"Australia’s aged care system is a mess"

The Melbourne-based Grattan Institute’s new report (released yesterday) on the aged care industry pulls no punches. Given the traumatic news scenes and tragic personal stories from wall-to-wall coverage of pandemic-related failures of the system in Australia in recent months, this is only appropriate. It’s a refreshing fillip for those with eyes blurred from so much corporate speak and innovation fluff being created and circulated by the tonne during lockdown.

Australia’s aged care system is a mess. A new horror story is revealed almost every day the Royal Commission into Aged Care Quality and Safety sits. Almost every day the COVID-19 death toll mounts in non-government residential aged care facilities in Victoria. The solutions are not simple. More money and better regulation are both necessary, but won’t be enough. Unless Australia fundamentally changes the culture of its aged care system – by changing legislated underlying principles, governance, and financial incentives – the Royal Commission’s report will be added to the pile of previous reports which haven’t led to the necessary, transformative change. There is no single cause for the litany of failures of the system.

My emphasis added. This speaks to the need for large scale systems change. But how does that happen? A system needs an objective and until now (let’s see if that will change) the system has been serving providers, according to the report. A shift is needed towards the residents – a ‘rights-based approach’. There are going to be plenty of obstacles in the way to overcome, not least near universal ageism, one of the last remaining acceptable -isms.

Changing systems is hard. Currently the aged care industry (like most countries) is separated from the rest of the economy and society, and within it there are silos preventing operational efficiency and information sharing, plus business incentives that focus on medicalising care and risk reduction not the quality of life. This results in heinous stories such as those in the report whereby people with dementia are restrained for up to 14 hours per day. The reports authors don’t hold back, as reported by 9News:   

“There’s no accountability to how much they spend on care, how much they spend on board and lodging, and profit they take to buy their Ferraris,” the institute’s Dr Stephen Duckett said. The industry was accused of lax accreditation standards, understaffing, and putting profits before people.

With this context, the topic of today’s monthly Aging2.0 Melbourne event (first Tuesday of the month) was ‘Loneliness and Engagement’, and we had a lively, interactive brainstorming event with virtual break outs. The key takeaways speak to some of the issues raised in the Grattan Report: 

• Need to empower and share best practices around community efforts e.g. Compassionate Communities in UK
• Need to upgrade the role of peers and self empowerment. Clayton from Vancouver shared a new report on peer mentoring: “The Impact of Peer Mentoring on Loneliness, Depression, and Social Engagement in Long-Term Care“
• We need more emphasis on individual behaviour change. Ilsa from Meaningful Ageing shared Frameworks See Me, Know Me – for older people and her new crowd-funded effort, Meaningful Ageing – for service providers. We need to invest in behaviour change models from top-down care activities to ‘consumer delivered’ care. “We need new frameworks to change individual behaviour towards self actualisation and self awareness and self care.”
• Easier contact tracing reduces the need for lockdown and solitary confinement. Elissa from Contact Harald shared their recent work which allows precise tracking without privacy violations. 
• Ageism can be reduced by more of a reduction of “othering” (will a Human Rights approach help this?)
• Lack of roles in society leads to social isolation. What are new roles and common interests. Currently roles are being replaced by “edutainment”, which isn’t sufficient. 
• Locality as the nexus of impact i.e. suburb/street is an important nexus of innovation. 
• We need new ways of getting to scale beyond pilots. Institutes and government don’t seemed concerned about quality of life or mental health, and so far limited progress with PEAK bodies – who naturally appear “focused on needs of provider members not residents”. Individual innovators and specific best practice providers are the key – need culture change. Paradox of change- the ones we need to engage to make change e.g. governments and policy makers seems those least likely to be able to deliver.
• Quick Win 1: Hearing loss. $500m is spent annually on hearing aids and 80% of them are abandoned. How can we make it easier for people with hearing loss – and arthritis – to change batteries? How do we inform those in their orbit (e.g. care providers). It’s not about buying new tech, it’s about diffusing existing tech with better wrap around, personalised services.
• Quick Win 2: Digital Divide. Need to make it easier to provide access to tools and sharing each other with mental health. Use tech to “empower each other through self actualisation”. Hayylo already is doing this well with tens of thousands of people connected. 
• Quick Win 3: Intergenerational engagement. It’s an opportunity to engage young by documenting history. Older friends die out, making this something that constantly needs to be addressed with older people. It was pointed out that COVID is a lived experience that connects all generations. 

We’ve reached out to the Grattan Institute and have invited them to join our next Aging2.0 Melbourne event, taking place at 8am Melbourne time on Tuesday November 3, 2020. (If you know key folks there, please point them in my direction – stephen at aging2.com)

A final word from the Grattan Institute Report about the needs to shift from a provider-centric to a rights-based approach. What this means in practice is fascinating and we’ll be looking more into that in future events: 

Australia needs a new approach to aged care. The pandemic has been another tragic reminder that the current system fails older Australians. We need to abandon the top-down, market-driven, provider-centric approach. Instead, we need a system that does not regard older people as passive recipients of care. The new system should support older people to participate in society as much as they can, and give them as much autonomy as possible. This is best achieved through a rights-based philosophy.