Speaking up for the elders

Uniting’s role in advocacy in Aged Care

Australians have been shocked at the stories emerging from the Royal Commission into Aged Care Quality and Safety. The Royal Commission was established to investigate the quality of Australian aged care services and reports of substandard care and abuse. It aims to identify the causes of failures and recommend changes to ensure better care into the future.

The Royal Commission’s interim report was released last week. Its findings were damning. The report described the current system as “cruel and harmful”. The problems identified range from poor quality care to neglect and outright abuse, to inadequate staffing and oversight of services. Concerns about service viability and insufficient government funding have also been voiced. The overall picture is of a system needing, in the interim report’s words, a “fundamental overhaul of the design, objectives, regulation and funding”.

The Uniting Church, through Uniting, is the largest provider of aged care services in NSW and the ACT. Whilst, our services have not been the subject of the most serious concerns highlighted by the Commission to date, we are focused on ensuring we provide the best possible support to our elders and see the Royal Commission as an opportunity to learn what we can do better.

But with the proper care of older Australian in question, what can Uniting do apart from ensuring the quality of its own services? Well, Uniting can, and is, speaking out on this issue on behalf of the wider church.

Why we must advocate for better care for older Australians

As mentioned above Uniting is a major provider of aged care in NSW and the ACT. We support around 7,700 residents in aged care services and more than 6,100 home care clients each year. The church commissions Uniting to provide high-quality services for all, especially for those who are vulnerable and disadvantaged. This experience in providing care grounds our understanding of the needs of older people and shapes our speaking on their behalf.

Our advocacy for older Australians is also an explicit part of the role delegated to us by the church. It is a sharing in the church’s wider work of social responsibility and social justice. As the Uniting Church declared at its inception:

“A Christian responsibility to society has always been regarded as fundamental to the mission of the Church”

Statement to the Nation, 1977

We advocate for older Australians because of our beliefs about human beings. With the wider church, we affirm the dignity and worth of every person. Older people can feel diminished as their capacities decline. But in the Christian understanding, human dignity and worth are gifts that cannot be lost. Older people remain whole beings, with a range of different needs – physical, psychological, social and spiritual. It is important that our aged care system recognises our older citizens as having the same rights to live as fully as possible as other groups.

What changes to the aged care system is Uniting calling for?

The Royal Commission is far from the first examination of Australia’s aged care system. In recent years there have been 20 inquiries across the country, many highlighting similar issues. Unfortunately, their suggested solutions have not been applied. While governments have responded with ad hoc reforms to parts of the system, the underlying problems remain. As the Royal Commission’s interim report notes, this lack of progress reveals an implicit undervaluing of older people in our society, treating them and their needs as a lesser priority.

In Uniting’s view, truly valuing older people would mean they receive the right mix of care and support, at the right time, in the setting they choose.

This requires a more sustainable aged care system characterised by the following principles:

People know what they are getting and can make choices: Aged care providers must be transparent on matters like staffing levels and training and publish quality indicators for their services. These indicators can be adjusted for clients with more complex needs. This data will help older people and their families make more informed choices about their care options.

There must be a shift to more home-based care: Australia has one of the highest rates of older people in residential aged care in the OECD (6.4% versus an OECD average of 3.6%). However, research demonstrates that the vast majority of people would prefer to age at home if they had the right support. Currently, 120,000 people who have been approved for home care are waiting for their packages to be provided. Higher-level care packages are especially needed. The Interim Report identified the Home Care waiting list as an area requiring urgent attention. Shifting the balance of care packages to the home care model, as well as being preferred by most people, would also have economic benefits because home care is less expensive than residential care.

Service innovation to improve health and wellbeing: People are entering aged care with more complex health problems that previously. Yet current funding models don’t offer incentives for providers to improve the health and wellbeing of older people. Initiatives such as Uniting’s Healthy Living for Seniors programs, Senior’s Gyms, Transitional Care programs and programs that connect older people with younger generations, especially children, make a real difference to peoples’ wellbeing and help reduce health care costs in the longer term.

A skilled and fairly paid workforce delivering high-quality care: We need to see wage increases and investment in training for aged care workers consistent with valuing their work and the people they care for. Wage rises and training opportunities can be linked to improvements in the quality of care provided.

Sustainable services through a mix of government and consumer contributions: Uniting believes that, where consumers have the means to contribute to their care, they should be able to do so. At the same time, it is vital that government contributions are sufficient to secure a good quality of care for those who are unable to contribute. That is not the case now. Even though Australia has a greater proportion of older people in aged care than many other countries (see above), Australia only spends 1 per cent of our gross domestic product (GDP) on aged care services. This is much less than the average of 1.7 per cent in OECD countries, while Sweden spends 3.2 per cent to fund an aged care system of which they can be rightly proud.1

How will Uniting go about advocating for these changes?

Uniting is speaking out on behalf of older Australians in different ways.

Uniting NSW.ACT is part of a large national network of Uniting Church aged care providers. Collectively we are represented by Uniting Care Australia, who advocate to government on behalf of member organisations and the people we serve.

As a large provider in its own right, Uniting is undertaking its own campaign to influence government decision-makers to support the changes we are calling for. We do this as part of the mission and advocacy responsibilities entrusted to us by the wider Uniting Church.

More and more organisations seeking social change are realising they need to speak together if they are to be effective. Uniting is contacting other large aged care providers who have common concerns and a shared vision for change, to explore the possibility of joint advocacy.

A question for us all

The issue of valuing older people and ensuring they are provided with the support they need to live as fully as possible is not just a question for aged care services and government. It is a question posed to all of us. Are we willing to call on our governments to invest in better quality care for older persons? Do we really value the dignity and care of older Australians enough to demand the fundamental changes required and be willing to pay for them? With the population of people over age 65 years set to more than double by 2055, these are questions that must be faced.

Tracey Burton, Executive Director, Uniting

1. Health at a Glance 2017: OECD Indicators; OECD