19 June 2000

So what is happening in aged care?

The bottom line of the persistent problems in aged care is lack of money and lack of regulation. The current federal government's philosophy of small government has seen cuts made in a whole range of different areas, not just aged care. The message is one of small governments providing only a bottom line safety net.

The expectation of the federal government, despite mounting evidence to the contrary, is that private enterprise will take up the slack. Church and charity groups are expected to fill the void caused by cuts to government employment services, private health insurance is expected to fill the void caused by government cuts to health, private schools are expected to fill the void caused by government cuts to the education sector.

In aged care, the federal government originally proposed accommodation bonds to make up for the cuts to their aged care budget. Following public outcry, this proposal was scrapped, however, the planned $400 million cuts to the government's capital works budget for aged care went ahead. Once again, the expectation was that the industry would fill that void.

In addition to direct cuts, this government consistently defines regulation as 'red tape'- if regulation is removed the money made available to employers from not having to follow rules will be directed to more useful purposes. The removal of the requirement to prove care money has been spent on employing nurses in aged care is a classic example of this.

Saddled with funding cuts on top of the lowest level of nursing home subsidies in Australia, it appears some aged care employers based in Queensland are choosing to interpret changes in aged care as a license to attack nursing in order to save on costs. For example, Churches of Christ have interpreted regulations which list those tasks which MUST be performed by a registered nurse as meaning that registered nurses can do no other work than what is on the list and enrolled nurses are not required at all! In the same vein, the federal government's removal of the requirement for 24 hour Registered Nurse coverage where there were 8 or more high care residents has been interpreted by some as 'they don't need registered nurses anymore'.

This attitude is also reflected in the move by a group of 14 employers (including TriCare - another large Queensland-based aged care provider) to put in place an award which effectively abolishes the nursing classification structure and contains few references to nurses or nursing.

The federal government's 'Ageing in Place' policy based on the concept that elderly people should be able to remain 'in place' and not move between facilities when their care requirements changes has also been profoundly misunderstood. A policy meant to ensure that the care came to the person, rather than the person going to the care was never meant to deny people access to care according to their needs. Unfortunately, some providers are interpreting this to mean that high care residents do not need nurses. This profound misinterpretation of ageing in place has in fact seen an increase in admissions to public hospitals from aged care facilities - the opposite of the stated goal of ageing in place!

Statements by the government support the notion that some aged care providers in Queensland have misinterpreted their actions. Recent statements by the Minister for Aged Care of the need for a proper career path for nurses in aged care is one example. The commitment given by the previous Minister to the ANF that the removal of the requirement for 24 hour Registered Nurse coverage for 8 or more high care residents would not result in a reduction of registered nurse numbers in aged care is another. An industry however, cannot be regulated by statements alone!

The QNU and the ANF have been calling for greater funding and proper regulation of aged care. We believe Directors of Nursing should be responsible and accountable for care funds received from the government.

The attack on nursing in aged care is occurring across Australia, but seems to be worst in Queensland. Fortunately at a national level, many providers do recognise the importance of nursing in the care of elderly people and this is reflected in the willingness of a number of major national providers and employer groups to work with the ANF to come to potential solutions. In Queensland, we will continue to fight to defend the vital role of nursing in aged care and campaign with the ANF for proper regulation of the aged care industry.