"Neglect" - Royal Commission into Aged Care Quality and Safety - Interim Report

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By Louise Cantrill, Partner, and Jerome Germain, Lawyer

The Royal Commission released its interim report late yesterday. The interim report, fittingly entitled Neglect, comprises three volumes:

  1. Volume 1 – Information gathered and some conclusions;
  2. Volume 2 – Overview of public hearings; and
  3. Volume 3 – Appendices and summaries of community forums.

The interim report covers much of the work done by the Royal Commission up to September 2019. As transpired through the many hearings to date, the interim report confirmed that the aged care system is failing to meet the needs of older Australians in the delivery of safe and quality care.

Preliminary Recommendations

Whilst the final report is not due before November 2020, the Royal Commission has recommended urgent action to be taken in certain areas finding that there was no reason for further delay. These include:

  1. The provision of more Home Care Packages to reduce waiting lists;
  2. The reduction of over-reliance on chemical restraints; and
  3. The cessation of younger people with disabilities being placed into aged care.

Ageism and Ignorance

The current ageist mindset in Australia undervalues older citizens and their ability to still contribute to society. With that in mind, there has been little dedication to aged care until this Royal Commission commenced, in spite of 16 prior inquiries into the industry. Many of the previous reports and recommendations into aged care have been ignored, which resulted in the Royal Commission hearing a “shocking tale of neglect”.

It became apparent to the Royal Commission that many of the terrible stories relayed by way of direct evidence were in fact already known by service providers and government agencies. However, with a system based on the concepts of market, consumers and transactions, the many deficiencies cannot be adequately addressed. There needs to be a shift towards an aged care system that is focused on care recipients and built around them and their individual needs, which can only be achieved with a cultural transformation in the way older people are viewed.

My Aged Care

One of the primary issues when it comes to aged care services is the way in which prospective care recipients are expected to gain access to them. My Aged Care has been found to be a complete failure on the part of the Government, which tends to forget that those currently accessing aged care did not grow up with the technology that is required to access aged care services.

The use of technology can be frightening, confusing and confronting to aging Australians, who are provided with little guidance in the process. Instead, they are put through many assessments having to tell their story over and over, which can be traumatising if they have already experienced life trauma based on their background.

Home Care

The Royal Commission acknowledged that the main issue in receiving home care packages is the lengthy periods of time it usually takes for approval and commencement of care. Once an assessment is complete, it can still take up to a year or longer before a person receives the home care package they are entitled to. There have been reports of people dying waiting, which is unacceptable. In other instances, older Australians have had to move into residential aged care prematurely.

There has been a common assumption that aged care applicants will be able to manage whilst waiting. The Royal Commission found this approach to be unsafe practice equivalent to neglect.

Residential Care

When it comes to accessing residential aged care, the Royal Commission found that there is a lack of transparency and a lack of easy access to information that should be readily available to people to assist them in selecting a residential aged care facility which will respond to their particular needs. Aging citizens should be able to access information relating to the performance of facilities, including the number of complaints made against a facility, the number of reported assaults and the number of staff employed by a facility. The computerised processes employed by the Aged Care Quality and Safety Commission are completely inadequate to ensure appropriate safety and quality control.

In addition, there has been a lack of personalised aged care services delivered in residential aged care. Residents receive treatment based on their value, which is defined by the amount of funding they bring with them. There has been little effort in ensuring that aged care residents continue to live their life as though they were still living at home, where possible. Residents feel isolated and see themselves as another mouth to feed and another body to wash. The experience should be made more enjoyable and attractive.

Substandard Care and Workforce Issues

The Royal Commission was shocked to hear accounts of abuse, unkindness, neglect and assaults. This is, however, the current reality in aged care. Service providers were quick to deny any responsibility and that more could have and should have been done following reported abuse by care recipients and their families. Substandard care is the current norm in most aged care service delivery. Major quality and safety issues have been brought to the attention of the Royal Commission, including inadequate management of wounds, poor continence management, widespread malnutrition, high incidence of assaults, common use of physical restraints and overmedication. The current aged care system depersonalises older people, and what should be appropriate care is turned into neglect.

In response, the aged care industry has done very little. There is a clear lack of leadership on the part of the Government, particularly the Department of Heath, which results in a lack of accountability on the part of service providers. The complaint system is difficult to access and when complaints are made, they are oftentimes ignored or not adequately addressed. Aged care recipients feel frustrated, despairing and hopeless. The Royal Commission was greatly assisted by those who were brave enough to share their stories about traumatic experiences they had gone through in aged care.

The Royal Commission admitted that there were some positives, with most of the healthcare workforce doing their best in trying circumstances within the reported constraints on their time and resources. The industry is facing severe difficulties. Staff are being underpaid and working in poor conditions. Their workloads are heavy and their training and education are patchy. This has made the aged care industry unappealing and unattractive, which in turn creates more difficulties with recruiting and retaining skilled staff. Passion and dedication of the workforce are key to improving and transforming the industry and the Royal Commission believes that there is potential to achieve just that.

Next steps

There is much more to come in the upcoming hearings scheduled in Hobart, Mudgee and Canberra. The Royal Commission has provided the Australian Government and community with sufficient material in its interim report to cause what it hopes to be a serious reality check. It has however become clear to the Royal Commission that what is needed is “fundamental reform and redesign – not mere patching up” which will only provide short-term solutions.

A copy of the report can be found on the Royal Commission website, here.

For further information, please do not hesitate to contact us.

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