tag:theconversation.com,2011:/us/topics/royal-commission-into-aged-care-91089/articlesRoyal Commission into Aged Care – The Conversation2023-09-13T20:06:19Ztag:theconversation.com,2011:article/2090312023-09-13T20:06:19Z2023-09-13T20:06:19ZThe aged care system has failed Aboriginal people. Here’s what Elders say needs to change<p>The Royal Commission into Aged Care Quality and Safety recognised the aged care system has failed to provide culturally safe care for Aboriginal and Torres Strait Islander people as they age. It recommended major reforms, including active partnership with Aboriginal and Torres Strait Islander people. </p>
<p>The Australian government has also <a href="https://www.health.gov.au/our-work/aged-care-reforms/what-were-doing/equitable-access#more-funding-for-the-national-aboriginal-and-torres-strait-islander-flexible-aged-care-program">committed</a> more funding for Aboriginal and Torres Strait Islander aged care services, with a focus on boosting the role of Aboriginal community-controlled organisations.</p>
<p>So what do older Aboriginal people need to age well? And how can aged care funding and systems enable that?</p>
<p>This was at the centre of our <a href="https://www.cambridge.org/core/journals/ageing-and-society/article/elders-perspectives-and-priorities-for-ageing-well-in-a-remote-aboriginal-community/4EFCAD2A0DCE60F8F641A2E6BDDFBC66">study</a>, led by the <a href="https://www.dharriwaaeldersgroup.org.au/">Dharriwaa Elders Group</a> in its long-term partnership with UNSW, known as <a href="https://www.unsw.edu.au/walgett-partnership">Yuwaya Ngarra-li</a>.
The study involved speaking with 22 Elders in the remote New South Wales town of Walgett about what ageing well means to them.</p>
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<h2>Elders are the ‘wellspring’ for younger people</h2>
<p>Aboriginal Elders play an important role as community leaders and protectors of cultural heritage. This involves passing down knowledge and stories, leadership, care-giving and safeguarding family, community and intergenerational wellbeing. Supporting this aspect of ageing well is crucial. As one Elder explained:</p>
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<p>Talking about our stories and storylines, and telling those stories […] It’s Aboriginal culture – it’s an oral system of educating people and giving people information. It’s part and parcel of Aboriginal life […] you know your stories, you know where you come from.</p>
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<p>For Elders who have worked away from Walgett in various careers, this means a kind of “active retirement” – returning to Country to bring back knowledge and continue a legacy for future generations.</p>
<p>One said: </p>
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<p>Once you have an education, you take it back to your community.</p>
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<h2>Addressing the ongoing impacts of colonisation</h2>
<p>Elders explained how community health and wellbeing continue to be harmed by dispossession and climate change, drought and water insecurity:</p>
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<p>When I think about ageing and culture, I think one of the big things that is on people’s minds, especially elderly Aboriginal people, is the fact that the rivers have dried up, and how that affects culture. To me, it’s like another wave of destruction of our culture.</p>
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<p>Many Elders described experiencing institutional racism in mainstream services, including aged care services, and identified that current systems are not designed with consideration of the wellbeing of Aboriginal people: </p>
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<p>I think there’s always been a difference in the aged care needs of Aboriginal people. We’re in a system, an English system, and I think our care needs are different. Not that we need to be in a building with four walls and just sit there. They don’t understand the Aboriginal way because they never learn it, we learnt their way.</p>
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<p>Elders highlighted the need to acknowledge the intergenerational trauma of being placed in institutions for Aboriginal people, especially for survivors of the Stolen Generations who were taken from their families and put in government and church-run institutions.</p>
<h2>A holistic concept of wellbeing</h2>
<p>For Elders, wellbeing isn’t just about individual health. It also involves social, mental, physical, cultural, spiritual, political, family and community dimensions.</p>
<p>They saw the Dharriwaa Elders Group Centre – a space used for daily meetings, events, cultural exhibitions and other community activities – as vital: </p>
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<p>People tell jokes, you come in here and have a yarn about different things. Makes you feel good when you come in here and talk to people.</p>
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<p>Another said:</p>
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<p>I think the Elders Group is important, that we have this organisation here, we’ve got people together of the same age group, the same mindset. You see it when older people are just around young people, they aren’t exercising their minds as much because they don’t know what they’re talking about. The older person doesn’t understand, and they’re just left there wondering. So if you’ve got similar age, similar thinking, they can have a conversation.</p>
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<p>Elders saw staying politically engaged and active in the community through Aboriginal community-controlled organisations as crucial to wellbeing.</p>
<h2>A culturally safe model of aged care</h2>
<p>Elders talked passionately about how culturally safe aged care means being truly cared for, not just having your needs met. They described the traditional way of caring as based on being loved, valued, respected and safe. A culturally safe model of aged care would integrate these values into practice. </p>
<p>Elders felt strongly that mainstream models didn’t help show what aged care should look like. One said:</p>
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<p>They’ve had the royal commission, and the report […] They did do some investigation of ageing Aboriginal people, but how do they fully know what to look at? Come and talk to us. What I mean by this is Closing the Gap – well, there is no such thing for ageing […] Because non-Aboriginal people, we can see they’re getting a bad deal.</p>
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<p>Many feared becoming dependent on the aged care system. </p>
<h2>Building community capacity in aged care</h2>
<p>Walgett is a small remote community, which presents service delivery challenges. But enabling Elders to age on and care for Country, and to stay connected to extended family, would bring many benefits and opportunities. </p>
<p>For example, unemployment among Aboriginal people in Walgett is high; family and community members could be trained and employed to provide in-home support and transport for Elders:</p>
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<p>Aboriginal people know their people […] Racism is a big thing and it does rear its head in ageing. Aboriginal people understand the way a person speaks, what they might mean, as opposed to say, a non-Aboriginal person, they wouldn’t understand it. Aboriginal people are closer to the language, to the extended family. They’d be good, to be trained up in aged care.</p>
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<p>Local community-controlled organisations are ideally placed to do this, with appropriate resourcing.</p>
<h2>What now?</h2>
<p><a href="https://www.health.gov.au/our-work/aged-care-reforms/delivering-reforms-to-improve-aged-care">Aged care</a> reform is underway. The Dharriwaa Elders Group and others have <a href="https://www.unsw.edu.au/content/dam/pdfs/unsw-adobe-websites/yuwaya-ngarra-li/2023-06-news/2023-06-37-caring-for-elder-community-culture.pdf">raised concerns</a> about a fee-for-service aged care funding model with NDIS-like individualised entitlements.</p>
<p>Elders’ perspectives could guide a different kind of policy and service design reform.</p>
<p>The Dharriwaa Elders Group is an example of how Aboriginal community-controlled organisations provide places to gather and connect, and share knowledge and humour. They can be a hub for community leadership and advocacy. Governments could resource such organisations across Australia to support Elders to age well on Country.</p>
<p>A whole of system approach is required. Elders told us any policy reform must focus not just on aged care, but also on the health, housing and social sectors. This is vital as a non-medical approach to ageing well, enabling Elders to stay on Country, in their community, connected to peers.</p>
<p>This research is leading to possible solutions already. For example, <a href="https://www.architects.nsw.gov.au/news/622-2023-architects-medallion-winner">an award-winning Masters project</a> arising from this research drew on what Elders said they needed to design a culturally led model of housing that could be built in Walgett and other remote communities. </p>
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<p class="fine-print"><em><span>Ruth McCausland receives funding from the Paul Ramsay Foundation and National Health and Medical Research Council, and is on the Board of the Community Restorative Centre. </span></em></p><p class="fine-print"><em><span>Peta MacGillivray receives funding from the Paul Ramsay Foundation and is affiliated with the Community Restorative Centre (CRC NSW) as Chair of the Board of Directors.</span></em></p><p class="fine-print"><em><span>Sacha Kendall Jamieson receives funding from the National Health and Medical Research Council and through the Westpac Safer Children, Safer Communities grant scheme</span></em></p><p class="fine-print"><em><span>Virginia Robinson is Secretary of the Dharriwaa Elders Group </span></em></p>Aboriginal Elders play an important role as community leaders and cultural knowledge holders. Supporting this aspect of ageing well is crucial.Ruth McCausland, Associate Professor, UNSW SydneyPeta MacGillivray, Senior Research Fellow, UNSW SydneySacha Kendall Jamieson, Lecturer in Social Work and Policy Studies, University of SydneyVirginia Robinson, Secretary of the Dharriwaa Elders Group, Indigenous KnowledgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074052023-08-03T20:03:04Z2023-08-03T20:03:04ZLump sum, daily payments or a combination? What to consider when paying for nursing home accommodation<figure><img src="https://images.theconversation.com/files/540055/original/file-20230730-24-zd7sfx.jpg?ixlib=rb-1.1.0&rect=0%2C35%2C7951%2C5261&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Moving yourself or a loved one to a nursing home can be <a href="https://theconversation.com/should-we-move-our-loved-one-with-dementia-into-a-nursing-home-6-things-to-consider-when-making-this-tough-decision-189770">emotional and difficult</a>. While some have their nursing home accommodation costs fully covered by the government (based on a <a href="https://www.myagedcare.gov.au/how-much-will-i-pay">means test</a>), most will have to pay their own way.</p>
<p>The average lump sum room value is <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">A$334,000</a>. Choosing how to pay can make this time even more challenging, particularly for those with <a href="https://theconversation.com/would-you-pass-this-financial-literacy-quiz-many-wont-and-its-affecting-expensive-aged-care-decisions-175063">low financial literacy</a>.</p>
<p>This is an important and complex decision. It can affect your income, wealth, means-tested aged care fee, and bequests. Here are some things to consider before you decide.</p>
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<a href="https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Not everyone can readily access the amount needed to pay a lump sum.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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Read more:
<a href="https://theconversation.com/would-you-pass-this-financial-literacy-quiz-many-wont-and-its-affecting-expensive-aged-care-decisions-175063">Would you pass this financial literacy quiz? Many won't – and it's affecting expensive aged care decisions</a>
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<h2>3 ways to pay</h2>
<p>You can <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs">pay</a> for a nursing home room in three ways.</p>
<p>You can pay the entire room price as a one-off, refundable lump sum (a “refundable accommodation deposit”, sometimes shortened to RAD). This lump sum is refunded to the resident or their estate when the person leaves the nursing home (if they move or pass away).</p>
<p>The refund is <a href="https://www.myagedcare.gov.au/aged-care-home-accommodation-refunds">guaranteed by the government</a>, even if a provider goes bankrupt.</p>
<p>People who don’t want to pay a lump sum can instead choose rent-style, “daily accommodation payments” (sometimes shortened to DAP).</p>
<p>These are fixed, daily interest-only payments calculated on the total room price. The rate at which they are calculated is known as the “maximum permissible interest rate” or MPIR. </p>
<p>The maximum permissible interest rate is set by the government and is currently <a href="https://www.health.gov.au/sites/default/files/2023-06/base-interest-rate-bir-and-maximum-permissible-interest-rate-mpir-for-residential-aged-care_0.pdf">7.9%</a> per annum. The <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">formula</a> for a daily accommodation payment is (RAD × MPIR) ÷ 365.</p>
<p>Unlike lump sums, daily accommodation payments are not refunded.</p>
<p>The third option is a <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">combination payment</a>. This means paying part of the room price as a lump sum, with daily payments calculated on the remaining room amount. On leaving the home, the part lump sum is refunded to the resident or their estate.</p>
<p>With a combination payment, the consumer can choose to pay whatever amount they like for the lump sum.</p>
<p>The table below shows three different ways someone could pay for a room priced at $400,000.</p>
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<a href="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>So which is best? It’s impossible to say. It depends on a person’s circumstances, family situation, finances, preferences and expected length of stay.</p>
<h2>Why do some people choose a lump sum?</h2>
<p>One downside of a lump sum (or part lump sum) is that choosing this option means this money is not invested elsewhere.</p>
<p>By handing over the lump sum, for example, you forgo returns you could have made by investing this same money into property or stocks over the period of your nursing home stay.</p>
<p>On the other hand, paying lump sum means you get to avoid the daily interest payments (the 7.9% in the table above).</p>
<p>So you could potentially be better off paying a lump sum if you think there’s no way you could make investment returns on that money that are substantially higher than the interest you’d be charged through daily payments. </p>
<p>One advantage of choosing a lump sum is it’s considered an <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">exempt asset</a> for pension purposes; some people may get more <a href="https://www.afr.com/wealth/personal-finance/five-things-you-need-to-know-about-aged-care-deposits-20200302-p54606">pension</a> if they pay the lump sum.</p>
<p>The lump sum, however, does count as an asset in determining the <a href="https://www.health.gov.au/our-work/residential-aged-care/charging-for-residential-aged-care-services/residential-aged-care-fee-scenarios-for-people-entering-care-from-1-july-2014">means-tested care fee</a>.</p>
<p>And if you sell your house, remember any money leftover after you pay the lump sum will be counted as assets when you’re means-tested for the pension and means-tested care fee.</p>
<h2>Why might some people prefer daily payments?</h2>
<p>Not everyone can can afford a lump sum. Some may not want to <a href="https://theconversation.com/is-it-worth-selling-my-house-if-im-going-into-aged-care-161674">sell their home</a> to pay one. Some may want to hold onto their house if they think property prices may increase in the future.</p>
<p>Daily payments have recently overtaken lump sums as the most <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">popular payment option</a>, with 43% of people paying this way. However, recent <a href="https://amp-smh-com-au.cdn.ampproject.org/c/s/amp.smh.com.au/money/super-and-retirement/aged-care-interest-rate-increase-sees-daily-payments-almost-double-20230324-p5cuz2.html">interest rate rises</a> may slow or reverse this trend.</p>
<p>And if a spouse or “<a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/residential-aged-care/aged-care-costs">protected person</a>” – such as a dependant or relative that meets certain criteria – is still living in the house, it’s also exempt from assets tests for the pension and other aged care fees.</p>
<p>If the home is vacated by a protected person, its value is still excluded from the pension means test for <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">two years</a> (although rental income is still assessed).</p>
<p>If you do not anticipate a lengthy nursing home stay, daily payments may potentially be the easiest option. But it’s best to consult a financial adviser.</p>
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<a href="https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some 60% of people we surveyed found the decision on payment options complex.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>What does the research say?</h2>
<p>My <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">research</a> with colleagues found many people choose the lump sum option simply because they can afford to.</p>
<p>Those <a href="https://ahes.org.au/portfolio-items/entering-aged-care/">owning residential property</a> are more likely to pay a lump sum, mostly because they can sell a house to get the money.</p>
<p>People who consult financial advisers are also more likely to choose lump sums. This may be due to <a href="https://www.afr.com/wealth/aged-care-costs-most-opt-for-pay-as-you-go-20181023-h170g4">financial advice</a> suggesting it’s tough to earn investment returns higher than what you’d save by avoiding the interest charged in the daily payment option.</p>
<p>Some aged care providers <a href="https://www.mq.edu.au/__data/assets/pdf_file/0003/1164243/the-role-of-refundable-accommodation-deposits-FINAL.pdf">prefer</a> lump sum payment since they <a href="https://www.agedcarequality.gov.au/providers/prudential-standards/permitted-use-refundable-deposits">use</a> these to renovate or refurbish their facilities. But providers are not allowed to influence or control your decision on how to pay.</p>
<p>The recent Royal Commission into Aged Care recommended <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf">phasing out</a> lump sums as a payment option, leaving only daily payments. While that would reduce the complexity of the payment decision and remove the incentive for providers to sway decisions, it would also reduce consumer choice. </p>
<h2>Is there anything else I should know?</h2>
<p>Some 60% of people we <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">surveyed</a> found the decision complex, while 54% said it was stressful.</p>
<p>It is best to seek professional <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs#financial-advice">financial advice</a> before you decide.</p>
<p>Services Australia also runs a free <a href="https://www.servicesaustralia.gov.au/what-financial-information-service?context=21836">Financial Information Service</a> that can help you better understand your finances and the payment decision. But it does not give <a href="https://www.servicesaustralia.gov.au/financial-information-service-officers?context=21836#a2">financial advice or prepare plans</a>.</p>
<p>You have <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">28 days to choose a payment method</a> after admission, and six months to pay if you <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">choose a lump-sum payment</a>.</p>
<p>In the interim, you will be charged daily interest payments on the room price.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-private-health-insurance-rebate-has-cost-taxpayers-100-billion-and-only-benefits-some-should-we-scrap-it-181264">The private health insurance rebate has cost taxpayers $100 billion and only benefits some. Should we scrap it?</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/207405/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anam Bilgrami does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This is an important and complex decision. It can affect your income, wealth, means-tested aged care fee, and bequests. Here are some things to consider before you decide.Anam Bilgrami, Research Fellow, Macquarie University Centre for the Health Economy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1984162023-02-09T19:10:29Z2023-02-09T19:10:29ZFriday essay: love in the time of incontinence – why young people don’t have the monopoly on love, or even sex<figure><img src="https://images.theconversation.com/files/506758/original/file-20230127-13-c3qgpf.jpg?ixlib=rb-1.1.0&rect=9%2C9%2C2035%2C1345&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Julie Christie and Gordon Pinsent in Away from Her (2006), based on Alice Munro's short story, The Bear Came Over the Mountain.</span> <span class="attribution"><span class="source">IMDB</span></span></figcaption></figure><p>A friend with a close relative in a residential aged care home reports – in a tone of scandalised surprise – on romantic entanglements among the elderly. </p>
<p>In one case, a man and woman have become so inseparable that staff have been forced to move his bed into her room so the two can sleep side by side. When the woman’s son made an unexpected visit, he was distressed to find his mother in her nightdress in the arms of a stranger, though eventually he had to accept it was what she wanted.</p>
<p>The concept of the elderly, with their age-altered bodies, demonstrating an appetite for intimacy, especially in an institutionalised setting, appears widely regarded as funny at best – and at worst, disgusting. But should we be surprised if in this difficult, final phase of their lives, elderly people yearn for human contact? </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-grey-haired-and-radiant-reimagining-ageing-for-women-182336">Friday essay: grey-haired and radiant – reimagining ageing for women</a>
</strong>
</em>
</p>
<hr>
<h2>Love is short, forgetting is long</h2>
<p>As another friend, an experienced nurse, points out, the rooms of aged care residents are routinely lined with framed family photographs, what she calls “the people with the big hats and the scrolls”. But where, my friend demands, are these people in the lives of the lonely residents? Why do they never visit? </p>
<p>She describes how in her childhood in Ireland, any house you’d go to would have an old man or woman in it being cared for by the family; though she admits this may no longer be the case, since so many women have found work outside the home. </p>
<p>For Australians in aged care, living among strangers, removed from all that was once familiar – including the ordinary luxuries of an outing to a local cafe, or to watch the sun set over the sea – it is surely natural that they should turn to those nearest them for comfort. As the poet Pablo Neruda says: “Love is so short, forgetting is so long.”</p>
<p>Each February, the Day of Love rolls around, with its buckets of poor, forced roses outside florists’ shops, its gaudy greetings cards, and supermarkets crammed with chocolate. Young people, of course, are mad for all the hullabaloo, with Valentine’s Day themed parties, and singing telegrams delivered in the lunch breaks in high schools. But if those young people imagine they have a monopoly on love – or even on sex – the truth appears otherwise; in real life and in books.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older man looks lovingly at a smiling older woman. He holds a bunch of flowers towards her." src="https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507234/original/file-20230130-9120-zca5wm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Young people don’t have a monopoly on love, or even sex.</span>
<span class="attribution"><span class="source">Rodnae Productions/Pexels</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Romance in residential care</h2>
<p>For a moving narrative of love at the end of days, read Alice Munro’s <a href="https://www.penguin.com.au/books/hateship-friendship-courtship-loveship-marriage-9780099422747">The Bear Came Over the Mountain</a>, from her book <a href="https://www.penguin.com.au/books/hateship-friendship-courtship-loveship-marriage-9780099422747">Hateship, Friendship, Courtship, Loveship, Marriage</a> (filmed as <a href="https://www.imdb.com/title/tt0491747/">Away From Her</a>; director Sarah Polley was Oscar nominated for her screenplay adaptation of Munro’s story).</p>
<p>The story documents both romantic attachment in residential care, and the lengths a spouse might go to for love. Grant and Fiona have been married for almost 50 years when she starts leaving sticky notes on their kitchen drawers: Cutlery, Dishtowels, Knives. Grant is shaken by the realisation that it is not where things are kept that Fiona is struggling with, but what they are. </p>
<p>As Fiona’s memory loss accelerates, she moves voluntarily to Meadowlake, a nursing home where she and Grant have previously visited a neighbour. The home’s rules forbid visitors during the first month; Grant is told this is to help Fiona settle in. But when the month is up his wife does not recognise him, and at each visit he finds her sitting close beside her new friend, Aubrey.</p>
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<a href="https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=912&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=912&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=912&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1146&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1146&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506771/original/file-20230127-14-vjwvhj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1146&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>Grant’s eventual acceptance of Fiona’s and Aubrey’s relationship, his efforts, after Aubrey’s wife takes him home, to have him returned to Meadowlake, is where the real love lies in this story. It is not the stuff of cellophane-wrapped roses and chocolate hearts, but the devotion that has accreted over the course of a long marriage. In Grant’s case devotion may be tinged with guilt, for in the past he has been a philanderer, though he never wanted to risk losing his wife. Now that he has lost her, he throws his effort into securing the only thing that appears to make her happy.</p>
<p>At the end of Elizabeth Strout’s Pulitzer prize-winning <a href="https://www.simonandschuster.com.au/books/Olive-Kitteridge/Elizabeth-Strout/9781849831550">Olive Kitteridge</a>, Olive seeks out the widowed Jack Kennison. She puts her hand on his chest and feels the thump of his heart “and her body – old, big, sagging – felt straight-out desire for his”. Olive is saddened to remember she had not loved her husband Henry in this way for a long time before he died. </p>
<blockquote>
<p>What young people didn’t know, she thought, lying down beside this man, his hand on her shoulder, her arm; oh, what young people did not know. They did not know that lumpy, aged, and wrinkled bodies were as needy as their own young, firm ones, that love was not to be tossed away carelessly.</p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/elizabeth-strouts-lucy-by-the-sea-a-claustrophobic-portrait-of-a-terrible-pandemic-year-191073">Elizabeth Strout's Lucy By the Sea: a claustrophobic portrait of a terrible pandemic year</a>
</strong>
</em>
</p>
<hr>
<h2>Privacy, consent and family resistance</h2>
<p>Intimate relationships have been associated with lower levels of stress and depression, with higher levels of oxytocin, a feel-good hormone, and a general lift in physical and mental wellbeing, even taking into account cognitive or physical impairment. </p>
<p>Intimacy, of course, does not necessarily mean sex; it can be expressed through touch, such as hugging, cuddling, or hand-holding. But in an Australian aged care setting, this may not be as straightforward as it seems in fiction. For one thing, there is a discouraging lack of privacy, including a scarcity of shared rooms, rooms with double beds and lockable doors. Then, if a resident’s husband or wife is still living in the wider community, a new attachment might stir family resistance.</p>
<p>A <a href="https://www.latrobe.edu.au/news/articles/2023/release/issues-around-aged-care-and-intimacy">recent survey</a> of almost 3,000 Australian residential aged-care facilities conducted by researchers at La Trobe University’s <a href="https://www.latrobe.edu.au/aipca/australian-centre-for-evidence-based-aged-care">Australian Centre for Evidence Based Aged Care</a> found that only half of facilities surveyed had written policies on sexuality, and only one third had policies on sexual behaviour. </p>
<p><a href="https://theconversation.com/possible-link-between-alzheimers-disease-and-gut-microbiome-found-in-mice-new-study-197945">Dementia</a> raises the question of a capacity to properly consent. Legislation is clear concerning a resident’s will and medical and financial matters. But when it comes to people’s sexual decisions, it is left to staff to negotiate a balance between the rights of individuals and the facility’s duty of care to a group of people who are particularly vulnerable to unwanted attentions, or even sexual assault. </p>
<p>It must be acknowledged that in Australia <a href="https://theconversation.com/aged-care-staff-urgently-need-training-to-report-and-prevent-sexual-assault-169734">an estimated</a> 50 sexual assaults occur every week in residential aged care, and that the elderly also experience such assaults in their own homes; victims are invariably female. Police and care providers can be unwilling to take action, believing that dementia makes the victim’s evidence unreliable – and, mistakenly, that people with dementia will not remember, nor be traumatised.</p>
<p>The <a href="https://opan.org.au/about-us/campaigns-and-projects/ready-to-listen">Ready to Listen</a> project, launched in 2021 by the Older Persons Advocacy Network, aims to address the rights of people in aged care to be heard, to be believed, and (following open disclosure of assault) to have their cases followed up by police. It is also concerned with establishing a charter of sexual rights for older people, including their right to a consenting, romantic relationship, and clarifying the all-important question of consent.</p>
<p>But the possibility of non-consensual contact exacerbates the difficulty of forming genuine attachments, and family disapproval may be enough to cause staff to intervene. Even without this, the lack of guidance, or the ageist prejudices of staff members, may mean intimate friendships within an aged care setting will be firmly discouraged. </p>
<p>Children, especially adult children, can complicate mature love, and are often unscrupulous in thwarting it. Because aside from what they perceive as age-appropriate behaviour, late-life attachments can, of course, have consequences for an offspring’s anticipated inheritance. </p>
<h2>‘You’re not even ashamed’</h2>
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<a href="https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=910&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=910&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=910&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1143&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1143&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506763/original/file-20230127-26-4gu17a.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1143&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>In Kent Haruf’s <a href="https://www.panmacmillan.com.au/9781447299370/">Our Souls at Night</a>, Addie Moore and Louis Waters, neighbours for years, both live alone; their houses empty of family, their evenings solitary. Then Addie visits Louis with the astonishing proposal that he sleep over with her at night: for the company, for the quiet conversations after lights out. Louis agrees, and they fall into a companionable routine. The town soon notices this new intimacy, but at 70, Addie does not care what anyone thinks, and nor does Louis. </p>
<p>Alerted by a friend to her father’s behaviour, Louis’s daughter Holly tells him, “It just seems embarrassing”. But Addie’s son Gene is incensed. “Because he’s after your money too, isn’t he?” he says. “If you married him he’d get half of everything wouldn’t he? I couldn’t stop him.”</p>
<p>Addie’s six-year-old grandson Jamie is sent to stay with her when Gene separates from his wife. Frightened at night, Jamie ends up sleeping in Addie’s bed, making her arrangement with Louis impossible. But gradually the three of them bond, and when Louis gives Jamie a dog, Bonny, Bonny is allowed to sleep on Jamie’s bed. When the three of them go camping, they share the same tent.</p>
<p>Gene comes and takes Jamie and Bonny away, and afterwards Addie and Louis decide they will do what the town believes they’ve been doing all along.</p>
<p>Addie says, “This old body. I’m an old woman now.”
Louis says, “Well, old woman Moore. You’ve won me completely. You’re just right. You’re how you’re supposed to look.”</p>
<p>When their lovemaking is not a success, Louis says, “I’ve got the old man’s complaint.”
Addie says, “It’s just the first time. We have all the time ahead of us […] Let’s try again another night.”
But Addie’s son returns. “I want this to stop,” he says. “You’re not even ashamed of yourselves.”</p>
<p>Gene bans Addie from speaking on the phone to her grandson. When she does get through to Jamie, he tells her that if he talks to her “they’ll take Bonny away”. Addie must have contact with the boy; she cannot afford to wait until Jamie is 16. She tells Louis they must remain separate.</p>
<p>When Addie falls in the street, Gene has her transferred from the town of Holt, where she and Louis live, to Denver. Louis goes to the hospital, where Gene tells him, “You’re not wanted here.”</p>
<p>When Addie is discharged, she will move into assisted living in another town. Gene’s disgust, while partly motivated by financial need, is also an expression of a common distaste for age-altered bodies. To Gene, this is all the justification he needs to use his small son as a weapon. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/todays-aged-care-falls-well-short-of-how-wed-like-to-be-treated-but-there-is-another-way-177067">Today's aged care falls well short of how we'd like to be treated – but there is another way</a>
</strong>
</em>
</p>
<hr>
<h2>Love after ‘50 years of being parched’</h2>
<p>Addie Moore is not the first elderly woman to discover that the last great love of her life is settled on a grandchild. The unconditional love can flow both ways, to their mutual joy, if it is not pinched out by parents with a loveless attitude towards the older generation. In her surrealist novel <a href="https://www.goodreads.com/en/book/show/46987">The Hearing Trumpet</a>, Leonora Carrington delivers this dehumanising impulse with devastating economy as a woman speaks to her husband about his aged mother, Marian.</p>
<p>“Remember, Galahad,” added Muriel, “those old people do not have feelings like you or I. She would be so much happier in an institution.”
Unfortunately for Marian, her adult grandson is not the loving kind.
“She ought to be dead,” Robert said. “At that age people are better off dead.”</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=921&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=921&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=921&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1157&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1157&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506764/original/file-20230127-12-55wj44.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1157&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>Even when offspring are not primarily focused on their inheritance, a lifetime’s accumulation of feelings and resentments can be in play. In <a href="https://www.penguin.com.au/books/anything-is-possible-9780241248799">Anything is Possible</a>, also by Elizabeth Strout, the story Mississippi Mary tells of a 78-year-old woman living in Italy, married to a man so much younger than her that at first the locals assumed she was his mother. </p>
<p>When her youngest daughter visits, Mary thinks she will not understand “what it had been like to be so famished. Almost fifty years of being parched”. At their 50th wedding anniversary party her husband had not asked her to dance. Later, when Mary was 69, her daughters had given her a trip to Italy as a birthday gift, and it was there that she had wandered off and become lost, and was found by Paolo. </p>
<blockquote>
<p>She fell in love. She did. He’d been married for twenty years, it had seemed like fifty to him, and now he was alone – they were both parched.</p>
</blockquote>
<p>Mary’s first husband had been in a long-term affair. Their daughter Angelina judges it “pathetic […] painful, of course, but pathetic”. Her father “really was a mean snake of a man” Angelina admits, but then the selfishness of the hurt child kicks in: </p>
<blockquote>
<p>Why couldn’t her mother see what she had done by leaving? Why couldn’t she see it? There could be only one reason: that her mother was, behind her daffiness, a little bit dumb; she lacked imagination.</p>
</blockquote>
<p>Angelina accuses her mother of having taken from her the ability to care for her in her old age, and to be with her when she dies. Mary is a little stricken by this, because she suspects death is not far away. But “she did not dread her death […] she was almost ready for it, not really but getting there”. Mary admits that </p>
<blockquote>
<p>Always, there was that grasping for a few more years, Mary had seen this with many people, and she did not feel it – or she did, but she did not. No. She felt tired out, she felt almost ready, and she could not tell her child this.</p>
</blockquote>
<h2>Sexy old women</h2>
<p>In her essay, <a href="https://fremantlepress.com.au/books/women-of-a-certain-age/">Sexy Old Women</a>, Krissy Kneen has just finished writing a novel that would go on to be shortlisted for the Stella Prize, <a href="https://www.textpublishing.com.au/books/an-uncertain-grace">An Uncertain Grace</a>, in which the main character, Liv, reaches 130 years of age and is still very much a sexual being. Kneen writes: </p>
<blockquote>
<p>The older I get the more I see that the signifiers of sex are inextricably linked to youth. We say young, sexy bodies. We say sexy young things. We do not say sexy old woman. </p>
</blockquote>
<p>In the work of writers such as <a href="https://theconversation.com/love-politics-and-the-fundamental-humanity-of-gabriel-garcia-marquez-25835">Gabriel Garcia Marquez</a>, <a href="https://theconversation.com/philip-roth-was-the-best-post-war-american-writer-no-ifs-or-buts-97108">Philip Roth</a>, Yasunari Kawabata, Michel Houellebecq, <a href="https://theconversation.com/a-clever-operatic-adaptation-of-oscar-and-lucinda-is-let-down-by-music-that-fails-to-captivate-121101">Peter Carey</a>, and <a href="https://theconversation.com/cover-girl-the-difficulty-of-illustrating-lolita-persists-60-years-on-44305">Vladimir Nabokov</a>, Kneen easily finds literary examples of sexual old men. But it is harder to find a model for a sexual older woman, and in the few examples she does find – <a href="https://www.goodreads.com/book/show/69864.In_Praise_of_the_Stepmother">In Praise of the Stepmother</a>, by Mario Vargas Llosa, and <a href="https://www.penguin.com.au/books/the-graduate-9780141190242">The Graduate</a> by Charles Webb (the basis for the 1967 film starring Dustin Hoffman) – the women are portrayed as “dangerous, manipulating, clever enough to cause a man’s downfall”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506768/original/file-20230127-14-5wwdne.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ann Bancroft’s Mrs Robinson, one of the few models for a sexual older woman, is ‘dangerous, manipulating’ in the 1967 film of Charles Webb’s novel, The Graduate.</span>
<span class="attribution"><span class="source">Rialto Pictures</span></span>
</figcaption>
</figure>
<p>Kneen recalls watching the screening of a documentary, <a href="https://barbarahammer.com/films/nitrate-kisses/">Nitrate Kisses</a>, in which a sex scene involving two very old women draws a shocked response from the young audience. Describing the scene as “caring and quite frankly, beautiful” Kneen, though at the time still young herself, hopes that as an old woman she will still be “equally sexually bold”.</p>
<h2>Ripe glamour</h2>
<p>Septuagenarian American novelist and poet <a href="https://www.theparisreview.org/interviews/3040/the-art-of-poetry-no-32-may-sarton">May Sarton</a> famously developed the optimistic concept of “ripening towards death in a fruitful way”. But ripeness as it relates to the elderly, especially elderly women, can be a fraught topic. Some pro-ageing advocates insist that an essential element of a woman ageing well is glamour, but glamour is a construct; in our times it is often measured by the subject’s perceived sexual appeal, as demonstrated by the clichéd poses and facial expressions of those modelling “glamour” in magazines, or on screens. </p>
<p>The pro-ageing movement on Instagram is divided between older women who still lay claim to the glamorous props of their youth – skin-baring garments, high heels, extravagant quantities of makeup – and those who are evolving towards a kind of beauty that does not rely on overt sexuality, but focuses instead on being comfortable in one’s own skin. Neither approach is right or wrong, but of the two ways of going forward, the “less is more” philosophy of the natural agers somehow seems more universally doable. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=451&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=451&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506774/original/file-20230127-22-1b0tbb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=451&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">May Sarton favoured the concept of ‘ripening towards death in a fruitful way’.</span>
</figcaption>
</figure>
<p>The roots of the word “glamour” can be traced to the Scottish word gramarye, meaning “magic, enchantment, spell”, including the lovely phrase “to cast the glamour”. Gramarye may be from an Ancient Greek word for the weight unit of ingredients used in magic potions. Or it is an alteration of the English word “grammar”, in its medieval sense of “scholarship” and especially “occult learning”? </p>
<p>In John Jamieson’s 1825 <a href="https://academic.oup.com/book/35316/chapter-abstract/299965574?redirectedFrom=fulltext">Etymological Dictionary of the Scottish Language</a>, glamer, glamour, is </p>
<blockquote>
<p>the supposed influence of a charm on the eye, causing it to see objects differently from what they really are. Hence to “cast glamer o’er one, to cause deception of sight”.</p>
</blockquote>
<p>This definition draws glamour closer to the Old Norse words glámr, “moon”, or “name of a ghost”, and glámsýni, “illusion” – which makes of glamour a deception, a beauty trick.</p>
<p>Jamieson’s dictionary contains many old words that women might use to describe themselves in ways that stand outside the conventions formed around youthful beauty. </p>
<p>For those of us anticipating our own extreme old age, when we will be more frooch (“frail, brittle”) than now, let us hope we shall still be able to summon the odd moment of gleit (“to glitter”), and that our eyes, our hair, will be touched at times with their old glister (“lustre”).</p>
<p>And looking back over the fiction I’ve drawn on for this essay, I see the writers were both forsy (“powerful”) and formois (“beautiful”). </p>
<h2>The right to relationships</h2>
<p>The <a href="https://agedcare.royalcommission.gov.au/">Royal Commission into Aged Care Quality and Safety</a> was announced by the Morrison government in 2018, following a string of <a href="https://theconversation.com/essential-reading-to-get-your-head-around-australias-aged-care-crisis-103325">disturbing incidents</a> – including South Australia’s <a href="https://www.abc.net.au/news/2018-02-13/oakden-senate-inquiry-criticises-government-response-times/9443778">Oakden Aged Care scandal</a>, where the facility was closed after evidence came to light of neglect and abuse. Among the findings of the Royal Commission were that “sub-standard care and abuse pervades the Australian aged care system”. In its final report, it pronounced this “a source of national shame”. </p>
<p>Reforms suggested by the Royal Commission in any overhaul of Australia’s aged care system include the right of autonomy, the right to the presumption of legal capacity, and in particular the right of elders in residential aged care to make decisions about their care and the quality of their lives, and the right to social participation. </p>
<p>The recommendations state that older people should be supported to exercise choice about their own lives and make decisions to the fullest extent possible, including being able to take risks and be involved in the planning and delivery of their care. They also state that older people are entitled to receive support that acknowledges the aged care setting is their home, and enables them to live in security, safety and comfort, with their privacy respected. </p>
<p>For those of us who are not yet quite ready to access these late-life services, let us hope the Albanese government follows through on the Royal Commission’s recommendations, which state that people should be treated as individuals. And that the relationships older people have with significant others in their lives should be acknowledged, respected, and fostered.</p><img src="https://counter.theconversation.com/content/198416/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Lefevre does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Love and intimacy are valuable for wellbeing at every age. But for older people, especially those in aged care, intimacy can be complicated. Carol Lefevre explores, through real life and fiction.Carol Lefevre, Visiting Research Fellow, Department of English and Creative Writing, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1801332022-03-28T11:33:56Z2022-03-28T11:33:56ZBudget gives $49.5 million for aged care training, but what about wages?<p>Tuesday’s budget will provide $49.5 million for aged care training for existing workers and people who want to work in the sector.</p>
<p>With aged care beset by a shortage of staff as well as an under-trained workforce the funding, over two years, will be for an additional 15,000 subsidised vocational education and training places. </p>
<p>But the sector’s workforce shortages go centrally to the issue of low wages. </p>
<p>The Australian Aged Care Collaboration, said in a Monday statement workers in the sector “should be getting the pay they deserve and career certainty”.</p>
<p>It said the royal commission into aged care had called for higher wages, better qualifications, and more time for staff to spend with those they were caring for.</p>
<p>“As we approach the 2022 federal election, the government and opposition have both so far failed to commit fully to implement and fund the royal commission’s workforce recommendations,” AACC said.</p>
<p>AACC represents six aged care peak bodies whose membership delivers the majority of aged care services in residential and home settings across Australia. </p>
<p>The budget will be firmly focused on the May election, its centrepiece a cost of living package, with a cut in petrol excise, expected to be temporary, and cash handouts to lower and middle income earners, pensioners and others tipped to be main sweeteners.</p>
<p>The government has already unveiled a $17.9 billion infrastructure package, sparking claims the project funding is politically skewed. </p>
<p>q12
On the economic side the budget will forecast that Australia’s unemployment rate, now 4%, will fall to 3.75% in the September quarter. This would be the lowest rate since August 1974 – and three percentage points below the forecast in the October 2020 budget, delivered in COVID’s first year. </p>
<p>The budget will predict unemployment will stay historically low over the forecast period, and wages growth to pick up to their strongest in a decade. The budget’s deficit will be lower than forecast in the December mid-year update.</p>
<p>Treasurer Josh Frydenberg said on Monday:“With more people in work and less people on welfare the budget bottom line is improving after providing unprecedented economic support to Australians.</p>
<p>"But there is more to do and now is not the time to risk the gains we have made in our economic recovery with Labor’s higher taxes.” </p>
<p>Anthony Albanese stressed to reporters the budget reply he will deliver on Thursday “is a speech. It is not an alternative budget.”</p>
<p>However his reply will contain a major policy announcement. </p>
<p>Parliament is back for just one week of sitting, before the election is called for May. </p>
<p>The Senate sitting was brought forward to Monday for a condolence motion for the late Labor senator Kimberley Kitching who died of a suspected heart attack. Her death triggered contested claims that she was bullied by senior Labor women senators, allegedly dubbed “the mean girls” by Kitching and some of her supporters. </p>
<p>In her condolence speech NSW Liberal senator Concetta Fierravanti-Wells, who has just lost out in a preselection battle, drew parallels between her troubles and those of Kitching.</p>
<p>“The concept of mean girls is not confined to one political party,” Fierravanti-Wells said. </p>
<p>“I empathised with Kimberley about the bitter internal factional fights within our respective political parties. We both had factional enemies who desperately wanted to see us defeated, and they worked very hard at it.”</p><img src="https://counter.theconversation.com/content/180133/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tuesday’s budget will provide $49.5 million for aged care training for existing workers and people who want to work in the sector.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1750632022-01-31T23:34:14Z2022-01-31T23:34:14ZWould you pass this financial literacy quiz? Many won’t – and it’s affecting expensive aged care decisions<figure><img src="https://images.theconversation.com/files/441204/original/file-20220118-19-16ka7jy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6720%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Paying for residential aged care accommodation in Australia is complex. Residents can pay a lump sum payment known as a refundable accommodation deposit (RAD), a rental style payment known as a daily accommodation payment (DAP), or a combination of both.</p>
<p>Deciding between the two is an important, complex financial decision and influenced by a host of factors unique to each person. And the stakes are high; it’s common to sell the family home to pay for aged care accommodation. Making the wrong accommodation payment decision could lead to reduced income and wealth, paying more for care, and having less to leave in bequests when you pass away.</p>
<p>Many residents get help from loved ones to navigate their way into residential aged care because they are experiencing age-related cognitive decline. So how do people make this decision and what role does financial literacy play?</p>
<p>To find out, colleagues and I measured financial literacy among 589 informal carers that substantially helped a resident decide. </p>
<p>Our <a href="https://www.mq.edu.au/__data/assets/pdf_file/0004/1182406/The-role-of-financial-literacy-when-paying-for-aged-care_FINAL.pdf">study</a> found less than half of all respondents were financially literate. Many were underconfident in
their financial literacy. Others were overconfident, potentially leading to accommodation payment decision mistakes.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441205/original/file-20220118-15-nd1bgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many residents receive help from loved ones to navigate their way into residential aged care.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weve-had-20-aged-care-reviews-in-20-years-will-the-royal-commission-be-any-different-103347">We've had 20 aged care reviews in 20 years – will the royal commission be any different?</a>
</strong>
</em>
</p>
<hr>
<h2>The role of financial literacy</h2>
<p>Our study explored whether financial literacy influenced the decision to consult a financial adviser and whether financial literacy impacted decision confidence, stress, and perceived decision complexity. </p>
<p>We used a validated financial literacy measure known as the “Big Three” questions. You can do the quiz below; we defined someone as financially literate if they got three questions correct.</p>
<p><iframe id="tc-infographic-629" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/629/31c0d4b67fe36d4880dc9342bc6736418d127b9d/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>This measured literacy on inflation, interest rate, and risk diversification. We also asked respondents to rate their financial literacy.</p>
<p>We found:</p>
<ul>
<li><p>nearly one third of respondents were not certain the accommodation payment decision was the best for the resident financially</p></li>
<li><p>around 60% of respondents found deciding on how to pay for accommodation complex, and over half found deciding how to pay for accommodation stressful</p></li>
<li><p>less than half of all respondents were financially literate. Many were overconfident in their financial literacy, which could lead to worse financial outcomes for the resident. </p></li>
</ul>
<p>Many respondents may have ignored complex information or used a mental shortcut (what researchers call “simplifying heuristics”) when making an accommodation payment decision. For example, they might sell their home and choose a RAD without considering the capital gain they could have received if they had kept the home. </p>
<h2>Getting advice</h2>
<p>Just over one third of respondents used a financial advisor. More financial literacy was unlikely to have increased the use of a financial adviser. Highly financially literate individuals were more likely to use a financial adviser if they perceived their financial literacy as low. </p>
<p>Residential aged care providers also played a role. A respondent was more likely to use a financial adviser if the aged care provider suggested using a financial adviser, or informed them the resident had 28 days to make a payment decision once they entered care. While this condition should be in the final accommodation agreement, it may not be explicitly stated by the provider when discussing accommodation payment options. </p>
<p>We found higher financial literacy may help respondents understand the difference between a RAD and DAP, but was unlikely to increase decision confidence or reduce decision stress.</p>
<p>High financial literacy was associated with greater confidence only if respondents thought they had been enough time to make the decision. This suggests some people could make better decisions if aged care providers gave people more time to make a decision.</p>
<p>Respondents with high financial literacy were also more likely to be confident in their decision if the aged care provider didn’t say whether it preferred the resident to pay a RAD or a DAP. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441206/original/file-20220118-27-1n06mjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Financial literacy education may help some people, but our study suggests benefits will be limited.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So what would help?</h2>
<p>It’s not possible to say whether RAD, DAP, or some combination of both is better; the answer depends on your circumstances. Selling the home when entering care may not be the best option financially.</p>
<p>The <a href="https://www.servicesaustralia.gov.au/financial-information-service">Financial Information Service</a> run by Services Australia can help people better understand their financial affairs and how to use financial planning advice, but does not advise on which accommodation payment type is best. </p>
<p>Financial literacy education may help some people, but our study suggests benefits will be limited. </p>
<p>Each resident has unique financial and personal circumstances. To make an informed accommodation payment decision, you need to factor in and predict the future value of financial assets.</p>
<p>The Australian government is still exploring whether it should remove RADs, as suggested by the Royal Commission on Aged Care Quality and Safety. This would simplify the accommodation payment choice but likely take years to implement. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=265&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=265&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=265&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=333&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=333&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441888/original/file-20220121-9299-620icq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=333&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Royal Commission on Aged Care Quality and Safety recommended RADs be phased out.</span>
<span class="attribution"><span class="source">https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf</span></span>
</figcaption>
</figure>
<p>When discussing accommodation payment options, all residential aged care providers should ensure residents know they have 28 days to make a decision once they enter care. </p>
<p>That will help reduce decision complexity and stress and increase decision confidence. </p>
<p>Providers should also not express their preference for receiving a RAD or DAP, as our results show, this can make the decision more complex for people and give them less confidence in their decision.</p>
<p>The Australian government should also explore subsidising access to financial advice or establishing its own financial adviser service. </p>
<p>This would align with other Australian government programs to improve health and wealth outcomes for older Australians, such as prostate and breast cancer screening and Life Checks.</p>
<p>When moving into residential aged care, good financial outcomes are as important.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/older-australians-are-already-bamboozled-by-a-complex-home-care-system-so-why-give-them-more-of-the-same-173326">Older Australians are already bamboozled by a complex home-care system. So why give them more of the same?</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/175063/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was funded using an unconditional grant from the Ecstra Foundation. MUCHE has received government funding for aged care related work. This story is part of a series on financial and economic literacy funded by Ecstra Foundation.</span></em></p>We measured financial literacy among 589 informal carers that substantially helped an older person make a decision about paying for residential aged care. Less than half were financially literate.Henry Cutler, Professor and Director, Macquarie University Centre for the Health Economy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1697342021-10-18T06:12:03Z2021-10-18T06:12:03ZAged care staff urgently need training to report and prevent sexual assault<figure><img src="https://images.theconversation.com/files/426822/original/file-20211018-27-1nzhgi2.jpg?ixlib=rb-1.1.0&rect=33%2C44%2C7315%2C4858&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/azerbaijan-baku-october-15-2017-600w-768686728.jpg">Shutterstock</a></span></figcaption></figure><p>An estimated <a href="https://www.abc.net.au/news/2020-10-22/aged-care-royal-comm-told-of-50-sex-assaults-a-week/12801806">50 sexual assaults</a> occur nationally every week in Australian residential aged care facilities. Despite this shocking figure, none of the Aged Care Royal Commission’s <a href="https://agedcare.royalcommission.gov.au/publications/final-report">148 recommendations</a> released earlier this year specifically address the prevention of sexual violence. </p>
<p>Our recent <a href="https://pubmed.ncbi.nlm.nih.gov/34399034/">study</a>, published in the International Journal of Older Persons Nursing, found two-thirds of aged care staff had not received any training in prevention of sexual violence in the previous 12 months. Staff confirmed aged care approved providers often do not have dedicated or specific procedures to prevent or manage incidents.</p>
<p>Failing to combat sexual violence in aged care homes demonstrates an apathy towards older survivors and reinforces the existing difficulties faced by older people to achieve a basic human right: to live free from sexual violence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/4-key-takeaways-from-the-aged-care-royal-commissions-final-report-156109">4 key takeaways from the aged care royal commission's final report</a>
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</em>
</p>
<hr>
<h2>Reacting, not preventing</h2>
<p>Australia’s approach to preventing sexual violence in aged care focuses on mandatory reporting obligations set down by the <a href="https://www.agedcarequality.gov.au/sirs">Aged Care Quality and Safety Commission</a>. The rules require staff to define “victim impact” and “incident seriousness”. This approach lacks a scientific basis and deprives the older person of their autonomy – a right included prominently in the Royal Commission recommendations. It also shifts responsibility of complex social, legal and health issues unfairly onto care staff.</p>
<p>In response to the concerns from the aged care sector about how to apply the new rule, this month the regulator released the <a href="https://www.agedcarequality.gov.au/sirs/decision-support-tool/unlawful-sexual-contact">unlawful sexual contact decision support tool</a>. This tool seeks to define incidents as “Priority 1” or “Priority 2” according to how staff, not the survivor, have the perceived seriousness.</p>
<p>Criminal acts of sexual violence, including those perpetrated by staff members, may fall under the tool’s less urgent category – if the resident doesn’t require medical or psychological treatment as judged by the person using the tool. This means reporting to the regulator only needs to occur within a 30-day period. The longer reporting period could put others in danger and cause distress to residents and co-workers.</p>
<p>The regulator <a href="https://www.abc.net.au/radio/programs/worldtoday/anger-over-new-online-sexual-assault-reporting-tool-in-aged-care/13572522">has argued</a> there’s an expectation aged care providers will report any “serious” incident immediately to police and to the regulator. In a statement, the Aged Care Quality and Safety Commission told the ABC this was covered by the question: “Are there reasonable grounds to report the incident to the police?”</p>
<p>However, an earlier <a href="https://www.health.gov.au/resources/publications/prevalence-study-for-a-serious-incident-response-scheme-sirs">report commissioned from KPMG</a> into the prevalence of abuse between aged care residents found aged staff reported no (58.1%) or minor (35%) physical or psychological impact afterwards for those raped or otherwise sexually assaulted survivors. </p>
<p>This report also revealed only 3 of the 1,259 incidents deemed Priority 1 or “very serious” were reported to the police. Although this was before the advent of the decision tool, it highlights the dangers of placing responsibility on individual staff members with inadequate training. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1445149603683201031"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/only-3-8-of-australian-aged-care-homes-would-meet-new-mandatory-minimum-staffing-standards-new-research-165877">Only 3.8% of Australian aged care homes would meet new mandatory minimum staffing standards: new research</a>
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</em>
</p>
<hr>
<h2>Expecting aged care staff to do forensic work</h2>
<p>A fundamental flaw in this tool is that it assumes certain capabilities of aged care staff. </p>
<p>What constitutes reasonable grounds to report to police is a complicated forensic concept. In the aged care setting, incidents of sexual violence may involve both a survivor and a perpetrator with <a href="https://pubmed.ncbi.nlm.nih.gov/30469073/">cognitive impairment</a>. This adds to the already difficult task of “proving” an act of sexual violence has occurred. When the crime involves staff assaulting a resident, <a href="https://humanrights.gov.au/our-work/part-2-sexual-harassment-perspective-bystanders">bystander stress</a> and the daunting task of reporting a co-worker add further complexity. </p>
<p>Asking aged care staff to take on decisions that require policing expertise is dangerous.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman cries in hands" src="https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Asking care staff to determine victim impact is a problem.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1456162018889-1d2b969f7084?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=2073&q=80">Unsplash/Danie Franco</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-hard-to-think-about-but-frail-older-women-in-nursing-homes-get-sexually-abused-too-107013">It's hard to think about, but frail older women in nursing homes get sexually abused too</a>
</strong>
</em>
</p>
<hr>
<h2>Tailored training could help</h2>
<p>At the Health, Law and Ageing Research Unit we have developed an <a href="https://www.monash.edu/__data/assets/pdf_file/0008/2535758/PREVENTING_UNWANTED_SEXUAL_BEHAVIOUR_IN_RESIDENTIAL_AGED_CARE_SERVICES.pdf">e-training intervention</a> to improve sexual violence incident detection, management and prevention. It aims to promote collaboration with expert dementia and sexual violence support services.</p>
<p>The e-training intervention covers key definitions and characteristics, detection, management and ways to support resident victim-survivors, as well as tools to teach staff how to manage residents and prevent incidents.</p>
<p>Participants in our <a href="https://pubmed.ncbi.nlm.nih.gov/34399034/">study</a> who did the training reported better awareness, enhanced reflection on their current practice and improvement in sexual violence workplace management. The majority said they found the training relevant, practical and useful.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1369172598903349249"}"></div></p>
<h2>Only part of the solution</h2>
<p>This training provides a first step to identify the learning needs of this population. It provides a model curriculum to guide development of training initiatives nationally and internationally.</p>
<p>Advocate’s for reform have repeatedly detailed <a href="https://www.lawreform.vic.gov.au/wp-content/uploads/2021/07/Sub_3_Ibrahim_et_al_Health_Law_and_Ageing_Research_Unit_final.pdf">what else should be addressed</a>. This includes engaging government, insurers, boards of management and executives to resource and develop an organisational culture that eliminates sexual violence. </p>
<p>Preventing sexual violence should be of critical concern to Australia. We must move past reactive measures and unsubstantiated approaches such as asking staff to assess the impact of sexual violence. Instead we should be developing solutions to protect residents from incidents ever occurring.</p><img src="https://counter.theconversation.com/content/169734/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim received funding from Commonwealth Social Service (2015-17) and State Health Department (ongoing) for research, education and consultancies into residential aged care services and health care services. He also is an independent advocate for age care reform details available at <a href="https://www.profjoe.com.au/">https://www.profjoe.com.au/</a></span></em></p><p class="fine-print"><em><span>Amelia Grossi is a research assistant for The Victorian Institute of Forensic Medicine, Health, Law & Ageing Research Unit, Monash University. </span></em></p><p class="fine-print"><em><span>Daisy Smith is a research officer for The Department of Forensic Medicine, Health Law & Ageing Research Unit, Monash University.</span></em></p><p class="fine-print"><em><span>Meghan Wright is a research assistant for The Victorian Institute of Forensic Medicine, Health, Law & Ageing Research Unit, Monash University.</span></em></p>There are around 50 sexual assaults in Australian aged care homes every week. But staff are expected to assess the severity and impact of incidents without training.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityAmelia Grossi, Monash UniversityDaisy Smith, Research Assistant, Monash UniversityMeghan Wright, Research assistant, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1647072021-07-20T03:25:17Z2021-07-20T03:25:17ZWhen COVID is behind us, Australians are going to have to pay more tax<figure><img src="https://images.theconversation.com/files/412060/original/file-20210720-25-zuxlcu.jpg?ixlib=rb-1.1.0&rect=40%2C307%2C3385%2C2063&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australian Tax Office</span> </figcaption></figure><p>The biggest unstated message from the <a href="https://treasury.gov.au/publication/2021-intergenerational-report">intergenerational report</a> released during the lull between lockdowns is that we will need more tax.</p>
<p>Not now. At the moment it’s a matter of throwing everything we’ve got at getting on top of the COVID outbreaks and worrying about how to (and the extent to which we will need to) pay for it later.</p>
<p>But when the economy is healthy again, taxes are going to have to rise, big time. </p>
<p>That the intergenerational report doesn’t say so explicitly might be because the government is sticking with its arbitrary and implausible guarantee that tax collections will never climb above <a href="https://www.afr.com/policy/tax-and-super/scott-morrisons-tax-cap-straitjacket-starts-to-bite-20180502-h0zj9t">23.9% of GDP</a>, which is the average between the introduction of the goods and services tax and the global financial crisis.</p>
<p>Or it might be because what’s needed sits oddly with legislated high-end tax cuts likely to cost <a href="https://www.smh.com.au/politics/federal/pandemic-will-help-make-stage-3-tax-cuts-cheaper-20210507-p57pzg.html">$17 billion</a> per year from 2024-25.</p>
<p>Among the drivers of increased government spending identified by the report is spending on health, at present 4.6% of gross domestic product, and on the report’s projections set to climb to 6.2% over the next 40 years.</p>
<h2>We’ll want better health</h2>
<p>To fund that alone the government will need to collect 6% more tax in 2061 than had spending on health stayed where it was as a proportion of GDP.</p>
<p>Perhaps surprisingly, most of the extra spending on health won’t be a direct result of the population ageing. It’ll be because health technologies are getting better and becoming much, much more expensive (à la the COVID vaccines). And because incomes are rising. </p>
<p>Rising incomes, the report explains, are the largest driver of government spending on health internationally. </p>
<p>That’s because for some things, including the provision of hospitals, private spending can’t cut it, no matter how well off you are. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=975&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=975&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=975&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1226&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1226&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412054/original/file-20210720-19-tbn5yv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1226&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australia’s richest man needed hospitals as much as anyone.</span>
<span class="attribution"><span class="source">AP</span></span>
</figcaption>
</figure>
<p>After billionaire Kerry Packer suffered a massive heart attack while playing polo in 1990, he was rushed to Sydney’s Liverpool Hospital.</p>
<p>When the ANU election survey began in 1990, 54% of Australians surveyed regarded health as “extremely important” in determining their vote. It’s now 70%. In 1990 11% regarded health as “not very important”. It’s now just <a href="https://australianelectionstudy.org/wp-content/uploads/Trends-in-Australian-Political-Opinion-1987-2019.pdf">2%</a>.</p>
<p>The intergenerational report has spending on aged care climbing from 1.2% to 2.1% of GDP, which by itself means the tax take will have to be 4% higher than otherwise, but it was prepared ahead of the government’s final response to the aged care royal commission. </p>
<p>The interim response had 14 (mostly expensive) recommendations subject to “<a href="https://www.health.gov.au/sites/default/files/documents/2021/05/australian-government-response-to-the-final-report-of-the-royal-commission-into-aged-care-quality-and-safety.pdf">further consideration</a>”.</p>
<p>The National Disability Insurance Scheme already accounts for one in 20 tax dollars collected and is set to overtake Medicare. </p>
<p>The report says the government’s response to the royal commission into disability care presently underway is likely to place “additional pressure” on costs.</p>
<h2>We’ll need to spend more than projected</h2>
<p>None of this extra spending is bad if it delivers value for money, and it’s what the public wants. But it is hard to reconcile with official projections in the report showing government spending climbing only 2.5% per year in real terms over the next 40 years, compared to 3.4% per year in the past 40.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/intergenerational-report-to-show-australia-older-smaller-in-debt-163474">Intergenerational report to show Australia older, smaller, in debt</a>
</strong>
</em>
</p>
<hr>
<p>The report gets there in part by an outrageous sleight of hand. It says JobSeeker and other payments will become tiny as a proportion of GDP because they will only climb with inflation (which is typically low) rather than wage growth or GDP growth (which is typically higher, and lines up with how the pension grows).</p>
<p>A moment’s reflection would show that if that actually happened for 40 years — which is what the treasury’s report assumes — JobSeeker would fall from 70% of the single age pension to a hard-to-justify 40%.</p>
<hr>
<p><strong>JobSeeker and age pension as projected in intergenerational report</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=247&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=247&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=247&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=310&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=310&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412051/original/file-20210720-15-jrjreu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=310&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Payment for a single person, dollars per fortnight. JobSeeker indexed to IGR inflation projections, pension indexed to IGR wage projections.</span>
</figcaption>
</figure>
<hr>
<p>We know it won’t happen because it hasn’t happened. </p>
<p>JobSeeker was boosted this year after only <a href="https://theconversation.com/the-50-boost-to-jobseeker-will-take-australias-payment-from-the-lowest-in-the-oecd-to-the-second-lowest-after-greece-155739">20 years</a> rather than 40 in order to make sure that sort of thing wouldn’t happen.</p>
<p>And we know there’s nothing to stop an intergenerational report using more realistic assumptions. </p>
<p>The 2015 report, released at a time when the Abbott government planned to adjust the pension in line with the more miserly JobSeeker formula, relaxed the assumption after <a href="https://treasury.gov.au/publication/2015-igr">13 years</a> because if it left it in place the pension would slide untenably below community expectations.</p>
<h2>We’ll easily be able to afford more tax</h2>
<p>There’s nothing wrong with paying more tax if it’s for things we want, like better health care, better aged care, better disability care and benefits we can live on.</p>
<p>The intergenerational report has government spending climbing by four percentage points of GDP between now and 2061. But it also has real GDP per person almost doubling, climbing 80%.</p>
<p>Even if that’s an overestimate and GDP per person grows by, say, 50%, and the need for tax grows by more than four points, we’ll easily be able to afford the extra tax, and we’ll want what that tax will buy. Expectations climb with income.</p>
<p>The present government will be long gone by the time the tax to GDP ratio reaches its “cap” of 23.9% of GDP (which the report expects in 2035).</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=967&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=967&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=967&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1215&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1215&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412057/original/file-20210720-15-13zncps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1215&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mathias Cormann has moved to the OECD where average tax rates are high.</span>
<span class="attribution"><span class="source">Ian Langsdon/EPA</span></span>
</figcaption>
</figure>
<p>The finance minister who came up with the cap, <a href="https://www.skynews.com.au/australia-news/politics/finance-minister-mathias-cormann-has-announced-a-tax-rule-for-the-turnbull-governments-budget-limiting-it-from-exceeding-a-threshold-of-239-per-cent-of-gpd/video/8d378e1aa4e3ca862a0c438d69484500">Mathias Cormann</a>, is now head of the Organisation for Economic Co-operation and Development, in which the average tax take is <a href="https://data.oecd.org/tax/tax-revenue.htm">34%</a> of GDP.</p>
<p>An obvious place to look for the tax is high-income senior citizens, at present enjoying tax-free super, <a href="https://theconversation.com/words-that-matter-whats-a-franking-credit-whats-dividend-imputation-and-whats-retiree-tax-111423">refundable franking credits</a> and special tax offsets. </p>
<p>Grattan Institute calculations suggest an older household earning $100,000 pays <a href="https://theconversation.com/intergenerational-reports-ought-to-do-more-than-scare-us-they-ought-to-spark-action-163505">less than half</a> the tax of a working-age household on the same amount.</p>
<p>Like the households of less well-off seniors, those households are highly likely to use the services tax provides.</p>
<p>To say we’ll need more tax is not to say the government needs to fund all of its spending with tax. </p>
<p>It is projecting budget deficits for the next <a href="https://theconversation.com/intergenerational-report-to-show-australia-older-smaller-and-more-in-debt-163474">40 years</a>. Budgets have been in deficit for all but a few of the <a href="https://theconversation.com/memories-in-1961-labor-promised-to-boost-the-deficit-to-fight-unemployment-the-promise-won-115376">past 100 years</a>.</p>
<p>But it will need to cover much of it with tax to keep the economy in check. If we want what tax provides, we’ll be prepared to pay it.</p><img src="https://counter.theconversation.com/content/164707/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Martin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If we want the latest health care, disability care and aged care, we’ll have to be prepared to pay for it.Peter Martin, Visiting Fellow, Crawford School of Public Policy, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1569372021-04-09T04:19:49Z2021-04-09T04:19:49ZDesign makes a place a prison or a home. Turning ‘human-centred’ vision for aged care into reality<figure><img src="https://images.theconversation.com/files/393005/original/file-20210401-13-udbqnp.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6519%2C3831&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The <a href="https://agedcare.royalcommission.gov.au/">Royal Commission into Aged Care</a> left organisations that provide housing for aged care wondering how they will put its <a href="https://agedcare.royalcommission.gov.au/publications/final-report">recommendations</a> into effect. Most of these recommendations relate to the models of care and levels of staffing in homes. Put simply, in the architectural rabbit warrens that typify aged-care facilities, there can never be enough staff to manage every nook. </p>
<p>Models of care are also difficult to change when the architecture is obsolete. Yet these difficulties aren’t detailed in the report. It barely mentions architecture. Only two of the 148 recommendations relate specifically to architecture, numbers 45 and 46: to improve the design of residential care accommodation; and to provide “small household” models of accommodation. </p>
<p>But don’t be mistaken. Architecture has a profound impact on how we live our lives, work and respond socially. </p>
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Read more:
<a href="https://theconversation.com/4-key-takeaways-from-the-aged-care-royal-commissions-final-report-156109">4 key takeaways from the aged care royal commission's final report</a>
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<p>If architects are able to work with some basic design rules – to design to a vision, with simplicity and a non-institutional design language – architecture can play a role in implementing the bulk of the recommendations. But, if the importance of design is neglected, obsolete architectural models will undermine the best efforts to reform the models of care. </p>
<h2>We can design to remove restraint</h2>
<p>Architecture is a critical element of “embedding a human rights-based and human-centred approach to care”, the focus of chapter 3 of the royal commission’s <a href="https://agedcare.royalcommission.gov.au/publications/final-report">report</a>. To understand the relationship between architecture and human rights, consider how human rights are taken away: look at prisons, detention centres, mental health facilities and even the residences where we care for our elderly citizens. Invariably, it’s architecture that stifles the freedom of movement, the dignity, the freedom of association, choice and other rights. </p>
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<strong>
Read more:
<a href="https://theconversation.com/the-bad-buildings-scream-lessons-from-don-dale-and-other-failed-institutions-81990">The bad buildings scream – lessons from Don Dale and other failed institutions</a>
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<p>The commission <a href="https://agedcare.royalcommission.gov.au/publications/background-paper-4-restrictive-practices-residential-aged-care-australia">estimates</a> architectural solutions to seclusion and other forms of physical restraint are used on 25-50% of all residents of high-care residences. These restraints can look innocuous – including “seating residents in chairs with deep seats, or rockers and recliners, that the resident cannot stand up from”. But for residents who can’t get up on their own, deep seats restrict their freedom of movement and ability to make their own choices about as much as handcuffs do. </p>
<figure class="align-center ">
<img alt="old women being helped to get out of a chair" src="https://images.theconversation.com/files/393007/original/file-20210401-17-1rstrxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393007/original/file-20210401-17-1rstrxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393007/original/file-20210401-17-1rstrxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393007/original/file-20210401-17-1rstrxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393007/original/file-20210401-17-1rstrxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393007/original/file-20210401-17-1rstrxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393007/original/file-20210401-17-1rstrxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When a person can’t get up from a seat unaided, it becomes a form of restraint.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/search/aged+care+armchair">Shutterstock</a></span>
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<p>The forms of restraint (including in high-care aged-care residences) are increasingly disguised, but a locked door remains impenetrable even if it’s made of clear glass. Along with fences and high walls, such features are designed to keep some people in and others out. </p>
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Read more:
<a href="https://theconversation.com/retire-the-retirement-village-the-wall-and-whats-behind-it-is-so-2020-135953">Retire the retirement village – the wall and what’s behind it is so 2020</a>
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<h2>Or we can design for quality of life</h2>
<p>If people fail to see how the design of a prison is the primary instrument for imprisonment, then it’s also hard to comprehend just how much good architecture improves people’s circumstances and well-being. But a well-designed aged-care building is replete with wholesome invitations to do such things as explore gardens without putting residents at undue risk. </p>
<p>In turn, spending time outdoors helps prevent “sundowning” – people with dementia may become more confused, restless or insecure late in the afternoon or early evening. It also improves the resident’s experience (personal well-being and satisfaction). Recent unpublished data (in review) shows time outdoors even protects against viral flu-like infections. </p>
<p>And that’s just one example of the benefits of good design. All good architectural choices have similarly positive effects. </p>
<h2>3 principles for human-centred design in aged care</h2>
<p><strong>Principle 1: projects are driven by a vision that maintains and enables human dignity, even for people with cognitive impairment.</strong></p>
<p>A vision includes a single, well-articulated concept that cannot be dismissed or ignored. The vision creates a hierarchy in which important things are valued more than anything else. A vision that makes human dignity a priority ensures other functional or pragmatic concerns do not lead to human rights being deprioritised. </p>
<p>A good vision isn’t just words or intentions. It involves concrete decisions that are armed with bravery and honesty. Bravery because a good vision always aspires beyond known benchmarks and guidelines. Honesty, because a good vision isn’t shy about speaking the truth. </p>
<p>The diagram below shows an example of a vision in which high-care aged-care residences were to be incorporated into a new precinct for the University of Wollongong. The vision prioritised human centredness – a human-centred workplace, a student-centred learning environment, patient-centred aged-care residences and a person-centred environment overall. </p>
<p>The above vision led to this conceptual diagram.</p>
<p>The conceptual diagram was developed as a masterplan.</p>
<p>In this concept, the educational, residential (non-aged-care) and health facilities make natural walls around a shared village. Car-free streets, cafes, shops, parklands and a distributed residential aged-care facility create a pleasant and safe environment for everybody. The exterior buildings are accessible from both sides for students and staff, but not for high-care residents unless they are accompanied. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aged-care-isnt-working-but-we-can-create-neighbourhoods-to-support-healthy-ageing-in-place-148635">Aged care isn't working, but we can create neighbourhoods to support healthy ageing in place</a>
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<p><strong>Principle 2: keep it simple.</strong></p>
<p>As cognitive abilities decline, this reduces people’s capacity to deal with complexity. So keep design simple, with destinations that are visible and clear. </p>
<p>Think about turning all bedrooms inwards to provide immediate access to common spaces, activities and gardens. The reception, all offices and commercial facilities can face outwards, and be invisible to residents. </p>
<p>Simplifying the layout also aids staff. Hidden spaces and doors to unsafe places cause anxiety for residents and staff alike, adding to the staffing burden. </p>
<p>Simple design doesn’t mean plain. It means keeping plans simple - especially for the residents, who have all they might need (and all they want) immediately visible. All no-go areas are hidden.</p>
<p><strong>Principle 3: Residential means non-institutional.</strong></p>
<p>Much as they assist with routines of care, residences are residences. They are ruined by staff stations and institutional touches like vinyl flooring, strip lighting and furniture lined up against the walls. </p>
<p>Residents’ bedrooms must be customisable – meaning people should be able to hang their own art, listen to their own music, and have their own furniture and belongings. After all, these rooms are where people live. And how can people feel at home, unless they are allowed to feel at home with their surroundings? </p>
<p>The left image shows a relatively typical scene in an Australian residential-care facility. The details are institutional – the windows, the lighting, the residents lined up along a wall. The opposite (right) is a residential milieu. Which one would you choose?</p><img src="https://counter.theconversation.com/content/156937/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jan Golembiewski is the director and registered architect at Psychological Design, a firm that specialises in architecture that cares. </span></em></p>Remaking aged care in Australia starts with embracing people-centred design. Instead of the institutional model with its focus on restraint, we need to understand and design for people’s needs.Jan Golembiewski, Researcher, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1521912021-03-15T18:57:01Z2021-03-15T18:57:01ZIn 2020 our workforce and caring system broke. They are the same thing<figure><img src="https://images.theconversation.com/files/388985/original/file-20210311-18-q01iuh.jpg?ixlib=rb-1.1.0&rect=694%2C135%2C1989%2C1204&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">George Rudy/Shutterstock</span></span></figcaption></figure><p>The 2020 pandemic and bushfire crises exposed longstanding weakness in our labour market and the child-care, aged care and disability care systems.</p>
<p>They are two sides of the same coin.</p>
<p>To"‘build back better", work, care and family policies must support decent work <em>and</em> high quality care.</p>
<p>An evaluation of the impact of the crisis by the <a href="https://www.workandfamilypolicyroundtable.org/wp-content/uploads/2020/12/Work-Family-Policy-Roundtable_FINAL-Statement_Dec-11.pdf">Work and Family Policy Roundtable</a> finds that in addition to disproportionately harming female workers, precarious employment, low wages and the absence of rights such as paid sick and carers’ leave, harm the quality of care.</p>
<p>Many formal care services for the aged, children, and people with disability, already strained, collapsed under the pressure of the pandemic. </p>
<p>This has been documented by the Royal Commission into <a href="https://agedcare.royalcommission.gov.au/">aged care</a> quality and safety, and the Royal Commission into violence, abuse, neglect and exploitation of <a href="https://disability.royalcommission.gov.au/">people with disability</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/50-of-australians-are-prepared-to-pay-more-tax-to-improve-aged-care-workers-pay-survey-shows-156299">50% of Australians are prepared to pay more tax to improve aged care workers' pay, survey shows</a>
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<p>Closed schools and working from home added to the care crisis as massive amounts of care were channelled into domestic homes, <a href="https://onlinelibrary.wiley.com/doi/10.1111/gwao.12497">exacerbating inequalities</a> in the distribution of paid and unpaid work and raising concerns about shadow pandemics of <a href="https://www.aic.gov.au/publications/sb/sb28">domestic violence</a>, <a href="https://www.mja.com.au/journal/2020/mental-health-people-australia-first-month-covid-19-restrictions-national-survey">mental illness</a> and <a href="https://csrm.cass.anu.edu.au/sites/default/files/docs/2020/6/Alcohol_consumption_during_the_COVID-19_period.pdf">substance abuse</a>.</p>
<p>The <a href="https://www.workandfamilypolicyroundtable.org/">Roundtable</a> was established in 2005 as a research network of what are now 33 academics from 17 institutions with expertise in work, care and family policy.</p>
<p>We propose a four-part program to fix our broken work and care systems.</p>
<h2>1. Protection for workers</h2>
<p>A robust floor of universal worker rights across all sectors that provides:</p>
<ul>
<li><p>a right to paid leave for all workers </p></li>
<li><p>paid time for training </p></li>
<li><p>an effective right to equal remuneration </p></li>
<li><p>a cap on long working hours that is enforced </p></li>
</ul>
<p>Over and above this floor, workers need genuine industry bargaining to address industry-specific issues relating to notice of shifts, minimum engagements and sufficient guaranteed hours.</p>
<h2>2. Infrastructure for care</h2>
<p>The infrastructure for a more inclusive, accessible, resilient, and caring society should include</p>
<ul>
<li><p>universal free high-quality early childhood education and care with robust and transparent quality standards that are publicly audited and enforced</p></li>
<li><p>high quality, adequately and securely resourced aged care and disability services</p></li>
<li><p>business models and governance arrangements for all care service providers that are transparent and fit for purpose</p></li>
<li><p>providers that are fully accountable for the expenditure of public money and the provision of high-quality accessible services</p></li>
<li><p>accessible and responsive respite, end of life and palliative care and other services to support unpaid carers</p></li>
<li><p>the extension of paid “care leave” to all workers, including at least nine months paid parental leave incorporating three months dedicated leave for each parent</p></li>
<li><p>workplace flexibility that works for women and other worker-carers that gives workers voice, control, predictability and security</p></li>
</ul>
<h2>3. A sustainable workforce</h2>
<p>The federal government is effectively the lead employer for contracted out care services and must act to redress low wages, casualised conditions, underemployment and fragmented working time schedules.</p>
<ul>
<li><p>industry awards must be revitalised to recognise and remunerate the skills frontline workers currently use and provide clear career paths with meaningful wage increases as workers progress. </p></li>
<li><p>the government must commit to policy and funding arrangements that end structural gender pay inequity in frontline care jobs.</p></li>
</ul>
<h2>4. Useful data</h2>
<p>In Australia there is very little data on or publicly-available analysis of decisions that affect workers with caring responsibilities. We suggest</p>
<ul>
<li><p>all government and private sector data that tracks workforce characteristics be able to be disaggregated by gender together with characteristics such as Indigenous status, birthplace and visa status, age, disability, sexual orientation and forms of employment and care responsibilities</p></li>
<li><p>the Bureau of Statistics publish hourly wage rates that includes managerial as well as non-managerial employees to identify the gender pay gap for different groups of women</p></li>
<li><p>the Parliamentary Budget Office publish an overall gender analysis of government policies and programs</p></li>
<li><p>all new policies and programs, including those put in place to ameliorate the impact of COVID-19, be subjected to a rigorous gender-impact evaluation </p></li>
</ul>
<p>This agenda would help deliver prosperity, equality, and a better life for all.</p><img src="https://counter.theconversation.com/content/152191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span> </span></em></p><p class="fine-print"><em><span>Sara Charlesworth receives funding from the Australian Research Council</span></em></p>We’ve developed a four-point plan to build back better.Elizabeth Hill, Associate Professor Political Economy and Deputy Director, The Gender Equality in Working Life Research Initiative, University of SydneySara Charlesworth, Professor, School of Management, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1565752021-03-05T03:18:25Z2021-03-05T03:18:25ZVIDEO: Michelle Grattan on the royal commission into aged care, Christian Porter and Linda Reynolds<p>University of Canberra Professorial Fellow Michelle Grattan and Director of the Institute for Governance & Policy Analysis Dr Laine Dare discuss the week in politics.</p>
<p>This week the pair discuss some of the 148 recommendations made by the Royal Commission into Aged Care, including the likelihood and feasibility of their adoption. Also discussed, the allegations against Christian Porter, the national accounts figures released on Wednesday, and Linda Reynold’s political future.</p>
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<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>University of Canberra Professorial Fellow Michelle Grattan and Director of the Institute for Governance & Policy Analysis, Dr Laine Dare discuss the week in politics.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1562072021-03-01T07:11:42Z2021-03-01T07:11:42ZView from The Hill: royal commission confronts Morrison government with call for aged care tax levy<p>The Royal Commission into Aged Care Quality and Safety has recommended a levy to help fund aged care on a sustainable basis, and given the federal government two radically different options for running a reformed system.</p>
<p>Releasing the multi-volume report on Monday, Prime Minister Scott Morrison played down the prospect of the government adopting the levy proposal, which would go against its mantra of not raising tax.</p>
<p>The commission’s long-awaited final report, titled Care, Dignity and Respect, with 148 recommendations, complicates the government’s already massive task in trying to overhaul what is recognised to be an ill-functioning system.</p>
<p>In some areas it leaves questions rather than provides answers – such as how much extra money will be needed.</p>
<p>In other areas, it invites difficult choices between competing options presented by the two commissioners, Tony Pagone and Lynelle Briggs. They have split on the fundamental issue of how best to administer the system, as well as on the best way to improve the present inadequate regulatory arrangements.</p>
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<p>Aged care is a federal government responsibility and the pandemic exposed the vulnerabilities in the system, with the majority of COVID-19 deaths occurring among aged care residents.</p>
<p>In an immediate response to the commission report, the government announced $452 million over the forward estimates, for limited initiatives in the areas of home care, residential aged care quality and safety, improving services in residential care; workforce growth, and governance measures.</p>
<p>The government’s main response is due at budget time. But much work will need to be done to craft a policy.</p>
<p>As expected, the commission is damning about the inadequacies in the present system.</p>
<p>“A profound shift is required in which the people receiving care are placed at the centre of a new aged care system. In the words of one commentator, aged care does not ‘need renovations, it needs a rebuild’,” Pagone writes in his preface.</p>
<p>The commissioners found a “gloomy picture” of systemic problems. Many of the sector’s people and institutions “are overwhelmed, underfunded or out of their depth”.</p>
<p>Briggs said that at least one in three people accessing residential care or home care services “have experienced substandard care”.</p>
<p>The commissioners jointly call a new Aged Care Act putting older people first, entitling them to high quality and safe care based on their needs.</p>
<p>While both stress the need for fundamental change, Pagone argues the system should be run by an independent commission, while Briggs favours strengthening the existing system of government administration.</p>
<p>As Pagone writes the decision will be up to the government and, “The adoption of one model over the other will have consequences for many … of the recommendations we make.”</p>
<p>It would be a huge step for the government to go down the road of an independent commission.</p>
<p>Briggs argues that establishing a new Australian Aged Care Commission would only delay important reforms. Such an arms-length body would also “weaken the direct accountability” of ministers for the quality of care.</p>
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<a href="https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386953/original/file-20210301-21-5c1van.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>Her alternative “Government Leadership” model would include greater independence in certain areas such as quality regulation and pricing, but maintain a strong federal government system leadership and stewardship role. </p>
<p>The commissioners propose tougher regulation of the system, with Pagone saying, “The move to ritualistic regulation was a natural consequence of the Government’s desire to restrain expenditure in aged care”.</p>
<p>They advocate different regulation arrangements. With Briggs supporting greater independence. They “both recommend stronger accountability through the establishment of an Inspector-General of Aged Care”.</p>
<p>The findings on home packages contradict the government’s claims about how well it has done in this area.</p>
<p>Pagone writes that people have waited about seven months for the lowest level of need and about 34 months for those with the highest need.</p>
<p>“Something has gone badly wrong when those most in need are forced to wait the longest for care,” he observes.</p>
<p>On funding, Pagone set out a proposal for an Aged Care levy, which would mean “each person will contribute toward the financing of the aged care system through their working life” according to their income. They would then be able to access it when they needed it, without a means test – as happens with Medicare.</p>
<p>Briggs puts forward an “aged care improvement levy” on personal taxable income of 1% to fund the increasing costs of aged care.</p>
<p>Asked about the levy Morrison said: “We’ll consider those things. You know our government’s disposition when it comes to increased levies and taxes. It is not something we lean to.”</p>
<p>He recalled that when he was treasurer, “I once sought to increase the Medicare levy by 0.5% to support the National Disability Insurance Scheme and I wasn’t supported in that by the Labor Party or the Greens for that matter.</p>
<p>"So that’s something that I’ve seen in other contexts that the parliament hasn’t supported before. So you’d forgive me for being a little wary at this point.”</p>
<p>The commission recommends an extensive shakeup of workforce arrangements, including registration of personal care workers, and professionalising the workforce through changes to education, training, wages, labour conditions and career progression. </p>
<p><iframe id="0n1Zw" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/0n1Zw/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p><img src="https://counter.theconversation.com/content/156207/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After two years, the Royal Commission into Aged Care Quality and Safety has handed down its final report .Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1510252020-11-29T10:02:05Z2020-11-29T10:02:05Z3 ways to transform our ‘Soviet-style’ aged-care mess into a system that puts older Australians first<figure><img src="https://images.theconversation.com/files/371694/original/file-20201127-20-913ys6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C997%2C699&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-lady-60152803">Shutterstock</a></span></figcaption></figure><p>Australia’s aged-care system is in sore need of transformation. This is becoming increasingly clear. If the Royal Commission into Aged Care Quality and Safety — whose interim report was titled <a href="https://agedcare.royalcommission.gov.au/publications/interim-report">Neglect</a> — was not enough to demonstrate the need for change, the <a href="https://agedcare.royalcommission.gov.au/publications/aged-care-and-covid-19-special-report">tragic impact of COVID-19 on residential care</a> has tipped it over the edge.</p>
<p>Many older Australians say they are not getting the care and support they need. Families complain of unchecked neglect and abuse. Many aged-care providers are saying the sector’s services are <a href="https://www.australianageingagenda.com.au/executive/peaks-say-aged-care-sector-unsustainable/">underfunded</a>. Care staff say they are <a href="https://anmj.org.au/aged-care-workers-underpaid-undervalued-and-short-staffed-royal-commission-told/">overworked and underpaid</a>. And many older Australians are <a href="https://www.myagedcare.gov.au/help-at-home/home-care-packages">waiting more than a year</a> to get the home care package they need.</p>
<p>At its core, Australia’s aged care is a Soviet-style, centrally planned and rationed system that controls availability of home care packages and beds from Canberra. It focuses on the transactional relationships between government and providers, rather than on delivering for the vulnerable older Australians it is meant to support.</p>
<p>The royal commission’s findings have prised open a window for reform. Before it slams shut again, we need to reshape the aged-care system to put the rights of older Australians at its heart.</p>
<p>Last month, Grattan Institute <a href="https://grattan.edu.au/report/rethinking-aged-care/">published a report</a> that argued a reformed system should be based on enhancing the rights of older Australians.</p>
<p>Today, we release a <a href="https://grattan.edu.au/report/reforming-aged-care-a-practical-plan-for-a-rights-based-system/">second report</a> detailing what this actually means in practice. It sets out a new rights-based system design with a new funding and governance model.</p>
<p>The report identifies three key changes needed to create a rights-based system that would empower older Australians to get the support they need to be independent and engaged in the community for as long as possible.</p>
<h2>1. Tailor services to people’s needs</h2>
<p>Currently, the aged-care system is capped, meaning the government supports only a certain number of people in home care and residential care at a given time. This means many older Australians are left without the support they need. As a result, some people end up in residential care when home care would have been better for them and, potentially, cheaper for taxpayers too.</p>
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<img alt="Woman preparing vegetables in kitchen" src="https://images.theconversation.com/files/371684/original/file-20201127-21-jisl2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371684/original/file-20201127-21-jisl2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371684/original/file-20201127-21-jisl2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371684/original/file-20201127-21-jisl2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371684/original/file-20201127-21-jisl2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371684/original/file-20201127-21-jisl2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371684/original/file-20201127-21-jisl2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many older Australians would rather stay in their own homes to receive care, but the system currently caps these options.</span>
<span class="attribution"><span class="source">Cade Martin/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>We believe older Australians who need support should have universal access to care. Just like Medicare, access to aged care should be based on need, not on people’s capacity to pay.</p>
<p>Under our proposed model, funding for aged care would match a person’s individual care needs. This should be documented in individual support plans, which then form a contract about the care that person should receive. This would cater for people’s diverse care needs and allow more people to receive care at home.</p>
<p>But this universality should only cover necessary care services, such as nursing. Non-care services, such as cleaning or gardening, should be means-tested.</p>
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Read more:
<a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">So you're thinking of going into a nursing home? Here's what you'll have to pay for</a>
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<h2>2. Bring the system to the local level</h2>
<p>Older Australians should receive face-to-face help to obtain a range of high-quality service options.</p>
<p>Instead of a poorly regulated and fragmented system with accountability far away in Canberra, 30 regionally based independent “system managers” across the country should be made responsible for the care of older Australians in a defined geographic area.</p>
<p>They should be the local gateway for older people into the aged-care system and provide a “one-stop shop” for all older people who need care – helping them develop their support plans and negotiate access to services.</p>
<p>They should manage the local service system in their region, and only accredit service providers dedicated to the rights of older Australians. A “national system steward”, like an independent Australian Aged Care Commission, would hold the regional bodies to account and ensure equity and performance across the whole system.</p>
<h2>3. Enhance the voice of older Australians</h2>
<p>Rather than viewing older Australians as passive recipients of care, we should empower and encourage them to raise issues and engage socially in the community.</p>
<p>Community representative committees in each region should be established that are connected to a national body. Working with regional system managers, they should enhance the independence of older people through social participation programs, promoting healthy ageing, and better integrating the aged-care system with health care and other non-aged-care services.</p>
<h2>Funding is vital</h2>
<p>These three measures on their own won’t be enough. A raft of fundamental changes will be needed to fix the system, and nothing will improve unless the federal government spends more on aged care. </p>
<p>We estimate our proposed changes will require an extra A$7 billion per year – a 35% increase on current spending. And even more will be needed as the population continues to age.</p>
<p>Significant reform is also needed to ensure better pay and support for staff. In residential care, <a href="https://agedcare.royalcommission.gov.au/system/files/2020-06/AHS.0001.0001.0001.pdf">regulations should mandate minimum carer-to-resident ratios</a> and 24-hour nursing supervision.</p>
<p>Aged care also needs to be more accountable and transparent. We recommend a <a href="https://agedcare.royalcommission.gov.au/publications/research-paper-15-residential-care-quality-indicator-profile">public reporting system</a> to monitor the quality of care.</p>
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Read more:
<a href="https://theconversation.com/older-australians-deserve-more-than-the-aged-care-royal-commissions-covid-19-report-delivers-147273">Older Australians deserve more than the aged care royal commission's COVID-19 report delivers</a>
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<p>Of course, creating a new aged-care system will take time. We propose that our model be phased in over three years, beginning with a trial in the smaller states of South Australia and Tasmania, and with emergency funding measures to immediately lift the quality of residential care.</p>
<p>Australia cannot let this window for change close without demanding a better support system that upholds the rights of older Australians.</p><img src="https://counter.theconversation.com/content/151025/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett is a member of the board of directors of the Brotherhood of St Laurence which, among other services, is a provider of aged care. Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website. </span></em></p><p class="fine-print"><em><span>Anika Stobart does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The royal commission into aged care has opened a priceless window for reform. A Grattan Institute report says this requires more funding, local accountability, and a louder voice for older Australians.Stephen Duckett, Director, Health Program, Grattan InstituteAnika Stobart, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1473072020-10-01T14:36:57Z2020-10-01T14:36:57ZFederal government did not prepare aged care sector adequately for COVID: royal commission<p>The royal commission into aged care has said government did not prepare the sector well enough for the pandemic.</p>
<p>In a damning report the commission rejected the government’s repeated claim it had a plan for aged care, which is a federal responsibility.</p>
<p>The commission said that now “is not the time for blame” for what happened in aged care, where most of the Australian deaths have occurred – as at September 19, 629 out of 844 total deaths. The latest number of deaths from residential aged care is 665.</p>
<p>But, the commission said, it was clear the measures implemented by the federal government on advice from the Australian Health Protection Principal Committee “were in some respects insufficient to ensure preparedness of the aged care sector”.</p>
<p>It called for immediate action on infection prevention and to ensure residents weren’t cut off from visitors.</p>
<p>In its special report into COVID, the commission said the government should establish a national aged care plan and a permanent aged care advisory body.</p>
<p>Under pressure from evidence to the commission, the government belatedly set up an advisory committee in August but made it clear it was temporary.</p>
<p>As soon as the report was tabled on Thursday, Aged Care minister Richard Colbeck said the government was accepting all its recommendations.</p>
<p>But he continued to insist the government did have a plan for the sector.</p>
<p>“Never before has the aged care sector in Australia faced a challenge like COVID-19,” the report said.</p>
<p>It said the government should fund providers to ensure there were adequate staff available to deal with visits from family and friends.</p>
<p>The understandable restriction of visits “has had tragic, irreparable and lasting effects which must immediately be addressed as much as possible”.</p>
<p>“Maintaining the quality of life of those people living in residential aged care throughout the pandemic is just as important as preparing for and responding to outbreaks,” the report said.</p>
<p>“Funding to support increased visits is needed immediately.”</p>
<p>The commission recommended the Medicare schedule be changed to increase the provision of allied health and mental health services to residents during the pandemic, and the government should “arrange for the deployment of accredited infection prevention and control experts” into facilities.</p>
<p>Announcing $40.6 million as an initial response, Colbeck said the government was already well progressed in delivering some of the recommendations.</p>
<p>The commission said that “confused and inconsistent messaging” from providers, the federal government, state and territory governments had been themes in submissions to it.</p>
<p>“All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge?</p>
<p>"At a time of crisis, such as this pandemic, clear leadership, direction and lines of communication are essential”.</p>
<p>The commission said much had been made during its hearing about whether there was an aged care specific plan for COVID.</p>
<p>“There was not a COVID-19 plan devoted solely to aged care. But there was a national COVID-19 plan that the Australian Government sought to adapt and apply to the aged care sector.”</p>
<p>However “there is a clear need for a defined, consolidated, national aged care COVID-19 plan”. </p>
<p>The commission said the recommended plan should be established through the national cabinet in consultation with the aged care sector. </p>
<p>The plan should establish federal-state protocols, maximise the ability for residents in facilities to have visitors, and establish a mechanism for consultation with the sector about the use of “Hospital in the Home” programs.</p>
<p>It should establish protocols on who would decide about transfers to hospitals of residents with COVID, and ensure significant outbreaks were investigated by an independent expert, with the results disseminated to the sector.</p>
<p>The commission said the government should report to parliament no later than December 1 on the implementation of the recommendations in its report.</p><img src="https://counter.theconversation.com/content/147307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The royal commission into aged care has said government did not prepare the sector well enough for the pandemic.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1451182020-08-26T14:01:08Z2020-08-26T14:01:08ZView from The Hill: The role of ‘profit’ is the elephant in the aged care room<p>Scott Morrison finds himself besieged on two fronts in the political war over aged care.</p>
<p>The royal commissioners inquiring into the sector have made their second sortie within days into the debate, while Labor, struggling for cut-through, has resorted to an assault with shades of that successful “Mediscare” campaign.</p>
<p>Releasing research undertaken by the University of Queensland, commissioners Tony Pagone and Lynelle Briggs said it suggested higher funding was needed for residential care to meet basic standards, and even more would be required to achieve high-quality care.</p>
<p>The commissioners said: “Australians expect that all are entitled to the best quality level of care in aged care homes. Additional funding will be needed to enable providers to meet those expectations consistently”. </p>
<p>The research divided facilities into three quality categories, using various criteria: 11% were in the best group, 78% in the middle, and 11% in the worst group.</p>
<p>Those most likely to be in the best quality group were small-sized or government-owned facilities. The top group contained 41% of homes with up to 15 beds, but only 17% of those with 31-60 beds and 5% of those with more beds. The highest quality group contained 24% of government-owned facilities, 13% of not-for-profits, and only 4% of for-profit homes.</p>
<p>The problem with aged care being “for profit” is increasingly coming to the fore as the elephant in the room in the aged care debate.</p>
<p>Liberal backbencher Russell Broadbent told The Guardian this week, “Successive governments over 30 years have handed the care of people into the private sector, and that has been a mistake. Profit became more important than care. This [situation in Victoria] was a disaster waiting to happen.”</p>
<p>Peter Baume, a facilitator in medicine at the University of New South Wales and a former federal Liberal minister (including very briefly health minister), also says it was a mistake to privatise aged care.</p>
<p>“Private providers who operate for profit too often have scarce regard for the welfare and needs of old people, ” Baume told The Conversation.</p>
<p>“We now have a hierarchy of care. ‘For profit’ homes are sometimes awful. Food is poor, personal care is poor, provision of support is minimal, recent television footage has shown how some old people are abused, infections spread like wildfire.</p>
<p>”‘Not for profit’ homes are better. More money is available for food and for wages".</p>
<p>As Scott Morrison contemplates how much extra he is going to have to spend on aged care in the coming couple of budgets, Labor’s attack has homed in on how much he allegedly cut in the past.</p>
<p>In the 2016 election Labor had great success with its Mediscare campaign – endlessly claiming what the Coalition would do to Medicare. Government denials were in vain. In Wednesday’s question time, the opposition applied a version of the same tactic, with the twist that it focused on the past rather than the future.</p>
<p>The opposition’s questions repeatedly insisted the government had cut $1.7 billion from aged care.</p>
<p>This number was based on two sources.</p>
<p>The 2015-16 mid-year budget update said the government “will achieve savings of $472.4 million over four years by refining the Aged Care Funding Instrument”. The 2016-17 budget said the government “will achieve efficiencies of $1.2 billion over four years through changes to the scoring matrix”.</p>
<p>Morrison rejected the Labor claim, and pointed to a RMIT ABC Fact Check (he couldn’t resist a snide reference to it being from the ABC). This examined the claim from then opposition leader Bill Shorten that Morrison had cut $1.2 billion from aged care in his first budget as treasurer.</p>
<p>The Fact Check concluded Shorten’s claim was “misleading”.</p>
<p>It said in 2016-17, Commonwealth funding for aged care was $17.4 billion – an increase of more than $1 billion over the previous year.</p>
<p>“The increase came despite a decision to pare $1.2 billion of ‘efficiencies’ over four years, largely by reducing the subsidies paid to aged care providers to tackle potential over-claiming and an unexpected cost blowout,” it said.</p>
<p>“Fact Check deems that an adjustment to future spending does not represent a ‘cut’ when the overall level of spending continues to rise.”</p>
<p>Though Morrison denied the “cut” every time it was raised, he knows this game as well as Labor does. It’s all about getting an impression across.</p>
<p>Unsurprisingly, aged care will be a major theme of Anthony Albanese’s Thursday National Press Club speech.</p>
<p>He will put forward “eight points the government could consider” to improve aged care. They are:</p>
<ul>
<li><p>minimum staffing levels in residential aged care</p></li>
<li><p>reduce the home care package waiting list so more people can stay in their homes for longer</p></li>
<li><p>ensure transparency and accountability of funding to support higher quality care</p></li>
<li><p>independent measurement and public reporting as recommended by the Royal Commission this week</p></li>
<li><p>ensure every residential aged care facility has adequate personal protective equipment</p></li>
<li><p>better training for staff, including infection control</p></li>
<li><p>a better surge workforce strategy</p></li>
<li><p>provide additional resources so the Aged Care Royal Commission can inquire specifically into COVID-19 across the sector.</p></li>
</ul>
<p>The $1.7 billion “cut” will likely get another run in the speech, not least because it is judged to have cut-through.</p><img src="https://counter.theconversation.com/content/145118/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scott Morrison finds himself besieged on two fronts in the political war over aged care.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1449642020-08-24T11:14:26Z2020-08-24T11:14:26ZView from The Hill: Aged Care royal commissioners say sector needs independent performance reporting<p>Scott Morrison is finding, to his great discomfort, the royal commissioners probing aged care aren’t keeping their thoughts to themselves until their final report in February.</p>
<p>The week before last, commissioner Tony Pagone QC said the government should set up an expert aged care advisory body ASAP. On Friday the national cabinet did so, although Morrison chooses to play it down by describing it as an add-on to an existing group.</p>
<p>Now Pagone and commissioner Lynelle Briggs have declared it’s “unacceptable” there isn’t an independent body publicly reporting on the sector.</p>
<p>The commissioners weighed in as Scott Morrison came under a strong attack, on the first day of the parliamentary sitting, over the COVID crisis that as of Monday had taken the lives of 328 people in residential care and seven in at-home aged care.</p>
<p>Monday also saw the release of the government-commissioned <a href="https://www.health.gov.au/sites/default/files/documents/2020/08/newmarch-house-covid-19-outbreak-independent-review-newmarch-house-covid-19-outbreak-independent-review-final-report.pdf">report on Sydney’s Newmarch House</a>, where 17 of 19 deaths were attributed to COVID, which was 46% of the COVID-positive residents. The report criticised “a lack of clarity in the relationships and hierarchy” between various state and federal government health agencies.</p>
<p>With Labor devoting every question in the House of Representatives to aged care, Morrison made his most explicit apology so far.</p>
<p>But equally, the Prime Minister went out of his way to stress COVID had hit only a very small proportion of facilities.</p>
<p>He told parliament there were “2706 residential aged care facilities in Australia. In 92% of these facilities, there’s been no infections… This compares sharply to many countries around the world.</p>
<p>"In Victoria, where there’s been high levels of transmission, 126 of the 766 facilities have outbreaks among residents and staff.</p>
<p>"The impact has been significant in 16 cases. And in four cases, the impact has been severe. And completely unacceptable.</p>
<p>"Again, I offer my apologies to the residents and families of those affected in those facilities. It was not good enough.”</p>
<p>Pagone and Briggs believe the eyes on the system aren’t good enough.</p>
<p><a href="https://agedcare.royalcommission.gov.au/sites/default/files/2020-08/research_paper_8_-_international_and_national_quality_and_safety_indicators_for_aged_care.pdf">Releasing research conducted for the commission on monitoring</a>, the commissioners said independent measurement and public reporting were essential for the good operation of the aged care system.</p>
<p>“Unbiased measurement and reporting of performance is vital to create accountability and continuous improvement in the aged care sector.</p>
<p>"Without it, problems are hidden from sight and not addressed,” they said in a statement.</p>
<p>They went further. “It is unacceptable that in 2020 the aged care system is still without this. Had the Australian Government acted upon previous reviews of aged care, the persistent problems in aged care would have been known much earlier and the suffering of many people could have been avoided.”</p>
<p>They referenced recommendations from the <a href="https://www.pc.gov.au/inquiries/completed/aged-care/report">Productivity Commission in 2011</a>, and a <a href="https://www.health.gov.au/sites/default/files/review-of-national-aged-care-quality-regulatory-processes-report.pdf">2017 review of aged care quality regulatory processes</a>.</p>
<p>This goes to the underlying problem – the long term faults of the system, often identified but never properly fixed.</p>
<p>Morrison fell back on the history of the issue as he responded in question time, saying that was why he called the royal commission.</p>
<p>“All governments have failed to measure up to the mark, including those who were members of governments previously who now sit opposite.”</p>
<p>While that’s correct, it is equally true that the Coalition is in its third term – it could have had reform under way years ago.</p>
<p>The research released by the commission has been done by the South Australian Health and Medical Research Institute.</p>
<p>It looks at a number of indicators to measure the quality of aged care, on which Australia has a mixed performance.</p>
<p>They include indicators for medication-related quality of care, falls and fractures, hospital re-admissions, hospitalisation for dementia and delirium, pain, premature mortality, pressure injury, use of care plans and medication reviews, and weight loss and malnutrition.</p>
<p>At present the federal government reports on only three indicators for residential care.</p>
<p>The research says: “Public reporting of quality and safety indicators may increase transparency and accountability of the system, potentially improving performance, and provide aged care recipients and their families the opportunity to make informed decisions regarding service use”. </p>
<p>Asked about the commissioners’ comments, Morrison said he’d wait for their report. He wasn’t going to undertake a running commentary, although he again indicated there’ll be further responses to the commission’s interim report in the budget.</p>
<p>He urged the opposition not to “partisanise” the commission’s activities.</p>
<p>But the commission, with its strong voice, now is very much caught in the partisan debate.</p><img src="https://counter.theconversation.com/content/144964/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scott Morrison is finding, to his great discomfort, the royal commissioners probing aged care aren’t keeping their thoughts to themselves until their final report in February.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1445012020-08-14T04:03:24Z2020-08-14T04:03:24ZVIDEO: Michelle Grattan on the Royal Commission into Aged Care and Melbourne’s ongoing quarantine<p>University of Canberra Professorial Fellow Michelle Grattan and University of Canberra Vice-Chancellor and President Professor Paddy Nixon discuss the week in politics.</p>
<p>This week Michelle and Paddy discuss the week of hearings before the Royal Commission into Aged Care, Victorian Premier Daniel Andrews and his quarantine approach, and a report following an inquiry into the alleged killing, by Australian special force in Afghanistan of unarmed civilians and surrendered insurgents.</p>
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<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Michelle Grattan discusses the political week that was with Professor Paddy NixonMichelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1444472020-08-13T13:01:38Z2020-08-13T13:01:38ZGrattan on Friday: Morrison government needs to improve, rather than defend, its poor COVID aged care performance<p>The state of aged care preparation in the era of COVID-19 is, it seems, in the eye of the beholder.</p>
<p>Vastly different claims emerged this week, when the royal commission examining the sector turned its attention to the handling of the pandemic.</p>
<p>According to the senior counsel assisting the commission, Peter Rozen, QC, federal authorities had no COVID-19 plan specifically for aged care, always potentially a major risk area. And, Rozen noted, compared with many countries, residents of facilities form a very high proportion of Australia’s deaths.</p>
<p>The government disputes the lack-of-plan allegation and has a different take on the statistics.</p>
<p>Brendan Murphy, secretary of the health department and until recently Australia’s chief medical officer, <a href="https://webstreaming.lawinorder.com.au/acrc">appearing before the commission</a>, insisted there had been proper planning, and said the death proportion reflected not a failure in aged care but the low number of fatalities in the general community.</p>
<p>If you were taking a bet on who most people would believe, Rozen would be short odds.</p>
<p>Morrison knows the government is highly vulnerable on the issue. Aged care is a federal responsibility. It affects millions of Australians, counting those with relatives in homes. People’s anger buttons are easily triggered when things go wrong.</p>
<p>Some around the government might like to discount Rozen’s attack as being what counsels-assisting do at royal commissions. But his claims were backed by witnesses, from highly regarded geriatrician Joseph Ibrahim of Monash University to union officials with members on the front line.</p>
<p>They also resonated after the numerous first-hand accounts in the media from families as the virus has ripped through well over 100 facilities in Victoria. Currently, there are more than 1,000 cases among residents and over 1,000 among staff, linked to these homes.</p>
<p>Politicians have been congratulated during the pandemic for listening to experts, but according to Ibrahim, there was not enough aged care expertise applied in the preparations to firewall the sector.</p>
<p>It’s hard if not impossible, anyway, to build adequate safeguards when the structure itself is so compromised, due to bad decisions and neglect over many years.</p>
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<a href="https://theconversation.com/royal-commission-into-aged-care-reminds-health-department-secretary-brendan-murphy-it-sets-the-rules-144385">Royal Commission into Aged Care reminds Health Department Secretary Brendan Murphy it sets the rules</a>
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<p>A sector operating with low paid, often short term, casuals who pick up work across facilities and often have inadequate English (complicating even basic training) was always inviting disaster.</p>
<p>Health Minister Greg Hunt declared recently, after Victoria Premier Dan Andrews said he wouldn’t want his mother to be in some of these places: </p>
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<p>The idea that our carers, that our nurses are not providing that care, I think, is a dangerous statement to make. They are wonderful human beings and I won’t hear a word against them.</p>
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<p>This misses the point. No one doubts the commitment the majority of the carers have to their work. But the nature of the workforce brings dangers for residents.</p>
<p>Many facilities run on narrow financial margins. The rules allow them to keep their staffing to a minimum, in terms of numbers and skill.</p>
<p>Nor has regulatory oversight been adequate. Often it is families and the media that have exposed neglect and abuses. Morrison announced the royal commission in September 2018 a day before an ABC Four Corners investigation was to air.</p>
<p>The for-profit system emphasises the idea of facilities being “home-like”, which sounds great but can mean inadequate specialised care and challenges for inflection control.</p>
<p>The word “tragic” is thrown around too much by politicians and media. But what’s happened in aged care during COVID-19 has indeed been a tragedy.</p>
<p>It’s just possible if the pandemic had come two years later, after next year’s final report of the royal commission had forced some reform, that fewer lives would have been lost. But even with the system as it is, the evidence indicates better planning could have saved lives.</p>
<p>That’s certainly Ibrahim’s view. In his <a href="https://agedcare.royalcommission.gov.au/system/files/2020-08/RCD.9999.0411.0001.pdf">precis of evidence</a>, he argued “hundreds of residents will die prematurely because people failed to act”.</p>
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<p>We had enough knowledge to do better. We failed because when residents are treated as second class citizens there is an absence of accountability and consequences for those responsible for aged care in Australia.</p>
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<p>There was “failure to provide the same health response to residential aged care that was delivered to the rest of Australia.”</p>
<p>The government has been playing catch-up on aged care all through the pandemic. It had to put substantial money in to help with staffing; it was slow to acknowledge the importance of masks; it set up a co-ordinated response in Victoria belatedly; National Cabinet only a week ago stepped up preparations in other parts of the country.</p>
<p>Morrison is now confronted at two levels: there must be root and branch reform after the royal commission, and his government is under immediate pressure over this week’s indictment.</p>
<p>The government’s tactic of inserting Murphy into the commission’s witness list was a miscalculation.</p>
<p>It seemed to assume the commission would defer to Murphy when he sought to make a statement to reject Rozen’s claims. But he was refused permission to commence with the statement (which he delivered at the end of the session) and all his appearance did was highlight the government’s sensitivity.</p>
<p>When he summed up the hearings on Thursday, Rozen did not resile from his initial criticisms. He concluded the problems in aged care had been foreseeable; “not all that could be done was done”; and the challenge remained.</p>
<p>Picking up a recommendation from Ibrahim, Rozen urged an “age-care specific national coordinating body to advise government”. It would bring together expertise in aged care, infection control and emergency preparedness.</p>
<p>With such a body, “a national aged care plan for COVID could still be put in place,” Rozen said.</p>
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<a href="https://theconversation.com/government-rejects-royal-commissions-claim-of-no-aged-care-plan-as-commission-set-to-grill-regulator-144301">Government rejects Royal Commission's claim of no aged care plan, as commission set to grill regulator</a>
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<p>Although the advisory body is not a formal recommendation, commissioner Tony Pagone endorsed it among “practical things that perhaps should not wait.”</p>
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<p>The virus doesn’t wait and nor should the measures that need to be implemented to deal with the virus wait either.</p>
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<p>The government, which has previously signalled more assistance for aged care in the budget, should stop insisting it has done everything well and act immediately on this and some of the other suggestions made in the COVID-19 hearings.</p>
<p>Morrison said this week in a Facebook message, “I want to assure that where there are shortcomings in these areas they’ll be acknowledged. And the lessons will be learned.”</p>
<p>The government likes to talk about wanting a reform agenda, but this should not be just an economic one. Aged care must be near the top of any serious “reform” to-do list, and vested interests should not be allowed to limit necessary changes.</p>
<p>In his end-of-year ministerial reshuffle, prompted by Mathias Cormann deciding to quit parliament, Morrison should elevate the aged care portfolio from the outer ministry to cabinet.</p>
<p>Having the post in cabinet would send a positive signal but, more importantly, it would encourage a wider range of ministerial eyes on an issue that’s been mishandled for as long as anyone can remember.</p>
<p>Veterans’ affairs is in cabinet, and most families would think aged care is just as worthy of a place.</p><img src="https://counter.theconversation.com/content/144447/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The state of aged care preparation in the era of COVID is, it seems, in the eye of the beholder.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1443852020-08-12T12:53:51Z2020-08-12T12:53:51ZRoyal Commission into Aged Care reminds Health Department Secretary Brendan Murphy it sets the rules<p>The Royal Commission into Aged Care put the Secretary of the Federal Health Department, Brendan Murphy, firmly in his place when he tried to make an opening statement to attack claims by the senior counsel assisting the commission, Peter Rozen, QC.</p>
<p>Murphy, who became a nationally known figure when as Chief Medical Officer he appeared regularly at Scott Morrison’s news conferences, had not been due to give evidence at the commission’s sittings on COVID this week.</p>
<p>But after Rozen’s Monday statement the federal government, which is increasingly concerned at the criticism it is receiving over inadequate preparation for the pandemic in aged care facilities, asked to have him added to the panel of Commonwealth witnesses who appeared on Wednesday.</p>
<p>As questioning of the panel was about to start Murphy broke in, saying he wanted to make a statement in response to Rozen inaccurately claiming the Commonwealth had not planned for the outbreak in aged care and as a result there had been a high death rate.</p>
<p>But after a brief adjournment for consultations the commission denied his request, although he was allowed to make the statement at the session’s end. As commissioner Tony Pagone put it with the utmost politeness but equal firmness, “We are really in control of the procedure that we have and we just need to continue with that.”</p>
<p>On Wednesday Victoria announced a record 21 deaths from the previous 24 hours, 16 of them linked to aged care.</p>
<p>In a Facebook message Scott Morrison, expressing condolences, referred particularly to the need to protect the vulnerable elderly.</p>
<p>He also said pointedly: “I want to assure that where there are shortcomings in these areas they’ll be acknowledged. And the lessons will be learned.”</p>
<p>He warned there would be more “difficult news” in the days and weeks ahead.</p>
<p>Earlier on Wednesday professor Joseph Ibrahim, a specialist in geriatric medicine from Monash University, told the commission: “This is the worst disaster that is still unfolding before my eyes and it’s the worst in my entire career”.</p>
<p>He said hundreds of aged care residents would die prematurely because people had failed to act.</p>
<p>“There’s a level of apathy, a lack of urgency. There’s an attitude of futility which leads to an absence of action.</p>
<p>"The reliance or promotion of advance care plans as a way to manage the pandemic and the focus on leaving residents in their setting I think is wrong and inappropriate. When I voiced my concerns, I have had comments saying that everything is under control, that I’m simply overreacting and causing panic,” Ibrahim said.</p>
<p>Early in the crisis Ibrahim made representations to state and federal bodies, and to Morrison, health minister Greg Hunt and aged care minister Richard Colbeck.</p>
<p>The tension was evident when the panel of Commonwealth officials gave evidence.</p>
<p>Michael Lye, the health department’s deputy secretary for ageing and aged care, unsuccessfully tried to divert to Murphy a question about Australia faring badly on aged care deaths compared to other countries. Rozen insisted Lye answer, saying sharply, “No, I don’t want professor Murphy to answer the question, Mr Lye. I’m asking you. You told us you were the senior most official with aged care responsibility within the Commonwealth department of health”.</p>
<p>In one embarrassing moment for the federal officials, Rozen drew attention to Murphy prompting Lye when the latter was struggling under the questioning.</p>
<p>Rozen told both Lye and Murphy, as they periodically veered into wider comments, to just answer his questions.</p>
<p>Quizzed about the apparent lateness of a July 13 decision to make masks compulsory for care providers in Victorian homes, Murphy admitted “in hindsight, you could have implemented that earlier”, agreeing it was “possible” it might have reduced the number of infections entering homes.</p>
<p>In his forcefully-delivered statement at the end of the session, Murphy declared: “We reject categorically that the Australian government failed to adequately plan and prepare” for COVID in aged care.</p>
<p>He also strongly rejected that there was anything pejorative in the fact people from aged care formed a high proportion of “an extraordinary low death rate in Australia”. “I would say the contrary is true.” He said across Australia’s aged care facilities 0.1% of residents had succumbed to COVID compared to 5% in the UK with many more not detected.</p>
<p>The fact that two thirds of Australia’s about 350 deaths were from aged care “is really a reflection of the extraordinarily low community death rate,” Murphy said.</p>
<p>Diana Asmar, Victorian secretary of the Health Workers Union, told the commission: “Our members right now feel like they’re on the bottom of the Titanic ship”. They did not have proper access to personal protective equipment, they were suffering from huge staffing pressures, and they were feeling neglected.</p>
<p>“The lack of communication, the lack of training, the lack of staffing and the lack of protection unfortunately has caused a huge concern in the aged care sector,” she said.</p><img src="https://counter.theconversation.com/content/144385/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Royal Commission into Aged Care put the secretary of the federal health department, Brendan Murphy, firmly in his place.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1443012020-08-11T11:27:22Z2020-08-11T11:27:22ZGovernment rejects Royal Commission’s claim of no aged care plan, as commission set to grill regulator<p>The federal government has clashed with the Royal Commission into Aged Care, strongly rejecting the claim by senior counsel assisting the inquiry Peter Rozen that it had no specific COVID-19 plan for the sector.</p>
<p>Aged Care Minister Richard Colbeck told a news conference: “We have had a plan to deal with COVID-19 in residential aged care, going right back to the beginnings of our preparations.</p>
<p>"We’ve been engaged with the sector since late January, and continuously working with the sector to ensure they have all the information they require and the support that they need in the circumstance that they might have an outbreak of COVID-19.”</p>
<p>Acting chief medical officer Paul Kelly said: “We have been planning for our aged population as a vulnerable group since the beginning of our planning in relation to COVID-19”. And there had been “very strong communication with the sector throughout,” he said.</p>
<p>Rozen, in a Monday statement at the opening of this week’s hearings on COVID in the aged care sector, said while much was done to prepare the health sector more generally for the pandemic, “neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector”.</p>
<p>The sector had been underprepared, he said.</p>
<p>Asked whether the government’s plan had failed, Colbeck admitted there had been “some circumstances where things haven’t gone as we would like”, saying “the circumstance at St Basil’s [in Melbourne] is one, where we didn’t get it all right”.</p>
<p>On Wednesday the commission will take evidence from Janet Anderson, head of the Commonwealth regulator, the Aged Care Quality and Safety Commission, which Rozen said “did not have an appropriate aged care sector COVID-19 response plan”. </p>
<p>The government has left Anderson out to dry, after it was belatedly discovered her body was told of an outbreak at St Basil’s two days after a staffer was diagnosed, but it failed to pass on the information.</p>
<p>Quizzed about this, Colbeck said under the protocols, “the Commonwealth should have been advised of the outbreak on 9 July by either the Victorian health department or St Basil’s management or both. Instead it was formally informed on July 14.”</p>
<p>But he was also critical of the Quality and Safety Commission which was informed of the outbreak when it was speaking to the home as part of a survey about preparedness and infection control.</p>
<p>“The disappointing thing, from my perspective, is that the information that was gleaned … about a positive outbreak wasn’t passed on to anyone else,” Colbeck said.</p>
<p>“There was an assumption made … that information had already been passed on. It wasn’t.</p>
<p>"The gap in the supply chain, or the information chain, has now been closed. … There should not have been a hole in our systems. That’s been rectified appropriately, as it should have been.”</p><img src="https://counter.theconversation.com/content/144301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The federal government has clashed with the Royal Commission into Aged Care, strongly rejecting the claim that it had no specific COVID-19 plan.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1442042020-08-10T03:01:57Z2020-08-10T03:01:57ZFederal departments had no specific COVID plan for aged care: royal commission counsel<figure><img src="https://images.theconversation.com/files/351877/original/file-20200810-24-75i5vn.png?ixlib=rb-1.1.0&rect=0%2C2%2C1440%2C743&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>Australia’s aged care sector was “underprepared” to deal with the COVID-19 outbreak and federal authorities had no specific plan for it, according to a stinging indictment from Peter Rozen QC, senior counsel assisting the royal commission into aged care.</p>
<p>In a statement critical of authorities and providers, Rozen said while much was done to prepare the health sector more generally for the pandemic, “neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector”.</p>
<p>Rozen was speaking at the start of several days of hearings to look at the sector’s preparations and response to the crisis. The commission will probe the NSW outbreaks in homes but not delve in detail into particular homes in Victoria because the crisis is ongoing there. </p>
<p>Aged care is a Commonwealth responsibility, while the states are responsible for health.</p>
<p>Rozen said on Commonwealth data, more than 1,000 residents had been diagnosed with COVID-19, of whom 168 had died.</p>
<p>The pandemic had “starkly exposed” the flaws in the sector that had been highlighted during the royal commission.</p>
<p>In view of the deficiencies it was “hardly surprising that the aged care sector has struggled to respond to COVID-19”. </p>
<p>He stressed the consequences of the deskilling of the aged care workforce and a shortage of clinical skills in homes.</p>
<p>Rozen quoted health minister Greg Hunt saying on July 29 that “aged care around the country has been immensely prepared”. But, Rozen said, “in a number of important respects, the evidence will demonstrate that the sector has been underprepared”.</p>
<p>“We will be asking if greater attention to preparation may have saved lives and could save lives in the future.”</p>
<p>Rozen said that between June 19 and August 3, a crucial period when new infections in Victoria escalated, there was no updated advice for the aged care sector from the Australian Health Protection Principal Committee - the main source of COVID advice.</p>
<p>“There was no advice about how the sector should respond to the risk posed by aged care workers who may be COVID-19 positive yet asymptomatic, particularly those who work in multiple facilities.”</p>
<p>Rozen was critical of the Commonwealth regulator, the Aged Care Quality and Safety Commission, which oversees the sector.</p>
<p>“The regulator did not have an appropriate aged care sector COVID-19 response plan. Given that it was widely understood that recipients of aged care services were a high risk group, this seems surprising.”</p>
<p>On March 17, the regulator wrote to providers with a survey asking about their preparedness. Overwhelmingly they claimed to be prepared, but evidence would be critical of this survey, Rozen said.</p>
<p>He questioned the late timing of the regulator’s action in relation to the Newmarch House in Sydney and the fact the regulator had not investigated the circumstances of the Dorothy Henderson Lodge and Newmarch House outbreaks.</p>
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<a href="https://theconversation.com/view-from-the-hill-aged-care-crisis-reflects-poor-preparation-and-a-broken-system-143556">View from The Hill: Aged care crisis reflects poor preparation and a broken system</a>
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<p>“We also have concerns about whether the regulator’s powers of investigation are adequate,” Rozen said, adding that comparable regulators in areas such as workplace or airline safety were not as fettered.</p>
<p>There were “notorious problems” in the relationship between the health system run by the states and the Commonwealth aged care sector, Rozen said.</p>
<p>He detailed an argument between federal and NSW authorities about whether residents with COVID should be transferred to hospitals, with the federal authorities wanting transfers and the state official opposing.</p>
<p>“Equal access to the hospital system is the fundamental right of all Australians young or old and regardless of where they live,” Rozen said.</p>
<p>“Many of the residents in aged care homes worked their entire lives to build the world class health system of which Australians are justifiable proud.</p>
<p>"They have the same right to access it in their hour of need as the rest of the community. To put it very directly, older people are no less deserving of care because they are old. Such an approach is ageist”.</p>
<p>Rozen noted the time it took, after experience in Sydney, for the Commonwealth health department to advise providers that 80-100% of their workforce might need to isolate in a major outbreak, and even then it was not highlighted.</p>
<p>“Regulators in other fields such as workplace safety publish page one ‘alerts’ to disseminate promptly via safety information they learn from incident investigations.”</p>
<p>Rozen said masks were not made compulsory for aged care workers until July 13 – two days after the first recorded deaths of an aged care resident in Victoria. On July 13, the number of new Victorian infections was 250.</p>
<p>“Why did authorities wait until after the fir
st death to take what seems the simple and obvious step of making masks compulsory for aged care workers?”</p>
<h2>Commonwealth aged care regulator admits it was told of St Basil’s outbreak</h2>
<p>The head of the Commonwealth’s Aged Care Quality and Safety Commission, Janet Anderson, has told a Senate inquiry St Basil’s Home for the Aged informed the commission of its COVID outbreak on July 10 - contrary to claims made previously that the Commonwealth was not told until July 14. </p>
<p>In a letter to the Senate committee on COVID-19, Anderson wrote she had become aware that on July 10, during a telephone call responding to the commission’s assessment contact program the St Basil’s representative “provided information that one staff member … was diagnosed with COVID-19 on 8 July 2020 and the Public Health Unit (PHU) had been advised”. </p>
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<p>Anderson, the aged care minister, Richard Colbeck, and the secretary of the federal health department Brendan Murphy all told the committee on August 4 the Commonwealth had not been informed about the outbreak until July 14. </p>
<p>That was when the Victorian health and human services department notified it. The time lag has been seen by the Andrews government’s critics as further evidence of its poor administration. </p>
<p>In her letter Anderson said the commission was not the first responder to an outbreak and the phone contact had been part of a commission program to seek assurances from facilities that COVID plans had been developed and were ready to be acted on.</p>
<p>“The regulatory official from the Commission who made the assessment contact referred the service’s responses to the Commission’s COVID-19 Response Team and this information was escalated internally and recorded in the Commission’s daily COVID-19 confirmed case tracker, Anderson wrote. </p>
<p>"The Commission did not escalate the matter externally at the time because the St Basil’s representative had confirmed in the interview that they had advised the PHU [the Victorian Public Health Unit] of the outbreak. The representative also confirmed that they had read the ‘First 24 hours’ document.” </p>
<p>Anderson noted this federal health department document lists four actions to be taken in the first 30 minutes. These steps are: isolate and inform the COVID-19 positive case(s); contact the local Public Health Unit; contact the Commonwealth Health Department; lock down the facility. </p>
<p>Anderson said the commission was later advised about the outbreak by the health department on July 14. </p>
<p>“To manage any risks of provider failure to notify the relevant authorities of a COVID-19 outbreak, the Commission now has arrangements in place to confirm immediately with the Commonwealth Department of Health that they have been directly notified by the affected aged care service of any outbreak at that service that comes to the Commision’s attention by whatever means.”</p>
<p>Asked about the bungle, Scott Morrison was sharp. He said the commission was an independent body that operated formally separate from the government but he was concerned about the breakdown in communication. </p>
<p>He said where there were breakdowns and issues, he wanted to know about them and fix them. </p>
<p>“We will be following [the matter] through with the commissioner. And at the end of the day, they’re an independent statutory office and they know their responsibilities and they need to live up to them.”</p><img src="https://counter.theconversation.com/content/144204/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Peter Rozen QC declared before the Royal Commission into Aged Care that Australia’s aged care sector was “underprepared” to deal with COVID-19.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1440982020-08-07T02:50:49Z2020-08-07T02:50:49ZPolitics with Michelle Grattan: Concetta Fierravanti-Wells on aged care – what needs to be done differently<p>The Royal Commission into Aged-Care Quality and Safety delivered it’s interim report in October 2019. Titled ‘Neglect’, it provided a scathing insight into the aged care industry - finding it centred around transactions not care. It minimised the voices of people receiving care, lacked transparency, and was staffed by an under-appreciated and under-pressure workforce.</p>
<p>The outbreak of coronavirus, and the second-wave of infections in Melbourne, has raised fresh questions. The virus has infected residents and staff en masse, leaving aged-care residents major victims of the pandemic.</p>
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<a href="https://theconversation.com/view-from-the-hill-theres-no-case-for-keeping-secret-any-aged-care-facilitys-covid-details-143920">View from The Hill: There's no case for keeping secret any aged care facility's COVID details</a>
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<p>NSW Senator Concetta Fierravanti-Wells was the shadow minister for ageing for four years, during Tony Abbott’s time as opposition leader. She has made a detailed submission to the Royal Commission, critical of the government’s attempts to reform the troubled sector.</p>
<p>The Royal Commission is holding hearings next week to take evidence on the affects of the COVID virus. Among the questions Fierranvanti-Wells would like asked of the industry are</p>
<p>“How could you have avoided the situation that you were facing? </p>
<p>"What is it about the system that has led to you being in this difficult situation? </p>
<p>"What was in place to assist you in the event of a pandemic?</p>
<p>"Where have you found that the intersection between health and ageing has fallen over? </p>
<p>"Where could you have performed a better response if you’d had better medical services available in your aged care facility? </p>
<p>"And what workforce was required to have been available to you in your aged care facility to meet the potential of a pandemic?”</p>
<p>Concetta Fierravanti-Wells submission to the commission can be read <a href="https://www.senatorcfw.com.au/assets/Submission-Royal-Commission.pdf">here</a>.</p>
<p><a href="https://itunes.apple.com/au/podcast/politics-with-michelle-grattan/id703425900?mt=2"><img src="https://images.theconversation.com/files/233721/original/file-20180827-75984-1gfuvlr.png" alt="Listen on Apple Podcasts" width="268" height="68"></a> <a href="https://www.google.com/podcasts?feed=aHR0cHM6Ly90aGVjb252ZXJzYXRpb24uY29tL2F1L3BvZGNhc3RzL3BvbGl0aWNzLXdpdGgtbWljaGVsbGUtZ3JhdHRhbi5yc3M"><img src="https://images.theconversation.com/files/233720/original/file-20180827-75978-3mdxcf.png" alt="" width="268" height="68"></a></p>
<p><a href="https://www.stitcher.com/podcast/the-conversation-4/politics-with-michelle-grattan"><img src="https://images.theconversation.com/files/233716/original/file-20180827-75981-pdp50i.png" alt="Stitcher" width="300" height="88"></a> <a href="https://tunein.com/podcasts/News--Politics-Podcasts/Politics-with-Michelle-Grattan-p227852/"><img src="https://images.theconversation.com/files/233723/original/file-20180827-75984-f0y2gb.png" alt="Listen on TuneIn" width="318" height="125"></a></p>
<p><a href="https://radiopublic.com/politics-with-michelle-grattan-WRElBZ"><img class="alignnone size-medium wp-image-152" src="https://images.theconversation.com/files/233717/original/file-20180827-75990-86y5tg.png?ixlib=rb-1.1.0&q=45&auto=format&w=268&fit=clip" alt="Listen on RadioPublic" width="268" height="87"></a> <a href="https://open.spotify.com/show/5NkaSQoUERalaLBQAqUOcC"><img src="https://images.theconversation.com/files/237984/original/file-20180925-149976-1ks72uy.png?ixlib=rb-1.1.0&q=45&auto=format&w=268&fit=clip" width="268" height="82"></a> </p>
<h2>Additional audio</h2>
<p><a href="http://freemusicarchive.org/music/Lee_Rosevere/The_Big_Loop_-_FML_original_podcast_score/Lee_Rosevere_-_The_Big_Loop_-_FML_original_podcast_score_-_10_A_List_of_Ways_to_Die">A List of Ways to Die</a>, Lee Rosevere, from Free Music Archive.</p><img src="https://counter.theconversation.com/content/144098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Michelle Grattan discussed aged-care reform, and the effect of the coronavirus on aged-care residents, with Senator Concetta Fierravanti-WellsMichelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.