RICK:

Sarah, can you tell me about your dad?

SARAH:

Yeah. So dad was an engineer, but he had a lot of hobbies. He was very, sort of, engaged with the arts. He played piano. He played the trumpet. He read a lot. He liked philosophy. He was just a, sort of, brilliant man and when I was 18 he was diagnosed with Parkinson's disease and that was a really tricky thing for someone who'd got a lot of joy out of the mind and so that was sort of the beginning, I suppose, of our journey in the aged care system.

RICK:

Sarah Holland-Batt had never thought about aged care until her father got sick.

SARAH:

All of a sudden you're faced with this conundrum of what home and you're not really equipped with many skills to work out what makes a good aged care home. I think mum and I initially were focused on the wrong things like the aesthetics, whether it felt nice, you know, and really, of course, the question that you and I now know you need to be asking is more like, well, how many staff do you have? How qualified are they? And then, you know, it's only in time that you start to realise the gaps when things start to go wrong.

RICK:

It’s a common story, not really putting much thought into aged care or where a loved one might go until someone you know, someone you love comes into contact with it.

Unfortunately, once in aged care, Sarah’s father experienced something which is also far too common.

SARAH:

Dad experienced some deliberate abuse from a worker, a personal care worker in his home. And we were alerted to that by a lovely nurse who we'd known for, you know, several years who was a whistleblower and who came to us and said she'd seen, you know, this person belittling dad, deliberately shutting the door on him when he needed to shower, when he wasn't clean. I was enraged. I've never been more furious about anything in my life. And so, as I sort of went through the system, my rage just deepened and the questions just piled up about, well, how is this actually happening?

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RICK:

From Schwartz Media, I’m Rick Morton, and this is 7am.

In 2018, then Prime Minister Scott Morrison announced a Royal Commission into aged care which shed light again on the astonishing amount of abuse that occurs in residential facilities and homecare providers around Australia.

It’s been three years since the final report from the Royal Commission was handed down and advocates say very little has improved.

The Commission highlighted just how difficult it can be to get any accountability when someone in care is actually harmed, especially from the people who run nursing homes and home care services.

The federal government is attempting to remedy that with new laws that could potentially see directors and management jailed for up to five years in particularly egregious cases.

Today, poet and aged care advocate Sarah Holland-Batt on whether the government's new laws will actually be enough to turn around the disaster that is our aged care system.

That’s coming up. It's Thursday, July 11.

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RICK:

Sarah, after your father’s experience you were deeply involved in around the Royal Commission into aged care and made a submission to it. What was in your submission?

SARAH:

My submission, I suppose the focus of it, was that I felt strongly that if someone like myself, you know, relatively educated, capable of understanding. You know, capable of making complaints, capable of pursuing issues, wasn't getting a good outcome from that process, then something was really deeply broken with the complaints process.

As I pushed and pushed and pushed to try and get an outcome, I couldn't get anyone to go and inspect the home. No one was interested. The care home manager was only interested in identifying the whistleblower, had no interest in dealing with the person involved.

So, I thought if I was unable to get a reasonable outcome for my father, which for me would have just been getting this person taken out of the aged care workforce, if I was unable to get any sort of satisfactory outcome at all, there was no outcome. That was the sort of impetus for my submission to the Royal Commission.

It was around the inadequate regulation of aged care, the fact that there was really no one, you know, advocating on behalf of these really vulnerable people who have cognitive issues, physical issues. So that's been the passion of mine, I think, is to see greater protections for older people's human rights come through out of the Royal Commission, and to see some professionalisation of that personal care workforce.

RICK:

And, having sat through all of the many of the hearings for the Aged Care Royal Commission and then seen the final report and read those recommendations, what stood out to you in that final document as being substantial recommendations? And can you just walk us through some of those?

Audio Excerpt - Scott Morrison

“Good afternoon everyone. I'm here to release the Royal Commission into Aged Care Quality and Safety. This is the first of many volumes.”

SARAH:

I think there were lots of positives. There's certain aspects around staffing, and around qualifications that have been proposed that have been good.

Audio Excerpt - News Reporter 1:

“The report recommends a registered nurse to be on duty 24 hours a day, more nurses giving hands on care, mandatory training for personal care workers and, most significantly, a Medicare-style levy to fund the massive shortfall in aged care funding.”

SARAH:

I did think that the introduction of guardrails around staffing numbers was important.

I do think that some minimum standard of qualification to ensure a level of familiarity, say, with working with people with dementia, would be very, very helpful.

Audio Excerpt - News Reporter 2:

“The Royal Commission has recommended an urgent review of the country's specialist dementia care units to ensure they're up to scratch. It also says there should be more support for people living with dementia, their carers and families once the diagnosis is made.”

SARAH:

I thought the commission's recommendations around, sort of, penalties could have been stronger and there were some disappointments in the final report in that there were a lot of split recommendations. I think that really diluted the power of the final report.

There were split recommendations around the funding of the system and around the regulation of the system and both of those, I think, the Commission really should have tried its hardest to speak in one voice about that. Because it's sort of given government, now we've had two governments who've had a crack at responding to this and still no act, it's given government a little bit of an out to go with the easier path.

RICK:

Well, that was going to be my next question of course, because it did recommend an entirely new Aged Care Act to replace the one from 1997 that John Howard implemented. But of course, we didn't know exactly what that act was going to look like. And, given everything else that was in that report, did you have any kind of hope that things might change for the better?

SARAH:

I mean I did, and I think the new act, even if it's not perfect of course, you still want to advocate for it to be perfect because, I mean let's be real Rick, we'll all be touched by this system in one way or the other.

Whether it's us, our parents, whatever we do in this act will see my mother through her, through her journey if she ever needs aged care. And I, you know, after dad's experience I hope she doesn't have to go into residential aged care but realistically, it's taken 20 plus years to get a replacement Act after Howard’s Act. That seems to be roughly the time frame to make major changes. So whatever we lock in here now, we're sort of stuck with.

RICK:

After the break, how the government wants to hold bad providers accountable with criminal penalties and the risk of those proposals being watered down.

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RICK:

Sarah, it's now been three years since the Royal Commission handed down what was quite a harrowing exposé into aged care in Australia. In that time, what has actually changed?

SARAH:

Well, that's a good question, Rick. I mean, one of the big wins was pay rises for workers, although that's been sort of delayed and stepped out in its implementation. Another win was the introduction of mandatory care minutes which, again, has been stepped out and there's a big caveat with that.

Care minutes, when you look at the actual numbers that are being reported, and you can see that through My Aged Care through the star rating reportings, very few homes are meeting the required standard. And then when you look at the Serious Incident Reporting Scheme, you see that providers are, sort of, chronically under estimating the impacts of serious incidents such as physical altercations, unlawful sexual conduct, unexplained absence from the service which is when a resident has been allowed to, you know, leave the premises unsupervised, really major issues. Providers are chronically underestimating the psychological and physical impact on aged care residents.

So, in terms of is the situation actually better for an older person in an aged care home than it was three years ago? I'm not sure that there were really any profound indicators saying yes. I'm yet to see any statistics showing that. Malnutrition, dehydration, rates of chemical and physical restraint, we don't have any indication as yet. It depends on whether you're viewing it from a, sort of, legislative view point in which things seem to be happening and or whether you're viewing it from the perspective of a person in residential aged care or in home care, has their reality improved? I don't think that we have any data to support that.

RICK:

And so the government’s new Aged Care Act is going to be tabled in parliament soon. What does their proposed new act look like and what have you made of it?

SARAH:

I think there are aspects of it that are positive, and I think one of the strongest things that I feel most passionate about is the proposed introduction of criminal penalties. I think it's a sector that really does need some consequences. It's had, there’ve been no consequences for providers who failed and failed and failed and, you know, that means lots of older people and their families going through heartbreak. I do think that will be positive. But I do have concerns that it replicates some of the faults of previous legislation. The government is touting this as a human rights based act. But, you know, the statement of rights that's in the draft legislation that's about to be tabled to Parliament are not enforceable.

There is no obligation on providers now in the draft legislation to provide high quality care and that was a strong recommendation from advocates, from people like me, from people in the workforce, from people working at the coalface. And instead, what we've got in the current kind of version of that, now there's just going to be a duty imposed on providers to not basically actively harm older people or put them, you know, at risk of grave injury or illness or harm. And, you know, in an aged care home, you have a term called quote unquote rough handling, which anywhere else means assault. That's where, you know, in order to get an older person to do what you want, you drag them by the wrist and then they end up with a giant bruise and, you know, or they end up with a dislocated shoulder or something like that, that is wallpapered with this term, rough handling.

So, I mean, it's kind of astonishing that we could say it is a rights based piece of legislation, yet the rights within it are not enforceable. What is that?

RICK:

One of those areas they’ve gone further in is, you mentioned, in the criminal penalties, particularly for directors of aged care providers, right?

SARAH:

Yeah, so the Royal Commission recommended that there should be the statutory duty imposed to provide high quality care. If that duty was not upheld, the Royal Commission recommended that civil penalties should apply, fines should apply. So the government has sort of watered this down from an emphasis on high quality and safe care. So that the duty that the government's proposing in the new legislation is that there is a duty to take, quote, “reasonable steps to avoid their actions adversely affecting the health and safety of persons in their care”. But, what the government is proposing goes beyond the Royal Commission in that they're proposing there should be civil penalties, but also criminal penalties, in the very worst cases of up to five years jail.

Effectively it's a serious case that would warrant jail only in cases where provider’s breach involved significant failures, systemic patterns of conduct, especially when there's a death, serious injury or illness or reckless conduct involved. And then there's a loophole, though, that says providers and and responsible persons won't be held responsible if they have a reasonable excuse for causing the death of an older person, then you could be subjected to five years of jail.

You know, if you ask the average person in a pub, does this seem okay? Should the people who are responsible for this neglect go to jail? I think you'd struggle to find someone who would say no. So I think it does meet community expectations. It certainly meets, you know, advocates' expectations that there should be some criminal provisions somewhere in the system so that, in the very worst instances, there is a lever to punish these individuals. But yeah, you know, the lobby doesn't want it. Providers don't want it. They don't want any more liability.

And the opposition spokesperson, Anne Ruston, has also come out against this as well.

Audio Excerpt - Anne Ruston:

“But if we continue to put the kind of pressure that we are on the sector by making all of these demands like, you know, bringing forward the recommendations of the Royal Commission knowing that they can't be delivered, it just continues to put, you know, the negative pressure on…”

SARAH:

The lobby's talking point on this is just beyond farce, which is that it might discourage good people from directing an aged care home rather than eliminate the very few that, you know, horrific directors. And there are some, there are some people who have gone into aged care to make a buck.

It's the same old talking points that we've had the entire time, which is just that providers have too much regulation already, too much paperwork, too much red tape and what they really would like is just to be left alone to their own devices with more money.

RICK:

I'm really interested in the lobby itself, right? Because they've really been the only voice in aged care policy. Full stop. The lobby is a provider lobby, and they have a very big voice.

SARAH:

I think so, Rick, and I think, you know, there's an element of regulatory capture here, I think, where people are rotating out of either government into aged care or out of aged care into regulation.

You know, but I think the worry is that, you know, it's a very loud, very powerful voice, you know, the aged care lobby. They're very good at, sort of, co-opting useful individuals in and out of government to their cause. Really it's so important that the perspectives of older people are vociferously represented because, of course, in aged care those people aren't able to represent themselves because of the very nature of, you know, their vulnerability in certain ways. So, yeah I despair a little bit at the sort of influence that the aged care lobby has had.

I think it has argued on the side of de-regulation, inevitably stood in the way of financial transparency, inevitably raised concerns about any moves to create guardrails around staffing levels or professionalisation of the workforce. All of these things have been resisted. So, in a way it's a sector that sort of being dragged kicking and screaming to these changes.

RICK:

Unfortunately for them, they sent the poet Sarah Holland-Batt to advocate for people in the sector which is a very powerful enemy to have, I think. Sarah Holland-Batt thank you so much for joining us, I really appreciate your advocacy and your insight on this issue.

SARAH:

Thank you Rick and It's a pleasure to chat to you. I also have appreciated for many, many years your work and reporting on this issue so it's been a joy.

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RICK:

Also in the news today,

A study published in the Lancet medical journal has estimated the true death toll of Israel’s ongoing offensive in Gaza could be 186,000 people.

According to Gaza’s Ministry of Health, more than 38,000 Palestinians have been killed but the study, based on methodology applied by public health scientists, says the official toll doesn’t take into account the dead buried under rubble, or indirect deaths due to destruction, disease and the absence of medical care.

And, advocates have warned that age verification for young people on social media is a trap by tech companies to avoid regulation in other areas being imposed on their platforms.

A parliamentary inquiry into the impact of social media has heard that age restrictions on social media platforms would not make the sites any safer and governments should instead be looking at other safety standards that could be implemented.

That’s all for today. I’m Rick Morton, this is 7am. See you tomorrow.

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