Now for the hard part: who will care after the Royal Commission? Opinion

We’ve lived with it for so long, it was beginning to seem like the Royal Commission on Aged Care would always be with us. But now that the astonishing, apparently never-ending series of revelations that shocked the nation will no longer be the subject of further public hearings, the hard part starts. 

The RC’s report, released on 26 February, presents a final and extensive set of recommendations by the commissioners. After reading, digesting and debating their learned words, Australia enters the next stage, facing the true challenge of finally taking action.

The first hard part will be reading or otherwise consulting the actual report. Of course, few people will read the actual report. Will you? It will take a lot of time, real dedication and probably a pack or two of tissues to get through it all.

Most people are far more likely to shoot off their own opinion about what is needed, based on their experience with their parents or their long-held beliefs about what works. Those who wish to be informed are likely to rely on short and quite selective, often unreliable summaries presented in the media. Typically, these will focus on the proposed solutions but lack documentation of the evidence on which the Commissioners have been reached their conclusions.

The second and much harder part of the challenge is about actually taking responsibility by doing something and implementing changes. Even the simplest changes, such as introducing staffing standards that include numbers of registered nurses to be employed in residential care services (as was the case before the 1997 Act), are highly contested.

The options for action will be simplified in the process of public debate, with competing interests forcing people to take sides in dumbed down debates. My bet is that the biggest debate will be around costs and funding. Should we spend more money on people in their final years of life? If so, where will the money come from?

Richard Colbeck, who amazingly is still Minister for Aged Care after all that has happened, indicated that this would be the Federal Government’s main response. The government’s answers to the RC, he announced recently, will come in the budget which is released in May.

Most aged care workers have long deserved better pay, decent careers and improved work conditions. Beyond this, throwing money at the system won’t change much. In many cases it will reward and perpetuate bad practice, perhaps, as happened in recent years, simply swelling management salaries and financial costs. 

As Dr Sarah Russell, director of Aged Care Matters pointed out in the Age and SMH two days before the report’s release, there should be no more money given to aged care providers without fundamental reform of the system. She called for nothing less than a complete rewriting of the 1997 Aged Care Act as a starting point.

Many others, myself included, have been calling for renewed attention on the design and funding of home care services. This must go beyond fundamental reform of the Home Care Package program, with its vast waiting lists and ever-increasing management and care coordination costs that consumers find incomprehensible. We need renewed commitment to block funding to strengthen the CHSP, the Commonwealth Home Support Programme, and the removal of the assessment barrier to entry to such basic services. Family carers need a much better deal, and the current approach of MyCarer Gateway and MyAgedCare needs to be completely rethought.

Whatever responses are made to the RC’s report, the complexity of governance in aged care needs to be acknowledged and managed, not ignored.  This has been the central problem of the two keystones of system redesign since the 1997 Act, both of which have failed to deliver the intended outcomes.

In constitutional terms, the most significant change over the past decade has been bringing responsibility for all aged care under Commonwealth control, cutting out the overlap with the states and territories. This was supposed to reduce duplication and waste when states were involved, helping to provide equal access to services no matter where those in need lived. 

But that responsibility has then been contracted out to proprietors and service providers, as the system has been radically reshaped into a market. In theory, markets are believed to be self-regulating, so it makes sense to leave day-to-day operations to the service providers. But we’ve seen the system fail too many times, the horrifyingly large numbers of care home deaths due to COVID-19 being just the most recent and sensitive example. In the aged care field, regulation can’t be left to the market, any more than can funding.

An awareness of the governance and legal issues uncovered by the RC requires the Commonwealth government to take responsibility, not avoid it or hide behind yet more enquiries. But, like saying sorry, taking responsibility seems to be the hardest thing for the current government to do.

The release of the RC’s final report will not be the end of the revelations. These are likely to continue unabated, as shown by the emerging discussion of the prevalence of sexual abuse in residential care homes and the ABC’s expose of events in Regis Nedlands, ‘a luxury nursing home’ in WA where residents can pay $1.4 million in accommodation bonds. But March 2021 clearly draws a line in the sand for aged care in Australia. From here on, the whole business of government taking responsibility for aged care gets serious again.

Michael Fine is Honorary Professor at Macquarie University.

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