Mar 02, 2021

4 key takeaways from the aged care royal commission’s final report

Senior man at bedtime

The Royal Commission into Aged Care Quality and Safety’s final report into aged care has laid out an extensive plan to overhaul Australia’s aged-care system.

Among the 148 recommendations, the report calls for a new system underpinned by a rights-based Act, funding based on need, and much stronger regulation and transparency.

Over two years, through more than 10,500 submissions and 600 witnesses, the two commissioners heard extensive evidence of a system in crisis. Australians might have expected the commissioners to provide one streamlined blueprint for reform.

But the commissioners diverged on a number of large and some smaller recommendations. This makes the already complex path to reform even more confusing. It reduces the power of the final report. More disappointingly, it gives the government room to pick and choose recommendations as the cabinet likes.

Nonetheless, if the major recommendations are adopted, Australia will get a transformed aged care system over the next five years.

Here are our top four takeaways from this landmark report.

Read more:
Paid on par with cleaners: the broader issue affecting the quality of aged care

1. Australia needs a rights-based aged-care system

In its recommendations, the final report highlights Australia needs a new Aged Care Act to underpin reform. The new Act should set out the rights of older people, including their entitlement to care and support based on their needs and preferences.

This would be a significant shift away from the current ration-based system, and would bring aged care more in line with the principles of Medicare.

Practically, this would mean the number of people in the system would no longer be capped — the long waiting lists for care would disappear over time. The current aged-care programs, such as home-care packages and residential care, would be replaced by a single program.

Under this new program, all older Australians in need of support would be independently assessed, and allocated care according to their personal needs and preferences — whether at home or in residential care.

This is a huge step forward, and, with the right support, would enable older Australians more choice and control over their care.

2. The system needs stronger governance

Ineffective governance and weak regulation of aged care must end. The final report calls for much stronger governance, regulation of the quality of care, prudential regulation, and an independent mechanism to set prices.

These changes would ensure the “quasi-market” aged-care system, as commissioner Tony Pagone described it, was much better regulated, holding providers to a higher standard of care, and better able to address any service gaps in the system. We might see the introduction of home care in locations where home-care services were not previously available, for example.

This change would require all aged-care providers to be accredited against the new standards. We hope that process would weed out some of the poorest performers in the sector. The new system would have offices across the country, to provide on-the-ground support to older Australians and providers.

Unfortunately, the commissioners diverged on the exact mechanisms for these changes. Pagone wants an independent commission to be responsible for aged care, at arms-length from the health department. Meanwhile, commissioner Lynelle Briggs wants governance to remain with a reformed department, but with quality regulation managed by an independent quality commission.

Given the department’s poor track record on managing aged care, we need to see a major change of culture. We urge the government to accept commissioner Pagone’s recommendation.

3. We need to improve workforce conditions and capability

The final report makes numerous important recommendations to enhance the capability and work conditions of formal carers. It calls for better wages and a new national registration scheme for all personal care workers, who would be required to have a minimum Certificate III training.

Residential care facilities would need to ensure minimum staff time with residents. By July 1 2022, this would be at least 200 minutes per resident per day for the average resident, with at least 40 minutes of that time with a registered nurse.

The facilities would be required to report staffing hours provided each day, specifying the breakdown of residents’ time with personal care workers versus nursing staff.

While these measures are good, they are the bare minimum, and would only give facilities a minimum 2 or 3 star rating. But coupled with recommendations for stronger transparency, including the publication of star ratings and quality indicators to compare provider performance, providers might be incentivised to go above this minimum standard.

4. A better system will cost more

The final report makes a series of complex recommendations about fees and funding, with the commissioners diverging in view as to the specific arrangements. But essentially, the proposed new funding model would provide universal funding for care services, such as nursing.

This means there would be no requirement for aged-care recipients to pay a co-contribution, like public patients in public hospitals. Instead, the expectation is people pay for their ordinary costs of living, such as cleaning, subject to a means test and up to a maximum amount in residential care.

A carer holds the hand of an elderly person.
A rights-based system means funding is determined by each individual’s needs.

These changes would coincide with the phase-out of the burdensome refundable accommodation deposits, which some residents currently pay as a lump sum to providers when they enter residential care. This approach is a shift away from the current muddled set of means-tested arrangements, and may help offset some of the additional spending needed to pay for a rights-based system.

Unfortunately, the report does not touch on how much the recommended changes would cost. Australia should be prepared to pay the price of a better aged care system.

Read more:
View from The Hill: royal commission confronts Morrison government with call for aged care tax levy

The government has been underspending on aged care. Most Australians agree the government should provide more funding for aged care. Commissioner Briggs has the more persuasive proposal for funding the new system. She wants the government to introduce legislation by July 1 2022 that establishes an aged-care improvement levy of 1% of taxable personal income.

Commissioner Pagone is weaker on this point. He wants the Productivity Commission to investigate the establishment of an hypothecated aged-care levy (meaning the money raised by the levy can only be spent on aged care).

Either approach will be politically difficult, but Australians should demand their government lock-in a secure funding supply. That will help produce an aged-care system that protects the rights, upholds the dignity, and celebrates the contribution of all older Australians.

Stephen Duckett, Director, Health Program, Grattan Institute and Anika Stobart, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  1. The Royal Commission identified what we need in Aged Care but those with relatives and workers all knew that; What I dislike is that the current system does not mandate what must be spent on patients and how. Many Aged care homes are guilty of misrepresenting what they offer( to gain residents). Spending the minimum and shaving off a share usually to the owners. The building s are funded so they can set up a system that pays them at the expense of residents. Any solution seems to reward owners for past diversion of money to their own needs .

  2. The Guardianship Act also needs to be reviewed so that one person cannot be the Guardian and the Attorney at the same time. At the moment there is no oversight so for example one member of a family can hold both roles and even pay himself if he provides services outside of his voluntary roles. For example if the Estate needs a Gardener or a Plumber there is nothing to stop this person from billing the Estate for services that he provides at his request using his ABN number. Sadly financial abuse usually happens when the older person is most vulnerable. VCAT also needs to be reviewed to stop fraudsters from hiring expensive Lawyers (that they then bill the Estate) ostensibly to protect their own reputation. This really is the perfect crime because the Attorney does not have to hand over the financial records of the Estate and so no-one is any the wiser. Nursing home rorts where they bill for ‘lifestyle packages’, etc that are either not delivered or cannot be accessed due to cognitive decline would be much easier to stop if there was more transparency and accountability. The current financial landscape allows financial abuse and fraud on an industrial scale. My mother was defrauded by a Lawyer and that Lawyer ended up going to jail. This fraud happened because of a lack of oversight. This has to change.

  3. Tired of hearing what the government needs to contribute to aged care facilities….HOW ABOUT the owners of these very wealthy companies INVEST THEIR money.. How about they employ Managers that really CARE ABOUT the elderly, how about the aged care accreditation team look a bit deeper than the lovely progress notes and paperwork and OF COURSE staff on their very best behaviour on the days they arrive.. How about they employ nurses that can literally go into the residents rooms and see them in the flesh re: chronic wounds etc WAKE UP AUSTRALIA the system is stuffed IF YOU are passionate about aged care residents you are treated like dirt is you are a favorite of the manager but a lousy carer you get away with anything

    1. Ignorance is bliss. Facility owners have invested tens of millions to be in a position to contract to the government. That contract was supposed to be for the safe and sustainable care but the government cut the funding. Like any other business if your main client fails to pay the business and customers suffer.

      Nursing homes are fantastic organisations mostly run by professionals that care immensely for their residents.

      If the government could run a decent home at a reasonable cost then the private sector would never have been invited to supply services. Even today the 10% of homes run by the government get far more in funding than other homes!!!

  4. How does the government stop the extra money from turning into profit for the corporate bodies ???

  5. I suggest to all and sunder to sit down with nurses ains, cleaners.laundry and kitchen staff in aged care facilities and ask US what we need to do a great job. Might even save some money for the government. We work hard so we are used to hard work but not to the extent where you are more often than not exhausted and stressed most times. …. All staff to be trained for level 3 or more certification in aged care at reputable places like Royal College of Nursing. Teachers are wonderful and so knowledgeable and won’t treat you like an idiot. They show respect and love what they do and have specialised nursing backgrounds…. NEXT…all facilities to have regular in-house training not just manual handling or fire and have education through work at times that are fair so all can attend. All shifts should be able to do training after work NOT IN WORK TIMES so everyone can attend. The courses can be held 3 days per week and cater for am ( after work) pm (before work) ND (before work). Nobody should have to come in for the 1.30 pm courses after being rostered on night. How would you like to get out of bed at 12.00 midnight for a course starting at 1.30 am? Noticed we don’t get paid for coming in anymore. Our kitchen should be bigger like a small hospital with a conveyer belt and kitchen staff on either side placing thr required food and cups etc on trays. Should have a dietician on full-time. More physiotherapists as 2 is a joke for 120 residents! Should be one physio for each ward realistically! That’s 8!! A real chef not a pretend chef that works well with the dietician/s! Bloody places should be run like hospitals!!!

  6. It will be interesting to see how this plays out. As a Care worker who has personally spent over $10,000 education myself with 2 diplomas and heaps of certificates for diabetes, palliative care, and looking at ageing through the person’s eyes. I have no employer recognition and was told it is good but a waste of time as I am not an EEN or RN.
    So it will be fascinating also to see the new career pathways.


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