Royal Commission in Aged Care Quality and Safety – March Update

Ilsa Bird – Sector Support Coordinator

Adelaide Hearing 1

11-13 February 2019 and 11-22 February 2019

 “the way we care for older Australians…needs to change fundamentally.” – Dr Timothy McEvoy, Counsel Assisting.

During the Month of February, the Royal Commission’s hearing was held in Adelaide. The hearing was held to inquire into the state of aged care as it currently exists, specifically:

• the concerns of advocacy bodies relating to the current state of the aged care system
• the clinical issues affecting elderly people and general challenges that arise in meeting clinical needs
• the concerns and view of medical and nursing professional bodies relating to the current state of the aged care system
• demographic information relating to the provision of aged care services
• the perspectives of government and regulators as to the state of the aged care system
• the perspectives of workforce representative bodies as to the state of the aged care system
• experiences of people receiving services in the aged care system or their family members.

Subsequently, a report was released at the end of February 2019 titled ‘Navigating the maze: An overview of Australia’s current aged care system’. This report provides background information to support the Royal Commission and includes information related to models of care, workforce, aged care regulation and funding. The full report is below:

Download the background paper here

Witness List

During this hearing, 28 witnesses provided evidence to the Commission over two weeks. Representatives included:

• Spouses and family members of Oakden residents
• Peak representatives including COTA, Carers Australia, Dementia Australia, LASA, ACSA, CHA and Aged Care Guild
• Consumer lobby groups including National Seniors Australia, Older Persons Advocacy Network and Combined Pensioners and Superannuants Association of NSW
• Research bodies including ABS and AIHW
• Workforce, training and education representative bodies including Australian and New Zealand Society for Geriatric Medicine, Australian College of Nursing and Australian Nursing and Midwifery Federation, The Royal Australian College of General Practitioners, Australian Medical Association and United Voice
• Government representatives including Commonwealth Department Health and Aged Care Quality and Safety Commission

A full list of witnesses can be viewed here.

Summary of Adelaide Hearing 1

On the final day of the Adelaide hearing, Dr Timothy McEvoy, Counsel Assisting, summarised the issues and topics presented over the preceding two weeks including the following:

1. Quality and Safety. The regulatory failures of Oakden were made clear by family members of Oakden residents. The recommendations of the Carnell and Patterson report were discussed, however progress in their implementation is slow. The new Quality and Safety commissioner has acknowledged “that there is further work to be done by the new commission”.
2. The nature and scope of issues presenting strain on age care. Firstly, the growing ageing population is and will continue to place strain on the aged care system. Statistics showed that the percentage of Australians over the aged of 85 will double in the next 40 years. Secondly, the prevalence and incidence of dementia is increasing. Dementia is expected to become the leading cause of death for all Australians by 2020. Thirdly, ageing in place. Australians prefer to remain at home to receive care.
3. HCP wait times. Evidence was heard that wait times for packages are between 18-24 months. Witnesses also stated that once a level 2 package is approved, a level 4 is required and therefore level 4 assessments are being undertaken in anticipation of this issue.
4. Individualised funding for HCP which has produced less flexibility for providers. Ms Patricia Sparrow from ACSA stated that providers have the capacity to take on more packages however there is no funding to do so.
5. Level 5 packages. Ian Yates, CEO of COTA urged that the government should consider a level 5 package in order to assist with demand. It was also suggested that this would save money which could be reinvested to improve residential care.
6. Consumer literacy. Craig Gear, CEO of OPAN expressed his concern over the correspondence sent from MAC to consumers including the “understandability” of letters and the need for face-to-face support for consumers. Gear went on to say that OPAN receive more requests from consumers to understand and negotiate HCP than request for advocacy regarding quality care.
7. Dementia including community awareness, staff training, dementia diagnosis and the need for more innovative models of care.
8. Physical and chemical restraint. A Dutch study revealed that 80 percent of people in residential care are prescribed psychotropic medications, with an efficacy rate of 10-20 per cent. Associate Prof Strivens, President Australia and New Zealand Society for Geriatric Medicine stated “the side effects [of psychotropic medications] will often outweigh the possible benefits. They are a last resort but too often we see them used as a first resort”. Strivens continued by stating that “medication should never be a substitute for good quality care”. This has sparked debate around the regulation of medication in aged care.
9. The fragmented health care system. Evidence was presented regarding the lack of funding for services available to residential care consumers including dental, mental health, GP services, end of life care and hospital care. Witnesses also described the issues surrounding the lack of communication between hospitals and residential care and presented a strong argument for integrated care.
10. Workforce issues. Witnesses talked about the work of personal care attendants which is “hard and poorly remunerated”. It is also to be further debated as to whether there should be a minimum qualification for PC workers and a screening database. Evidence for staff attraction and retention was discussed and it was determined that “there is a need for a larger, better educated and better skilled workforce”. This includes a demand for specialised dementia education and training.
11. The role of informal carers. Sue Elderton from Carers Australia stated that there are 2.7 million carers in Australia who suffer very high levels of stress due to their caring responsibilities. According to Elderton, the value of unpaid carers was estimated at $60.3 billion in 2015.
12. Experiences of older Australians receiving care. Witnesses described the lack of communication surrounding consumer directed care, inequity between high and low income earners and the shortfalls of dementia care.

Mr McEvoy closed by describing the remembrance and respect that occurs on Anzac Day towards our veterans and that the challenge for policy makers and regulators is to create this level of dignity for all older Australians, every day.

The full transcripts for Adelaide Hearing 1 can be found here.

Adelaide Hearing 2

The next round of hearings will take place in Adelaide from Monday 18 March until Friday 22 March 2019. This hearing will on inquire into home care, specifically:

• 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.

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