The disaster of Australia's privatised aged care

Australia’s scandal-ridden aged care sector is in crisis. More than 220 aged care residents have died of COVID-19, and 1,000 of the sector’s 3,600 personal care workers have tested positive for the virus. In the hardest hit state of Victoria, there have been outbreaks in 124 of the state’s 770 aged care homes.

Both federal and state governments have acted with “hubris”, according to submissions to the ongoing Royal Commission into Aged Care Quality and Safety, by doing almost nothing to prepare for COVID-19 outbreaks. Scandalously, the government allowed private providers to conduct “self-assessments” of their preparedness. Predictably, all reported that their readiness was either satisfactory or best practice. But almost none have hired more staff since the pandemic began, with 20 percent of facilities reducing staff numbers and 80 percent failing to hire more, according to an Australian Nursing and Midwifery Federation survey.

For residents, the experience has been horrendous. Many are imprisoned in their rooms and sedated without properly trained staff to monitor their vitals. Others have been denied access to medical treatment or hospital transfers.

The long-term structure of aged care in Australia has led us to this moment. What passes for aged care consists of hundreds of private companies and misnamed not-for-profits all competing for government funds and market share. More than 90 percent of nursing homes are run by the private sector, operating with minimal oversight or regulation. Governments that are unwilling to accept responsibility for caring for the elderly routinely cover for or apologise for the money-grubbing providers that do.

Alongside the behemoth of aged care sit its equally loathsome siblings, superannuation funds and retirement villages, all three jostling to make billions out of the business of growing old.

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Humans have always aspired to live to a ripe old age in relative health and comfort. But in our wretched society, to be old is to be useless and a burden to society.

Longer life expectancies and lower birth rates mean the Australian population is now older on average. Almost 16 percent are currently 65 or older, up from 12.3 percent 20 years ago. The proportion of people who are more than 85 years old has increased by 117.1 percent over the same period. While this should be a perfectly manageable situation, capitalism considers it a “demographic time bomb”.

This disparaging attitude has a lot to do with the economics of capitalism. Bosses are constantly competing to maximise the productivity of their workers. Those who can no longer keep up with expected productivity levels (or are merely perceived not to), or who are further through their working life and therefore no longer considered worth training, find it difficult to be hired or promoted, and are the first to be targeted for redundancies.

Once people get to the stage where they need help looking after themselves, they are often warehoused, cut off from the rest of society in poorly funded facilities or depressing retirement villages. In her diary, published as This Bed My Centre, Ellen Newton described her six-year stint in a Victorian nursing home in the 1970s: “The sense of segregation is palpable ... there’s no sound of traffic passing by. You never hear young people singing, speeding recklessly home from late parties ... Never the sound of children’s voices ... Only a spasmodic screeching a few doors away, that would send cold shivers down anyone’s spine”.

The elderly are patronised and robbed of their autonomy. In nursing homes, residents are denied the dignity of taking risks or making decisions about how they spend their time. Their individual personalities and desires are ignored in favour of uniformity, as it is much easier to manage a nursing home where residents lead predictable and controlled lives. Older people, particularly women, are assumed to have lost all sexual desire and the need for intimacy.

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Before the federation of Australia’s six British colonies in 1901, generations of propertyless people—ex-convicts, migrants and Indigenous people—were at the mercy of their families and charity once they reached old age. As historian Pat Jalland has documented, the worst off lived out their autumn years in overcrowded “destitute asylums”, which were as bad as they sound.

One such facility, the notorious Newington Asylum for Aged Women in Sydney, acknowledged at an 1887 inquest that “neglect, oppression and cruelty have been suffered by the patients”. In Queensland, one inquiry labelled the state’s asylums, including one on a remote island, a “dumping ground” for sick older people.

Where the asylums had a less shameful reputation, as in Victoria and South Australia, they practised a version of the uptight Protestant moralism inherited from Britain, sorting between the “deserving and undeserving poor” via probing assessments of an applicant’s worthiness. The Melbourne asylums constantly complained that almost all the elderly under their care were “undeserving” and “burdens on charity”. Most of these institutions were run by independent charitable and religious organisations, although by federation most of their funding mostly came from government.

Campaigns by unions and reformers throughout the late nineteenth century insisted that access to health and aged care was a right, rather than a matter of charity. A number of states won pitiful, morality-tested pensions from their colonial governments. Begrudgingly, the new federal government in 1908 amalgamated these into the national age pension, though Indigenous people, “aliens” and “Asiatics” were excluded, and tests of “moral character” still defined eligibility.

During the Great Depression of the 1930s, the government was especially savage in its approach to the pension. In 1933, it began charging for the cost of (now reduced) payments upon the deceased recipient’s estate, indebting grieving families. Working class people fought back. In Victoria, the Pensioners Association grew to 40,000 members and published a fortnightly journal, the Pensioner. One issue called the pension cuts “the most vicious class legislation”. At a well-attended meeting at Prahran Town Hall in Melbourne, one campaigner declared: “Anything less than the full restoration of the pension to £1 per week and the repeal of the iniquitous property clauses of the Act, will not appease the wrath of pensioners”. The pension was restored in the mid-1930s, but there was still no guarantee of decent housing or income.

The postwar boom raised working class people’s expectations, and an idea bubbled up from below that working-class people should be allowed some years of retirement, in relative comfort, after decades of hard work.

The Communist Party gave special attention to the issue. Marjorie Nunan was the secretary of their Brunswick branch between 1948 and 1956. Gregarious and less than five feet tall, Nunan was born with a debilitating disorder and received an invalid’s pension her whole life. She created the Combined Pensioners’ Association and tirelessly organised pensioners, both the elderly and disabled, to resist evictions and protest for their rights, marching delegations of old people to Canberra to demand an increase to payments.

Successive governments improved the pension, health care and aged care through gritted teeth, particularly in response to the mass strike wave of the late 1960s and early 1970s. Additional structural changes increased the need for reform, including the entrance of many women into paid work, which meant fewer older people could be cared for by their daughters in the family home. State governments built more aged care facilities in this period, but most providers continued to be private.

In 1963, right-wing Prime Minister Robert Menzies approved an extra $2 per day for frail elderly patients in approved nursing homes. In response, the nursing home industry experienced an unprecedented boom. A 20 percent growth in the number of nursing homes, and 48 percent growth in the number of beds, resulted. Many for-profit companies saw an opportunity and began to compete with the charities. Menzies’ system made bedridden patients more profitable, and as a result, by 1972, Australia had the most people in nursing homes in the world per capita, with 25 percent of patients having no medical reason to be there. They had been institutionalised against their will because they couldn’t afford the private care necessary to live at home.

The charities and religious institutions were and are no better than for-profit companies. They compete with for-profits for government funding, to cut costs and maximise fees. They generate a “surplus” to fund their bureaucracies, indistinguishable from the private pursuit of profits. This is still the case today, with no evidence that the religious and charitable institutions have responded any better to the COVID-19 outbreak or treat their staff any better than the for-profits. Only the small number of publicly run homes left in the country have better nurse-to-patient ratios than the dismal average. They are also better unionised, like much of the public sector, and have agreements that guarantee better pay, conditions and ratios.

As the neoliberal era dawned in the 1980s, aged care was subjected to a series of reviews and productivity enquiries. The Hawke and Keating Labor governments introduced the now ubiquitous and compulsory system of superannuation, the fourth largest industry of its kind in the world. This legislation forced workers to hand over a part of their wages to fund managers to be gambled on the stock market. The government called this a “compulsory contribution” from employers, but of course the bosses factor this into their wages calculation – it’s not extra money they wouldn’t otherwise pay.

Still, many employers simply never pay the compulsory contribution, stealing an estimated $2.6 billion from workers each year. The system is even worse for low-paid workers and people (mainly women) who take time off to raise children or care for others. The superannuation swindle exists only to offset the cost to government of people’s retirements, and to give cover for running down the pension and treating those who depend on it punitively.

In 1997 the Howard government used the language of “intergenerational fairness” to justify attacks on the aged care pension. They generalised the “user pays” system, increased up-front fees for nursing homes and encouraged the growth of the for-profit aged care sector and retirement villages. Previous expectations that nursing homes would use government funds for actual nursing and personal care were relaxed.

The language of ageing today mirrors the nauseating self-help and mindfulness culture of the corporate world. “Positive ageing” and “successful ageing” are the catch phrases of demographers and gerontologists, who urge that people make the right choices in life to set themselves up for a positive experience after retirement. Any negative feelings about ageing are therefore not a matter of government failing to provide for the elderly, but a personal failing on the part of individuals.

Perversely, the government seems to think “positive ageing” involves older people working well past the point that they have earned the right to retire and relax. According to a government report published last year titled Realising the economic potential of senior Australians: Turning grey into gold, businesses can tap into a productive workforce and save government money by keeping older workers in employment. The government has raised the retirement age to 67 in recent years, and there is persistent talk of raising it again.

In France, a similar attempt to raise the retirement age from 62 to 64 last year was beaten back by sweeping strikes across several industries. We need a similar fight back here. The COVID crisis has underlined the urgent need to dismantle and replace the Australian aged care system.

But a truly humane alternative is impossible in a society that treats people as useful only so long as they can create profits for a boss. There already exists the capacity for people to live fulfilling, autonomous lives well into old age. There is no reason why older people shouldn’t remain integrated in society and encouraged to make a positive contribution, whether by using their life experience to help and guide young people in life, interacting with children or teaching, writing, painting or simply relaxing. Humanity is perfectly capable of this if we get rid of capitalism.