Monetising your mum: The industrification of aged care

摘要

Even before the COVID-19 pandemic, in many parts of the world there have been considerable, ongoing concerns about care quality provision for older people, particularly for those in residential aged care facilities. People understand that something has been fundamentally corrupted when the care of our older citizens becomes ‘simply another commodity to be purchased, rather than an essential service that is their right’ (Davidson, 2018: 104). Depressingly, regular ‘scandal stories’ and public enquiries come and go, but nothing changes. A most egregious example is illustrated in the official report on the recent sudden closure and evacuation of the residents of an aged care facility in Australia. Among the many corporate outrages and derelictions of care uncovered, the report explicitly commends the home's care staff who ‘remained on site to support the residents amid the chaos despite being told they would not be paid or covered by insurance’, while roundly condemning the home's owners, managers and liquidators for their ‘deplorable lack of accountability (...) for the consequences of their actions’ (Commonwealth of Australia as represented by the Department of Health, 2019:4). The mistakes that ‘must never happen again’ reoccur and the ‘lessons that must be learned’ never are. We may never discover the true number of people who have died in residential care homes as a result of COVID-19 but reliable estimates suggest that it will be around half of all COVID-19 deaths worldwide (Reynolds, 2020; Comas-Herrera et al., 2020). The COVID-19 crisis has not created the crisis in aged care but rather it has ruthlessly exposed its every fatal flaw and failing. It is difficult to know where to begin to describe the utter bankruptcy of the current ‘aged care industry’ and their political backers. Whether it is the woeful lack of evidence-based clinical governance frameworks, or any coherent COVID-19 national planning that effectively protects residents, or the epic failures in care at almost every level. While aged care facilities are often advertised as homes and many have some superficial decor meant to resemble a private home, these are unabashed institutions and profit centres and the ethos within bears little resemblance to anything we would recognise as home (Molony, 2010) or to any place where we would feel ‘at home’ (de Veer & Kerkstra, 2001). Values such as dignity, autonomy, freedom of choice or person-centred care wither under a lexicon that reinforces capitalist and Taylorist ideologies exemplifying ‘assembly line’ (Daly & Szebehely, 2012:143) care and underpin most operations in this sector. Even outlining the catalogue of failures in human warehousing that exemplify today's ‘aged care industry’ is beyond the scope of this paper. Currently, in Australia, we have (yet another) enquiry underway— an entire Royal Commission forensically revealing all of these shortcomings (https://agedcare.royalcommission.gov.au/). The aged care industry has sunk beyond Ungerson's influential identification of ‘the commodification of care’ (Ungerson, 1997) to an even more bereft ‘corporatization of care’ (Farris & Marchetti, 2017:110), where ‘caregivers might not be the ones assessing the care needs; instead, they are only those implementing services designed by upper-level authorities, usually managers who might know very little about care’ (Farris & Marchetti, 2017:127). Here, however, we focus on the ‘linguistic Chernobyl’ (Solchanyk, 1992:xiii) that has seen every vestige of humanity and human connection expunged from the language of aged care, supplanted by the arid argot of managerialism, capitalism, industrialism and marketisation (Henderson & Willis, 2020) in the ‘new public management drive for productivity and effectiveness rather than quality and professionalism’ (Attrash-Najjar & Strier, 2020:35). Heidegger once observed that language does not simply describe, noting that; ‘Language is the house of being’ (Heidegger, 1977:193). If thi