Australia hands out the best part of A$1 billion per year in grants to businesses. Many of these come with no strings attached, meaning there is no need to evaluate whether the grants boost employment, help the recipients become more efficient, or benefit the nation.

To test what good these grants do, my team at the Institute of Public Accountants-Deakin University Small and Medium Enterprise Research Centre tracked the performance of the 141,800 firms that received a total of $4.2 billion in Commonwealth government grants in the five years from 2018 to 2022.

Our task was made easier by a requirement that from 2018 all grants from Commonwealth entities be published on the government’s GrantConnect website.

GrantConnect gave us information about each firm that received a grant, which we used to examine its finances and compare them to the finances of other firms of similar sizes in similar locations and industries.

The largest number of grants were to firms that specialised in innovation and R&D (9,086), especially in the manufacturing and professional, scientific and technical industries. Another 2,150 were for “business development” and 2,084 were aimed at “small business”.

As far as we know, ours is the first such study in Australia.

Multiple recipients performed poorly

We find many of the grants generated no significant improvements in the performance of the firms that received them. In some cases they might have harmed them.

The firms that received repeated grants (almost two-thirds of the total) exhibited lower than normal efficiency and productivity. This suggests Australia’s system of grants might be propping up and sustaining an entire cohort of underperforming “subsidy businesses”.

This finding lends weight to predictions of global studies that have found receiving grants can lead to a “grant mentality” or “grant culture” within individual businesses.

These generally low-performing multiple grant recipients got $1.3 billion of the $4.2 billion total.

How grants are awarded matters

The average picture looked good. On average, the firms that received the grants boosted their employment, their business performance and their efficiency.

But the way in which the recipient was selected mattered a lot.

The firms that were simply awarded grants on the basis of being eligible rather than having to compete for them did badly. They suffered average declines in their returns on assets of 4.9% and declines in their turnover of 6.6%.

The overwhelming majority of grants (eight in ten) were awarded this way. Applicants merely had to meet eligibility criteria, without any assessment of their merits relative to other applicants or their obligations to taxpayers.

Older businesses gained more from grants than younger businesses. Recipients aged ten years and older increased their returns on assets by an average of 3.5% compared to startups, which increased their returns by an average of 2.7%.

For employment, things were the other way around. Startups recorded high average workforce gains of 5.1% compared to older firms, which recorded only 1.3%.

Opaque by design

We found it hard to assess the outcomes of grants against criteria because the Commonwealth seldom provides criteria with which to assess grant outcomes.

Nor, typically, does it provide comprehensive information on the purposes of individual grants.

This suggests a worrying lack of rigour in the government’s grant selection processes. There’s little to stop public funds going to companies that fail to convert taxpayer support into positive results for themselves or for the nation.

The Australian National Audit Office has also found a broad and systemic lack of transparency throughout most Commonwealth government grants programs, as we did in an earlier report on the process by which grants are awarded in February.

Our report found that while competitive selection was rare for every category of business grants, it was especially rare for business development grants, small business grants and industry innovation grants.

Small business grants awarded via ministerial discretion had higher average values than grants awarded via formal processes.

Ministers handed out about half-a-billion dollars without formal processes between 2018 and 2022.

While small tweaks to the existing system might help, our report recommends a complete overhaul to make the processes merit-based with clear criteria and benchmarks for success as well as evaluations of success after the event.

Importantly, our recommendations would be relatively costless, both for grant administrators and applicants.

Our investigations are not complete. Later this year we will publish our findings about grants to non-business community organisations.

George A. Tanewski, Professor in Accounting, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australian celebrity cook Maggie Beer has long been an advocate for better quality meals in aged care. It led her to a four-month immersion in an aged care residence with the goal of transforming the meals and dining experiences there.

She and the producers of a three-part ABC documentary series, Maggie Beer’s Big Mission, which will premiere and stream from tonight, hope it will spark nationwide change.

The program was motivated by the high levels of neglect, malnutrition and social isolation identified by the Royal Commission into Aged Care Quality and Safety and a new rights-based Aged Care Act, which is currently being drafted.

Our team of speech pathologists, occupational therapists, dietitians, and researchers had a behind-the-scenes view of this “social experiment”. We helped evaluate its impact for residents and staff, to understand how other centres could use the same evidence-based approach.

Turning problems into solutions

The experiment took place in a section of Meath Care’s Dr Mary Surveyor Centre in Kingsley, Western Australia, home to 44 residents.

At the start of the experiment 78% of residents evaluated were at risk of malnutrition or malnourished and 46% experienced depression. These figures are confronting yet not unusual based on previous studies and the Royal Commission estimate that 68% of Australians in residential aged care are malnourished or at risk of becoming so.

Maggie, aged 79, and her team of experts worked alongside staff and residents to design and implement a new model of mealtime care. This included:

• making meals more nourishing, flavoursome and visually appealing, with increased protein and fresh ingredients
• giving residents variety, choice and independence with a buffet-style offering
• involving residents in mealtime roles such as setting tables and restocking supplies
• creating a calmer, more dignified and social mealtime experience.

These sound like simple changes, but they can be challenging given budget adjustments, physical renovations and staff training and support. Resident and staff responses revealed a pathway to better nutrition and socially engaging care.

Here’s what the experiment showed can work:

1. Influential leadership

Maggie Beer has championed this issue, modelling humility and openness to learning. She fronted a team with a shared vision – “to make every mouthful count”.

She shows leaders can work alongside staff to understand the challenges and identify solutions, share accountability for change and celebrate success.

2. Questioning habits and the status quo

Just because meals have always been prepared or served in a certain way, doesn’t mean it’s the best way. Standards of care can be re-imagined and the evidence translated into resident-centred care.

What the program shows is small changes (like making one’s own fresh toast, served hot) can make a difference to choice and mealtime enjoyment.

It also means being flexible enough for different needs and safety considerations. For example, texture modified diets – food textures that improve safety for residents with swallowing difficulties – can be hard to get right. But that doesn’t mean change can’t happen. As one senior staff member noted, there is dignity in having the same meal as others:

Traditionally, the aged care puree diet would be yesterday’s food or batch prepared and put in the freezer. Now, having the same food cooked out of the same oven and then modified, for me, I think that runs to dignity.

3. Experiencing change

Maggie and her team provided more than 175 hours of training to staff. Topics included nutrition, swallowing, oral health, as well as leadership and person-centred care.

Coaching, mentorship and support in the kitchen and dining room was also provided.

Staff valued seeing, feeling and experiencing the benefits that flowed from new ways of facilitating residents’ choice and independence during meals. This built momentum and shifted mindsets. As one care worker said:

[…] you don’t realise how independent some people [residents] can be. They’ve never had the opportunity. They never cease to amaze me about what they can do if they’re given the opportunity.

4. Harnessing mealtime expertise

We know there is not enough access to allied health care in residential settings. This means residents don’t always get the support of occupational therapists, dietitians or speech pathologists when they need it.

The series shows bringing allied health expertise into the dining room can enhance residents’ health and wellbeing. Mealtime interventions – making therapeutic changes such as suitable eating implements, modified diets and textures or assistance with eating in a real-life context – helps care staff see the residents’ potential.

5. Keeping the model going

The program and the changes it brought were not without tension. But these were viewed as a positive sign of change.

As part of the recipe for change it is important to set staff up for success, providing the knowledge, tools (such as self-assessments and mealtime auditing) and ongoing support to sustain change and recognise if the quality of meals and dining experiences are slipping. As one team leader said:

I’m probably most proud of the way the staff have been able to adapt […] I’m proud of how they’ve stood up and said, oh, hang on a minute, we’ve all learned that this is not a really good way of doing it.

Will it work on a bigger scale?

This real-life experiment successsfully improved residents’ appetite, mealtime satisfaction and mood, with full results being prepared for publication.

The standard of mealtime care was lifted with many residents enjoying increased choice and independence, as one resident said:

I can see what I’m getting, and I can get what I want.

It is a model that can be adopted nationwide if aged care organisations invest in the vision, training and ongoing support for staff to make the necessary change.

Tools have been created for other aged care organisations to replicate the model, considering self-service options for example.

We all have a role to play in supporting this mission and lifting the standard of care – ensuring residents are nourished, socially engaged and active partners in their care.

Jade Cartwright, Associate Professor, School of Health Sciences, University of Tasmania; Anne Whitworth, Professor, School of Health Sciences, University of Tasmania; Elizabeth Oliver, Sessional Academic, Occupational Therapy, Curtin University, and Lynette R. Goldberg, Associate Professor, Wicking Dementia Research Education Centre, University of Tasmania

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Our ageing population brings a growing crisis: people over 65 are at greater risk of dual sensory impairment (also known as “deafblindness” or combined vision and hearing loss).

Some 66% of people over 60 have hearing loss and 33% of older Australians have low vision. Estimates suggest more than a quarter of Australians over 80 are living with dual sensory impairment.

Combined vision and hearing loss describes any degree of sight and hearing loss, so neither sense can compensate for the other. Dual sensory impairment can occur at any point in life but is increasingly common as people get older.

The experience can make older people feel isolated and unable to participate in important conversations, including about their health.

Causes and conditions

Conditions related to hearing and vision impairment often increase as we age – but many of these changes are subtle.

Hearing loss can start as early as our 50s and often accompany other age-related visual changes, such as age-related macular degeneration.

Other age-related conditions are frequently prioritised by patients, doctors or carers, such as diabetes or heart disease. Vision and hearing changes can be easy to overlook or accept as a normal aspect of ageing. As an older person we interviewed for our research told us

I don’t see too good or hear too well. It’s just part of old age.

An invisible disability

Dual sensory impairment has a significant and negative impact in all aspects of a person’s life. It reduces access to information, mobility and orientation, impacts social activities and communication, making it difficult for older adults to manage.

It is underdiagnosed, underrecognised and sometimes misattributed (for example, to cognitive impairment or decline). However, there is also growing evidence of links between dementia and dual sensory loss. If left untreated or without appropriate support, dual sensory impairment diminishes the capacity of older people to live independently, feel happy and be safe.

A dearth of specific resources to educate and support older Australians with their dual sensory impairment means when older people do raise the issue, their GP or health professional may not understand its significance or where to refer them. One older person told us:

There’s another thing too about the GP, the sort of mentality ‘well what do you expect? You’re 95.’ Hearing and vision loss in old age is not seen as a disability, it’s seen as something else.

Isolated yet more dependent on others

Global trends show a worrying conundrum. Older people with dual sensory impairment become more socially isolated, which impacts their mental health and wellbeing. At the same time they can become increasingly dependent on other people to help them navigate and manage day-to-day activities with limited sight and hearing.

One aspect of this is how effectively they can comprehend and communicate in a health-care setting. Recent research shows doctors and nurses in hospitals aren’t making themselves understood to most of their patients with dual sensory impairment. Good communication in the health context is about more than just “knowing what is going on”, researchers note. It facilitates:

• shorter hospital stays
• fewer re-admissions
• reduced emergency room visits
• better treatment adherence and medical follow up
• less unnecessary diagnostic testing
• improved health-care outcomes.

‘Too hard’

Globally, there is a better understanding of how important it is to maintain active social lives as people age. But this is difficult for older adults with dual sensory loss. One person told us

I don’t particularly want to mix with people. Too hard, because they can’t understand. I can no longer now walk into that room, see nothing, find my seat and not recognise [or hear] people.

Again, these experiences increase reliance on family. But caring in this context is tough and largely hidden. Family members describe being the “eyes and ears” for their loved one. It’s a 24/7 role which can bring frustration, social isolation and depression for carers too. One spouse told us:

He doesn’t talk anymore much, because he doesn’t know whether [people are] talking to him, unless they use his name, he’s unaware they’re speaking to him, so he might ignore people and so on. And in the end, I noticed people weren’t even bothering him to talk, so now I refuse to go. Because I don’t think it’s fair.

So, what can we do?

Dual sensory impairment is a growing problem with potentially devastating impacts.

It should be considered a unique and distinct disability in all relevant protections and policies. This includes the right to dedicated diagnosis and support, accessibility provisions and specialised skill development for health and social professionals and carers.

We need to develop resources to help people with dual sensory impairment and their families and carers understand the condition, what it means and how everyone can be supported. This could include communication adaptation, such as social haptics (communicating using touch) and specialised support for older adults to navigate health care.

Increasing awareness and understanding of dual sensory impairment will also help those impacted with everyday engagement with the world around them – rather than the isolation many feel now.

Moira Dunsmore, Senior Lecturer, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, University of Sydney; Annmaree Watharow, Lived Experience Research Fellow, Centre for Disability Research and Policy, University of Sydney, and Emily Kecman, Postdoctoral research fellow, Department of Linguistics, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.