New OPAN report unveils ongoing aged care challenges and abuse of older people

Aged care workforce issues are pushing aged and home care providers to “close their books”, while older people continue to experience abuse and neglect in aged care, a report by the peak advocacy group, Older Persons Advocacy Network (OPAN), has revealed.

The National Aged Care Advocacy Program Presenting Issues report was released today at the Aged & Community Care Providers Association (ACCPA) National Conference and calls for aged care providers and the Government to work together to strengthen the sector.

From June 2021 to June 2022, 27,104 calls were made by older people, their families and carers to aged care advocates, an increase of 17% compared to the previous 12 month period. 

The OPAN report identified five key themes from these calls, including:

• Workforce shortages have led to decreased access to services, especially home care, where providers are often struggling to meet demand
• Residential aged care homes are providing poor levels of care with reports of neglect and care plans not being followed
• Older people are struggling with aged care affordability and the cost of services
• A lack of communication and transparency between providers and clients is frequent
• The inappropriate use of Guardianship and Power of Attorney to make decisions without the input of older people impacts their human rights

Craig Gear, OPAN Chief Executive Officer (CEO), said that strengthening the aged care workforce is a difficult issue but the time for reform and change is now.

“We know workforce issues have been driven by COVID-19, due to illness and immigration and other restrictions, but the report also highlights issues caused by changes to the Social, Community, Home Care and Disability Services Award (SCHADS),” Mr Gear said.

“These long-overdue changes were necessary and will improve conditions for aged care workers, but, unfortunately, they have been coupled with insufficient funding across all types of aged care, as increased demand outstripped supply. 

“What the Presenting Issues report really highlights is that providers need to be keeping an eye on this, this could happen in any facility, and the role of an advocate is to shine a light on the quality of care.”

Challenges impact the entire sector

Almost 50% of calls made to aged care advocates were about issues in Home Care Packages, such as fees and charges and the impact of changes to the SCHADS Award.

Concerns about the quality of care, fees and charges and COVID restrictions were the most common queries for the 39% of calls related to residential aged care.

Mr Gear explained that the Australian National Aged Care Classification (AN-ACC) funding model will hopefully deliver much-needed support for residential aged care, but work is needed for more individualised Home Care Packages. 

“We need to look at solutions now,” said Mr Gear.

“It is the consumer organisations, the unions, the providers and Government all coming together for solutions.”

Interim support is necessary as the report revealed an increasing number of calls from home care recipients impacted by SCHADS Award changes to the minimum shift requirements. 

Casual and part-time staff are now required to work a minimum two hour shift, a challenge for workers in remorse and regional areas where jobs cannot always be placed together to meet those requirements.

Many home care providers were concerned about the SCHADS Award changes as it stretches the sustainability of their business.

“Care has to be delivered with the right training and right staff with a continued focus on care quality and the fees and charges, which residents are telling us are too high,” Mr Gear said.

“We also need home care that is designed around the needs of the older person rather than a capped amount in a package. We are excited by the proposed Support at Home program coming [by July 2024].”

He said work is still required to implement reforms handed down by the Royal Commission into Aged Care Quality and Safety.

Home care cancellations poorly communicated

The report revealed that 49% of the calls received by aged care advocates focused on home care programs, with an increased number of calls about service cancellations.

Unexpected cancellations have a direct impact on the quality of care provided in both community and residential care, with cancellations often occurring on a weekly basis for some clients.

This includes social support and transportation service cancellations that have denied clients access to critical health appointments.

“We know there are challenges, like staff sickness, but older people are telling us it’s about poor communication. The pre-warning or looking for alternative rostering solutions is what they’re looking for. 

“When the communication doesn’t happen, that’s when the relationship with the provider breaks down and people become dissatisfied.”

Mr Gear said a focus on clear communication processes and monitoring of cancellations and shifts changes can improve the client’s experience of care, allowing them to better prepare for support changes.

Closed books are a recurring barrier for many older people as some providers are unable to meet client demand due to a lack of staffing resources.

“Overstretched, or under-resourced, services are a particular challenge in rural and remote locations,” Mr Gear said.

“In some communities, providers have “closed their books” because they do not have the required staff to take on new clients.”

Elder abuse and neglect is still rife

Examples of elder abuse and neglect were common in the OPAN report, including one aged care resident who was denied the chance to use the bathroom when a continence aid was changed at night.

Another resident was frequently found sitting in their own faeces, had developed bed sores, and was not being showered or cleaned properly. 

The report found issues often extended to an abuse of power with an increased number of incidents where Guardianship and Attorney powers were used to make decisions that ignored the wishes of an older person.

There was a case highlighted of a Spanish-speaking client with dementia who was placed into residential aged care by a Public Guardian despite having 24 hour support available at home with a family member. No one in the aged care facility spoke Spanish.

This consumer had four separate Public Guardians across a one-year period and it was not until an advocate stepped in that a Public Guardian actually contacted the client. They are now living at home with support from their own community.

Mr Gear said Guardianship and Power of Attorney roles are “privileged” and both guardians and providers need to support the wishes of older persons.

“Even when someone has impaired cognition the role of the Power of Attorney or Enduring Guardian is a privileged one. It’s about making sure you’re working in the wishes and interests of that person. 

“We need to do better and use supportive decision making processes rather than substituting the decisions of an older person who has controlled their whole life – they can still control their life now.”

Mr Gear said the aged care industry needs to “collectively do better” to address the human rights of older people.

“We’re looking forward to working with providers across the sector so they can champion human rights, relationship-based care and make sure they’re supporting advocates who come in and work with them,” Mr Gear said.

“It’s about helping older people stay in control of their lives, to make their own decisions, to be empowered and to live their best lives.”

OPAN is working with the Government to support a new Aged Care Act, as the current Act turns 25 this year, that better incorporates the basic human rights for older people.