Why two websites and what the hub is about
The Inside Aged Care website complements and adds to web pages I wrote for the Solving Aged Care section of the Aged Care Crisis website. The Inside Aged Care website describes the background to the proposals on the Aged Care Crisis website and also how and why a community based solution to the problems in aged care would work. It does so by examining aged care from several different points of view.
Whether you visit Solving Aged Care on the Aged Care Crisis website or read on, depends on what your interests and objectives are. This page is a brief outline of my contribution.
Aged care is broken
Aged care is broken and as far as aged care is concerned, politics is broken too. Both have been failing in aged care for 19 years. They are incapable of acting effectively.
Professor Sir Michael Marmot, in the first of his Boyer lectures, argued that “health is a better measure of social progress than national income”. Its not wealth itself but the nature of society - its structure - that determine the quality of our lives and our health. We know what needs to be done but no one is looking.
So close is the link between the nature of society and health, that we can tell a great deal about how well a country meets the needs of its citizens – provides the conditions for them to lead flourishing lives – by the health status of its citizens.
Evidence shows that we need action from government – federal, state and local – from civil society, communities and families.
Source: Health inequalities and the causes of the causes Professor Sir Michael Marmot ABC Boyer Lectures: Episode 1
There are multiple problems facing the world. Our leaders don't have answers but they won't admit that to us. Our politicians have lost touch with citizens. They are locked in a thought bubble and in a world of catchphrases. They seem to be incapable of thinking outside the narrow framework which comprises this bubble.
It is civil society, citizens themselves, who will need to take control of the situation, start thinking logically and independently - and then partner with government to do something about it. Health and aged care are both part of a larger problem in society.
Our failure to address this lies in our difficulty in escaping from the past without understanding and learning its lessons. The proposed changes for aged care can be seen as part of a process of escaping the past by building on it to find a better future. It is interesting that more and more of us are talking about the same sort of path into the future.
Maddocks' proposal modified: Professor Maddocks, Senior Australian of the year in 2013 proposed a hub initiated and driven by the medical profession. Four years later nothing has happened and the profession have not stepped up to lead this process.
My proposal adopts Maddocks idea and extends it by adding proposals that I have previously made and building on them. While it welcomes participation and leadership from the medical profession my proposal is primarily community driven and controlled. It is a partnership between community and government whether federal, state or local in which citizens play a leading role and are supported by government - part of the process of taking democracy into the 21st century. It includes what Maddocks proposed but extends the proposal to meet larger objectives.
Tip: Click to expand (+) or collapse (-) content on this page
Why two web sites
I do not want to harp on the failures in the system on the Solving Aged Care section of the ACC website. I want people to accept that there are problems, know what the key ones are, and then be forward looking with suggestions. The in depth analysis and strong criticism on this website is inappropriate for a website that we want to be essentially forward looking and constructive.
There is enough information on the Solving Aged Care section of the Aged Care Crisis website to make it clear that we need change and to suggest the sort of change we need.
But many in the industry and some in the community, will strongly disagree or have doubts about my assertions. The media is filled with positive claims and glossy advertisements. We all like to believe that the laws and regulations in Australia protect us from being misinformed or being misused and exploited. Sadly, that is a pipe dream and there is plenty of evidence that there are serious problems if we actually look and assemble the material that is available. Nevertheless, for many my analysis will be contentious and unacceptable to some in the industry.
I cannot justify the proposals without a clear diagnosis of what is fundamentally wrong and how widespread it is. I need to show how my proposals might change that. It needs to be well-researched and documented. People need an opportunity to debate it and argue for and against it. That cannot be done with sound-grabs. If these things are happening then we need to understand how so many apparently well meaning people can be doing this to us.
I have collected the material that I wrote as I worked through the large number of reports, onto this web site so that those who need to look in depth or dispute my arguments can study it. We do need to have something like this to fall back on to explain in depth and for critics of the need for major change to confront. The government is making changes and some of it is desirable but we need to be far more sceptical than we were in the past because they have a 19 year very poor track record in aged care and have steadfastly refused to address failures that are due to their policies. What is being done is not a change of policy and will be compromised as a result.
The Community Aged Care Hub in the marketplace
A community service: Aged care has moved away from what it essentially was: a community service provided for members of the community by the community. The lessons that we learned there have been ignored.
The proposal is a suggestion for reinstating the community by placing it at the heart of and in control of the aged care process. It starts from the premise that aged care is essentially a community service provided by the community for their members. Over the years it has lost its way to the extent that the community is not involved and has little say in the care of its members.
Now a market: In 1997, aged care was turned into a strongly competitive free market, but free markets do not work unless there is a knowledgeable customer with the power to control the market. Whenever customers lack knowledge and are vulnerable the market fails. The customers are exploited and misused. There has been ongoing criticism and many failures in care since 1997 when aged care was turned into a competitive free market. The proposal I make offers a way in which we can create an effective and interested customer to stand behind and support the vulnerable seniors and their families so that they are protected and the market works to benefit them.
The proposed hub: The proposal is for a partly voluntary and partly not-for-profit organisations drawn from each local community. These local community organisations would coordinate and control all aged care activities in that community. Local organisations would have representation on a central coordinating national committee which would integrate their activities and represent them nationally.
Core functions: The local hubs would have a broad role in the community but two core functions will be critical in this marketplace
- the collection of accurate data about aged care and
- acting as an effective proxy customer by working with consumers and providers.
The hub would play a central role in monitoring standards of care, record keeping and quality of life for all aged care services in the community. This information would be coordinated centrally and reported publicly.
Other functions: Accreditation oversight, complaints handling and advocacy would be conducted through the community hub. Government would play an important role in supporting, educating and ongoing mentoring. Government agencies would operate through the hubs. Communities differ widely and the services would be tailored to each community’s needs and adapt flexibly to individuals requirements. Too many are falling through the cracks in an impersonal centralised and rigidly structured system. It does not respond well to individual needs.
The local hubs would be the primary source of information, advice and support for prospective consumers of aged care and would guide them and empower them as effective customers in this marketplace.
Control of who provides care: The central hub organisation would be represented on the approved provider assessment process and have the power to veto owners and providers who they consider unsuitable to operate in this marketplace. Individual local hubs would ultimately decide who provided services to that community.
A successful customer: To be a successful community customer and to turn consumers into successful individual customers it is essential that
- local hubs have full access to and control of data,
- be the primary source of advice and support,
- advocate for and support consumers in and outside nursing homes, and
- have control over which owners and providers deliver services in their communities.
Government would work through and mentor local hubs which would in turn work closely with providers in organising and integrating aged care services in each community.
An analysis of aged care as a failed market and the details of the proposal can be explored in more detail in Part 1 and Part 2 of my contribution to the debate about the future of aged care on the Aged Care Crisis web site.
Other Community Aged care Hub activities and benefits
The proposed hub would be a broad community organisation which would integrate and support all aged related services and activities in each community, helping to integrate the aged within the community and combat ageism. Older citizens and their families would be involved in organising and running the hub.
A broad societal problem left over from the 20th century: Our aged care market was created in the 1990s and is still trapped in 20th century patterns of thinking. This has resulted in the centralisation of decision making processes, the weakening of civil society and a loss of effective citizenship. Decisions and policies are being made by leaders and managers without community participation and are then marketed to the community. This has been called a "hollowing out" of communities - meaning a loss of knowledge, of expertise, of confidence, of effectiveness and of involvement within communities. Society feels powerless, is influenced by slogans and sound grabs,and has largely disengaged from real in depth involvement with issues.
Communities no longer control what happens within them - a loss of social capital. The balance between politics, the market and civil society has been lost. In a democracy it is civil society that holds the other two to account and controls them. Both politics and civil society have increasingly been acculturated and controlled by the increasingly powerful market sector.
21st century solutions: The proposed hub is set within emerging 21st century thinking. In this thinking citizens have a far greater role to play at all levels of politics and in the running of society. Instead of looking to politicians and managers to make decisions, the community itself will generate ideas and then work with managers and politicians to get what they want. Ideology will be required to confront real life arguments and discussion. It will be more difficult to impose policies based on illusions.
By re-engaging citizens we reignite interest. This leads to a search for knowledge, increasing expertise, growing confidence, increased effectiveness, a growth in social capital and the empowerment of civil society. Citizens will be in a position to exert both their rights and their responsibilities as citizens in a democracy.
Social services: Within this new movement the marginalised and vulnerable including the disabled and aged become citizens with rights and responsibilities, empowered to act as such to the limits of their capacities. When these are impaired they are supported and empowered by their families and communities.
21st century ideas still constrained by the 20th century: In fairness, some 21st century ideas about providing social services have been embraced by industry dominated bodies like the National Aged Care Alliance (NACA) and by politicians. Both the National Disability Service and Consumer Directed Aged care seek to put consumers in charge of their own care. The criticism is that they are trying to do that within a 20th century managed framework that does not acknowledge their vulnerability or really include the community. The ideas do not come from the community itself. Because this is being structured as a 20th century style free market the vulnerable are at risk.
These ideas are introduced and discussed in Part 3, 4 and 5 of my contribution to the Aged Care Crisis web site.
The pages on this website drill down more deeply into aged care itself using many examples to show how the indiscriminate application of free market (note I am not talking about appropriate markets for each sector) and top down management systems have resulted in a dangerously dysfunctional system.
Overview: Solving Aged Care section on the Aged Care Crisis website
- Part 1: How do we solve aged care: - a broken system and failed politics. On the ACC web site I start with the simple proposition of a failed market due to the absence of an effective customer. It is simply another example of many similar problems in western capitalist democracies that results from a failure to heed over 200 years of marketplace common sense.
- Part 2: A big change to aged care:- controlling and integrating aged care services. This describes a proposal to create local community based organisations to take control of aged care. All regulatory and many other activities would be funnelled through these organisations, which would have the power to act as an effective customer.
- Part 3: Past, current and future: - how we got here and where we would like to be. This section explains how we got the sort of aged care system that we have then goes on to suggest the sort of system that we might like to have.
- Part 4: Debating other ideas: - a lot of information about politics, society and aged care. This is educational and is intended to give the uninitiated a better idea of what is happening before they make proposals of their own. The page looks critically at the political system that we have, at the difficulties in criticising and initiating social change, at similar failed aged care systems in the UK and the USA, at a multitude of issues and opinions about aged care, and at recent 21st century thinking about democracy and the provision of services to the community. The final page in this section is a collection of links and references to material describing failures in the system and critical of what is happening. By bringing material together in one place we can appreciate the extent and nature of the problem.
- Part 5: Background of Community Aged Care Hub: - a diagnosis of the problem showing how the hub would work. This page sets out the diagnosis of social pathology (I call it “culturopathy”) that I have made giving other examples. It then outlines the features generally and describes their presence in aged care. It looks at this in several ways to show how the proposed hub would operate to address the current problems and also provide a context where the community would continue to engage with providers and government in debating aged care issues and moving forward.
Parts 1, 2 and 3 describe the primary basis for my proposal, the proposal itself and its intent. Those sections are relevant if you want more detail and understand better how the proposal fits into the Inside Aged Care analysis.
Part 4 is a long section providing an overview and links to a large amount of sometimes conflicting material. It is intended to show the depth, breadth and complexity of the issues aged care addresses or which potentially impact on it. The pages on politics, on evidence and policy, and on developments in social theory do provide useful background and greater depth but are not essential. The other pages won't help you read the Inside Aged Care web site. There are large numbers of links which you will need to explore to come to grip with some developments as the comments only indicate what each is about. The page developments in social theory links to web sites which explore social thinking much of which impacts on or is relevant for aged care. Some of the material is complex.
Part 5 covers the content of the Inside Aged Care analysis but selects only key issues and arguments. There are no quotes and no links. If you plan to go through the detailed material on this Inside Aged Care web site then you don't need to read Part 5 unless you want the equivalent of a long executive summary before or afterwards.
Continue on this website where issues raised in Part 5 are explored in much greater depth.
Contributing to the discussion
Both websites invite comment and ask people who have different ideas to make their contributions.
- The Solving Aged Care section of the Aged Care Crisis website focuses on proposals for the future and will only publish criticisms of the system within this section if they lead on to proposals for change. Other criticisms will go elsewhere on that site.
- The Inside Aged Care website (this website), will focus on the diagnosis of what is wrong or right about aged care. This is where we can dispute and argue about what is happening and the explanations of it.