When Gohar Yazdabadi looks at what the Support at Home program has done to older Australians, there is a rawness to her language that sits at odds with her corporate title.
It sounds less like the assessment of a peak body CEO and more like the words of a frustrated family member who has lived through the system’s failures first-hand, because that is precisely what has happened to the current Chief Executive Officer of Council on the Ageing NSW.
“Is this what state-sanctioned elder abuse looks like?” she asks. “I do not suggest that the program was designed with that intention. But intention cannot be the only measure.”
Yazdabadi gave evidence to the Senate Community Affairs References Committee’s inquiry into Support at Home last week. This year, she lost both her parents within two months of each other. Her father died in February while a stranded patient in the NSW hospital system, waiting for home care that never arrived in time. Her mother died two months later.
“Once someone is ready to leave hospital, the care needed to get them home should be treated as urgent,” she says. “Every additional day is a day of their life spent somewhere they no longer need to be… For some people, those become the final days of their lives. It is too late for my father.”
Older people are going without essential care because they can’t navigate a system built to serve them. People already assessed and approved for support who remain on waiting lists regardless. People stranded in hospital. People who die waiting.
“Once those consequences are known, continuing with the same settings becomes a conscious policy choice,” she says. “Decision-makers must accept responsibility for the foreseeable harm that follows. At what point does knowingly allowing older people to remain without essential care become institutional neglect?”
Professor Kathy Eager, who advised the Royal Commission into Aged Care Quality and Safety, gave evidence to the same inquiry that the Department, “developed the algorithm in-house and when it’s now making a mistake, it gets to mark its own homework.”
Greens spokesperson for older people, Senator Penny Allman-Payne, said the government “still gave it absolute power over aged care assessments,” adding: “The Department shouldn’t be trusted to check its own homework when it comes to its mistakes, that power should rest with clinical professionals.”
“We are seeing adult children prevent older people from accessing care to preserve an inheritance,” Yazdabadi says. “The older person goes without essential support so that there will be more money left for someone else. That is financial abuse and neglect.”
Partners are restricting a spouse’s home care out of fear of exhausting shared savings needed for future residential care. “That financial fear is translating into one partner denying the other the care they need.”
Council on the Ageing NSW’s own research, surveying more than 2,500 older people using the De Jong Gierveld Loneliness Scale, found 60 per cent experiencing loneliness, half socially isolated, and a quarter at the most extreme level measured.
“The use of an algorithm to determine funding adds to that loss of trust,” Yazdabadi says, “when people cannot see how the decision reflects their circumstances or how professional judgement can correct an inadequate outcome.”
Allman-Payne put it more bluntly: “The IAT systematically denies essential care to older people, especially those with cognitive issues, mental health conditions and frailty.”
For people already isolated, turning to a system that then fails them “reinforces the feeling that there is no one they can depend on.”
“We need fundamental reform,” Yazdabadi says. “We need to stop and rethink Support at Home altogether, starting with the experiences and outcomes of the people it is supposed to serve.
“If we can see these outcomes clearly and still fail to act, we move closer to a system that accepts the neglect of older people as a consequence of its design.”
As blunt as Yazdabadi’s opinions are, it is refreshing to hear an aged care leader speak this emotively and honestly. The sector needs far more of it, particularly from those who are paid to advocate for seniors.
