Journalists, social policy and social justice

For 18 years Adele Horin was the Sydney Morning Herald's  social affairs correspondent where she wrote important and ground breaking articles about social policy issues and the development and implementation of social policy by Federal and State Governments.

Along with her former colleague at the Sydney Morning Herald Elisabeth Wynhausen (whose website is backstreetbondi),  Adele Horin was a journalist who reported on social policy issues from a strong social justice perspective.

She has a great ability to write about the myriad of ways that social policy decisions impact on the daily lives of ordinary people.

 In  her final article for the SMH For richer and poorer the battle goes on Horin writes:

Harsh and simplistic solutions to complex social problems are still trotted out by the rich and powerful whose encounters with the lives of the poor are usually non-existent.

It is the same story in the schools debate. Twenty-four years ago I wrote, ''If state schools are to avoid their fate as repositories of the poor, and thus electorally dispensable, the middle class must be wooed back.'' They weren't.

The Gonski report presents a compelling economic and social argument for equalising opportunities for children in public schools. No subject is more important than improving the life chances of poor children through the best education possible.

But the debate appears lost, as the Prime Minister, once dedicated to the cause, panders to a middle-class with kids in private schools who consider themselves hard-up. She promises to give extra funds she doesn't have to wealthy schools while the Opposition Leader claims rich schools are the true victims of funding injustice. Plus c¸a change.

Mandatory detention of refugees began in 1992 under then prime minister Paul Keating. A lot of us overlooked the development in far-away Port Hedland at the time. All these years later, harsh treatment of refugees of a kind we know is bound to cause mental illness and suicides remains our only response, and the ''regional solution'' is no close

Adele Horin now works as a freelance journalist and reports on the interface between aged care policy and the experiences of Australians getting older. Her articles are published at her website Adele Horin: Coming of Age and in online publications such as the Global Mail.

Her latest article  The New  Nasty Sibling Rivalry looks at the ways families are responding to the demands of caring for ageing parents and the consequences of Federal Government policies hat often require the sale of the family home to pay for the costs of care for ageing parents.

Not for profit aged care provider Baptistcare protests Federal Government funding cuts

Always pleasing to see large Not- for- profit organizations like Baptistcare willing to make a stand  and protest against Government policy that disadvantages the people they serve.

This report describes a protest by staff at Baptistcare's Rockingham aged care facility against Federal Government funding decisions in aged care that are resulting in $500 million being cut from aged care funding.

Baptistcare is extending the protest to 13 of its residential aged care facilities and three disability and community care sites from today, in protest at the Federal government's decision

The organisation has taken the step of launching the visual protest, which includes a call to action via social media, to raise greater public awareness of the government's 1 July adjustments to the Aged Care Funding Instrument (ACFI).


The protest is part of  a larger campaign being run by not- for- profit aged care providers through Aged and Community Services WA  which represents not-for-profit aged care providers which care for 100,000 of the state's most frail and vulnerable citizens.

Flags emblazoned with “Government Neglects Aged Care” flew outside the Gracehaven facility protesting reduced federal funds for aged-care organisations to deliver clinical care services to its residents.

Baptistcare CEO Lucy Morris said the Government had made it almost impossible for not-for-profit residential care providers, like Baptistcare, to provide appropriate care for the elderly and vulnerable.

“Through its adjustment of the assessment tool used to fund high-care services, the Government has stripped money from the services needed to care for older, sicker residents, who have more complex health needs and need higher levels of care,” Dr Morris said.

But Mental Health and Ageing Minister Mark Butler said subsidies would not be reduced and they would continue to grow by 2.7 per cent a year above indexation, per resident over the next five years.

He said early data for providers’ care funding claims made in July showed average subsidies increased from $133.96 per resident per day in June to $134.83 in July.

“Leading Aged Services Australia (LASA) and Aged and Community Services Australia (ACSA) have claimed funding will be cut by hundreds of millions of dollars in 2012 and beyond,” Mr Butler said.

“These claims are clearly untrue, as these early figures show. The Government’s aged care package will increase funding for residential care. This year’s subsidies will be $310 million more than last year.”

ACSA WA chief Stephen Kobelke said WA’s not-for-profit aged care sector had struggled for years to survive in one of the world’s most expensive cities.

“There has been unprecedented stagnation in the provision of aged-care services in WA, to the point that 3368 bed licences have now not been taken up since 2007,” he said.

He said ACSWA figures showed some aged-care providers would face cuts of over $14,000 per resident.

A crises parly caused by decades of market driven reform

photo courtesy of ABC News and Micaela Rehle, file photo Reuters)

The crises in the aged care sector is indicative of what lies ahead for the human and communty service sector more broadly.

It is the culmination of 2 decades of market driven reform in which the provision of care and the delivery of human services is marketized, privatized and corporatized.

The report below is from ABC News:

The aged care sector in WA says nursing homes are sacking staff and cutting services in a bid to stay viable, following an overhaul of Commonwealth funding.

Providers predict they will receive up to $24,000 less for each elderly person in their care, under the new funding arrangements.

The head of Aged and Community Services WA, Stephen Kobelke, will attend crisis talks with dozens of stakeholders today.

He says the cuts have put pressure on an industry already struggling to cope.

"Is it sustainable to remain in residential aged care?

"They're the things they'll start to look at; WA providers are deeply concerned about their ability to operate, or in fact their desire to do so.

"They want to look after older people but they've got to have the tools."

Mr Kobelke warns companies have no choice but to cut services and staff.

"Rural providers have already needed to start some sort of downsizing," he said.

Mr Kobelke says the industry is already doing it tough thanks to WA's workforce shortages, building costs and isolation.

Corporate run nursing homes deliver lower quality care than not-for-profit providers

More evidence of the danger of allowing for- profit corporations to provide human and caring services to vulnerable people.

A major US study  to be published in the Journal Health Services Research has found that for-profit nursing homes deliver significantly lower quality of care than not-for- profit and government run nursing homes.

In the US the 10 largest for-profit corporate providers of hursing homes  operate about 2,000 nursing homes, controlling approximately 13 percent of the country’s nursing home beds.

The study found that the main reason that the quality of care is worse in corporate and for-profit run  nursing homes is that corporate and for- profit providers employ fewer staff  to keep costs down and profits up. In studying staffing and quality in the 10 largest corporate for profit providers of nursing homes the researchers found that the corporate providers  have a strategy of keeping labor costs low to increase profits, with the result that the quality of care suffers and there is a higher number of rated deficiencies.

The researchers found that low nurse staffing levels are the strongest predictor of poor nursing home quality.

The study found that between 2003 and 2008, both the percent of registered nurses and the numbers of all nursing staff were significantly less (30 percent) in the corporate for profit providers than the non-profit homes.  The lower staffing correlated with a considerably higher number of rated deficiencies - the private chains having 36 percent more deficiencies, and 41 percent more serious deficiencies than the non-profits.  Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.

What is also troubling is that the study found that the quality of care worsened in nursing homes taken over by private equity companies. Nursing homes had more deficiencies after being acquired by a private equity company.This is directly relevant to Australia where private equity companies are increasingly involved in aged care and nursing home provision. The study is the first to make the connection between worse care following acquisition by private equity companies.

"In recent decades, nursing home chains have undergone a considerable expansion.A number of chains were publicly-traded companies until the early 2000s, when five of the country’s largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses. 

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share. 

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse “staffing hours” than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

 The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

There is now a growing body of evidence that demonstrates conclusively that for-profit corporate run nursing homes deliver lower quality care than not-for profit nursing homes.

A study in the British Medical Journal  compared quality-of-care measurements in 82 individual studies that collected data from 1965 to 2003 involving tens of thousands of nursing homes, mostly in the United States. It found that

The authors' meta-analysis, i.e. their integration and statistical analysis of the data from the multiple studies, shows that nonprofit facilities delivered higher quality care than for-profit facilities for two of the four most frequently reported quality measures: (1) more or higher quality staffing and (2) less prevalence of pressure ulcers, sometimes called bedsores.

The results also suggest better performance of nonprofit homes in two other quality measures: less frequent use of physical restraints and fewer noted deficiencies (quality violations) in governmental regulatory assessments.

"The reason patients' quality of care is inferior in for-profit nursing homes is that administrators must spend 10 percent to 15 percent of revenues satisfying shareholders and paying taxes..... For-profit providers cut corners to ensure shareholders achieve their expected return on investment."