You know you have entered the parallel universe of residential aged care when you find yourself saying, “Just to clarify, the deposit for the room is $1.95m, and the charges will be about $10,000 a month?”
“That’s correct,” the kindly sales agent replies.
Sure, it’s Sydney’s eastern suburbs, but that is a lot of money for a 20 sq metre room – almost double the median price for a one-bedroom apartment in the same suburb.
“In the brochure there are rooms for $1.25m, are they available?” you ask.
“No, and when the current residents leave [die] they will be renovated, with new bathrooms.”
“I guess that will make them more expensive?” you speculate.
“Yes, they will be $1.65m.”
Even with imported marble that seems excessive. Like all the privatised care services, the business of aged care is about property, cheap labour and public money.
But when your loved one has been deteriorating in a hospital bed for eight months without any therapies, eating hospital food on plastic plates, with only a car park to walk around, you are desperate and say yes, hoping against hope that another option will emerge.
In my case it did, and a few days later a 16 sq metre room with a big window in a well-run little centre became available. A mere $995,000 plus the day rate, the “hotelling fee”, non-clinical care contribution and special services charges.
Welcome to the for-profit, highly regulated, severely rationed, underpaid, world of aged care – where no one is a winner, and the most frail and vulnerable and their carers are forced to navigate an extraordinarily complex system.
There are endless online forms to complete, passwords to remember, physical certification to prove you are who you say you are, then more documents to sign, financial advisers to consult, medical specialists to listen to, occupational therapists to perform for, providers to negotiate with and an ever-changing group of service providers and staff.
This time last year there were more than 2,000 older people in hospitals – “bed blockers” they were cruelly called – too frail to go home without more support, but with Buckley’s chance of finding a residential care bed, even if they could afford the now standard deposit of $750,000. Beds for the poorest and most needy were even scarcer.
This year, despite the state health ministers winning extra money from Canberra, the “bed blockers” are understood to have almost doubled.
The specialised facilities the frail elderly need cannot be conjured overnight. Last year few new beds became available nationwide. The health minister, Mark Butler, says a new facility is needed every 72 hours to meet the 18,000 target in three years.
The new system of aged care, which was meant to address problems of the old model identified with heart-breaking detail by the royal commission into aged care, is not even a year old but already broken.
At least the Commonwealth Home Support Program, which costs 8% of the $40bn budget to assist 65% of aged care clients, will now continue until 2029.
Hundreds of thousands of people are waiting for assessments and, when these assessments are completed with an algorithm that doesn’t allow for human oversight, they find themselves waiting months for a package to meet their needs and enable them to age at home. When the package is allocated they wait even longer for a provider to deliver the services they need.
If they can afford them.
For the three-quarters of aged people on pensions, the new co-payments for non-clinical services are often beyond their means.
That is, if they can find someone to do the work.
In the first two months of the new system, applications for financial hardship increased by 88%. “The way aged care reform is being implemented is causing harm … we have built inefficiency into the system by design,” the recently departed inspector general of aged care, Natalie Siegel-Brown, observed.
She believes the system should be turned upside down to start with the outcomes we want, rather than the mechanics of funding and services: to put care first, help people stay at home and connected to their communities.
This already occurs with the aged veterans’ care program.
It has also worked in countries including Denmark, Japan and South Korea, where investment in individual home care is prioritised, reducing the need for much more expensive residential facilities. It would mean a system where the assessor is a human being, where the person delivering meals warms them and sits down and talks with the client as they eat, where assistive technology is delivered when it is needed, not after months of checking and vetting and another fall.
All the ministerial platitudes in the world will not solve the problem. Action is needed, now, to keep people safely at home longer, before it becomes too hard, thousands of people and their carers needlessly suffer, and we all pay for it.
