Royal Commission – July Update

Written by Ilsa Bird, Sector Support Coordinator

Background Paper 5

On 20 June, Background Paper 5 was published by the Royal Commission. This paper is titled ‘Advanced care planning in Australia’ and provides an overview of the components of advance care planning, practices in each state and information related to aged care.

Download the paper here: Background Paper 5 Advance Care Planning in Australia

June Hearings

During June, the Royal Commission held public hearings in Broome and Perth.

Witnesses

During the Broome and Perth hearings, 46 witnesses provided evidence to the Commission. Representatives included:

• Consumers and those with direct experiences in the aged care system
• Aged care professionals and regional service delivery providers
• Palliative care experts
• Aboriginal and Torres Strait Islander Health experts
• General Practitioners
• Frontline staff
• Researchers and academics
• Primary and Allied healthcare professionals
• Policy experts

Broome Hearing

The Broome hearing was held from Monday 17 June – Wednesday 19 June 2019 to inquire into:

• the unique needs of Aboriginal and Torres Strait Islander people when it comes to aged care services
• the perspective and experience of people who access aged care in remote areas including family members and carers
• the nature and scope of aged care services for Aboriginal and Torres Strait Islander people living in remote areas
• the barriers to accessing aged care services for people living in remote areas
• the challenges of maintaining an adequately skilled and culturally appropriate workforce
• good practice care models for people living in remote areas.

Broome Hearing Summary

On the final day of the Broome Hearing, Mr Paul Bolster, Counsel Assisting, summarised how aged care is being delivered to Aboriginal and Torres Strait Islander people in remote and very remote locations. Discussions included:

• Best practice models of care where the care is delivered by people who are embedded in the community and who truly understand the cultural needs of the recipient.
• Cultural safety which is defined by the people receiving care and includes “having an awareness of the underlying issues, cultural and social and emotional issues, and historical issues that affect that person’s relationship with you.”
• The need for understanding the location of service delivery and the people who live there which includes the need to obtain trust of the community by respecting cultural matters
• The importance of staff building relationship with elders and families over time and that high staff turnover negatively impacts this relationship.
• The cultural inappropriateness of MAC including the reliance that clients have a phone and internet access, speak English and have a fixed address

Perth Hearing

The Perth hearing was held from Monday 24 June – Friday 28 June 2019 to inquire into:

• how aged-care services can be provided in a way which is person-centred, including care which values the identity, experience and autonomy of the person accessing care and promotes choice and control
• the factors that influence whether aged care services are delivered in a person-centred manner, including:
  • the relationships between the person accessing care, people providing support (including family and other members of the community) and the service provider
  • broader societal attitudes towards older people
• the perspective and experience of people who access aged care, including the ways in which aged care services are, or are not, person-centred
• good practice care models for providing person-centred aged care
• the role of advance care planning to support the provision of quality aged care services
• the extent to which people accessing aged care services are able to access palliative care
• the quality of palliative care services available to people accessing aged care services

Perth Hearing Summary

On the final of the Perth Hearing, Mr Peter Rozen, Counsel Assisting, summarised three key themes.

1. How social attitudes inform the delivery of aged care including:

• • Ageism in the community, and beliefs and assumptions that older people are “incapable of making decisions for themselves” and that they are not interested in “meaningful activity in personal growth”
  • The need for education to create deep change in culture and community attitudes

2. The importance of relationships in delivering person-centred care including:

• • Relationship-centred care and staffing consistency to build familiarity
  • Individualised care that goes beyond a “task-based and tick-a-box focus”
  • The importance of choice and control for people in the care they receive, supported decision-making and a right-based approach
  • Palliative care approaches that are “needs-based, holistic and responsive to a person’s psychological situation.”

3. The importance of organisational leadership including:

• • Recruiting the right staff and fostering a culture of person-centred care
  • Lack of suitably skilled staff and resourcing for palliative care
  • The need for organisations to care for staff in order to create caring staff

Full transcript and witness list for the Broome and Perth hearing can be found here:

https://agedcare.royalcommission.gov.au/hearings/Pages/Transcripts.aspx

The next hearings will take place from 8-12 July in Darwin and then 15-17 July in Cairns and will focus on:

1. Aspects of care in residential, home and flexible age care programs including:

• accessibility and availability
• wound, medication and pain management
• nutrition and hydration
• continence care
• mobility
• social supports

2. Rural and regional issues for service delivery of aged care
3. Quality of life for people receiving aged care