Nursing homes are not hospitals: how the aged care system is broken

This is an opinion piece by Anton Hutchinson, it should not be read as an editorial story by HelloCare.

There is a sad lack of understanding about what is going on with nursing homes or “Residential Aged Care Facilities*”.

My family has owned and operated a highly regarded facility that cares for resident’s living essentially with varying degrees of dementia and have been doing this for 35 years. We have invested our lives and our money in this industry of aged care services and yes, while we deliver excellent service, we expect not to go broke. I don’t think that is unreasonable.

An aged care history lesson

Nursing Home services were put out to the market around 40 years ago, for the same reason the government privatizes anything. They are incapable of running any service at a prescribed cost. The proposal was put to the public and caring people, like my mother, said that this is what we should be doing with our lives. It is what we have done as a family, and continue to do with our son now in charge of operations.

What was put to the above interested investors? The country needed an alternative care option, Australians were living 30-40 years longer than even the last generation, the government needed an alternative to home and hospital where a patient (residents were called patients but the health department insisted on that change as well) could be assisted with daily living needs and light medications. Obviously as our lifespan increased residents were entering care with much more serious health needs and new medications would keep them alive considerably longer than only a few years earlier.

This has only increased in the last years. But in 2015/16 the then treasurer started to move away from residential care and essentially brought about its collapse.

Yes, it costs a lot to look after a million plus old tax payers. As a comparison of that cost in today’s dollars I give an example. A high care nursing home resident can attract up to around $200 a day from the government. If that resident were in hospital that increases to almost $2000 per day. Now I don’t give a hoot what hospitals charge, they deliver a much needed highly qualified service that nursing homes were never expected to deliver. Until the last five years things went pretty well and homes were not on the front page of anything, ignored by the public right up to the point of immediate need.

So what happened? Let’s go back to said treasurer above, he decided that some nursing homes were over claiming for care. Now, how do you claim (or over claim)? Massive amounts of time and paperwork. Each staff member in a facility has to accurately detail each and every interaction with each and every resident and if you don’t write it down we don’t get paid for that service. It’s like selling a customer a cup of coffee but not charging for it. And here is the clincher; if you are suspected of overcharging your facility will have a financial ACFI (aged care funding instrument) validation and if the documentation does not match the claim, all the over claim is deducted.

So instead of working on this they changed the ACFI scoring mechanism. Say a high high care dementia resident would have a care score of 10, lots of needs, behaviours, aggression, diabetes and daily showering etc etc The best we could now claim was an 8. This cost the nursing home businesses 30% of government funding. 30 per cent!!!

This was in 2014/15 and it wasn’t the end of the attack on nursing homes. In 2015/16 another 6% and 2016/17 another 7% funding cut. At the same time the federal government axed the payroll tax supplement that both private and not-for-profit homes enjoyed, but they only taxed the private sector. They had introduced, in recognition that very high care dementia residents didn’t fit the ACFI model, a High Care Dementia Supplement, well they axed that too. And just to twist the knife they essentially froze CPI.

Underfunding, too much documentation and higher care needs

We now have massive underfunding, over documentation, much higher care needs than ever considered and an industry that simply cant afford to deliver services needed for frail elderly residents. We have a government that is well aware of the hurt they have created but with no interest in fixing the problem.

If you are interested in the facts and have bothered to read this long please read the ACFA report No 8 put to the Government in May 2020. It’s the government’s own agency saying that the industry is unsustainable and on the brink of collapse.

OK, so the government over the last five years has taken billions of dollars out of residential care to the point of collapse. What did they do with the loot? They invented Home Care, but like every other government project, they completely underestimated the cost.

Although that is mostly on the government, our general public has played a part in the blow out. Whoever expected that the taxpayer funded Home Care would be paying a carer to go to the shop with Nan or mow Pop’s lawn and dozens of menial tasks previously addressed by family? But family doesn’t want to inconvenience themselves, they certainly don’t want the oldies hogging the TV and stopping normal family activities because they have this responsibility. Hats off to those that actually put their hands in their own pockets, send the grandkids to mow and help around the house or take a frail family member into their home. It’s a big job.

The disastrous COVID-19 response

Enter COVID-19. What an inconvenience to our spoiled lazy society, nothing like this in a 100 years. The Dorothy Henderson facility was first in the news and was soon forgotten with the Newmarch house outbreak that was unprecedented. No one was prepared for this.

But what went wrong really?  When you, a resident enters residential care a Care Plan is arranged with your likes, needs, habits etc all listed. As you deteriorate an Advanced Care Plan is created and it essentially describes how and where you wish to die from your ongoing current ailments. “I don’t want to have intervention, I just want to die pain free here in my bed amongst people I know”, or the exact opposite may be the case, and this is how you end your time here on earth.

If a fire comes roaring through the building no one looks at the care plans. It’s get everyone to safety..now!!! Infected COVID residents and their families were threatened with $11000 fines or 6-months in jail (same to the provider) if they tried to move a resident out of an infected facility to specially set up hospital coronavirus wards.

These residents were forced to stay in the facility. The government, state or federal, practically murdered them. Almost exclusively nursing homes are full of dementia residents, who are, as a result of their condition, intrusive, unaware, confused. They have no idea of social distancing or even that COVID is a thing at all but they were left unprotected by uncaring governments saying “we need to look at each case individually”.

The very first case should have been immediately transferred to hospital but that was (and remains) essentially forbidden. It’s not going to happen. In an act that was supposed to show compassion the federal government gave every home around $900 per resident to cover the additional costs of care. Seriously? A hundred bed home would get $90,000, it was costing a minimum of $21,000 per day for PPE at Newmarch so that $90,000 was good for four days.

Melbourne homes are under attack, not just private, but governments run facilities as well. The confusion and frustration is immense. Some homes have been able to send affected residents to hospital, some could send residents NOT affected and others couldn’t send any at all.

Nursing home staff are among the most caring individuals on God’s great earth but they aren’t equipped or qualified to deal with COVID-19 and anyone that thinks differently is a fool. These nurses offer a substitute not available at home. In general they are gentle decent people. In our facility it brings a tear to my eye when I see a nurse give a resident a cuddle, a kiss, a hug. This is precious and undervalued.

Funding must be increased now

I support wage increases and more on the floor staff but they must be funded. People have said that private only cares about profit. That’s just not true. It’s important to be able to pay the bills but we are about care first and foremost.

The system needs funding increases now, the Royal Commission is a great delaying tactic of the federal government. Next February a plethora of recommendations will be presented to the government, chewed over while trying to sweep it all under the carpet. It will then be election time and there will be empty promises from both sides.

There is a very practical way forward and I’m happy to share that with anyone interested in being able to continue to offer good sustainable care to elderly Australians.

Thanks for listening.

* As a matter of interest the federal government a few years ago insisted on that name change, they felt it was somehow offensive to residents! A couple of years later they insisted that residents can’t be described as high or low care needs….just a bit of an example about who pulls the strings in residential aged care services across Australia.