Aged Care in Australia: The Royal Commission’s Interim Report

The Royal Commission into Aged Care Quality and Safety’s Interim Report has found the aged care system fails to meet the needs of its older, vulnerable, citizens. It does not deliver uniformly safe and quality care, is unkind and uncaring towards older people and, in too many instances, it neglects them.

Commissioners Richard Tracey AM, RFD, QC and Lynelle Briggs’s AO investigation into Australia’s aged care system led them to describe the aged care system as “a shocking tale of neglect”.

“The neglect that we have found in this Royal Commission, to date, is far from the best that can be done. Rather, it is a sad and shocking system that diminishes Australia as a nation.”

Entitled Neglect, the Interim Report of the Royal Commission into Aged Care Quality and Safety, which was tabled in the Australian Parliament today, found that a fundamental overhaul of the design, objectives, regulation and funding of aged care in Australia is required.

The Interim Report sets out the extent of the failure of Australia’s aged care services and what the Royal Commission has learned to date.

Commissioners describe the many problems that older people and their families have in trying to get access to aged care services, service shortfalls, the dispiriting nature of residential care, serious substandard care and unsafe practice, an underpaid, undervalued and insufficiently trained workforce, and isolation of young people with disabilities.

Commissioners identified three areas where immediate action can be taken:

to provide more Home Care Packages to reduce the waiting list for higher level care at home
to respond to the significant over-reliance on chemical restraint in aged care, including through the seventh Community Pharmacy Agreement
to stop the flow of younger people with a disability going into aged care, and speed up the process of getting out those young people who are already in aged care

The Interim Report is in three volumes and is now available to read on the Royal Commission’s website along with an extract from the foreword, ‘A Shocking Tale of Neglect’.

It covers much, but not all, of the work of the Royal Commission through to September 2019. Most of the Royal Commission’s work on quality and safety considerations will be in the Final Report.

The Interim Report explains that the aged care system needs fundamental reform and redesign.

It identifies systemic problems in aged care with a system that:

is designed around transactions, not relationships or care
minimises the voices of people receiving care and their loved ones
is hard to navigate and does not provide information people need to make informed choices about their care
relies on a regulatory model that does not provide transparency or an incentive to improve
has a workforce that is under pressure and under-appreciated and that lacks key skills

Volume 1 of the Interim Report contains key information about aged care and conclusions the Commissioners have reached over the course of hearings held from February to September 2019.

There are seven chapters in Volume 1 which flag recommendations for reform to be contained in the Final Report:

Chapter 4 ‘An overwhelming sense of loss’

Every person’s experience of aged care is different. While some people’s stories have been positive, others have been overwhelmingly distressing. The aged care system should not be a signifier for loss, abandonment and fear.

The Royal Commission will over the next 12 months examine whether there are societal barriers to the enthusiastic acceptance of reforms to aged care. The Final Report will recommend a whole-of-system reform and redesign.

Chapter 5 Finding the Door

The ‘front door’ to our aged care system – an online portal on the My Aged Care website and a call centre – has proved costly and has failed to provide adequate information to people about aged care and how to access it.

The system could be improved to provide users with information to compare quality, safety and cost of services in their area, to find help, and to find accurate information about waiting lists.

Chapter 6 The Lottery

The aged care system is unable to deal with the level of demand for home care services. Waiting times of up to 12 months or more for high care Level 4 Home Care Packages are unacceptable. People are dying on the waiting list.

The Royal Commission believes that significant additional funding is needed immediately and in the future to increase access to Home Care Packages.

Chapter 7 ‘Elders are our future’

Evidence shows that aged care for Aboriginal and Torres Strait Islander people needs to be delivered in ways that are flexible, adaptable and culturally safe. This includes assessment pathways, aged care integrated with other services, and facilitating aged care on Country, where possible.

The Royal Commission is exploring ways to support aged care services to be staffed and managed by Aboriginal and Torres Strait Islander people.

Chapter 8 Restrictive Practices

The Royal Commission has revealed instances where the use of restrictive practices have been inhumane, abusive and unjustified. A lack of permission in the use of restraint and prolonged use of powerful chemical restraints is common in Australia.

Early action by the Government in the context of current negotiations on the seventh Community Pharmacy Agreement would be an important first step towards correcting the problem.

Chapter 9 Workforce Matters

A poorly skilled, underpaid workforce under pressure to provide care is the picture so far revealed. The quality of care that people receive depends very much on the quality of the paid carers, their working conditions, their leadership and engagement.

The Royal Commission will continue to examine workforce issues over the next year, including: attraction and retention; education and training; choosing the right staff; remuneration and careers; continuity of care; staffing levels and staff mix; and leadership.

Chapter 10 Falling through the Gaps: Younger People in Residential Aged Care

The Australian Department of Health told the Royal Commission that the 6000 younger people with a disability living in aged care is a ‘somewhat intractable problem’. The Commissioners found there was a lack of will and effort to address the issues that have left young people in aged care.

Now that the NDIS exists, Commissioners do not accept that the problem is intractable and consider that swift action needs to be taken to fix the situation so that younger people with disabilities are able to live in the community, as other young people do.

Volume 2 of the report contains detailed overviews of the public hearings from February up to and including hearings in Darwin and Cairns in July 2019, including the Royal Commission’s findings in case studies conducted at those hearings.

Volume 3 contains a number of appendices, including summaries of the nine community forums the Royal Commission has held throughout Australia since February. The Interim Report provides an insight into the Commissioners’ thinking to date, but does not include specific recommendations.

The Royal Commission invites submissions in response to the content of the Interim Report. The Royal Commission’s Final Report will be handed to the Governor-General on 12 November 2020. That report will set the framework for a complete overhaul of the aged care system — from system philosophy and design, to interactions with health and disability services, to workforce, funding and regulation.

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Aged Care in Australia: The Royal Commission’s Interim Report

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