By Louise Cantrill, Partner 

The Perth Hearing of the Royal Commission into Aged Care Quality and Safety focussed on three broad topics: person-centred care, advance care planning, and palliative care. A large portion of the Commission’s time was spent on understanding person-centred care, including understanding why it was important for good quality aged care providers to practice it and what issues were faced by current providers and residents.

Evidence

The Commission heard evidence from a number of providers, aged care workers, residents, and their family members. Two case studies were put to the Commission involving poor quality aged care, they stemmed from complaints about the treatment of residents. There were also a number of case studies showcasing excellent quality aged care.

The main themes that emerged from the hearing were as follows.

1. What is person-centred care?: Person-centred care was a term coined by Professor Tom Kitwood, a UK dementia researcher – although it was principally a philosophy of caring for people who were suffering from dementia, it has been applied over the years as a guiding philosophy for all aged care. At its simplest, person-centred care is care that aims to maintain the ‘personhood’ of the person by providing them with as much choice as possible so that they can maintain their dignity.
2. How is person-centred care applied in Australia: Some witnesses criticised the term ‘person-centred care’ as being ‘abused’ by aged care providers. The criticism was that some providers use the term while only offering token gestures of ‘choice’ to care recipients, but ignore their core needs. The term ‘relationship-based care’ was said to build on the principles of person-centred care, but puts the focus back on building quality relationships between the provider, care workers, the resident and their family. Maintaining a sense of personhood is about more than just choice, it is about emotional connection and compassionate care.
3. Advance care planning: Advance care planning is where an individual documents and discusses how they wish to be cared for as they become more cognitively impaired. There were criticisms by some witnesses over ‘power of attorney’ requirements being drastically different in each state. Overall, there was a call to centralise enduring documentation so that cross-state issues relating to care decisions could be resolved. Some witnesses noted that ‘advance care planning’ was about more than enduring documentation – it could be partly achieved by informal discussions among families so that wishes could be known. A greater cultural willingness to discuss these sorts of issues was identified as a goal.
4. Palliative care: The Commission heard evidence of a situation where palliative care was offered by a residential aged care facility but it in fact could not be adequately provided by them. Specifically, the staff were not trained in palliative medication requirements and there was generally a lack of staff with the capacity to attend to the person requiring care. Palliative care experts gave evidence to suggest that awareness campaigns, and greater recognition of the importance of palliative care in funding decisions are integral to improving Australia’s standard of palliative care.

What’s next?

The Royal Commission into Aged Care Quality and Safety will continue its public hearings in Darwin on 8 July 2019 to 12 July 2019. It will inquire into aspects of care in aged care programs, rural and regional issues for service delivery of aged care, and quality of life for people receiving aged care.

Stay tuned for further updates.