More than two years after it was first established, the final report of the Royal Commission into Aged Care Quality and Safety has called for systemic overhaul of an underfunded and under-regulated sector. By Rick Morton.

Aged Care Royal Commission report lashes failing sector

Scott Morrison delivers the Royal Commission Report into Aged Care.
Scott Morrison delivers the Royal Commission Report into Aged Care.
Credit: AAP/Dean Lewis

Older Australians have been failed repeatedly by an aged care system that is dramatically underfunded and understaffed, overseen by a toothless regulator, run by uninterested ministers, and hides its critical problems, the aged care royal commission found in a scathing final report.

The report of commissioners Tony Pagone, QC, and Lynelle Briggs was tabled in the federal parliament this afternoon, as Prime Minister Scott Morrison offered $452 million to immediately address some of the system’s most pressing concerns.

“Our comprehensive response will come in the course of the budget,” Morrison said.

However, the federal government appears ready to pick and choose from the commission’s 148 recommendations. Some of the recommendations conflict with one or another, the Prime Minister made a point of telling reporters on Monday, noting that the commissioners disagreed among themselves on certain matters.

The aged care sector, meanwhile, is trying to combat what could be a pernicious interpretation of the final report.

“There is no split on the need for a total overhaul that means providers are resourced to employ more staff and deliver more care and support,” Patricia Sparrow, chief executive of Aged and Community Services, said in a statement.

“This cannot be used as an excuse to not progress major reforms. We know what the big problems are – we now need the big solutions.”

On the facts of it, there is much about which the royal commissioners do agree.

“Reform of aged care has been reactive, responding to financial, demographic or other concerns of the time,” the commission’s final report says.

“This has triggered repeated reviews, which have tended to be confined to particular areas of focus. The same issues have arisen repeatedly in these reviews without being resolved. It is clear to us that piecemeal adjustments and improvements have not achieved, and will not achieve, the change that is required to ensure high quality care in the future.”

To achieve this, the commissioners say, the Aged Care Act 1997 will need to be thrown out and completely replaced with a new underpinning legislation that enshrines the rights of elderly Australians. Both Pagone and Briggs indicated that the Coalition’s flagship aged care regulator, the Aged Care Quality and Safety Commission, has failed.

“We both consider that the ACQSC and its predecessors have not demonstrated strong and effective regulation. The regulator adopted a light touch approach to regulation when a more rigorous system of continuous monitoring and investigation was required for aged care,” the report says.

“Current regulation policies and processes have many deficiencies... The system is insufficiently responsive to the experiences of older people. The oversight of home care is particularly underdeveloped. There is a poor track record – in both home care and residential care – on enforcement, and the approach to monitoring and compliance is overly reactive.”

Such a scheme has, over time, allowed things to deteriorate to the point where Commissioner Briggs now believes the instance of substandard care in both the home and residential aged care sector has hit “at least one in three people”.

In the residential aged care sector, she notes, the incidence of assaults may be as high as 18 per cent. She said there was also a clear overuse of physical and chemical restraint.

“Some 47 per cent of people have concerns about staff, including understaffing, unanswered call bells, high rates of staff turnover, and agency staff not knowing the residents and their needs,” the report says.

In 2019-20 there were more than 5700 reported allegations of assault under mandatory reporting requirements in residential aged care; but because the system does not capture assaults by residents on one another, the real annual figure of incidents is between 27,000 and 39,000.

The findings are clear that service providers run by state governments are the best performing, on average, ahead of those operated by the not-for-profit sector “and, in particular, for-profit aged care providers”. This is linked to higher workforce standards and ratios in state facilities, especially in Victoria.

“We have found that Australia’s aged care system is understaffed and the workforce underpaid and undertrained,” the report says.

“Too often there are not enough staff members, particularly nurses, in home and residential aged care. In addition, the mix of staff who provide aged care is not matched to the needs of older people.

“Inadequate staffing levels, skill mix and training are principal causes of substandard care in the current system.”

Both commissioners Pagone and Briggs recommend the establishment of an Inspector-General of Aged Care, while differing on how major reform should be delivered.

Pagone suggests the entire system should be removed from direct stewardship of the Australian government and in particular the Department of Health. Briggs says that would take too long to get up and running, stating instead that the job could be handled by an overhauled department and “reconstituted” regulatory body.

“The Australian Government has been the dominant funder of aged care services, but it has not funded the system adequately,” the report says.

“It has been in a position to create mechanisms for measuring performance of the aged care system and identifying areas for improvement. It has been responsible for design of an effective regulatory system. It has failed to discharge these responsibilities adequately.”

For more detailed reporting and analysis of the final aged care royal commission report, read this weekend’s edition of The Saturday Paper.

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