I DESPAIR OF WHERE THE ACRC IS HEADING

I submitted the following document for publication in MJA InSight a few weeks ago. The release of the interim report of the Aged Care Quality and Safety Royal Commission last week beat the journal. My submission turns out to be a very apropos response.

The ACRC 
I despair of where the ACRC is heading and wonder if anything useful will come of it. There seem to be several unchallengeable “givens” that it is deaf to hear questioned. These are that:

1. High Level Residential Care is the provision of Sheltered Accommodation, not active Long-Term, Continuing, and Palliative Health Care for people, all of whom suffer from advanced chronic illness and disability (plural).
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There is now a vast body of research on the Frailty Syndrome. It is a multifactorial combination of  accumulated impairments and disabilities super-added to the underlying ageing process. It must be understood and addressed from a Bio/Psycho/Social perspective as it manifests as somatic, cognitive, and psychological disability and progressively increasing vulnerability to stressors of all kinds. Placement of itself is a formidable stressor.

The progression of the Frailty Syndrome can be slowed and even reversed by strict attention to the treatment of all comorbidities and particularly by regular structured exercise, appropriate nutrition, and socialisation. Sitting all day in front of the TV set is a quick way to accelerate it (“resting is rusting”).

​This cannot be achieved without capable health care of every type. The availability of general practitioner care is taken for granted. The GP is the most critically needed/important medical practitioner in the system and this must be recognised, respected, and properly financed.
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2.  The Business Model and its action arm Managerialism is the most appropriate and effective way to deliver said care in the Welfare State that we purport to be, lessons from history notwithstanding.

I was appalled, but not surprised to hear and read that “More than half of the nursing homes run by Australia's largest private provider Bupa are failing basic standards of care and 30 per cent are putting the health and safety of the elderly at "serious risk", according to accreditation reports analysed by the ABC’.

​Sad to say, many NGOs have forgotten their charitable and religious origins and behave with the same ruthlessness as businesses like BUPA. One needs only to look at the new buildings that house outreach services to see an example of “trickle-down economics”.

3.  The Commonwealth Government is capable of and has the infrastructure to deliver urgently needed support services to all corners of the Commonwealth, when the States have the personnel and infrastructures to do just that.

​The Commonwealth and its advisors and planners are too far removed from the coalface to understand the urgency that exists in this field. It often takes a considerable effort to persuade mother that she needs help. In real life, she needed it months ago, but with the incompetent bureaucratic delivery of My Aged Care, she will be waiting for a long time and her needs will grow throughout that period.

The States do not have to create massive new infrastructures and employ a new workforce to deliver additional services in areas in which they already operate. While some states do this better than others, all of them do this better than the Commonwealth.

The Commonwealth is the appropriate Funder (we used to talk a lot about the Funder/Provider split). The States are the most appropriate providers and are not as easily conned by lobbyists and political minders.

4.  The atrocities committed on care recipients by providers can be prevented by stricter accreditation and sanctions for the failure to provide the necessary services that they are not staffed and structured to provide.

Let’s hope that BUPA really suffers from having its wrist slapped.