around the rights of senior Australians.