Only a quarter of aged care residents feel that their care needs are always met, while nearly half are most concerned about understaffing, a new report for the Royal Commission into Aged Care Quality and Safety has found.

The National Ageing Research Institute study, Inside The System: Aged Care Residents’ Perspectives, was published today ahead of the Royal Commission’s last hearing, which begins tomorrow and will feature Counsel Assisting’s final submissions.

The report examines findings from a survey of 391 aged care residents from 67 nursing homes across Australia who were asked to express how they feel about their lives and the care they receive.

The survey was conducted earlier this year from January to mid-March, before many aged care facilities went into lockdown in the wake of the COVID-19 pandemic.

The biggest concern (46.7%) reported by aged care residents related to staffing, including understaffing, unanswered call bells, high rates of staff turnover and agency staff not knowing their needs.

Almost 40% of aged care residents raised concerns about services and fees, with most related to food or the dining experience, financial charges, and feeling lonely or bored.

A quarter of residents reported medical and health concerns connected to falls and fall prevention, as well as medication management and access to medical professionals. A similar amount were concerned about dignity and respect, with some reporting not having their specific care needs listened to, and lack of choice when it comes to meal times, personal care and lifestyle activities.

Personal care also emerged as a concern for 16.9% of residents, with issues related to showering, grooming, using the toilet, use of continence aids and moving around.

Disturbingly, the report found many of the concerns held by older Australians living in residential aged care are not raised as an official complaint or even formally because residents do not believe anything will change, feel that their concerns are viewed as too minor and do not want to be a burden, or are unsure of who to report to.

The report also examined how often aged care residents felt their care needs were being met across different areas, finding that a large number of residents believe some aspects of the quality of their care and services was “failing them”.

Just 27.6% of aged care residents surveyed felt their needs were always met in all areas, while 39% believe their needs are mostly met, and 33.4% considered their needs met only sometimes or less in any area.

Areas measured included respect and dignity, being supported to make decisions about the care and services received, receiving care from staff with appropriate skills and training, and support to maintain social relationships and community connections.

Specifically, the survey found almost 7% of residents felt they were ‘sometimes’, ‘rarely’ or ‘never’ treated with respect and dignity. Nearly 16% said they only sometimes (or less often) received care and support from appropriately skilled and trained staff, while almost 17% felt unsupported in maintaining their social relationships and community connections.

The report says the survey results highlight the aged care system is “clearly failing” residents and requires urgent action to improve the quality of care delivered.

It notes results were consistently better for residents living in state-run residential aged care facilities and usually better for residents in not-for-profit nursing homes than for-profit aged care facilities.

Lead author, Associate Professor Frances Batchelor argues staffing issues need to be urgently addressed.

“It is clear that staffing issues (including understaffing, high staff turnover, and family-staff communication) are in need of addressing,” she states in the report.

“Residents’ social and emotional needs need to be better addressed, as results reveal that many residents feel lonely or bored, do not feel socially connected, and do not feel their needs are understood by their residential aged care facility.”

Associate Professor Batchelor says the findings underscore the need for enhanced person-centred care within the aged care sector and point to the need for more effective management and regulation, including addressing how complaints are resolved and monitoring how the system is performing to ensure problems are identified and acted upon swiftly.

“It will be important to continue this work by establishing independent, transparent monitoring so that reform of the aged care system is comprehensive, effective and lasting,” the report concludes.

“We should not forget that the systematic problems in aged care were not widely acknowledged or given media attention until recently. Independent, transparent monitoring will help ensure public awareness is maintained, reforms are followed through, and history does not repeat.”