Today’s news coverage reports potentially unsafe levels of “forever chemicals” detected in drinking water supplies around Australia. These include human-made chemicals: perfluorooctane sulfonate (known as PFOS) and perflurooctanic acid (PFOA). They are classed under the broader category of per- and polyfluoroalkyl substances or PFAS chemicals.

The contaminants found in our drinking water are the same ones United States authorities warn can cause cancer over a long period of time, with reports warning there is “no safe level of exposure”.

In April, the US Environmental Protection Agency (USEPA) sent shock waves through the water industry around the world when it announced stricter advice on safe levels of PFOS/PFOA in drinking water. This reduced limits considered safe in supplies to zero and gave the water industry five years to meet legally enforceable limits of 4 parts per trillion.

So, should the same limits be enforced here in Australia? And how worried should we be that the drinking in many parts of Australia would fail the new US standards?

What are the health risks?

Medical knowledge about the human health effects of PFOS/PFOA is still emerging. An important factor is the bioaccumulation of these chemicals in different organs in the body over time.

Increased exposure of people to these chemicals has been associated with several adverse health effects. These include higher cholesterol, lower birth weights, modified immune responses, kidney and testicular cancer.

It has been very difficult to accurately track and measure effects of different levels of PFAS exposure on people. People may be exposed to PFAS chemicals in their everyday life through waterproofing of clothes, non-stick cookware coatings or through food and drinking water. PFAS can also be in pesticides, paints and cosmetics.

The International Agency for Research on Cancer (on behalf of the World Health Organization) regards PFOA as being carcinogenic to humans and PFOS as possibly carcinogenic to humans.

Our guidelines

Australian drinking water supplies are assessed against national water quality standards. These Australian Drinking Water Guidelines are continuously reviewed by industry and health experts that scan the international literature and update them accordingly.

All city and town water supplies across Australia are subject to a wide range of physical and chemical water tests. The results are compared to Australian water guidelines.

Some tests relate to human health considerations, such as levels of lead or bacteria. Others relate to “aesthetic” considerations, such as the appearance or taste of water. Most water authorities across Australia make water quality information and compliance with Australian guidelines freely available.

What about Australian PFOS and PFOA standards?

These chemicals can enter our drinking water system from many potential sources, such as via their use in fire-fighting foams or pesticides.

According to the Australian Drinking Water Guidelines, PFOS should not exceed 0.07 micrograms per litre in drinking water. And PFOA should not exceed 0.56 micrograms per litre. One microgram is equivalent to one part per billion.

The concentration of these chemicals in water is incredibly small. And much of the advice on their concentration is provided in different units. Sometimes in micrograms or nannograms. The USEPA uses parts per trillion.

In parts per trillion (ppt) the Australian Guidelines for PFOS is 70 ppt and PFOA is 560 ppt. The USEPA’s new maximum contaminant levels (enforceable levels) are 4 ppt for both PFOS and also PFOA. Previous news reports have pointed out Australian guidelines for these chemicals in drinking water are up to 140 times higher than the USEPA permits.

Yikes! That seems like a lot

Today’s news report cites PFOS and PFOA water tests done at many different water supplies across Australia. Some water samples did not detect either chemicals. But most did, with the highest PFOS concentration 15.1–15.6 parts per trillion from Glenunga, South Australia. The highest PFOA concentration was reported from a small water supply in western Sydney, where it was detected at 5.17–9.66 parts per trillion.

Australia and the US are not alone. This is an enormous global problem.

One of the obvious challenges for the Australian water industry is that current water treatment processes may not be effective at removing PFOS or PFOA. The Australian Drinking Water Guidelines provide this advice:

Standard water treatment technologies including coagulation followed by physical separation, aeration, chemical oxidation, UV irradiation, and disinfection have little or no effect on PFOS or PFOA concentrations.

Filtering with activated carbon and reverse osmosis may remove many PFAS chemicals. But no treatment systems appear to be completely effective at their removal.

Removing these contaminants might be particularly difficult for small regional water supplies already struggling to maintain their water infrastructure. The NSW Auditor General criticised the planning for, and funding of, town water infrastructure in regional NSW back in 2020.

Where to from here?

The Australian water industry likely has little choice but to follow the US lead and address PFOS/PFAS contamination in drinking water. Along with lower thresholds, the US committed US$1 billion to water infrastructure to improve detection and water treatment. They will also now require:

Public water systems must monitor for these PFAS and have three years to complete initial monitoring (by 2027) […]

As today’s report notes, it is very difficult to find any recent data on PFOS and PFOA in Australian drinking water supplies. Australian regulators should also require ongoing and widespread monitoring of our major city and regional water supplies for these “forever chemicals”.

The bottom line for drinking tap water is to keep watching this space. Buying bottled water might not be effective (2021 US research detected PFAS in 39 out of 100 bottled waters). The USEPA suggests people can reduce PFAS exposure with measures including avoiding fish from contaminated waters and considering home filtration systems.

Correction: this article previously listed the maximum Australian Drinking Water Guidelines PFOA level as 0.056 micrograms per litre. The figure has been updated to show the correct level of 0.56 micrograms per litre.

Ian A. Wright, Associate Professor in Environmental Science, Western Sydney University

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

Aged care financing is a vexed problem for the Australian government. It is already underfunded for the quality the community expects, and costs will increase dramatically. There are also significant concerns about the complexity of the system.

In 2021–22 the federal government spent A$25 billion on aged services for around 1.2 million people aged 65 and over. Around 60% went to residential care (190,000 people) and one-third to home care (one million people).

The final report from the government’s Aged Care Taskforce, which has been reviewing funding options, estimates the number of people who will need services is likely to grow to more than two million over the next 20 years. Costs are therefore likely to more than double.

The taskforce has considered what aged care services are reasonable and necessary and made recommendations to the government about how they can be paid for. This includes getting aged care users to pay for more of their care.

But rather than recommending an alternative financing arrangement that will safeguard Australians’ aged care services into the future, the taskforce largely recommends tidying up existing arrangements and keeping the status quo.

No Medicare-style levy

The taskforce rejected the aged care royal commission’s recommendation to introduce a levy to meet aged care cost increases. A 1% levy, similar to the Medicare levy, could have raised around $8 billion a year.

The taskforce failed to consider the mix of taxation, personal contributions and social insurance which are commonly used to fund aged care systems internationally. The Japanese system, for example, is financed by long-term insurance paid by those aged 40 and over, plus general taxation and a small copayment.

Instead, the taskforce puts forward a simple, pragmatic argument that older people are becoming wealthier through superannuation, there is a cost of living crisis for younger people and therefore older people should be required to pay more of their aged care costs.

Separating care from other services

In deciding what older people should pay more for, the taskforce divided services into care, everyday living and accommodation.

The taskforce thought the most important services were clinical services (including nursing and allied health) and these should be the main responsibility of government funding. Personal care, including showering and dressing were seen as a middle tier that is likely to attract some co-payment, despite these services often being necessary to maintain independence.

The task force recommended the costs for everyday living (such as food and utilities) and accommodation expenses (such as rent) should increasingly be a personal responsibility.

Making the system fairer

The taskforce thought it was unfair people in residential care were making substantial contributions for their everyday living expenses (about 25%) and those receiving home care weren’t (about 5%). This is, in part, because home care has always had a muddled set of rules about user co-payments.

But the taskforce provided no analysis of accommodation costs (such as utilities and maintenance) people meet at home compared with residential care.

To address the inefficiencies of upfront daily fees for packages, the taskforce recommends means testing co-payments for home care packages and basing them on the actual level of service users receive for everyday support (for food, cleaning, and so on) and to a lesser extent for support to maintain independence.

It is unclear whether clinical and personal care costs and user contributions will be treated the same for residential and home care.

Making residential aged care sustainable

The taskforce was concerned residential care operators were losing $4 per resident day on “hotel” (accommodation services) and everyday living costs.

The taskforce recommends means tested user contributions for room services and everyday living costs be increased.

It also recommends that wealthier older people be given more choice by allowing them to pay more (per resident day) for better amenities. This would allow providers to fully meet the cost of these services.

Effectively, this means daily living charges for residents are too low and inflexible and that fees would go up, although the taskforce was clear that low-income residents should be protected.

Moving from buying to renting rooms

Currently older people who need residential care have a choice of making a refundable up-front payment for their room or to pay rent to offset the loans providers take out to build facilities. Providers raise capital to build aged care facilities through equity or loan financing.

However, the taskforce did not consider the overall efficiency of the private capital market for financing aged care or alternative solutions.

Instead, it recommended capital contributions be streamlined and simplified by phasing out up-front payments and focusing on rental contributions. This echoes the royal commission, which found rent to be a more efficient and less risky method of financing capital for aged care in private capital markets.

It’s likely that in a decade or so, once the new home care arrangements are in place, there will be proportionally fewer older people in residential aged care. Those who do go are likely to be more disabled and have greater care needs. And those with more money will pay more for their accommodation and everyday living arrangements. But they may have more choice too.

Although the federal government has ruled out an aged care levy and changes to assets test on the family home, it has yet to respond to the majority of the recommendations. But given the aged care minister chaired the taskforce, it’s likely to provide a good indication of current thinking.

Hal Swerissen, Emeritus Professor, La Trobe University

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