Awaiting the Royal Commission's final report

The Royal Commission into Aged Care Quality and Safety will submit its Final Report on 26 February 2021, marking the culmination of two years of inquiry into the state of Australia’s aged-care sector.

The completion of this gargantuan undertaking will provide recommendations for comprehensive reform and significant transformations within Australia’s aged-care sector. We are potentially (and hopefully) on the cusp of a revolution in our aged-care system. So what can we expect?

Addressing neglect

The Commission’s Interim Report, titled ‘Neglect’, reflects serious shortfalls in the sector, detailing underfunding, understaffing, heartbreaking stories of human rights abuses and widespread failure to meet required standards. The report reveals that to truly create a world-class, sustainable aged-care industry, the system will have to be rebuilt from the ground up.

The Royal Commission states that it is committed to systemic reform, which will involve a fundamental overhaul of the design, objectives, regulation and funding of aged care in Australia.

Leading Age Services Australia (LASA) CEO Sean Rooney said, “If we take the changes recommended by Counsel Assisting as indicative of the Final Report, overall we will see a system that goes through great transformation, with much more. More places in care and more hours of care, delivered by more staff, with more education and higher pay. More access to the health system, more institutions within government to determine aged-care policy and administer the system. And more regulation including more requirements to collect and report data, along with more formal governance arrangements and more powers for the regulator to investigate and enforce the rules.

“In the end, what we hope to achieve is a system where access is based on need and where people can choose how they are cared for. A system that is adequately funded so age-service providers are enabled to simultaneously deliver high-quality support that meets community expectations, provide pay and conditions for staff that reflects the value and challenges of their work, and enabling recruitment, training and retention, while achieving financial sustainability.”

Counsel Assisting’s key recommendations

In its final submission to the Commission, Counsel Assisting suggested that 124 recommendations be made. These included the creation of a new Aged Care Act; demand-driven access to care; an independent process for setting aged-care quality standards; enforceable general duty of care on approved providers; compulsory registration of personal care workers; and staffing ratios in residential aged care and additional nurses for patients needing palliative or dementia care.

To help residents and their families choose an aged-care home, a star rating system based on quality and safety was suggested to allow easier comparison of facilities. Access to any reports of neglect or abuse via this rating system would also increase transparency and hold providers accountable.

An independent pricing authority to determine aged-care prices was recommended, as well as the establishment of an independent Australian Aged Care Commission that will be responsible for administering and regulating the aged-care system.

Aged & Community Services Australia (ACSA) CEO Patricia Sparrow is hopeful the Royal Commission’s Final Report will bring about real, lasting reform to the aged-care system.

“The Royal Commission provides a significant opportunity for a reset of aged care so it meets our growing expectations for how older Australians live and are supported in the 21st century,” she said.

“This is a once-in-a-generation opportunity to find solutions to support better health and quality-of-life outcomes for older Australians, now and in the future.

“ACSA welcomes the recommendations for new rights-based legislation and creating a demand-driven aged-care system.

“The recommendations that support the workforce are important, because we need more workers in aged care. We need measures that help retain good workers across the sector, better train them and help attract new people who can make their contribution.

“Importantly, the financial pressures aged-care providers are operating under has been recognised by Counsel Assisting. The public financing of such a system is still under consideration but is absolutely critical to deliver on the promise of these recommendations.”

The Grattan Report: a blueprint for our aged-care system

In November 2020, the Grattan Institute released its report ‘Reforming aged care: a practical plan for a rights-based system’, finding that an additional $7 billion a year from the Australian Government could provide older Australians with the care and support they need.

The report suggests a new system to be phased in over three years, starting in 2021. According to the report, Australia should be divided into 30 regions, each with a ‘system manager’ responsible for individual support plans. Local ‘assessment officers’ would help to draw up individual support plans, and a local ‘support manager’ would act as their advocate in obtaining necessary services.

Residents of aged-care homes would contribute to their accommodation costs by paying rent, but a means test would be applied to ensure people who couldn’t afford the rent would pay less or not at all. Many Australians would receive care and support in their own homes.

Rogue proprietors of residential aged-care facilities would be driven out of the system. Aged-care homes would have to meet minimum resident-to-carer ratios, and provide nursing supervision 24 hours a day. Carers would be registered, better trained and better paid. The report also suggests that the federal government create a one-off $1 billion national ‘rescue fund’ to force the worst providers of residential care to lift their game or get out of the system.

What do our seniors want from aged care?

A study conducted by the National Ageing Research Institute approached Australians living in residential aged care, to gauge their feelings towards the care they receive. Using a series of questionnaires — covering quality of care, general life satisfaction, quality of life, and concerns and complaints — the researchers found that a significant proportion of residents felt that some aspect of their care and services was failing them.

The study found that most residents were satisfied with aspects of their care, but a large share were only partially satisfied — a significant minority reported low satisfaction.

Key concerns of residents

The main concerns of residents surveyed related to staffing, with 46.7% of respondents having a concern in this domain. The greatest concern in this area was understaffing, with 34.3% of respondents feeling that their facility was understaffed or did not have enough staff on duty.

In the domain of services and fees, 39.7% of residents had a concern, particularly relating to food and catering (19.4%) and feelings of boredom or loneliness (16%).

Just over 26% had medical and healthcare concerns, with falls or fall prevention and medication management being the primary concerns; 23.6% were concerned about dignity and respect, with 9.1% feeling forced to be dependent on staff and 7.6% feeling that their specific care needs were not listened to.

In regards to their room within the facility, 23.5% had a concern, mainly related to the security of the room and possessions, and cleanliness of the room and bathroom.

Other concerns related to choices, such as the availability of lifestyle activities, timing of meals, and how and when interaction with other residents occurred; personal care and whether help is received for showering, personal grooming and toiletting; and facility-related factors such as noise levels, cleanliness, and maintenance of equipment, furniture and gardens.

The study authors said, “Although this study found that a proportion of residents are satisfied with the quality of their care, it is clear that a substantial proportion are not.

“These results highlight the need for action to improve quality of care delivered to those for whom the system is clearly failing to provide them with quality care and services in some or all areas.”

The authors point to the need for person-centred care in the aged-care sector, with the study findings hoping to benchmark efforts to improve the system for all senior Australians.

Image credit: ©stock.adobe.com/au/Monkey Business