Australia The 10-page 1997 memo that brought us to where we are today on aged care

23:40  23 october  2020
23:40  23 october  2020 Source:   abc.net.au

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A 10-page memo to John Howard's cabinet decades ago foreshadowed an aged care system weighed down by waiting lists and funding shortages.

Unearthed for the final submission of counsel assisting to the aged care royal commission, a cabinet memo from 1997 doesn't sound particularly earth-shattering.

The memo, with the words "Cabinet in Confidence" stamped on the top of every page, is titled "Residential Aged Care — Long Term Outlays And Issues For Funding Structures".

The bureaucratic-sounding memo, written for then-prime minister John Howard, was prepared before the introduction of the Aged Care Act in 1997.

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The act overhauled the aged care system and introduced partial privatisation.

Senior counsel assisting Peter Gray told the royal commission an idea canvassed in the memo has had a huge impact on how Australia's aged care system developed over the next two decades.

Mr Gray said the memo contemplated what would happen if the cost of aged care became more than what the government was prepared to spend.

"In essence, the memorandum is addressing the possibilities that … expenditure on aged care will be substantially greater as a result of the new arrangements," Mr Gray QC told the royal commission in final submissions.

Basically, it outlined the government's options if they wanted to limit aged care spending.

"The memorandum concluded that there were various options available if the ministers decided at some point that they needed to further reduce the risk of outlays or expenditures above the estimates," Mr Gray told the royal commission.

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These options included adopting quotas — essentially limiting the numbers of people receiving care at various levels depending on the funding available.

"In particular, there is reference here to controls on the numbers of places and quotas on people receiving care."

Not only does the memo raise the possibility of quotas, Mr Gray submitted it also opened the door for aged care spending to be influenced by "fiscal constraints and pressures of the day".

"There are risks that all of these sorts of matters might tend to erode the quality and safety of the care that is ultimately provided," he said.

The implication is clear: from the beginning of the "new" aged care system in 1997, those needing aged care would have to fit into the funds available, rather than funds expanding to meet aged care needs.

That idea describes the very system we have in 2020, with tens of thousands of people waiting for funding and many dying before they receive it.

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"This memo … actually showed that, in fact, [aged care] in Australia is not a demand-driven programme, but rather one that's rationed," said Ian Henschke, Chief Advocate for National Seniors Australia.

"That's what [Senior Counsel Assisting Mr Gray] drew from that memo … he discovered the fundamental fault or failure in the system by going back and looking at how it was structured when the act was created back in 1997."

An idea turned into policy

Even though the memo was written to consider funding structures for residential aged care, Mr Henschke said the principles of rationalising care have been adopted across the aged care system.

He believes they're particularly visible when it comes to federally funded packages to help care for older people at home.

"If we look at that today, the fact that you're creating a quota … is evidenced now by the latest budget," he said.

The Government announced there would be 23,000 additional Home Care Packages released this fiscal year.

But Ian Henschke said that's not the whole story — for example, level four packages, which provide the most care, are still in short supply.

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"When you drill down into those numbers, there's 2,000 extra level four packages … there are 18,000 people, as far as we know, on the waitlist from the Government's own figures.

"So we're addressing somewhere around a ninth of what is needed."

Advocates such as Lynda Saltarelli from the group Aged Care Crisis argue the cabinet memo is another indication that the market-driven issues that have developed in aged care were anticipated.

"You know, it was predicted … when these proposals were made in 1997, when the changes were made. … and documented multiple times since," she said.

Ms Saltarelli has long argued that introducing partially privatised for-profit aged care was a mistake.

"The pressures to be profitable, combined with the lack of accountability, ensured that this would happen," she said.

Others said the memo was an example of how one possibility raised by bureaucrats could transform from an idea into policy.

"The thing is that … the aged care sector has really run away with the rationalisation of care and has used it to its own advantage," said Paul Versteege, a long-time observer of aged care funding with the Combined Pensioners and Superannuants Association.

"Both the private sector and private providers and also too many of the charitable ones have used it to set up empires.

"They have made huge profits, and that has gone on at the expense of the people that this system is meant to serve."

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usr: 1
This is interesting!