There are tensions between market beliefs and community beliefs which cannot be resolved and must be acknowledged. Traditionally they have been handled by having social structures in place to deal with them. Those have now been removed and the two sectors are expected to compete against each other and against aggressive for-profit corporations. This competition is often more about impression management than substance. There are consequently tensions between for-profit and not-for-profit providers.
Tensions also develop within the not-for-profit sector between those who are aculturated and adopt marketplace beliefs and those in the sector who adhere to a more traditional view of their mission and place in society.
There are consequent tensions between LASA (Leading Aged Care Services Australia), which can be seen as the organisation representing the for-profit providers and the aculturated not-for-profit groups, and ACSA( Aged & Community Services Australia Inc) to which both aculturated and not (or less) aculturated groups seem to belong. There are also tensions between the aculturated and not aculturated groups within ACSA.
The processes at work were explored on the web page Dilemma for not-for-profits in the Cultural Perspectives section. I gave examples of what was happening in the not-for-profit sector. On this web page I take a longer look at how this is playing out in Australia, and end up with something that looks encouraging and that I was not expecting.
As I indicated, you can use the sort of analysis I am using to predict likely behaviour based on social pressures but we humans have the capacity to rise above ourselves and do something completely different, sometimes good and sometimes bad.
As I indicated on the web page Cultural Perspectives, the imposition of a dominant belief system by society creates tensions within sectors when there is a conflict between the new and old established ways. People there are expected to think, behave and lead successful lives in very different ways and embrace very different ideas to those that they have previously used to guide their conduct. This becomes much more acute when the two paradigms that participants are expected to embrace are mutually exclusive.
The market paradigm is particularly challenging for not-for-profits whose very reason for existence is challenged. Market pressures by their very nature threaten care in vulnerable sectors, yet the not-for-profits must adopts these ideas and practices if they are to compete successfully and survive. They too must commit to and support market pratcices if they are to survive and prosper.
At the same time, their origins and beliefs originate in the community and they must be seen to maintain their committment to these previous beliefs. When the two belief systems are mutually exclusive the only way to cope is to compartmentalise and pretend the contradictions don't exist. You cannot serve two masters that require you to do very different things. You have to serve one and deceive the other. When success depends on adopting a dominant paradigm then there is pressure to deceive the other superceeded culture - in effect to deceive themselves into believing that they can serve both.
To explore this issue, I will look at the pressures to amalgamate the organisations representing for-profit and not-for-profit providers of aged care - the creation of Leading Age Services (LASA), an organisation claiming to represent the whole industry.
LASA is the organisation whose CEO has been put in charge of the government's "new" Quality Agency, the group responsible for monitoring standards of care in nursing homes and the community. This is an extreme example of the fox guarding the hen-house, but it clearly shows government's priorities and thinking.
The origin of Leading Age Services Australia (LASA)
LASA was formed in early 2012 in order to unite all of the providers of aged care services. They claim to speak with one voice for both for-profit and not-for-profit providers of care.
The move to unite the for-profit ACAA, and not-for-profit ACSA groups of providers into a single organisation started in 2010. That move probably came primarily from the for-profit sector, with some not-for profit-groups supporting this. Other not-for-profit operators felt that there were significant differences between the way they operated and they had different interests, which would not be well served by the merger. There was considerable debate.
Stxxxxn Jxxd from Hxxxond Care led the opposition to the proposed merger. It is interesting that it was INTFPcompanyB, the commercially focused UK group at the centre of many of the recent allegations of poor care, that was pressing to create LASA. Perhaps it was in response to Jxxd's arguments that INTFPcompanyB conducted a survey. It would be interesting to see how the survey was worded. But if the results are an accurate reflection of not-for-profit views, then it would show how far the not-for-profit sector has moved from its mission, something that Jxxd has written a book about.
Concern expressed about level of fragmented lobbying in sector
Eighty per cent of providers want one body to represent all aged care facilities in Australia on a national level, a new survey found. And, despite often being cited up as the reason why there isn’t one body, 82 per cent of not-for-profit organisations surveyed were in favour of the move.
The findings of the industry survey, conducted by INTFPcompanyB Care Services to seek opinion on having one voice at the advocacy, were released at a lunch held in Sydney last week, attended by CEOs and representatives of some of the nation’s leading providers.
Source: Providers want united voice: survey (Aged Care Insight, 26 Jul 2010)
What is more interesting is the comments made in the Comments section below the article by those who opposed the formation of LASA. They reveal the divide in perceptions between "market think" and "community think". I quote a brief extract from each which illustrates how differently they think.
Dxxg Sxxxxn, CEO NFPCompanyU Homes: "I cannot subscribe to the notion of dividing the industry on the basis of for-profit and not-for-profit organisations. What we need is one powerful, empowered industry association that has some real clout. We are all in the same operating environment and the only real difference is our tax arrangement."
Dr Stxxxxn Jxxd - Thursday, 29 July 2010 (extract only): - - - - - Will 'for profits' care for the poor and the disadvantaged? Perhaps...but only if it is consistent with that commercial Purpose or if they are required legislatively to do so. Will they focus on the hard cases? Perhaps, but only if it is aligned with that commercial Purpose. Are the 'for profit' social welfare agencies known for Innovation? Not especially because they start with a financial rather than a faith-based or social model.
Examples? When Nursing Home Care Packages (now EACH) pilots started in 1998, prominent ANHECA members fought their introduction tooth and nail because they feared it would affect occupancy.
The Department had NO applications for the pilots from 'for profit' providers. More recently Amity (pre-INTFPcompanyB) commissioned a 'research' report claiming that community care cost more than residential care. If that wasn't an anti-competitive attempt to protect the residential aged care market share by arguing against alternatives, I don't know what is. Why are 'private operators' so keen to align with and neutralise (silence?) charitable organisations or sledge them as 'ice age mastodons'? - - - - -
Source: Providers want united voice: survey - Comments section (Aged Care Insight, 26 Jul 2010)
There is more but it is interesting that in response to INTFPcompanyB's study Jxxd quotes a misleading study by the for-profit that wanted an answer that suited them - Amity, the for-profit that INTFPcompanyB subsequently bought. Is he suggesting the same has happened here? Those favouring the formation of LASA resorted to attacking the messenger, calling them "mastodons".
Despite the 80% figure, ACSA did not become part of LASA. Its website and "Australian Ageing Agenda" continues to publish articles that reflect both the not-for-profit perspective, as well as the for-profit perspective some have adopted - including perhaps the latter's gut response to criticism described later in this section - so sending mixed messages. It is not clear how many not-for-profits joined LASA.
In 2012, Jxxd strongly supported the continued operation of ACSA, in representing and promoting the not-for-profit sector. The phrase "or should be" shows us that he is concerned, as many of us are, about what has happened to the not-for-profit ethic.
The CEO of the large not for profit health and aged care provider, HxxxxxdCare, Dr Stxxxxn Jxxd, has added his voice to the defence of Aged and Community Services Australia (ACSA) as the “premier voice for not-for-profit and faith-based providers of aged care and disability services”, following the announcement last Thursday of a new peak industry association for aged care, Leading Age Services Australia (LASA).
“While we share many things in common with ‘for-profit’ providers, charities and other not-for-profit providers are driven by purpose, not profit. Their motivation is entirely different – or should be – from the for profit providers.”
Dr Jxxd said that the mergers of for-profit and not-for-profit providers into a single body in Queensland and Victoria had seen many specific messages and issues of relevance to NFPs drowned out and subsumed within the agreed messages of the whole group.
“The conversation tends to end up being around the things you have in common – the Government representation and funding issues etc – and not around the things that are different.
“The distinctiveness of the church, community and charitable service providers in the aged care space needs to be highlighted and properly articulated, not subsumed by the issues that concern the sector as a whole.”
“A ‘single voice’ is not an ideal that we should automatically or slavishly aspire to. And ‘unity’ is not preferable to maintaining honestly held but differing beliefs. Part of the colour of a vibrant policy and practice is to have a range of voices and opinion.
Source:Single voice a misguided ideal (Australian Ageing Agenda, 3 Apr 2012)
LASA and ACSA
ACSA remained as the body representing not-for-profits and the majority of not-for-profits probably stayed with them. ACAA and other for-profit groups became LASA. I do not know how many not-for-profits also joined LASA, but clearly many did. So while it is clear that LASA represents the for-profit sector, the extent to which it also represents the not-for-profits, as it claims, is far from clear. It is likely that those not-for-profits that joined LASA are those that have more closely adopted for-profit culture and thinking.
So it appears that LASA, from which the new CEO of the Quality Agency comes, probably represents the for-profit sector and a large splinter group of similarly-thinking not-for-profit providers. Those who still identify with the not-for-profit ethic have probably stayed with ACSA. Many would have stayed with both.
LASA: The following extracts are from the LASA web site. While there are many motherhood statements about quality of care and working towards that, this is a body that represents and lobbies for the industry. I have no doubt that it believes that it puts the interests of the frail elderly ahead of members demands, like Jxxd, I am not persuaded that for-profits with a primary responsibility to shareholders often do that.
The suggestion that advancing the interests of providers is in the interests of older Australians is obviously partly true. But culturopathic groups that have exploited vulnerable people have used similar statements to justify putting the company's interests ahead of those they claim to serve. This should therefore be accepted with caution.
Leading Age Services Australia (LASA) is the new national peak organisation for all providers of care, services and accommodation for older Australians.
The founding members of LASA include:
- The Boards of Aged Care Association Australia (ACAA)
- Aged and Community Care Victoria (ACCV)
- Aged Care Queensland (ACQ)
LASA is the only national organisation listening to and speaking for the age services industry.
------ working with government and other stakeholders to advance the interests of all age services providers, and through them the interests of older Australians.
Leading Age Services Australia is an alliance of state bodies coming together based upon mutual interest and synergistic benefits for members. We have member interests at our core, and will work hard to canvas member preferences and follow through to deliver.
Membership: Membership of LASA is also open to any other state or territory-based representative of service providers in the age services industry.
Ensure that members are actively engaged and influential in the life and voice of Leading Age Services Australia: We will unite the age services industry under a banner of excellence and viability. We will provide opportunities for member involvement in decision making and seek out member opinion. And we will develop services and platforms that respond to recognised member needs.
Source: LASA website
Reopening the merger issue 2015
In March 2015, there was renewed agitation from LASA for a merger with ACSA. LASA itself is consolidating to give it greater power. They want a more powerful voice in lobbying for the industry.
LASA will loudly proclaim that they are amalgamating in our interest, we should heed Adam Smith's 200 year old warning and view that with the greatest suspicion. What we need is powerful community representation so that providers only get what they want when we are quite satisfied that it is in our interests as well as theirs.
Leading Age Services Australia has intensified its push for a merger with mission-based aged care peak body Aged and Community Services Australia, telling a state conference that the lack of a unified, single provider peak was "harming" industry advocacy.
- - - - LASA chairman Dr Grxxxx Blxxxxxn said a single peak would bolster the influence of service providers and hinder government ‘divide and rule' tactics.
- - - - would significantly impact government's ability to sideline the interests of older Australians and play political games that favour a particular interest group," he told the Gold Coast audience.
- - - - - It is universally understood that if we are divided we will be conquered
(Blxxxxxns said) "LASA has never resiled from our position that there should be one organisation representing providers, and as both LASA and ACSA move towards restructuring themselves into truly national organisations, we firmly believe that this process will facilitate the ultimate aim of 2012 to create a merger with ACSA and create a single voice across all the sectors of our industry."
Source: LASA agitates for peak body merger Australian Ageing Agenda, 20 Mar 2015
ACSA CEO Jxxx Kxxxx sat on the fence indicating that they would be happy to enter into negotiations. The religious organisations seemed to be quite strongly divided. Some representatives from the religious institutions took a strong stand against it and others were in favour. The Reverend Dr Lxxx Mxxxxs and Stxxxxn Jxxd were strongly opposed with Jxxd indicating that the idea that aged care providers need a unified voice was a "furphy".
But Sxxxxx Hxxxx, CEO of Benetas (Angican nor-for-profit) felt that "A unified peak body would provide greater opportunity to achieve like goals" and " - - - would provide a broader base for consultation, knowledge transfer and workforce development across the sector".
Sxxxxx Hxxxx is a director of LASA and in addition Benetas' chairman. She has worked in both for-profit and not-for-profit sectors. There is only one priest on its board. I found it interesting that while Benetas web pages, acknowledge its Anglican history and affiliation, I felt as if they were distancing themselves from this heritage. There is little if anything, about a religious mission in their mission statements.
Lxxx Mxxxxs, a priest from Baptistcare, put her contrary views strongly in a separate article on the Australian Ageing Agenda website and her article is well worth reading in full. She stresses the links to community and addressing its diversity.
- - - diversity and inclusion is far more powerful than homogenised, single monopolies
The character and diversity of the community benefit sector delivering services to elderly Australians, and to the wider community would be significantly disadvantaged by the establishment of a single peak body, - -
The current situation might be messier, apparently more chaotic and uncontrolled, which I suspect unnerves and frustrates those who want to direct and establish a single powerful entity, but the richness of voices coming together to sing in harmony is a far more enriching and engaging experience and requires a different skillset to directing and controlling. A different type of leadership is required - perhaps this is the issue?
- - - - - It allows for a greater transparency, visibility of power and accountability and enables our services to the elderly to be delivered locally where local solutions can be reached.
- - - - the desire to become one comes from a lack of willingness and capacity to deal creatively with the diversity in our community,
Source: ‘I'm glad both ACSA and LASA exist because both are needed' Australian Ageing Agenda, 20 Mar 2015
It is significant that none of the religious participants except Jxxd are prepared to be really critical of the for-profit sector and the pressures it faces to funnel resources away from care to profits. Mxxxxs sees a need for both and there is no mention of religion or mission in her article. It has become a secular debate, which is illustrative of the distance that not-for-profits have moved to accommodate changes in society. It probably says much about the way our society now thinks.
As shown earlier, Jxxd also seems to welcome the new competitive marketplace and believes that competing in this sector will benefit those providing better services. This is in spite of the fact that very successful corporations that have recently listed on the sharemarket are claiming to treat sicker residents while reducing staffing costs. Jxxd recognises that there will be winners and losers but he does not look at the implications for the residents and their families in the facilities that are becoming losers.
What I find fascinating is the willingness of not-for-profits to simply ignore the vast volume of evidence available internationally as well as increasingly in Australia. Instead they tolerate and then adopt policies and practices that challenge the lessons of history and undermine the very reason for their existence. Aligning themselves so closely with a belief system that is contradictory will in time compound the problems for them.
But if they fail to do so, then they will be seen as obsolete (remember someone calling them mastodons) and they would no longer be credible. They would lose influence, fail to prosper and so not exist anyway. To survive they must do this.
In some respects it is a question of how much they can credibly hang on to? Whether they are prepared to become outsiders and lose influence in order to preserve their beliefs.
Jxxd is now on the Board of the Quality Agency and one wonders how this will impact on his views - or whether he will change theirs.
What would the public and seniors want?: Dr Blxxxxxn, the CEO of LASA sees government as dividing and conquering and so preventing providers from caring for older Australians "in a way that fits our national ideas". Now whether older Australians share LASA's views about the care of older Australians and would support giving LASA greater power is debatable. It would require skilled marketing. The major groups representing seniors have not commented.
The not-for-profits have their roots in the community and are responsible to them and not the marketplace. The proposed Community Aged Care Hub would create an environment where the public would be able to look at the issues and the evidence before deciding whether they wanted their not-for-profit organisations and their mission of caring to be independent and not beholden to the for-profits. The proposed hub would be reconnecting the not-for-profits to their communities. That they have lost touch with their roots is evident in their failure to include their constituents in the debate.
Update: Finally something really positive from ACSA - In probably the most encouraging press report that I have seen in several years ACSA's president has rejected LASA's move to amalgamate out of hand.
The president of Aged and Community Services Australia (ACSA) has publicly dismissed the campaign by Leading Age Services Australia (LASA) for a merger between the two organisations, saying the push for a single peak body is about securing LASA's "survival".
In an address to ACSWA's state conference in Perth yesterday, ACSA federal president Vxxghxn Hxxdxxg said the ‘one voice' argument for a single peak was "simplistic and does not withstand any scrutiny".
However, Mr Hxxdxxg countered that view in his address yesterday, saying of ACSA's move to a national model: "This is not about a merger with another industry body."
"The call for a merger that you're hearing is more about survival of another body than anything else," he said.
In October individual ACSA members would resolve at their annual general meetings to move to the national model, while from July 2016 the proposed new fee model would commence, Mr Hxxdxxg said.
ACSA distances itself from merger talk as progresses own restructure Australian Ageing Agenda, 27 Mar 2015
The Hub would contribute: This seems to be a clear signal that ACSA is not planning to follow the USA by getting into bed with the for-profits and that it is going to take the for-profit sector head on as regards quality of care and sell itself to the public. The evidence it needs is there. The informed public will certainly support it in that, but that is only a small segment of the public. The problem for ACSA at present is that success in this marketplace is determined by marketing skills and not actual standards of care.
The proposed Community Aged Care Hub would be eager to support this move. What it seeks to do is to obtain accurate information about care and quality of life from all facilities and advise residents based on solid data and not on success in marketing. If Mr Hxxdxxg and ACSA want the market to work properly and to recognise their superior services then they will want to support and join Aged Care Crisis in pressing for a Community Aged Care hub. They would then compete on an equal footing with the for-profit providers.
ACSA, the community organisations, and the professions interests would be well served by the hub and I believe that it would be in their interests to support the idea and form working groups to progress the idea publicly and politically.