‘No more excuses’: Takeaways from the Aged Care Royal Commission’s Final Report

There must be no more excuses and no more delays. Aged care reform must begin immediately.

That is the resounding view shared by numerous advocacy groups following yesterday’s release of the final report of the Aged Care Quality and Safety Royal Commission.

After more than two years of Inquiry, which included over 10,000 submissions and 641 witness appearances, the Aged Care Royal Commission’s final report has outlined an extensive plan to overhaul Australia’s aged care system.

Among the 148 recommendations, the report calls for the introduction of staff ratios and skills mix; a new Aged Care Act that protects the rights of older people; new funding models; stronger governance, and better regulation.

The Australian Medical Association (AMA), which made five submissions to the Royal Commission and appeared three times to give evidence, welcomed the final report’s pathway to reform.

“Older Australians deserve to have the same opportunity to have the best quality of life as everyone else, and the same access to high quality medical and nursing care they have enjoyed throughout their lives,” AMA President, Dr Omar Khorshid said.

“Sadly, this report shows that this has not been the case. In fact, far from it.”

Dr Khorshid said the AMA had continually warned the Federal Government that health and aged care systems are not equipped to deal with a growing population living longer and with multiple chronic diseases.

“Together, the AMA and Australian Nursing and Midwifery Federation have been calling on the Government to take urgent measures to improve the situation in aged care and bring comfort and confidence to our parents and grandparents who have given so much to their families and the communities throughout their lives.”

With the release of the final report, the AMA says there must be no more excuses or delays, arguing care can’t wait and that the reform process must start immediately.

“The Government must embrace this opportunity to make aged care a safe and high-quality place for older Australians.”

Included in the final report’s 148 recommendations is 14 key areas with a specific focus on dementia.

National peak body Dementia Australia said the final report captured the essence of the issues facing people living with dementia, their families and carers, and that it was now up to the Government to act.

“We welcome these recommendations and now call on the federal government to demonstrate they are serious about making quality dementia care core business for aged care in Australia,” Dementia Australia CEO Maree McCabe said.

Ms McCabe said the recommendations broadly cover key issues such as the need for clearer support pathways; new regulations on chemical and physical restraint; a review of the aged care standards relating to quality dementia care; and regular dementia training about dementia care for all workers engaged by providers.

Dementia Australia has provided the federal government with a plan on what it believes is needed to deliver quality dementia care and how the Government should respond to the final report. This includes dementia support pathways; transformed dementia workforce capability; and dementia friendly design of physical environments.

“We urge the government to demonstrate their commitment to the 472,000 Australians living with dementia and the 1.6 million people involved in their care,” Ms McCabe said.

“We will continue our dialogue with the federal government to ensure the dementia-related recommendations will be supported in the 2021-22 federal budget to be handed down in May.”

Responding to the final report, the Consumers Health Forum (CHF) of Australia have called on the Morrison Government to show they are serious about overhauling the aged care sector by immediately committing to four central challenges – substantially lift funding, establish rigorous quality and safety standards, introduce total system transparency and improve healthcare.

CHF says the final report makes it clear that only substantial reform of the system, funding and culture can fix the aged care crisis.

“The litany of widespread and substandard care, poor food, abuse, assaults and untrained staff – all made possible because of ineffectual regulatory oversight and a lip service approach to standards – demand nothing less than a change in mindset and transformational change by Government and industry,” CEO Leanne Wells said.

CHF has welcomed several of the Commission’s recommendations, including the establishment of a new Aged Care Act, a new primary care model, and strengthening the links between residential aged care and mainstream health services to ensure primary providers such as GPs are incentivised to in-reach into facilities.

Ms Wells said debate will emerge about the right way forward in terms of a funding model, but above all, stressed that the Government must lead the way.

“What Australia needs to see urgently from the Government is clear principles that will govern aged care quality and standards in future. These principles should be the guiding force for the financing and oversight of aged care.”

Palliative Care Australia (PCA) said it hoped the Government would act swiftly to enact the recommendations of the Royal Commission.

Palliative Care is one of four areas singled out for immediate action, with the Commission stating:

“A number of our recommendations will contribute to ensuring high quality palliative care becomes core business for aged care services.” Other key recommendations include funding that specifically incudes palliative and end-of-life care and a review of the Aged Care Quality Standards to require residential aged care providers to provide high-quality palliative care.

“Over a third of Australians will die in residential aged care, yet up until now, palliative care has never been considered core business in aged care. Backed by the Royal Commission’s final recommendations and our KPMG report, which proved palliative care also makes economic sense, we now have a very strong case to convince governments that we need to improve palliative care in aged care,” PCA Chair Professor Meera Agar said.

The National Ageing Research Institute (NARI), welcomed the Aged Care Royal Commission’s final report, particularly its recommendation for a new human-rights based Aged Care Act. However, it says the Government must make structural change to ensure the Act can be implemented to its full intent.

“This report is a defining moment for aged care reform in Australia. It presents opportunity for Government to drive transformational change to regain public trust in the aged care system,” said Professor Briony Dow, NARI Director.

Professor Dow said the Commission had exposed uncomfortable truths about the aged care system and that urgent reform was needed.

“All older Australians deserve access to high quality care that respects their dignity and preferences. It should encompass the right to freedom from abuse and neglect, and the right to make informed choices about their care,” Professor Dow said.

“However, a human-rights based approach will remain simply rhetoric if the structural and resourcing issues in aged care remain unchanged.”

Professor Dow said that while the system needs better governance and regulation, the most pressing problems in aged care cannot be fixed by regulation alone. Inadequate resourcing and training are other major issues, she said.

“Unless all aspects of aged care are adequately funded, enacting further regulation will not bring about the meaningful changes recommended by the Royal Commission,” Professor Dow said.

“A better system will cost more. But we need funds to increase resources, increase staffing levels and skills, and deliver care that is based on the best possible evidence and meets individuals’ needs and desires.”

NARI said the report’s recommendations for increased staff and minimum staff contact hours per patient are a good start, but must go further.

“Government must fund more staff with greater levels of clinical expertise, and better pay and conditions,” Professor Dow said.

“We must ensure adequate numbers of skilled nursing and allied health staff, supported by better integration with the primary health sector and specialist medical care.

“There’s a need for greater transparency around how aged care is financed, and we need funding mechanisms that cover the full care needs of each person. Those that exist are not sensitive enough to cover residents’ full care needs or recognise differences in care needs.”

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