Lobby Groups and the Australian Aged Care Sector
Guest Lobby Watch post by Dr Marie dela Rama, University of Technology Sydney for the Australasian Centre for Corporate Responsibility
We hear far too much, I believe, from the providers working in the system, not nearly enough from the people who are receiving our services.
Ron Paterson, Head of the National Aged Care Quality Regulatory Processes
In September 2018, the federal government called a Royal Commission into Aged Care Quality and Safety, in response to the ABC’s Who Cares? report. Who Cares?, and subsequent submissions and witness statements to the Commission, have shown a sector rife with abuse and neglect. Numerous stories of rapes, assaults, dehydration, malnutrition, and improper sedation experienced by patients and residents in the aged care system, are contrasted with stories of aged care staff with insufficient time to care, workers lacking the proper qualifications for the roles they are expected to perform, and a regulator that is woefully inadequate to deal with issues in the sector.
The parlous state of the Australian aged care sector cannot be understood without looking at the active role the sector’s lobby groups and vested interests have played in the formulation of public policy, resulting in the regulatory capture of our politicians, regulators and health department bureaucrats.
There are numerous peak bodies in the sector, however only four are influential in the formulation of aged care policy in this country: Leading Aged Services Australia (LASA), Aged and Community Services Australia (ACSA), the Aged Care Guild (the “Guild”) and the Council of the Aged (COTA).
Taking the “Care” out of “Aged Care”
The “care” in “aged care” has been secondary to the financial interests of providers since the introduction of the 1997 Aged Care Act under Prime Minister John Howard. The current act contains voluminous detail on financial incentives for providers paid through the main taxpayer funded instrument (ACFI), while failing to legislate for minimum standards of care (e.g. staff:resident ratios, minimum staffing qualifications).
In response to recent scandals, a number of attempts to reform the sector have been made:
- The Member for Mayo, Rebekah Sharkie, has introduced a bill that would require providers to publish their staffing ratios quarterly. Centres would be grouped according to average levels of resident acuity, to facilitate comparisons of level of staffing (and therefore care) between centres.
- The Queensland Government introduced its own transparency bill, covering state operated centres.
- A change.org petition calling for mandatory staffing ratios, which has received over 316,000 signatures.
- The Australian Law Reform Commission (ALRC) made a number of recommendations in its 2017 elder abuse report.
There has been limited or no movement on any of these initiatives. The expectation gap between the community and the aged care industry has never been wider.
2.0 LASA
LASA represents the largest group of aged care providers in the sector: its members are small to medium aged care providers of government, for-profit and not-for-profit operators.
LASA has consistently resisted legislative attempts to improve staffing numbers in the sector. In every sectoral review since the 2011 Productivity Commission into Aged Care, they have called mandatory staffing ratios a “blunt instrument”.
In 2018, CEO Sean Rooney was interviewed on 4 Corners about LASA’s opposition to mandated staffing numbers and on substantial cost-cutting on basic needs:
Sean Rooney: With regards to staff ratios, as I said, that is a very blunt instrument in order to deliver person-centred flexible care to meet a growing and changing set of needs. And his is not something that…
Anne Connolly (journalist): So, you don’t believe there should be staff-to-resident ratios?
Sean Rooney: No. I don’t believe because the international literature doesn’t actually support that.
Anne Connolly: If you’re talking about high care, for example if you’re talking about 30 high-care people in a unit, how many registered nurses and how many carers should be available to them.
Sean Rooney: Well, I don’t know. It depends on what their specific needs are. The point…
Anne Connolly: If they’re high care and they’re bedridden, they can’t move.
Sean Rooney: Well, you would expect that would require a higher number of carers than people that aren’t in that situation.
Anne Connolly: What number? What number do you need?
Sean Rooney: It’s not for me to know. I’m not a clinician. It’s not my role to be able to determine that.
In their submission to the QLD government’s inquiry ahead of their transparency bill, LASA have actively campaigned against the compulsory publishing of staffing numbers:
It would be more straightforward to allow residential care services to not respond to the request for information rather than requiring them to respond, but allowing them to refuse to provide the information.
[…]
The number of consumers that are likely to view the proposed website is fairly limited — however there is a risk that the information disclosed will be misrepresented for sensationalist purposes or to push a particular medically based care model (which may be contrary to the preferences of residents).
The aged care sector has been criticised for failing to provide adequate food to its residents, as cost cutting impacts catering budgets and staffing. A 2018 academic report of 800 aged care facilities found that on average nursing homes were only spending $6.08 a day on food per resident. When asked by 4 Corners if LASA deemed that it was appropriate for nursing homes to spend $6 per resident per day on food, CEO Sean Rooney said it was an ‘interesting issue’, cast doubt on the ‘veracity’ of the claim, and noted that meals in aged care facilities ‘are being prepared for people that have a low nutrition requirement’.
Under Rooney, LASA has also lobbied against air-conditioning in homes, opposing draft legislation that would have made it mandatory for aged care facilities to provide residents with a “comfortable internal temperature”.
In 2014, former LASA CEO Nick Ryan was appointed to the aged care regulator, then known as the Australian Aged Care Quality Agency (AACQA). Under his tenure at AACQA, the number of accreditation visits to nursing homes that received complaints dramatically decreased, and nursing homes that met the aged care accreditation standards increased, with 97.8 of all residential aged care facilities unexpectedly meeting this standard. In response, Professor Graeme Samuel, President of Alzheimer’s Australia said:
Clearly something is wrong. The bar is set too low…
After AACQA was replaced by a single central regulatory body, the Aged Care Quality and Safety Commission (ACQSC), Ryan went to work at provider Lutheran Services Australia.
3.0 ACSA
ACSA represents community-based, faith-based and not-for-profit organisations.
ACSA’s National CEO is Pat Sparrow. Sparrow previously worked as Deputy CEO for ACSA, before being appointed in 2011 as Director of Aged Care reform at Council On The Ageing (COTA), a newly created role. In 2014 Sparrow moved to the office of former Liberal Assistant Minister Mitch Fifield, where she worked as an Ageing and Aged Care Advisor. She then worked as a policy advisor to former Liberal Aged Care Minister Sussan Ley, before returning to ASCA as CEO in 2016.
Like LASA, ACSA has lobbied against the implementation of staffing ratios, arguing that ‘there is no firm evidence to support whether they achieve better outcomes for residents’ .
4.0 Aged Care Guild
The Aged Care Guild was established by the British multinational aged care provider, British United Provident Association (BUPA), to represent the larger providers in the sector.
The Guild is currently comprised 7 large for-profit providers including Allity, Arcare, BlueCross, Japara, McKenzie Aged Care Group and Regis Healthcare. It is led by CEO Matthew Richter, a Canberra stalwart.
Arguably, Aged Care Guild members have caused the most distress to policymakers to date.
BUPA, the biggest for-profit provider in the country, has been the subject of numerous negative reports and media coverage about their failings in the sector. According to current accreditation reports, 60% of BUPA homes have failed to meet “basic standards of care and 30% are putting the health and safety of the elderly at serious risk.” Liberal Aged Care Minister Senator Richard Colbeck has said the Department of Health has weekly meetings with BUPA to address its failures. In April this year, it was reported that the competition watchdog, the ACCC, was prosecuting BUPA in the Federal Court over its failure to provide services, such as air-conditioning in bedrooms and dementia “smart rooms” at its aged care homes, which it had promised in residential agreements and charged for.
BUPA was chaired by former Labor Health Minister Nicola Roxon, until she resigned in June this year. BUPA is also a long term political donor to the Australian Labor Party and the Liberal Party.
Unlike LASA and ACSA, The Aged Care Guild supports the introduction of the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018, which would require staff to resident ratios to be published Guild members are generally better resourced financially than their not-for-profit counterparts, and their listed company members are able to take advantage of market financing, so they may see the introduction of such a bill as being advantageous for their members, compared with others in the sector. However, chronic understaffing in their homes persists suggesting that their priorities in aged care are somewhat misguided and misallocated. Guild members have failed to take the lead in the sector over staffing and other issues, even though their financial constraints are less pressing than other providers.
5.0 COTA
The Council of the Ageing (COTA) ‘seeks to be recognised by government, the general community and media as representing, advocating for and serving all older Australians’. It is a prominent lobby group in Canberra, and is represented in eight different government departments, and on eight different government committees. COTA was termed a “critical friend” (with LASA, ACSA and the Guild) by Liberal Minister Ken Wyatt, when the Minister was under pressure to address the proliferation of physical and chemical constraints in the aged care sector.
Headed by CEO Ian Garth Yates, COTA differs from the previous three lobby groups in that they do not represent providers, but rather “consumer interests”. Yates was called as the first witness at the Aged Care Royal Commission. He reiterated that COTA do not support legislated staff ratios.
Yates is a member of several government committees, including the Aged Care Finance Authority, Aged Care Sector Committee, Aged Care Quality Advisory Council of ACQAA, Department of Health’s Aged Care Financing Instrument (ACFI) Group, Aged Rights Advisory Service, Aged Care Standards and Accreditation Agency, and the Consumer Consultative Committee to the Australian Competition and Consumer Commission (ACCC). His presence on multiple government committees have seen him termed as a policy entrepreneur and influencer in the sector.
COTA is chaired by Jane Halton, a former Health bureaucrat who worked in the Department of Prime Minister and Cabinet as Deputy Secretary.
COTA’s political connections have served them well. They have received various government tenders, including a $6M tender to address the clunkiness of the not-so-user friendly My Aged Care website. They are now expanding their business interests entering the insurance industry.
Conclusion
The lobby groups have dominated the policy agenda in the aged care sector for far too long, resulting in political inertia and poor outcomes for patients, their families, and workers. The sector is incredibly dysfunctional. The lobby groups listed above have an enormous amount of power and influence, and they do not reflect the values, interests and the concerns of the community. Change requires political will. We must push back against industry lobby groups and establish policies that will ensure quality care.
