The empathy deficit

Three weeks into his prime ministership in 2018, on the eve of a damaging Four Corners investigation probing endemic neglect in Australia’s residential aged-care system, Scott Morrison called the Royal Commission into Aged Care Quality and Safety.

Widely perceived as an act of political expediency to counter anticipated criticism of his record of cuts to aged-care funding as treasurer, Morrison’s announcement may well have been motivated more by a base instinct to get ahead of the story than a genuine commitment to policy reform, but he started his press conference with a tone of sombre concern. He highlighted non-compliance of providers, substandard care, dementia care and the plight of young people with disabilities in aged care as all “very disturbing” areas on which the royal commission would focus.

Then, inexplicably, he struck a note of bullish optimism, describing Australia’s aged-care facilities as “better than anywhere else in the world,” and aged care as “something Australians are very good at”. Pressed by journalist Rick Morton about why he had cut $1.2 billion from the aged-care budget while treasurer, Morrison flatly denied it, and his pugilistic side resurfaced. “I’m having a royal commission because I’m not going to put up with lies being told about what’s happening in the aged-care sector,” he said irritably. The façade had cracked, and the carefully cultivated air of empathy gave way to a familiar defensive stance.

More than three years later, and almost a year after the royal commission’s final report with 148 recommendations to overhaul the sector was handed down, the neglect and abuse that prompted its inquiry have escalated into a freewheeling human-rights crisis. Hundreds of residents have died in horrific circumstances, many alone and without adequate pain relief or palliative care. Tens of thousands more have experienced crippling isolation during brutal lockdowns with little or no mental health support. Since the start of the COVID-19 Omicron variant wave, outbreaks have struck just under half of Australia’s 2722 aged-care homes, with more than 30,000 residents and staff infected in January. A quarter of all aged-care shifts – 140,000 per week – are going unfilled, due to a staffing shortage so severe that defence personnel have had to be deployed into facilities. The daily suffering and failures of care that residents are being subjected to – including being denied food, water, showers, medication and basic dignity – is a national disgrace. While the death toll from COVID cases in aged care is known, the corollary premature deaths from neglect during this period are as yet unmeasured. And the federal government and the aged-care regulator have both been asleep at the wheel.

Morrison began his prime ministership defending his record on aged care. If there is any justice in politics, his record on aged care should end his prime ministership, too.

The Morrison government’s failure to fulfil its responsibilities to vulnerable older Australians in care over the course of the pandemic has been lethal and absolute. It failed to devise a national plan to prepare the sector for outbreaks, or prepare for the surge workforce it would evidently need. It dragged its heels on basic measures such as making face masks for staff compulsory. Its online PPE training for aged-care workers – a cohort with no medical training or familiarity with infection control – was initially voluntary. It failed to vaccinate and boost vulnerable residents according to its own deadlines. It was glacially slow to implement a vaccine mandate for aged-care workers, slow to monitor and report on vaccination rates, and is still yet to mandate a booster for staff.

The measures the federal government has put in place have inevitably been piecemeal, poorly implemented and ineffectually monitored. It ploughed $92 million into a failed “one worker, one site” scheme to belatedly try to address the infection control challenge posed by a casualised workforce, but later admitted it had no way of monitoring the scheme’s effectiveness, or even enforcing it. Worse, it rejected key recommendations from the royal commission that would have helped address aspects of the workforce crisis. As workers have left aged care in droves, the government has steadfastly refused to support an increase to the $23 per hour aged-care average wage, in spite of projections by the Committee for Economic Development of Australia showing that in order to deliver basic care for the nation’s ever-increasing aged care cohort an additional 17,000 new workers will need to be recruited each year. Instead, it has offered workers insultingly paltry one-off, pro-rata bonuses of a few hundred dollars.

Rather than supporting the staffing minimums that the royal commission recommended be introduced by this July and increased in 2024, the Morrison government has postponed the introduction of staffing minimums for more than a year, and neglected to support the commission’s optimal recommendation of 215 minutes of care per resident per day. It has flatly rejected the commission’s recommendation that at least one residential nurse be present in aged-care facilities 24 hours a day, opting instead for only 16 hours – a minimum standard that will not come into force until October 2023. And it has also rejected instituting a mandatory minimum Certificate III qualification or a registration scheme through the Australian Health Practitioner Regulation Agency for personal care workers, who are not presently required to hold any formal qualifications at all, and who are neither registered nor regulated like other healthcare staff.

In addition to its failure to tackle longstanding and well-known workforce issues and their foreseeable flow-on effects during a pandemic, the government has also comprehensively failed its responsibility to ensure adequate oversight and regulation of the sector. The dysfunctional and sclerotic aged-care regulator, the Aged Care Quality and Safety Commission, which the royal commission’s interim report described as “unfit for purpose,” indefensibly allowed providers to “self-assess” their readiness for outbreaks using an online survey, halted unannounced spot-checks, and recently scaled back its on-site inspections in spite of rising COVID outbreaks. In a shocking abrogation of its duties, it is presently re-accrediting facilities without undertaking site visits, and extending emergency accreditation even to providers who have failed its basic quality care standards. Its embattled commissioner, Janet Anderson, has recently been reappointed for a further three years, and was praised by Morrison’s terminally incompetent Minister for Senior Australians and Aged Care Services, Richard Colbeck, for her “exceptional leadership”.

There is no single figure more emblematic of the Morrison government’s failures in aged care than Colbeck himself. His ineptitude and negligence have taken many forms – a staggering lack of attention to detail; an unerring focus on the perspectives of providers and peak bodies at the expense of those of residents and workers; an unshakeable insistence that the aged-care crisis does not exist; a deluded belief that the cratering sector is functioning “exceptionally well” – and he has also offered a bewildering array of gotcha moments that should have ended his ministerial career years ago.

Perhaps the most infamous of these occurred in the Senate Select Committee on COVID-19 hearing in 2020, when Colbeck was asked how many aged-care residents had died of COVID to date. After an excruciating 35-second pause, he admitted he did not know the answer to this most critical of questions, and was subsequently censured by his colleagues. Last year, 16 weeks after the government’s aged-care vaccination deadline for aged-care workers had passed with more than 60 per cent of workers yet to receive a single shot, he jetted off to Tokyo to attend the Olympics. And early this year, when more than 80,000 aged-care residents were not yet vaccination-boosted, hundreds were dying and close to 10,000 were infected, he declined to appear in front of the Senate select committee, claiming that giving evidence would have an adverse impact on “urgent and critical work” required to manage the outbreaks. He instead spent three days at the Ashes cricket test match in Hobart. When caught out, Colbeck stood behind his decision, describing the match as a “historic” occasion. Staring down deafening calls for his minister to resign, Morrison backed Colbeck, noting that he had appeared in front of the select committee “countless times”. In fact, of the committee’s 55 hearings, Colbeck had appeared twice.

Among the Morrison government ranks, Colbeck is not alone in suffering from an empathy deficit. At a time when scores of residents were dying in Victoria’s aged-care outbreaks, the prime minister referred to aged-care residents as “pre-palliative”: a shameful attempt to diminish the value of their lives, and to cast them as already existing on the threshold between life and death. Health Minister Greg Hunt recently rehashed this notion, making the unverifiable claim that the majority of aged-care deaths in the Omicron wave occurred among residents who were already “palliating” and “in the absolute last days of their life”.

But perhaps the most indelible image of the Morrison government’s monstrous callousness towards aged-care residents came in the form of a failed photo-op. Last November, Morrison received his booster in an aged-care home alongside an 84-year-old resident and World War Two survivor, Jane Malysiak. The official photo shows Morrison sitting beside Malysiak in an Australian-flag face mask, with his hand raised in the Victory sign. But the cosy, good-news image of the aged-care booster rollout was a sham: only the prime minister and Malysiak herself received the jab. When the cameras departed, all the other residents in Malysiak’s home were told they would have to wait another three months for their dose.

Australia’s residential aged-care sector was experiencing grave systemic failures long before the pandemic. The royal commission’s interim report, “Neglect” – handed down in October 2019 – offered a searing view into the existing baseline standard of care prior to the onset of the pandemic. It revealed a poorly regulated, profit-driven sector that routinely subjected older Australians to high levels of chemical and physical restraint, medication mismanagement, malnutrition, dehydration, inadequate palliative and dementia care, physical and sexual assaults, preventable injuries and premature deaths. It noted that in the five-year period preceding, Australian aged-care providers self-reported 274, 409 instances of substandard care, including almost 112,000 instances of clinical-care failures and 69,000 instances of medication mismanagement. The magnitude of the failure is astronomical, considering that there are fewer than 200,000 older Australians living in residential aged care at any given time.

Yet, somehow in his tenure, Morrison has managed to make a sector that was already in dire straits immeasurably worse off. Aged care is presently in a state of abject and unprecedented crisis, and Morrison is the principal architect of its tide of human misery. He has failed our most vulnerable citizens in the profoundest ways. His shallow photo-ops, unjustifiable support for a hapless minister, glib rhetoric and unforgivable complacency will be his legacy, and his enduring shame.

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