The Royal Commission into Aged Care Quality and Safety’s final report has been released by the federal government.

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Throughout more than two years of investigation, the Royal Commission received more than 10,000 submissions and heard from over 640 witnesses.

The final report, titled Care, Dignity and Respect, comprises eight volumes and makes 148 wide-ranging recommendations for significant reform of the aged care sector.

Critically, the report acknowledges that staff ratios should be introduced to ensure that there are sufficient nursing and other care staff present at all times in residential aged care.

Key recommendations include a new Aged Care Act that ensures older people receive high quality care in a safe and caring environment; establishing an Aged Care Advisory Council; abolishing the Aged Care Quality and Safety Commission and replacing it with an independent authority; urgently reviewing the aged care quality standards; and the regulation of restraint in aged care.

In regards to the aged care workforce, recommendations include mandatory minimum qualifications for personal care workers (PCWs), specifically a Certificate III, as well as a national registration scheme that includes ongoing training.

Commissioners also recommend minimum staff time standards for residential care. Under the proposals, from July, 2022, aged care providers would be required to engage registered nurses, enrolled nurses, and PCWs to provide care for at least 200 minutes per resident per day for the average resident, with at least 40 minutes of the care provided by an RN.

Further, the minimum staff time standard should require at least one RN is on site at each aged care home for morning and afternoon shifts. From July, 2024, commissioners recommend the standard should increase so that the average resident receives 215 minutes of care per day, with at least 44 minutes of the care provided by an RN. By this stage, at least one RN should be on site at all residential aged care facilities at all times.

In his overview of the report, Commissioner Tony Pagone said the aged care system in Australia has many flaws and that a Royal Commission, the highest form of inquiry, was necessary to measure quality and safety.

He acknowledges that he and fellow Commissioner, Lynelle Briggs, reached different conclusions on certain matters and even make some separate recommendations on the best model and mechanisms for how the system can be fundamentally improved. By and large, however, they agree on the importance of high quality care.

To ensure that older people have an entitlement to high quality aged care and support and that they must receive it. Such care and support must be safe and timely and must assist older people to live an active, self-determined and meaningful life in a safe and caring environment that allows for dignified living in old age.

Commissioner Pagone argues the role of government, and its need to make decisions between competing government priorities, lies at the heart of the failures and shortfalls in Australia’s aged care system. He says a profound shift is required where people receiving care are put at the centre of the new aged care system.

Fortunately, the rebuild that is necessary has the firm foundations of a dedicated workforce whose attention to care is worthy of more praise and reward.

Commissioner Pagone says the Royal Commission identified systemic problems including – insufficient home care packages; insufficient funding for home care packages to meet the needs of many; and tellingly, inadequate staffing levels.

“One of the consequences of these low levels of staffing is that staff simply do not have time to interact meaningfully and compassionately with older people. Care therefore becomes merely transactional rather than based upon relationships,” he writes.

Commissioner Pagone’s three key building blocks for reform involve a rights foundation for high quality aged care, independence from government and a secure source of funding. Piecemeal adjustments and improvements are unlikely to achieve what is required, he suggests.

“We have proposed a new regulatory system that will be more rigorous and more vigilant. Providers will need to demonstrate their suitability and capacity to deliver high quality care before they are allowed to deliver care and the regulator will be more assiduous in assessing the performance of providers.”

In her summation, Commissioner Briggs said the final report aimed to trigger fundamental reform of the aged care system to ensure it delivers the quality the nation expects.

In the report, she says aged care providers must shoulder some of the responsibility for the systemic problems plaguing the system.

“Specifically, providers have not focused sufficiently on the provision of high quality and safe care, on older people’s wellbeing, on service innovation and excellence, on listening to older people and hearing their complaints, on effective clinical governance of their services, and on workforce leadership, development, skills and culture,” she states.

The workforce has also been neglected.

“It is underpaid and under-skilled, and has been undermined by the replacement of qualified staff by less qualified and unregistered workers. There are not enough qualified and well trained people working in aged care.”

On what needs to be done to transform Australia’s aged care system, Commissioner Briggs says that at its heart, the inquiry revealed that people receiving aged care want to be treated with care, dignity and respect.

To achieve this, the aged care system requires “transformational” reform based on fundamental elements including a new Aged Care Act; a universal entitlement to aged care; a new aged care program; proper support for informal carers; transparency and accountability when it comes to providers; a new regulatory system; and properly valuing the workforce.

“A sufficient, committed and high quality workforce is one of the main factors affecting the quality and safety of aged care. If an aged care worker is well educated and trained, has the right attitude of respect towards older people and their supportive caring work, and is increasingly experienced, older people will receive better care. As a society, we cannot continue to undervalue the work performed in aged care.”

In their interim report, titled Neglect, Commissioners said the aged care system failed to meet the needs of Australia’s elderly, vulnerable citizens. With its final report, Commissioner Briggs said the Royal Commission presented a comprehensive plan for aged care reform.

“We encourage the community to maintain their interest in this important area of public policy and to continue to press for improvements in the care of our elders in their most vulnerable years.”

At a press conference this afternoon, Prime Minister Scott Morrison said the Royal Commission’s final report laid out an important roadmap for establishing “generational change” when it comes to aged care.

“We need to make generational change so that the individualised needs and that needs-based care is developed that respects the dignity of the individual Australian, the values, the rights, the needs, this is what must drive the system of the individual.”

Outlining the federal government’s immediate response to the report, Health Minister Greg Hunt announced a $452 million package as one of the first steps to addressing immediate priorities in the sector.

Mr Hunt said the government’s pillars that make up its initial response to the final report include – investing more in home care; 1,500 extra audits of residential aged care facilities to improve quality and safety; growing the workforce, by investing $92 million to create 18,000 places for workers by mid-2023; and improving governance.

“Instead of it being about providers, instead of it being about money, it’s about respect for the individual needs and that is the fundamental generational transformation,” Mr Hunt said of the reform ahead of the aged care system.

Read the Aged Care Royal Commission’s Final Report here