Paying for quality care

The HSU's national secretary Craig Thomson addressed a National Aged Care Alliance Forum on future funding for aged care.

"I know the ANF like the HSU and the other union in aged care the LHMU is fully committed to making sure the highest quality of care is delivered in residential aged care facilities.

Of course the goal of delivering quality care is one all parties in the industry would share. Unfortunately there are a number of different views about how that is best achieved and indeed what quality care is.

I was thinking about this earlier when I looked at the title of this forum: Ageing: Who Will Pay?

It could just have easily been entitled, Ageing Who Will Care? In our view you cannot look at one without the other.

There are immense challenges ahead in delivering both the number and mix of nurses and care staff the industry will require as the ageing of the population accelerates.

We have to make sure that the workforce is adequately skilled and adaptable enough to meet the challenges of caring for an increasing number of people who will be older and have more complex care needs.

Coping with residents with dementia and the challenging behaviours that accompany is a major issue alone.

There will also be a greater demand for rehabilitative and palliative care services in residential aged care facilities which the industry is at present ill-equipped to provide.

But before we consider the future for a moment can I focus on what the HSU sees as the current state of aged care.

In our view there are some fundamental problems with an industry given the task of caring for the most vulnerable people in our society where there are no measurable standards regarding staffing and care.

It is not that there are no ratios of staff to residents but there is not even the most basic benchmarking done on a sector-wide scale that links care outcomes to staffing and skill mix.

In 1996, Providers essentially got the system they wanted: That is unhitching the natural link between staffing and funding so that they had the "flexibility " to manage.

What this artificial separation of funding and care did, was essentially destroy the ability of providers to argue for more money directly from government or to access money from residents because it is impossible to link such increase with an increase in the level of care.

How can the nursing home that has just one person looking after over 127 residents, some of whom are high care, possible argue for increased funding when there is absolutely no guarantee that that funding will in any way see a change in those residents level of care?

Some of you might rightly say "that's what the accreditation agency is about.

Well we all know that the accreditation standard that covers staffing is a joke. It states only that there should be "appropriate" staffing levels in a facility to deliver the standard of care required.

As unbelievable as it sounds it is left to individual inspectors from the Aged Care Standards and Accreditation agency to define what is appropriate according to what they see in front of them on the day they visit a facility.

I know employers are fond of saying that they want the flexibility to tailor staffing to the individual circumstances of their homes but it is pretty clear in an industry where people are balancing profit and care levels that you must have systems in place to ensure that wherever an elderly resident is, we can be confident that they will receive a decent standard of care.

At the moment that is just not the case.

I remind you of the results of the only national survey of aged care staff that has been done during the by the Howard Government's stewardship:

Only 13 per cent of nurses and 19 per cent of other care staff felt they had enough time to spend with residents. That means over eight out of ten care staff believe they are not delivering optimum care.

As worrying was the fact that 40 per cent of nurses and 25 per cent of allied health workers said they spent less than one-third of their time providing direct care.

Ever since I became national secretary of the HSU I have had providers tell me they are deeply worried about care standards and that they would like to recruit more staff and pay decent wages but they cannot afford it.

If we can get more money we can fix the problems, they say.

But the problem with this is that providers have been receiving more money and yet our members tell us that if anything staffing levels are being reduced rather than increased and that the level of care is suffering as a result.

Despite what earlier speakers have alleged, quite simply, providers have not been able to make out there case that they are under funded.

In fact there is evidence that aged care is already quite a profitable sector to be in.

We have major companies like Ramsay Health, DCA and RCA/Macquarie Bank buying up beds as fast as they can get them. Only last week Macquarie paid $186 million for 12 Moran homes with 1000 beds. That's $186,000 per bed!!

Pat Grier from Ramsay Health Care said recently: 'Margins on better quality aged care facilities are between 17 and 20 per cent while for hospitals it's more like 10 to 12 per cent."

I think some of you would say he was off-message that day.

The Hogan report itself did not see the industry being under funded at all but highlighted management inefficiencies that were costing money.

But seriously the days of going to the government and saying give us more money and trust us to spend it in the right areas are over.

We have not supported that approach in the past and we will certainly not support it in the future.

The way forward is to seek a funding system which links and measures appropriate care outcomes with staffing levels and skill mix.

This so-called Benchmark of Care has been supported by the Productivity Commission, by NACA, the Federal ALP and now the Senate inquiry into aged care.

For those who are not aware of the bi-partisan Senate committee report handed down a few months ago included the recommendation that:

The Aged Care Standards and Accreditation Agency in consultation with the aged care sector and consumers develop a benchmark of care which ensures that the level and skills mix of staffing at each residential aged care facility is sufficient to deliver the care required considering the needs of residents.

"The benchmark of care that is developed needs to be flexible so as to accommodate the changing needs of residents."

NACA has developed a series of principles for staffing levels and skill mix in aged care which deal with the fundamental components of a benchmark of care.

I will not go over all the principles which are available in a document on the NACA website but the key points are that:

• Staffing levels and skills mix should be driven primarily by the need to achieve optimal health and quality of life outcomes for residents

• That the level of staffing and skills mix enable providers to meet their duty of care requirements

• Staffing includes not only nursing staff, care staff but allied health practitioners, support staff and medical practitioners.

• That there is enough flexibility within the system to ensure that providers can tailor services to best meet the changing needs of residents

• And that the Federal Government should develop a model of funding that reflects to the cost of providing the level of staffing and skills mix necessary for quality care. This funding model must include guaranteed funding for wages and incorporate a transparent mechanism to achieve and maintain comparable wages for aged care staff with their counterparts in other sectors.

There is of course a huge amount of work that needs to be done to develop a proper benchmark of care.

But in our view it is the only way forward that will allow the industry to operate on a long-term sustainable basis, ensure quality care is provided and there is an adequately trained and skilled workforce.

We cannot afford to pay lip service to this concept anymore but we must be actively lobbying the government as an industry to conduct the workforce research and planning that will underpin it.

We must be able to move ahead together and not be afraid of regulation that ensures quality care but rather promote the use of such standards as a justification for increasing the funding to the aged care sector.

Without it we are an industry that will be seen to be crying wolf - and our elderly deserve better."

© 2003 Health Services Union (HSU)
This page: http://www.hsua.org.au/speeches/1124863106_8906.html
Last Modified: Wednesday, 16-Nov-2005 17:19:05 EST