Liz Barton and Cecilia Webster have for a long time been at the coalface of the aged care industry.
Both registered nurses, they say they have been “tied at the hip” for 20 years now, and have worked together within geriatric and palliative care roles, as well as championing various union campaigns.
Their latest venture has seen them representing the ‘Victorian chapter’ of the national, political-action group Aged Care Reform Now, which was recognised recently at the Holt electorate Australia Day Awards for 2022.
The ladies note that they are just two active members out of a diverse, national network, all pooling their strengths for the common goal of reforming aged care.
“There are people from all walks of life: there are bankers, there are female geologists, nurses, occupational therapists, people who’ve just had an interest in the community and serving the community,” Barton, pictured top receiving the Australia Day award, says.
Whilst awards are usually the end goal, the Australia Day accolade is only the beginning for the group.
After all, clout is not the goal; ACRN will not stop until tangible aged care sector reforms are materialised.
“We’ve been talking about this for how long? … There’s a heck of a lot of talking and no solutions,” Barton says.
“The only people that have the power to really change what is going on … are the actual politicians who sit in the parliament and read these bills and vote on them.”
Webster tells Aged Care News that ACRN members are endeavouring to be a direct voice to government.
“I don’t think there’s been any real voice for the people, for the people who are using aged care. So one of the things that we’re going to try and do is be that voice.
“ACRN is important because we don’t get any money, we do what we do under our own steam, finding ways of getting to the people who are making the decisions.
“Because these people who are making the decisions are not knowledgeable; they only come from a budget point of view.”
In contrast, concerned ACRN members like Webster and Barton come to the table with a wealth of experience as registered nurses.
Their years on the ground have provided first-hand insights into the decline of the industry since the advent of the Aged Care Act (1997), which advocates consider the basis of the crisis, which has only deepened, decade upon decade.
“I worked in aged care back in the ’90s when the changes happened, and that whole time there was no consultation; there was no discussion with nurses about the effects,” Webster tells Aged Care News.
In an industry that was already calling for increases to staff, a rapidly ageing population with increased care needs meant that decline was inevitable.
Barton recounts to Aged Care News that shifting ratios were an immediate symptom of the swelling crisis.
“It’s just got worse because the staffing has got worse,” she says.
“Once upon a time aged care was run by registered nurses like ourselves and enrolled nurses (ENs) … with only 50 per cent carers, but that proportion has gone from 30 per cent RNs/20 per cent ENs and 50 per cent carers to 70 per cent personal care assistants (PCAs).”
The dismantling of the aged care industry’s foundation, an adequate, highly skilled workforce comprising registered health care professionals, is at the heart of the decline in quality seen over the last few decades.
Naturally, the ladies suggest, this is where government must begin in repairing the industry from the ground up.
“An empowered, educated, properly resourced workforce, enough people-power on the floor to do the job, is what’s required,” Webster says.
“And unless they abolish this 1997 Act and bring in a new one with a re-designed aged care, things won’t change.
“All they’re doing is they’re tweaking, cherry-picking bits and pieces, making it look like they’re doing something, but as far as I’m concerned, they’re very election focused.”
Webster notes that according to the American star-rating system, a system the Federal Government says will be adopted before the end of the year, our country averages a mere two star rating based on workforce capacity.
“You have to ask yourself, how in this modern world did we get to this point?” Webster says.
Workforce shortages having a snowball effect on quality of care
Webster explains that current attempts to mitigate the staffing crisis are akin to ‘patchwork’, in particular, the fast-tracking of student and immigrant workers’ entry to the industry, most thrown into the deep end without adequate qualifications or training.
Barton offers an anecdote, received from a friend whose nephew has just arrived from Sri Lanka.
“This young man, very well meaning, has done three online units of a nursing course, has never had any hands-on experience, and is now working an in-charge shift at a local aged care facility.
“He walked in the door, was given a job and he’s worked something like ten, 12-hour shifts straight: this is the acute shortage of skilled workforce.”
“Twenty per cent of the people who work in aged care at the moment, have no formal training,” Webster adds.
“It’s not mandatory, and so this is one of the things that ACRN is trying to push for.
“Whether the carer is working in Darwin or Launceston or South Australia or Victoria… if I employ someone as a carer, you should know that they’ve done a certain number of units.”
“We need them to know that it takes more than a good heart and a preparedness to work hard,” Barton adds.
Furthermore, Webster and Barton point out that the casualisation of the industry, including a lack of consistent, full-time nursing staff, is preventing necessary cultures of cooperation and leadership within residential homes.
“Without leaders, good leadership in the aged care system, nothing that they do is going to work,” Webster says.
“The royal commission missed out very badly on the 24/7 nursing because they only gave us 16 (hours each day that registered nurses are required to be on-premise), which is just ludicrous.”
Barton notes that the expert, nuanced care provided by registered nurses is needed around the clock.
“A lot of the time people get confused at night for instance, because a bladder infection and you know, they exhibit extreme behaviours.
“This is just one reason why you should have nurses 24/7.”
Furthermore, they note that the extra investment in workers would most likely reduce the burden on the hospital system in the long run.
“Unnecessary hospitalisations, that’s actually a productivity issue,” Webster says.
“Health care prevention has to be cheaper than people being ferried to and from hospital constantly… so they [the Government] want to look at it from a productivity point of view, so they need to look at homecare and how they keep people at home, particularly allied health: falls prevention and all those sorts of things.”
Such preventative investment includes subsidies for rapid antigen tests for COVID-19, with Webster suggesting the privatised mode of delivery has ironically stalled overall productivity in the long run.
“If the Government are serious about the economy, if they want workers to get back to work, if they want people to be productive, then make the tests free,” she says.
Liberals need to drop party politics, collaborate across the aisle
“It didn’t surprise me when Senator Colbeck opted to go to the cricket between the 14th and 17th of [January], because he is much more across his sporting portfolio than he is across aged care,” Barton says.
Whilst there is no love lost between the passionate political group and the Liberal/National government of the day, Barton adds that their groups aims to transcend party politics.
“Quite frankly, as I’ve said before, it should be apolitical. I don’t care what your politics are, but please take this seriously.
“We should all be saying, ‘as a wealthy, first-world society, we owe it to our elders to look after them’.”
And Webster adds that this time, suggesting reforms is not enough, nor is simply creating a new aged care act on the Government’s terms: experts and the public alike must equally dictate the new path forward for the industry.
“… because the ambiguity of the ‘97 Act was so bad, the providers could just do what they wanted, how they wanted,” she explains.
“And they wanted to put money in their pockets and so that came out of care.
“So, as far as I’m concerned, as a taxpayer, every single cent that I put into that, all the Government funding… that should be completely accountable.
Barton notes that whilst conservatives may fear that the push for reforms may ‘blow-out’ the budget, greater transparency may lend itself to more consistent spending.
“Cecilia and I’ve been associate nurse managers, both of us in very different cities.
“We’ve had to deal with budgets. We understand that money is not unlimited, and that you’ve got to work within budgets… but [the money is] not being spent where it’s meant to be spent.”
In fact, some of the reforms presented have been deemed antithetical to the wellbeing of residents by advocates.
“I know they’ve got it wrong already,” Webster says.
To illustrate her suspicions, Webster refers to the Schedule 9 to be added to the Aged Care Act 1997. If ratified it, will mean that legal challenges cannot be brought against providers who have used a restrictive practice, be it physical or chemical, where certain consent conditions have been met.
The amendments have been allegedly put forth to remedy conflicts between federal and state law, but experts fear it will be ripe for abuse, with Sydney lawyer Rodney Lewis telling Aged Care News that it is “an astounding piece of legislation”.
“Why give [providers] indemnity?” questions Barton.
“I mean, truly, if there are no yardsticks to be measured against, with consequences… You just have to look at what’s humane.”
A busy year ahead for ACRN
ACRN has the expertise and the willpower to see real reform realised, and with election time around the corner, Barton and Webster will be working tirelessly alongside the national network of ACRN volunteers.
“We’ve got some very foxy ACRN members and they’re going to be fighting all the way, so it’s going to be a busy year,” Barton says.
Aged Care News questioned whether, in light of the Australia Day Award, Anthony Byrne, Labor member of the house of representatives, has actually committed to championing on ACRN’s behalf.
“He champions because we’ve made sure he does,” Webster says, with a smile.