The COVID-19 pandemic has shone a light on the extent to which privatization, outsourcing and casualization have impacted public services, in particular highlighting the destructive effects of neoliberalism on healthcare throughout the world. After decades of being told there is no alternative, dissenting voices have now been amplified. In Australia, this includes that of Judith Kiejda, Assistant General Secretary of the New South Wales Nurses and Midwives' Association (NSWNMA), and her members, who have been calling for substantial reforms to the way Aged Care is run in the country for many years.

While Australia has been relatively successful in handling the pandemic in global terms, the tragedies that unfolded in its Aged Care system over the course of 2020 have been a devastating realisation of the kind of dangers Judith and nurses in the sector had previously warned of. The deaths of 685 Aged Care residents (three-quarters of all COVID-19 deaths in the country) brought the reality of this situation home to millions, with many personally touched by the harrowing scenes displayed on throughout the media.

Corporatization and the hollowing out of Aged Care

PSI affiliate NSWNMA has been campaigning against the corporatization of Aged Care since the mid-nineties; in particular, since the law requiring providers to account for public funding as it related to care was removed in 1997. Since then, there have been no less than twenty reports into the sector, cataloguing horrendous stories from facilities across the nation.

“We could see that private investors were expanding and making a killing,” says Judith.

In a bid to address this, Australian PSI affiliates gathered to discuss their concerns and found one key commonality: corporatization. The Aged Care industry had in effect been privatized, with each facility receiving about 72% of their funding from the federal government, and the remainder coming from bonds of clients entering residential Aged Care. This was an area private investors were quickly moving into, with the potential to make a fortune.

“We could see that private investors were expanding and making a killing,” says Judith. “Funding of the sector has been substantial over time however the quality of care was reducing, there were no staff to patient ratios and wages were barely above minimum wage. But our campaigns were being ignored by the government.”

Enter CICTAR

In 2017, the Australian Nurses and Midwifes Federation (ANMF) approached the Centre for International Corporate Tax Accountability and Research (CICTAR) and commissioned them to author three reports on the tax practices of the ‘for profit’ sector, the family-owned facilities, and the ‘not-for-profit’ sector. This was an entirely new endeavor for the union, focused as it was on the economic practices of Aged Care operators rather than the conditions of care workers.

CICTAR’s findings were clear, and tragic. “The appalling tragedy of the aged care sector was that all providers, whether for profit or not, were using the same business model which basically ensured that they paid minimal to no tax and ultimately were not spending what they should have been on resident care and staff wages,” Judith observes. “It meant that less staff were employed, and those staff have minimal qualifications which all led to poor care for residents.”

The first report, focused on ‘for profit’ providers, was launched on May 18, 2018 – the day before the handing down of that year’s federal budget – and within 48 hours of its release had attracted so much media and public outrage that it sparked a federal Senate Inquiry. Released one year later, in May 2019, CICTAR’s report into family-owned facilities was similarly damning in its findings. Finally, the report into not-for-profit Aged Care was released in July 2020 and was tellingly titled ‘Caring for Growth’. Taken together, all three reports painted a bleak picture of the industry.

Media contrasted the billions in tax havens, the lavish lifestyles of the owners with the sickening conditions some residents were living in

“Media contrasted the billions in tax havens, the lavish lifestyles of the owners with the sickening conditions some residents were living in,” says Judith. This stirred outrage in communities across the country and forced Prime Minister Scott Morrison to establish a Royal Commission (RC) into Aged Care. The pandemic has intensified this attention and provided further evidence of the dangers of unregulated, privatized care – not a single COVID-19 death occurred in the public care system in Victoria, the worst hit state in the federation.

The fight goes on

The findings of the Royal Commission have now been handed down with a total of 148 recommendations, including many of the nurses’ key demands. These include recommendations on staffing numbers and qualifications, the amount of care to be delivered to residents and by whom, and the necessity of public reporting.

There is also a call for new Aged Care law which would establish a human right to care for older persons, with facilities being graded against a range of criteria to ensure they are compliant. “This is especially relevant for the PSI campaign on the social organisation of care led by the Women’s Committee,” Judith notes.

Public money must have clear and transparent accountability structures and processes.

However, with the federal government’s post-pandemic budget announced on May 11, not all of these recommendations were agreed for implementation. Despite much of the commentary focusing on the treasury’s ‘big spending’, there is very little accountability over the money that is being spent. Judith is clear about her perspective: “Public money must have clear and transparent accountability structures and processes.”

Although the Royal Commission recommended that Awards and Enterprise Agreements be amended to reflect wages and condition and recognize the value of the work performed, including remedying the gender pay gap, none of the $17.4bn announced for Aged Care in the nation’s budget was linked to higher wages for staff.

Now the nurses and their union have submitted a claim for a 25% wage increase for Aged Care workers on the back of the recommendations. The recommendations provide strong grounds to organize and put pressure on employers during bargaining.

“We know the public are with us, especially as the pandemic continues to expose the dangers of the corporatized model of care and its consequences for both workers and the public,” says Judith.

“Ultimately it would be ideal to see care provided as a public service delivered by publicly employed workers. But that seems a long way off under the current government, so the target is to have transparency around every cent spent on Aged Care, transparency around the workforce and hours of care, and exclusion of any providers who utilize tax havens.”