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When Peter O'Shannessy returned to his home from the hospital in January, he was unable to speak or eat after extensive surgery for throat cancer. The 74-year-old was assessed for aged care support and approved for a level-three home care package, which would fund a recliner to make him more comfortable, a suction machine to clear his airways and a personal carer to help him with showers and hygiene. The family soon learned they had to join a national queue of 121,000 people to receive a package — and that it would be seven to nine months before any help arrived. When the cancer returned months later, Peter was declared terminal and needed urgent nursing care. The family was advised to get a reassessment in the hope he could get the much-needed support. "Dad's needs were increasing by the moment," his daughter, Eloise Randall, said. "We needed personal care assistance, we needed nursing." The government agency My Aged Care referred the family to Aspire4Life, the organisation that would do the reassessment. It was one of more than a dozen companies contracted by the federal government late last year to take over aged care assessments. For the past 40 years, it's been Aged Care Assessment Teams (ACAT), based with state and territory health departments, who have done assessments and decided on the level of care needed. But in December last year, the government partially privatised the system at a cost of more than $1.2 billion. Latest figures show there are now more than 116,000 people waiting for aged care assessments around the country. Eloise said she spent hours on the phone to both My Aged Care and Aspire4Life, begging for support. "Aspire4Life gave mum and dad a reassessment date of eight weeks into the future, and that was the most urgent time they could get there," Eloise said. 'I warned and warned them, he'll be gone." Peter died four weeks before his urgent reassessment. "In the end, Dad had gone from messaging banter in our family WhatsApp chat to sending my mum a text message saying 'help'," Eloise said. "Within 20 minutes, my dad was gone." "He spent his last couple of weeks feeling like he was drowning, lying on a couch that was unsuitable for him and in a lot of fear and anxiety, and my mum spent those last few weeks absolutely burnt out and exhausted, caring for someone on her own with no support, despite hours and days and weeks of us just on the phone to these people," said Eloise through tears. Aspire4Life was responsible for an assessment for support services for Peter, not his medical care. In a statement, the organisation said it couldn't comment on Peter's case because of its "contract with the government" but said the "high demand for government subsidised aged care assessment services is universally acknowledged". It said it was investing to meet the additional demand and had provided more than 100,000 services in the preceding 12 months. Families at breaking point In Cairns, former ACAT assessor Coral Wilkinson now helps families navigate the aged care maze, dealing with a range of assessment organisations in Queensland. She says many clients are calling her for help to try to get an assessment done more quickly. "People have already been waiting months. Some are waiting nine or 10 months for an assessment," she said. "They're desperate. They ring us in tears. Some end up in hospital or a nursing home because they can't get support at home." Coral believes the Department of Health and some of the newly contracted companies weren't prepared. "I believe the workforce wasn't ready," she said. "I think there was some naivety on the part of the department and perhaps some of the newer assessing organisations who didn't really understand the level of knowledge and expertise that is required to assess older people who … have higher and more complex needs." The government doesn’t agree that people are waiting a long time. A spokesperson for the Aged Care Minister, Sam Rae, said the median wait time for aged care assessments was 23 days in the July-September quarter and that the government would “continue to focus on bringing down wait times even further”. Three phone calls and you're out Janine Mason, a former clinical assessor, joined one of the new private assessment companies – not Aspire4Life – early this year but quit after a few months, saying she felt under pressure to do assessments quickly. "I think the assessments now are actually becoming dehumanised because of the pressure to get them done." "It's coming from departmental decisions that are pushing down onto the companies that must remain viable and keep their contracts." Most disturbing for Janine was a practice that she claims meant elderly people dropped off the waiting list — often without their knowledge — if they didn't respond to phone calls in time. "There are obviously KPIs about how much time can be spent trying to contact the older person. We were advised three calls were to be given. "If they don't respond to those calls, then that referral would be rejected," she said. Janine's former employer said that although there were guidelines allowing assessors to reject clients if unsuccessful after several attempts, their organisation didn't adopt this policy and went to significant lengths to contact clients. The ABC has spoken to workers and families who say they have also encountered this practice at other organisations. Royal commission didn't recommend privatisation When the aged care royal commission reported in 2021, it recommended a streamlining of aged care assessments into a single assessment scheme, but it didn't recommend privatisation. It also said that assessments should be done by people "independent from approved providers". This would ensure there would not be any perceived conflict of interest for assessors who would have contact with clients and could potentially gain an advantage by recommending a provider's services. Despite that recommendation, the ABC can reveal that more than half of those companies contracted to provide assessments are also service providers or are a related entity to providers. In a statement, Mr Rae's spokesperson said the government had “robust arrangements to prevent conflicts” and said the Department of Health was able to take a range of strict actions, including terminating contracts, if a conflict was identified. In a tender document, the government put in a dozen KPIs, including that 90 per cent of urgent assessments should be done within 10 days and that 95 per cent of assessments should be face-to-face. But last month at Senate Estimates, the department admitted that it would not be enforcing the requirement to meet KPI obligations for 12 months. In a statement, a spokesperson said: "The Department is taking a flexible approach to enforcing those KPIs for approximately 12 months following the establishment date." Peter's family is still grieving the traumatic final months of his life. They fear for others who don't have family support. "I really despair for the number of vulnerable elderly Australians in this country who have no access to support or someone coming in to check on them," Eloise Randall said. "It's probably too hard to sit on the phone and navigate the bureaucracy that is the system." "Dad's final wish was to speak again. I think this process shows we had to speak for him, and we still got nowhere."
