Why the government's aged-care funding misses the mark

Minister for Health and Aged Care Greg Hunt declared aged-care reform to be the centrepiece of the federal government’s 2021–22 Budget, after promising to invest $17.7 billion in extra funding in response to the recommendations of the Royal Commission into Aged Care Safety and Quality. Impressive as this number may seem, it does not go far enough.

The government’s funding boost is a significant start to improving outcomes for aged Australians, but it will not solve the ingrained cultural problems in aged care. Clearly, there is still a need for careful planning and determination on the part of all stakeholders to solve the problems confronting the sector.

While mandated nurse–resident ratios are long overdue, we still have to wait for these measures to be put in place. At the very minimum, the government should have mandated minimum staffing levels in aged-care homes from now on and insisted on there being a registered nurse onsite 24 hours a day in all aged-care facilities. The Royal Commission demanded this, but the government has not delivered.

The Royal Commission recommended an injection of $10 billion a year and the Budget falls well short of that. The implications of this shortfall can be seen in some of the targets, such as the planned reduction in the home care waiting list. The government aims to reduce the list by 80,000 over the next two years, but an improvement of this magnitude is unlikely given that almost 103,000 older people were waiting for a package as of June 2020.

Other Budget measures include staffing requirements for residential care, which mandate that every aged-care resident will receive at least three hours and 20 minutes of care a day. At least 40 minutes of that time is supposed to be delivered by a registered nurse. From July next year, every aged-care facility is required to have at least one registered nurse on shift for a minimum of 16 hours a day. But this falls short of the Royal Commission’s recommendation that a nurse be onsite 24 hours a day to ensure a better standard of safety and care. Again, the government has not responded to a key recommendation.

It is also important that we draw more skilled workers to the sector. In aged-care homes around Australia, the Royal Commission found that there are simply not enough skilled workers, particularly nurses, to care for elderly people. This was one of the principal causes of substandard care, along with inadequate staffing and a lack of training. Yet the Budget does not address the need to attract more nurses to aged care. Australia has experienced a gradual slide in the number of nurses working in the sector and the quality of medical services received by the aged has deteriorated in tandem with the decline. Registered nurses comprised 21% of the residential direct care workforce in 2003, but only around 15% in 2016. The proportion of enrolled nurses also dropped, to 10% from 13%. The Budget funding will not reverse this trend, as it does not create clear career pathways for nurses.

The government will provide $216.7 million over three years to upskill staff, including by supporting specialist aged-care nursing scholarships. This allocation will also fund a retention bonus of $3700 for nurses who work for the same aged-care provider for at least 12 months. But with so many nurses leaving the sector or choosing to work in other healthcare scenarios with more rewarding workplaces, this will not be enough lure them back. Nor is it clear if the $3700 one-off payment will actually help keep them in the sector — especially given the Royal Commission identified that the sector as a whole is not only underpaid but undervalued as well. Many registered nurses are simply not happy working in aged care, and no amount of money can fix that.

Nor is there enough focus on the quality of care. The Budget does not do enough to address the urgent need for skills upgrading and training and the auditing of aged-care services. As many as 70% of people in residential aged care could be living with dementia. According to the Australian Bureau of Statistics (ABS), dementia, including Alzheimer’s disease, is the second leading cause of death for men and was the leading cause for women in 2019. The Royal Commission found that nurses and general practitioners do not have a full understanding of the needs of people living with dementia. It is therefore of crucial importance to train workers to better understand this disease.

Overall, the Budget falls short of what residents, their families and the community asked for to fix the floundering aged-care system. The Royal Commission into Aged Care Quality and Safety estimated one in three people living in aged care in Australia experiences neglect, or physical or emotional abuse. The risk remains that such neglect may not cease until better systems are established to entrench superior and safer aged care.

*Professor Joanne Travaglia is a medical sociologist with a background in health services research, management and leadership. She is Professor of the Master of Health Services Management, Director of the Centre for Health Services Management and Discipline Lead (Health Services Management) in the Faculty of Health at UTS. After training as a social worker, she has worked in the health, welfare and higher education fields. Joanne has undertaken research on policy implementation, service development and provision; aged and disability care; organisational diversity; cultural competence; peer support; leadership and management development in health care; and adult education and training. Over the last two decades, she has received multiple evaluation and research grants, including contracts with Australian and international governments.

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