Why Australia’s aged care system needs a TripAdvisor

As the Aged Care Royal Commission prepares to have its say, families are hoping the system will no longer keep them in the dark.

ACH Group trainer Mandy Neaylon with physiotherapist Owen Swan and personal trainer Jillian Smith experience some for the effects of ageing themselves in empathy suits. Picture: Tricia Watkinson

For a man aged in his 40s, Frank Weits suddenly felt old.

His hearing was muffled, his vision blurred and his hands felt crippled.

From his wheelchair in the nursing home, he couldn’t see who was talking to him, or hear what they were saying.

Mr Weits, chief executive of aged care provider ACH Group, was wearing an “empathy suit”, with straps, weights and braces to restrict movement, sight and hearing.

The suit is designed to help staff understand the physical impact of ageing and develop empathy for older people.

It worked for Mr Weits. When his “carer” asked him to stay put while she went to retrieve something, he was left alone – and afraid.

Now standing, and wearing a moon boot after breaking his foot, the empathy suit made him too scared to move. “I had a real sense of fear,” he said.

Empathy is something the Royal Commission into Aged Care Quality and Safety, whose report is due to be handed to the Federal Government today, would like to see more of.

The royal commission has been scathing of the aged-care sector, and is about to reveal how it believes it should be fixed. More money and more staff will be important.

But one of the biggest problems is that older Australians, and their families, are, like Mr Weits in the empathy suit, largely blind to what is really going on.

The sector lacks transparency.

The public does not know how aged-care providers actually spend the billions of taxpayers’ dollars they receive, or how they perform.

Aged care desperately needs a TripAdvisor.

SAHMRI has produced something close: the first national league table comparing aged-care providers across a range of clinical measures, showing the best and the worst.

Unfortunately, the public, and even those working in the sector, cannot access the results, and it is not clear if they ever will.

Yet the differences between aged-care providers’ costs and performances can be dramatic.

Mark McBriarty, executive director of aged care provider My Care Solution. Picture: Supplied.

Mark McBriarty used to help Hilton open hotels around the world. His wife, Lee, is a palliative care nurse.

Together, they run My Care Solution, helping older people spending their final years in their own homes

But there are challenges: the Home Care packages, which peak at $52,000 a year, do not provide as much care as many would hope.

Mr McBriarty said his company provided 15 hours a week of at-home care to people on the top level-four package, as assessed by the Federal Government, while he said some of the larger not-for-profits managed 10 hours.

He claimed that was because some bigger providers had become fat with middle management so did not provide the care hours they might otherwise manage.

Mr McBriarty paid his staff $28 an hour, more on weekends, and charged clients double that, to pay for the office and case-management staff, and still make a 10 per cent profit.

His pay appeared to be a little above the industry standard, but he said his 135 carers – aged from their 40s to 70s – did not expect to make themselves rich. “It’s intrinsically rewarding and flexible,” he said of working in the aged-care sector.

“And there are not many jobs where you can look in someone’s face and know that you’re the only person who has visited them that day, and managed to make their day.”

One of the problems with aged-care providers in South Australia, he argued, was that too many outsourced their work in clients’ homes to staff they do not employ directly.

Mr McBriarty’s experience in human resources at Telstra, when it was opened to competition, showed the only choice was to become more efficient and focus on delivery.

“You don’t outsource your business,” he says.

“If you look at the royal commission, one of the key findings is continuity of care – (elderly) people are just sick to death of 100 different people coming through the door.”

Back at ACH, Mr Weits said his team delivered about 10 hours of at-home care to clients on a level-four package. The hours of care varied according to the type of service provided, with cleaning cheaper than nursing, but Mr Weits said the benefit of his bigger operation was that it had better systems and greater reliability.

But he agreed with Mr McBriarty that the level of care provided through the Federal Government packages was not always enough. He pointed out that a person on the National Disability Insurance Scheme (NDIS) with dementia may receive an annual package of $200,000 for care, while those over 65 on a home-care package would max out at $52,000.

ACH boss Frank Weits with resident Kapara Mews resident Claire East at the Glenelg South age care home. Picture: Tom Huntley

He said there should be level-five and level-six packages that provide more care at home. But, like everything in aged care, he said there was not enough funding.

And he doubted the government, with budgets smashed by COVID-19, would provide the doubling of cash the sector is now lobbying for and which the royal commission may recommend.

One solution was for individuals who could afford it to pay more for their aged care. “At the moment, the family home is not being considered … and the reality is why wouldn’t it be?” Mr Weits said.

“You can’t take the money to your grave.”

But he said to encourage people to pay more, the industry needs to offer more.

His thought the airline model was a good one.

Basic government funding would get you economy-class care, but “there are all these different models all the way up to first class” for which individuals would need to pay.

So far, the “value discussion” was missing.

But Mr Weits thought it was the key to a viable future for the sector, where older people who owned their homes were willing to dip into that equity to pay for better care, while still leaving money for the next generation.

Jane Pickering, chief executive of South Australian aged-care provider Eldercare, agreed that people needed to contribute more, if they could afford it.

She said that otherwise, the money and service would not be there.

The royal commission is also likely to recommend nursing homes provide more direct care for each resident, including set amounts of time with nurses.

The current industry average is 3.24 hours a day.

Eldercare manages 3.47 hours, Ms Pickering said, but the commission could recommend an increase to 4.4 hours.

Royal Commission into Aged Care Quality and Safety commissioners: Chair, the Honourable Tony Pagone QC, and Commissioner Lynelle Briggs AO. Picture: Arsineh Houspian

So would a little bit more time with a nurse really hurt the sector financially?

Yes, Ms Pickering said.

For Eldercare, every six minutes a resident each day cost nearly $2m a year.

“To go from 3.47 hours per day to 4.4 hours … would cost nearly $20m a year,” Ms Pickering said.

She said the staffing levels and hours of care under discussion were simply unaffordable. “It will send every aged-care provider broke very quickly,” she said.

Ms Pickering said there were some bad aged-care providers that had tarnished the sector. But in reality there was not enough money to provide the care needed, even when you don’t make a profit. Eldercare only seeks to break even.

“The biggest problem facing aged care is that the community does not value older people enough to invest in a well-funded, high-quality aged-care system,” she said.

Nurse-led care was “absolutely necessary if we want high-quality care … but unaffordable and not sustainable within the current funding environment”, she said.

David Panter, chief executive at provider ECH, said aged-care funding was a matter of priorities for Canberra.

“It (the government) happily invests billions in the resources sector, defence industry and, indeed, the new space agency, to create jobs and drive the economy – they can equally invest in good-quality care for older Australians,” Dr Panter said.

The system needed wholesale reform to address problems as basic as the imbalance in demand between nursing homes, which, nationally, were at record low occupancy levels, and home care, which had a waiting list of 100,000 people, he said.

But he also said individuals could contribute more.

“Many who can afford to pay more don’t have to,” Dr Panter said.

“On the other hand, somebody on a basic government pension is expected to contribute 17 per cent of that as a co-payment for home-care costs.

“This increasingly means they are unable to afford the basic things like food medication and utilities.”

At Southern Cross Care, chief executive David Moran said the lack of funding for the sector was real, hurting residents, and needed to be urgently fixed.

He said Southern Cross had long worried about the growing gap between the cost of providing high-quality residential aged care and the direct funding from the government.

A year ago, he wrote to federal MPs to plead for five short-term measures, including a $10-a-day rise in daily fees for each bed, and a training subsidy for staff.

His appeal fell on deaf ears.

Mr Moran knows the royal commission is likely to urge more expensive staffing levels and ratios, but said it would not be possible to provide better-quality care without a sustainable funding model.

If that didn’t happen, he warns, “we will not be successful in keeping older Australians out of a state of dwindling and disability”.