Royal Commission in Aged Care Quality and Safety – April Update

Ilsa Bird – Sector Support Coordinator

Adelaide Hearing 2

18-22 March 2019

Home care services assist older Australians to “live out their lives where they choose to be” – Dr Timothy McEvoy, Counsel Assisting.

During the Month of March, the Royal Commission’s hearing was held in Adelaide. The hearing was held to inquire into:

• the perspective and experience of people seeking or receiving aged care services in their home, or their family members
• quality and safety in aged care in the home, accessibility to aged care in the home, the interface between aged care in the home and other care, sustainability and the future of aged care in the home
• other key issues affecting the functioning of the Australian aged care system as it relates to aged care in the home
• the regulatory framework as it applies to aged care in the home.

Witnesses

During this hearing, 25 witnesses provided evidence to the Commission over five days. Representatives included:

• Consumers
• Aged care providers
• Frontline staff
• Consumer lobby groups including Federation of Ethnic Communities’ Councils of Australia
• The Department of Health
• Policy experts including Grattan Institute

Hearing Summary

The commissioners heard background information relative to in-home care including:

• 847,534 older people were supported by CHSP in 2017/18 which was funded for more than $2 billion during the same period.
• As of June 2018, 91,847 people were receiving services under HCP

On the final day of the Adelaide Hearing 2, Dr Timothy McEvoy, Counsel Assisting, summarised seven major issues and topics, including:

Access to MAC

Evidence was provided regarding access to the MAC system including difficulties in navigating both the website and contact centre. Witnesses described MAC as a barrier for CALD groups and older people with hearing or visual impairments. Evidence also revealed the use of scripts and the delivery of incorrect and confusing information through the call centre. Dr McEvoy appealed to the Commission to provide further investigation into MAC improvements in later hearings including consideration of case managers, face-to-face assistance, and website and call centre improvements.

HCP wait times

Dr McEvoy described wait times as “cruel, unfair, disrespectful and discriminatory against older Australians” as time waiting for a package can be up to two years. It was revealed that during 2017-18 over 16,000 consumers died waiting for a package. Evidence provided estimates the annual cost to reduce wait times would be up to $2.5 billion as well as the addition of at least 50,000 packages. Mr Tune also recommended the introduction of a level 5 package to reduce early admissions into residential care. Dr McEvoy expressed concern for the workforce capacity to deliver services if the funding and packages were available to meet demand.

Approval of home care providers

Dr McEvoy stated that there may be flaws in the vetting process for provider approval which stems from under-resourcing of the assessment and approval process and lack of independent verification. Witnesses suggested that some new providers are approved without being appropriately prepared to deliver services. It was recommended that education should be implemented to better support newly approved providers.

Quality and safety regulation

Evidence was provided relative to the inadequacy of quality and safety regulation specifically whether regulations directly impact actual care outcomes. It was suggested that the standards most commonly not met by providers were relative to administration and record-keeping and not direct care however Dr McEvoy expressed concern as the presence of paperwork is an inadequate measure of quality. It was recommended that cases of sanctioned providers be re-visited as findings would have implications for future reform.

Regulation and transparency of fees and charges

The regulation of administrative fees was discussed as evidence showed that consumers were changed anywhere between 35-50% of their total HCP. It was suggested by witnesses that fees erode the hours of care for a level four package from 12-14 hours per week to roughly 9 hours of support. Evidence was also heard regarding the lack of transparency of fees. Even though providers are legally required to publish their existing pricing, roughly 22% have not done so. Dr McEvoy suggested that reform may be required for set pricing as seen in the NDIS.

Unspent funds

It is estimated that providers are holding roughly $330 million in unspent (Commonwealth and client contributed) funds and consumers are encouraged by providers not to spend their packages. The commission heard that there is no advice given to providers as to whether interest can be earnt on these funds and that it is not required that providers return interest earned to the Commonwealth. Dr McEvoy implored the commission to consider findings around the entitlement of providers to retain interest earned on unspent HCP funds and if this should be paid back to the government of the care recipient.

Workforce

Evidence was presented regarding the lack of a mandatory minimum qualification and training for workers. Witnesses expressed concern of the lack of dementia-specific training when it is estimated that a large percentage of clients have been diagnosed with a form of dementia. Although there is free training provided by the University of Tasmania, this is not a requirement of employers. Witnesses raised the issue of safety of the workforce and suggested that night-time workforce in homes should have a security button that links back to security or the police. It was heard that there are multiple issues regarding workforce retention including lack of guaranteed working hours, poor remuneration and time pressure during service. Dr McEvoy suggested that future hearings would address workforce issues in further detail.

Closing remarks

Dr McEvoy closed by describing the importance of the home care system is assisting older Australians to “live out their lives where they choose to be”. Dr McEvoy suggested that each of the seven matters are concerning but not beyond finding a solution.

Full transcript and witness list for Adelaide Hearing 2 can be found here

Sydney Hearing 3

The next round of hearings will take place in Sydney from Monday 6 May – 8 May and 13 May – 17 May 2019. This hearing will on inquire into residential care, specially the needs of people living with dementia.