The royal commission has released its latest background paper, a comprehensive summary of the many reports and inquiries of the aged care sector that have been completed over the last twenty years.
The paper casts a long, question-marked shadow over the highly anticipated interim report, which is due out later this week, that will outline the commissioners’ thinking at the mid-way point of their investigations.
The paper outlines 18 reviews and inquiries of the aged care sector that have been conducted since 1997, and how the government has responded to each.
Not only is it clear that the very same issues the royal commission is turning over today have been examined many times before, but, even more depressingly, simply working out how, or if, the government has responded, so opaque are its mechanisms, has been difficult.
“It is often difficult to determine the Australian Government response to previous reviews and Inquiries,” the authors of the paper say.
“Responses often come years after the review and recount what has been done in an almost tangential way to the actual recommendations. Even when responses are provided, they can be opaque, rendering it near impossible to even determine whether the Government intends to implement the recommendation in the form proposed by the reviewer.
“Changes committed to are often slow to eventuate or fall away prior to implementation,” the paper states.
Why, the paper asks, after “all these reviews”, does the aged care system still “fail to support an appropriate quality (of) life for the most frail and vulnerable members of our community?”
Perhaps it is this question the royal commission needs to answer to ensure its recommendations are implemented?
“Despite all of these reviews, and all of the Government responses, the underlying problems remain,” the report states.
We take a look at the some of the key issues to come out of the royal commission that have been canvassed in other enquiries previously – workforce issues, young people in residential aged care, complaints handling, and dementia care.
Low pay, long hours, not enough time to spend with residents, staff shortages, contract staff, lack of regulation and poor training have all been key themes to emerge from royal commission hearings.
Indeed, staff and workforce problems are probably the most prevailing issue to come out of royal commission.
On 15 October, counsel assisting the royal commission, Peter Rozen QC, explained that the royal commission had at that point received 6,631 submissions and more than half of those had raised concerns about the workforce.
Of the 296 witnesses that had given evidence at that time, 85 per cent had commented on the workforce.
Only a couple of weeks ago, John Pollaers told the royal commission he was disappointed the government had failed to properly respond to his Aged Care Workforce Strategy Taskforce recommendations.
And yet, almost every review over the last 20 years has touched on workforce issues, whether it be the shortage of appropriately skilled and qualified nursing and personal care workers, poor training, or lack of regulation, the same problems remain.
The royal commission heard harrowing accounts of young people living in residential aged care. Dr Bronwyn Morkham, National Director, Young People in Nursing Homes National Alliance, said there is an “express route” of younger people into residential aged care because there is an absence of alternatives.
The appropriateness of residential aged care for young people was looked into by senate affairs committees in 2005, 2014 and 2015 – and yet the problem still exists.
The royal commission has seen evidence of an industry resistant to complaints, hearing that complaints to management often resulted in retaliation, and complaints made through the official government channels were often not resolved to the satisfaction of the complainant.
The royal commission heard the tragic case of Clarence Hausler, whose abuse was uncovered when his family installed a camera secretly in his room. When the family confronted management with evidence of abuse, they were told what they were doing was illegal and accused her of stalking staff. Mr Hausler’s family eventually took the matter to police.
Poor complaints procedures have also been the subject of several earlier reviews, including the Senate Community Affairs Committee in 2005, the Productivity Commission in 2011, and the Carnell-Paterson report in 2017.
The royal commission spent two weeks in May looking specifically at the issues surrounding dementia care, a concern also raised in past reports.
The royal commission heard of the inappropriate use of physical and chemical restraint, of violent attacks by residents living with dementia, and Professor Brodaty talked about the importance of person-centered care for those living with dementia.
Poor care of people living with dementia and a lack of preparedness for the expected rise in the number of people living with dementia was identified in the paper as one of the recurring issues examined by most inquiries over the last 20 years.
On 11 October, Uncle Brian Campbell asked the commissioners if this enquiry would be any different to others that had come before it.
“I’ve sat with the Royal Commission into deaths in custody. I’ve sat with the Bringing Them Home hearing; right? And out of all of them, hardly anything gets done, and is this one going to be the same?” he asked.
Commissioner Pagone replied, “Well, I certainly hope this is one that does get something done. That’s our intention, that something gets done, and that’s why we are gathering your stories and the stories of others.”
Despite Commissioner Pagone’s reassurance, the truth is, no one knows what the outcomes of the royal commission will be. With all the goodwill in the world, even if every story of neglect is tabled, every problem countered with a practical solution, the royal commission’s recommendations will only be implemented if the wheels of government turn with them.