General aged care terms
This web site is an analysis and does not advise on aged care. Some terms that may be useful to readers of this web site include.
Myagedcare.gov.au: The complex aged care system as well as the complex funding are administered and managed through the MyAgedCare website which is also the information portal for potential residents. This complexity is well illustrated by the alphabetical glossary on that web site.
If you need to look up any particular term in aged care please visit the MyAgedCare Glossary
Funding: Government subsidies for both residential and home care are means tested. The funding allocated also depends on the level of care needed. After that the market determines the cost you will finally have to pay and the resident must negotiate thi9s with the provider. The options are complex and varied. Government has attempted to separate the fees paid for accommodation (hotel services) from those paid for care.
Accommodation can be paid for using a bond also called a Refundable Accommodation Deposit (RAD), a Daily Accommodation Payment (DAP) or a combination of both. When the resident leaves the RAD is refunded less a number of charges.
In home care, four funding packages are available depending on need. Any requirements above this are paid for by the resident.
Addditional fees: There are many additional fees and providers can add in any individual fees they decide they need and undisclosed fees are sometimes added after the resident has entered the facility. When government reduced payments because they believed they were being rorted many of the biggest companies whose large profits fell as a result elected to charge those residents who had opted to pay with a RAD a large additional daily fee.
Extra Services and Choice: These are additional services (eg, newspapers, internet or television) that many charge for. The government is selling its new aged care reforms as offering consumers "choice". Providers are encouraged to provide additional choices for residents. Whether this will improve the lives of residents or are primarily an opportunity for providers to make more money and so be attracted to the sector, is debatable.
Consumer Directed Care: A reform process where the funds are allocated to the person in need and that person decides how that money will be spent.
Aged Care Financing Authority: The Aged Care Financing Authority provides independent advice to the Australian Government about pricing and financing
Aged Care Funding Instrument (ACFI): ACFI is a tool used to assess the care needs of residents and allocate subsidies to residential aged care facilities.
Administrative Appeals Tribunal: (AAT) A body for resolving disputes in the sector.
Aged Care Assessment Team: ACATs (or ACAS in Victoria) is the process for assessing the level of care that is needed and which the government will subsidise.
Community Visitors Scheme (volunteer visitors): A volunteer from the Community Visitors Scheme visits someone living in an aged care home who may be lonely or socially isolated. The visitors have no role in monitoring care or in advocacy.
Advocacy: The government contracts with a body in each state to provide advocacy services when there is a dispute between residents and provider.
Respite care: Care given as an alternative care arrangement with the primary purpose of giving the carer or a care recipient a short-term break from their usual care arrangement.
Classification of residents: Facilities were previously classified into nursing homes that provided services to residents who needed High care and hostel that provided care to residents who were classified as Low care and paid bonds. The distinction has now been removed and the process is calle "ageing in place". Both pay bonds.
Quality Indicators: These are a response to criticisms and a call for objective measures of care. They are being developed and trialed. They do measure failures in care but are self assessed by providers and have been gamed in the USA.
Consumer advocacy groups
Aged Care Crisis: ACC are an outspoken independent volunteer group on aged care issues, and have consistently highlighted the inadequacies of the aged care system through various mediums to government over the years. ACC do not ask or receive funding, and are not aligned with any political or religious group.
Combined Pensioners & Superannuants Association of NSW Inc (CPSA): CPSA was founded in 1931 in response to pension cuts. CPSA is a non-profit, non-party-political membership association which serves pensioners of all ages, superannuants and low-income retirees. The aim of CPSA is to improve the standard of living and well-being of its members and constituents. An energetic and outspoken group who advocate without fear or favour from political parties or industry.
National Seniors: National Seniors is the largest senior's consumer lobby group for older Australians with over 200,000 members throughout Australia.
Council of the Ageing (COTA): COTA is the smaller of the two largest senior's associations in Australia with 40-50,000 members. Unlike CPSANSW and National Seniors, it is closely aligned with providers as a member of NACA (National Aged Care Alliance) and is generally supportive of industry and government. Two members of its board come from provider organisations. It is extensively funded by state and federal grants as well as government contracts. It is perceived by some community groups as supportive of government and providers rather than seniors.
Aged & Community Services Australia (ACSA): ACSA is the national peak body representing not-for-profit and faith-based providers of residential and community care, and housing and support for people with a disability and their carers.
Leading Aged Services Australia (LASA): LASA is a national peak body acting on behalf of private sector and not-for-profit providers delivering retirement living, home care and residential aged care services.
National Aged Care Alliance (NACA): NACA are a representative body of peak national organisations in aged care, including consumer groups, providers, unions and health professionals.
Australian Aged Care Quality Agency (AACQA): Renamed from the Aged Care Standards and Accreditation Agency (ACSAA). In 1997 accountability for spending funds and for staffing in nursing homes as well as state oversight were all abolished. They were replaced with an "independent" accreditation body appointed by the minister. Government funding was conditional on being accredited. The accreditation process was largely process driven and did not measure and report out the incidence of failures in care or staffing levels. It was criticiesed as being provider friendly. A review of the Agency carried out in 2009/10 was never publicly released.
In 2014, all pretense of independence was abolished and the government took over making the minister responsible. They appointed the retiring CEO of the industry organisation to be its CEO. A formal accreditation assessment which facilities prepare for are carried out every 3 to 5 years and the reports are available to the public. In addition, facilities are visited annually and many of these visits are unannounced. These reports are not publicly available.
Department of Health: (previously Department of Health and Ageing). Until 2014, aged care was a subsection of the federal Department of Health with its own minister in the cabinet. The Abbott government moved aged care to the Department of Social Services. When Abbott was replaced by Malcolm Turnbull it was moved back to the (renamed) Department of Health and under the control of the minister for health. The department manages funding and is responsible for sanctioning problem facilities.
Non-compliance: If an aged care home fails to provide care and services residents need, the Department of Health may investigate and give the provider a Notice of Non-Compliance (NNC). The Notice will let them know there are problems that need to be fixed within a certain time period. When a Notice of Non-Compliance is issued, the home will have up to 14 days under the Aged Care Act 1997 (the Act) to submit a written response. Information about the Notice will be published on the Department of Health website once the Department has considered the submission or if the Department does not receive a written response within the specified time period.
Sanction: Sanctions are imposed by the Department on approved providers where there is an immediate and severe risk to the health, safety or well being of care recipients or where the service does not rectify continued non-compliance. Issues considered when making a decision to impose sanctions include whether the non-compliance is minor or serious, whether the non-compliance has occurred before and whether the health, welfare or interests of care recipients at the service are threatened.
Aged Care Commissioner Complaints (ACCC): Until 2015, complaints were handled by a sub-department in the Department of Health. Later, an Aged Care Commissioner was appointed to review complaints when the residents objected. The Commissioner did not have the power to overturn decisions. In 2015 the Complaints system was turned into an "independent" body under the Aged Care Commissioner who was appointed by the minister and given additional power and funding.
FP (For-profit): A for-profit corporation is an organization which aims to earn profit through its operations and is concerned with its own interests and not those of the public. These can be differentiated into private for-profit, market listed for-profit and private equity. The profit pressures and conflict of interest posed by the need to balance the costs of service to customers with the imperative of profitability increase in this order. International studies suggest that i aged care this impacts on staffing levels and the incidence of failures in care.
Private for profit companies can be individually owned or have multiple owners or sharholders who profit from the business. The extent to which the business is motivated by an ethic of service or of profitability is variable depending on the owners. There is little if any public reporting.
Market listed companies are companies that sell a share in the company on the sharemarket where anyone can buy or sell them. A high level of accountabuility and of public reporting ensures that buyers and sellers are not defrauded. Mangers and the board have a primary fiduciuary responsibility to maximise profits for shareholders
Private Equity companies are not publicly listed so are not regulated or accountable in the same way. They have greater flexibility in the conduct of the business. They are a high risk investment returning big profits when successful and making big losses when their strategies fail. Wealthy individuals and large investment companies looking for larger profits invest in them. They depend on their management skills. Typically they buy distressed companies or into a poorly performing market, put in their own managers into the company to reduce costs and improve profits before selling the company or floating it on the sharemarket at a large profit within 2-5 years. If they misjudge the business or market trends they can suffer heavy losses. Dramatic private equity failures have created major problems in aged care in the Unied kingdom.
Essentially, a group of of investors get together to raise some cash - that’s the equity; then they go to the bank and borrow several times that initial amount -- that’s the leverage; and then they acquire a target company -- that’s the buyout. They then tweak the company with the aim of making it more profitable, so that they can sell it off in a few years for a profit. Pay back the loan and split the profits.
NFP (Not for profit): Or non-profit organisations are organisations that do not operate for the profit, personal gain or other benefit of particular people. They may have employees but do not have shareholders. All moneys are directed towards the service that is provided to the public. Not-for-profits traditionally have provided services to the needy in the community includng health and aged care. They have been funded by government or by community donations and fund raising, by government and corporate grants, and payment by those who could afford to do so. They have typically been charitable organisations.
International studies suggest that in the past, the NFPs have had more staff and less failures in care. Free market policies introduced into sectors that they traditionally dominated in the 1990s has forced them to compete directly with for-profits. This has created problems for them and they have had to find ways of adapting to this. The impact of this on care has not been evaluated. The NFP sector in aged care is made up of government run services (federal, state or local council), community owned and run organisations and religious organisations. Increaingly government run services have been privatised and sold to private groups, community groups have sold to for-profit and some religious groups have abandoned the sector.
Mutual company: A mutual company is "a private company whose ownership base is made of its clients or policyholders. The defining feature of a mutual company is since its customers are also its owners, they are entitled to receive profits or income generated by the mutual company". Mutuals have a responsibility to and serve their members but despite this definition not all customers are members and members do not seem to have any additional privileges. They do not elect management or vote on policy. Some mutuals are giant global growth companies and seem to be more focused on the game of empire building than serving anyone. In aged care in Australia they are classified as, and behave like, for-profit but in some jurisdictions they are called not-for-profit. In some countries there are a variety of related arrangements called provident, cooperative, Community Benefit Societies and Private company limited by guarantee
Venture capital: The term given to early-stage investments. Venture capital funds funds the commercialisation of ideas and research, bringing them to the market. It can also be high risk. There is often confusion surrounding this term. Many people use the term venture capital very loosely and what they actually mean is private equity.
GDP (Gross domestic product): The total monetary value of final output of goods and services produced by an economy within the country.
GNP (Gross national product): The total value of goods produced and services provided by a country during one year, equal to the gross domestic product plus the net income from foreign investments.
The total monetary value of output of goods and services produced by an economy - that is by residents and non -residents.
Initial public offering (IPO): An IPO is the official term for ‘going public’. It occurs when a privately held company – owned, for example, by its founders plus perhaps its private equity investors – lists a proportion of its shares on a stock exchange. IPOs are an exit route for private equity firms. Companies that do an IPO are often relatively small and new and are seeking equity capital to expand their businesses.
Privatisation: A government policy which is centred on reducing the public sector as much as possible through the transfer of industries and utilities from state ownership and control into the hands of private shareholders. Increased use of private sector in providing social benefits and services, such as greater reliance on occupational welfare or proprietary aged care or child care services. May involve reduced role of government and increased role of market in funding, delivery, and/or regulation.
Deregulation: Removal of governmental controls/restrictions from an industry (e.g., deregulation of the aged care industry) or social program (absence of federal hild care standards). Aged care was deregulated in 1997 when probity requirements for accountability for funding and staffing were removed.
Political and social theory terms
Capitalist Democracy: Capitalist Democracies refer to many differnt and complex social structures. They are variously defined and have multiple facets and interpretations that are sometimes in disagreement. On this web site I have accepted the view that capitalist markets are the engine which makes modern society possible and supports it but by itself it is exploitative and incapable of maintaining a fair and civil society.
Democracy is a system of government that enshrines not only the rights of citizens and capitalist markets but as importantly the responsibilities of both to protect the interests of society and the rights and well being of members of that society. It is a system of checks and balances that protects and prevents exploitation.
The democratic principle of government by the people for the people is an ideal limited by the realities of the political process. The two party system is a compromise. Its great weakness is its vulnerability to grand ideas (ideologies) that undermine its principles and the checks and balances. Too often this leads to exploitation or harm to some. My argument is that this is happening today. Democracy is an ideal which constantly slips away from us - the moment we look away it is gone. It requires continuous monitoring by civil society, repeated challenge and continuous renerwal. It succeeds to the extent that we strive towards the ideal.
Civil society is a broad concept that embraces a community of linked citizens communicating and embracing ideas as they participate in the affairs and.activities of society. Civil society builds and maintains the norms, values and morality of society, which are given form and expression in citizens day to day lives. They include all of society the ”aggregate of non-governmental organizations and institutions that manifest interests and will of citizens” and “distinct from government and business”. Not-for-profit organisations have been important components but increasingly many have become part of the market and so lost their close links with the societies that gave rise to them - part of the hollowing out of society.
In using the term I have focused on its role in balancing and controlling government and the market which are there to serve it. It is the social embodiment of our individual responsibilities as citizens to others and to the common good.
Ideology: It can be defined as "a system of ideas and ideals, especially one which forms the basis of economic or political theory and policy". It is used primarily for grand ideas and beliefs and often in a in a critical way.
Culturopathy or culturopathic: I have suggested this descriptive but related term. It focuses more directly on patterns of thought and beliefs that turn out to be harmful in everyday life and the cultures that result from them. I apply it to ideas and beliefs in everyday situations that are thought by believers to be beneficial or necessary, but which cause harm in some way. These situations are characterised by forceful assertions, a failure to collect data, control of data, ignoring data, censorship, a blindness to or refusal to acknowledge consequences and an aggressive response to criticism. The concept focuses more directly on what happens in day to day life rather than the grand sweep of ideology but they overlap. It is something we all do in many little ways.
Traditional market theory: I have used this term to describe the balance between the self interest of businessmen and that of the customer that is the basis of any market. The customer needs to be acutely aware that his interests are different to those of the businessman. Ultimately the customer has the final say. Civil society sets the parameters and the limits within which markets operate and ensures that they behave in a socially responsible way and serve the common good. It too needs to be constantly aware that businessmen's interests are not those of the community. As I understand it these ideas were set out in the writings of Adam Smith. The vulnerability of some customers was recognised and civil society sought to protect them.
Free markets: At various times markets have escaped the control of civil society and enjoyed enormous success.The more traditional ideas have been disregarded or eroded as the markets brought great wealth to society and so became more influential and had greater control. This occurred during the industrial revolution in the 19th century and during the early 20th century. While it brought wealth and advances it also brought inequality, hardship for those who were exploited and economic instability including the 1930s great depression, after which civil society acting through government once again took control.
The revival of free markets came in the 1980's when Reagan and Thatcher led the way in adopting the radical and grand ideas proposed by economist Milton Friedman. He argued that markets were self correcting and that any sort of interference or control by government or society impeded their operation and this is why harm resulted. He largely ignored the customer emphasising responsibility to shareholders rather than customers. He rejected any social responsibility which he considered to be socialist and a "fundamentally subversive doctrine”. Competition and efficiency were removed from the balanced social context where they were directed and controlled by society and instead given an omnipotence that makes them unchallengeable. Believers in free markets reject the idea that this radical interpretation of markets is an ideology built on illusions about the nature of markets, efficiency and competition.
Neo-liberalism: This is a term that has changed over the years. I use it to describe the political belief system that has grown from the Thatcher and Reagan adoption of free markets and a “laissez-faire" approach to economics. It is characterised by a view that government is bad and "socialist". It focuses on small government and the transfer of government and civil society functions to a liberalised market. All restrictions on markets activities including those that protect vulnerable citizens are removed. Free markets are seen as equally applicable to all sectors of society, including civil society. Both civil society and government, even politics and democracy itself, have been structured as if they are free markets. They adopt market thinking and practices. Leaders in the market are seen as credible, dominate parliament and are appointed to positions in government and civil society. Neoliberalism embraces globalisation with a primary focus on markets which are liberalised and empowered.
Managerialism: This refers to the culture of management taught in business and economic schools across the world. As managers and consultants they have been responsible for introducing free market and neoliberal principles and a set of processes into markets, nor-for-profits and across society. Their confidence and credibility as advisers in charge of change have been critically important in the dissemination and acceptance of free market ideas in the community. The discordance between the ideas that drive managerialismt and the responsible role of citizens in civil society can be seen as a root problem in the dissatisfaction of citizens in western nations with their politicians - this is in spite of their greater wealth.
Modernism: Modernism can, in short, be characterised by belief in the existence of truth, objectivity, determinacy, causality and impartial observation. It has been described as "a search for an underlying and unifying truth and certainty, a search for a definitive discourse that makes the world and self coherent, meaningful and masterable". Modernism thus seeks to capture, define, understand and control knowledge. (Medicine for the millennium: the challenge of postmodernism Chan and Chan Med J Aust. 2000 Apr 3)
Postmodernism: As a philosophy postmodernism was a critical movement that arose in the 20th century in response to the certainties of modernism, the ideologies that developed and their adverse consequences. It questioned the certainties, analysed them and challenged them. It focused on "lived lives" and the many different contexts within which they occurred. Postmodernism challenges the modernists idea of truth. It was impossible to clearly define exactly what postmodernism was. Chan and Chan spoke of “the small narrative based on lived lives, the diverse, the complex and the unique. Such an approach acknowledges individuality, complexity and the subjectivity of personal experience.“
It has been criticised, particularly by neoliberals, who are most challenged by it as not having a philosophical base, as being entirely negative and not offering anything real to believe in and so not offering a positive way forward for society. As a consequence of the global uncertainties following the 2011 terrorist attacks there was a swing back to a greater fundamentalism in the west. With the ascendancy of neoliberalism and the economic certainties created by free market beliefs postmodernism has become something of a dirty word.
I have been influenced by postmodernist thinking to the extent that it challenges the great ideologies that have decimated societies and gives insights into the lived lives and the contexts within which grand illusions are developed and then spread to become unchallenged truths. This website explores the lived lives of the aged, their famililies, the nurses and the businessmen who are now responsible for the care we receive - something that believers in grand ideas are too far away from and too often blind to.
It challenges the comfortable certainties that are so important to true believers in grand ideas and looks at the consequences for those the beliefs are intended to serve to see if they actually do that. As its critics indicate it is not based on and does not embrace any particular ideas and so does not offer a clear way forward.
Constructivism, Constructionism and sociology of knowledge: These terms refer to a school in social sciences that developed in the mid 20th century. It examined the social context within which people developed ideas and the process by which they built their ideas of the world they lived in. It has given rise to several strands of social thought including post-modernism. It is essentially a meta-analysis (standing back from and examining) the way individuals and society develop the ideas and beliefs they adopt and use to understand the world and what they do there. It does not in itself decide whether understandings and beliefs are valid or not, or what their consequences will be, but it creates a context within which the development of failed beliefs can be examined, understood and examined as social processes by looking at the contexts within which they arose as well as the contexts within which they are applied. I use it for this purpose in order to critically examine and criticise the patterns of thinking that have been imposed on to aged care. It does not however offer solutions and when people have attempted to do so they have not been very successful.
Constructivism has become important as a theory in education where it seeks to create educational contexts within which students engage with real world (or simulated) situations and construct the ideas and understandings that enable them to deal with them. I use it on this web site to create a context close to the real world of aged care where people from different backgrounds can not only examine the impact of current ways of understanding but can interact and construct understandings within the context of real aged care situations - the lived lives of the elderly.
Participatory Democracy is a movement to address the current problems in our two party market controlled political system by moving to a model where citizens and civil society make a much larger contribution to the management and operation of society and to the political process. Modern technology creates many opportunities.
Open Government: An international movement promoting a partnership between governments and civil society underpinned by increased transparency and a move to participatory democracy. Australia’s early active participation was put on hold by the Abbott government.
20th century thinking: I have used this description in order to refer to these belief systems. Criticisms are of the application of grand ideas to areas of society where they don’t work, the lack of social responsibility and the exploitation of any vulnerabilities in the system, the erosion and emasculation of civil society, the ownership of politics, the wide disparities in wealth, the financialization of assets that should belong to civil society and the instability of the economy. My interest is in how these changes have impacted on aged care and on the lived lives of staff and “consumers” of aged care.
21st century thinking: I have used this term to refer to the broad 21st century open government and participatory government movements that seek to contain and control the adverse outcomes of 20th century thinking without losing the benefits of markets. The movement aims to rebuild civil society and responsible citizenship, and to re-establish democracy as representative of civil society rather than the marketplace and as governing for the benefit of citizens rather than the marketplace alone. Currently citizens and society have increasingly become servants of the marketplace. Reforms are needed to ensure that the marketplace, an impersonal mechanism properly serves the society that created it - and does not control and cannibalise it.