Experts weigh in on the royal commissioners split opinion for allied health

Old people lawn bowls

Recipients of aged care services have suffered in recent years from the lack of allied health services available to them.

The commissioners wrote in their final report, “People in aged care have limited access to services from allied health professionals, including dietitians, exercise physiologists, mental health workers, occupational therapists, physiotherapists, podiatrists, psychologists, speech pathologists and specialist oral and dental health professionals,”

“Allied health care in residential aged care is also insufficient and we are concerned that the type of service provided may be influenced by funding arrangements,” the commissioners wrote.

The final report of the Royal Commission into Aged Care Quality and Safety seeks to rectify this problem, recommending that both residential and home care services should include allied health services as an intrinsic component of care.

“We recommend the benefits of allied health services should be considered in an assessment of a person’s aged care needs, and that the person’s aged care entitlement should adequately reflect those needs,” they write. 

HelloCare has heard from three allied health specialists about what the commissioners recommendations will mean for their specialisation.

Divided in their approach

Though united in their need to support allied health, each commissioner took a different approach.

Commissioner Pagone recommends providers deliver allied health services “as required by their assessment or care plan”.

Commissioner Briggs, on the other hand, takes the view that aged care providers should employ, or “retain” in some way, an oral health practitioner, a mental health practitioner, a podiatrist, a physiotherapist, an occupational therapist, a pharmacist, a speech pathologist, a dietitian, an exercise physiologist, and a music or art therapist.

Optometrists and audiologists should be available to provide services “as required”.

For home care, the commissioners recommended allied health services be provided, “appropriate to each person’s needs”.

Simon Kerrigan, physiotherapist and director of Guide Healthcare, told HelloCare the split in the recommendations between Pagone and Briggs is “very disappointing”. 

“In an industry which has struggled for unity and clear path forward, the last thing we needed was confusion.”

Allied health to play important role in aged care

However, Kerrigan is pleased to see the “overwhelming consensus” that physiotherapy, as part of a multidisciplinary team, needs to play “an important role in the aged care of the future”.

He is also happy both commissioners agreed provisions need to be made and consideration given to smaller providers, Aboriginal and Torres Strait Islander-specific services and services in regional, rural and remote areas.  

“I believe the recommendations have the potential to create a service which is more in-line with the Aged Care Quality Standards,” Kerrigan told HelloCare. 

“In particular, it was pleasing to see the recognition of the competing and often perverse incentives created between the quality standards, the aged care funding instrument and the quality of care principles.”

Monitoring of outcomes is a key component of the recommendations too.

“Monitoring services should mean that we create stronger benchmarks and ultimately better outcomes for residents,” said Kerrigan.

“I believe this increased transparency is actually an opportunity for innovative providers to create a significant point of difference, by prioritising these types of services.”

Given the choice, Kerrigan says he prefers the option proposed by Briggs.

“Pagone’s recommendation of flexible funding and control in the hands of providers is fraught with danger. I’d prefer a system which promotes and incentivises a multi-disciplinary approach,” Kerrigan says.

Pagone’s recommendation is “highly open to interpretation”, a problem that has been ongoing with the current aged care legislation.

Pagone’s recommendation “lacks specifics on the types of professions who should deliver services. Furthermore, the ambiguity of the language such as ‘provide services… as required by their assessment or care plan’, creates no real direction or opportunity for accountability. 

“The current view of what aged care residents ‘require’ could mean that a primarily ‘pain management’ based service continues.”

“A huge step forward” 

“Commissioner Briggs’ recommendation is much more holistic,” says Kerrigan, adding that it is the recommendation of the two that places higher importance on allied health in residential care, and therefore the one he supports.

Briggs “specifies a broad range of allied health professions and specifies that providers need to employ or retain at least one of each. 

“This would create a huge step forward for the residential care sector,” Kerrigan said, however, he noted that Briggs’ recommendation still lacks clear guidelines about the minimum expectation of service delivery 

“The argument for this will likely be that services need to reflect the individual needs of residents at each site,” Kerrigan notes. “This could be a difficult challenge to overcome, as placing an emphasis on ‘assessments and care plan’ and ‘appropriate treatments’ is again, too open to interpretation.” 

“In order for either of these recommendations to be effective, we need to redefine the ‘purpose’ of aged care,” Kerrigan told HelloCare. 

“A cultural shift needs to occur away from passive care towards evidence-based treatments. 

“And we need to drive recognition that residents can improve their physical function, psychosocial wellbeing, cognitive abilities and quality of life with the appropriate supports. 

“What is clear, is that more work still needs to be done.”

Kerrigan also supports Briggs’ blended funding model.

“I was impressed with what she believes would be the outcomes associated with this model. 

“An activity-based subsidy would be a simple addition to the AN-ACC, with the physical therapy subsidy outlined in the R-ACFI providing a simple and existing framework. Her blended model would seemingly incentivise multi-disciplinary care for providers, which is vital,” Kerrigan said.

Allied health not included in proposed staff ratios

Professor Kathy Eagar, director of the Australian Health Services Research Institute told Australian Ageing Agenda she was “disappointed” the commissioners did not include allied health professionals in the proposed staffing ratio model.

“We made recommendations about staff ratios in allied health, and the royal commission did not recommend that for allied health,” she said.

“We think that was a serious failing.”

Dental health another key focus

Dental health was also a high priority for the commissioners, with several recommendations for improvements.

“We heard consistently that oral and dental health care needs of people living in residential aged care are not treated as priorities,” the final report states. 

“Daily oral health care is often not undertaken and access to oral and dental health practitioners is limited. 

“Much of what we heard about the failures in oral and dental health care focused on lack of staff time and inadequate training, as well as a lack of access to oral and dental health professionals, but there can be no excuse for failing to brush older people’s teeth and clean their dentures daily.”

The commissioners recommended the Senior Dental Benefits Scheme be approved, as recommended by the Australian Dental Association.

“The scheme will fund dental services for people who live in residential care and older people who live in the community and receive the age pension or have a Commonwealth Seniors Health Card,” the report states.

“It will be limited to treatment required to maintain functional dentition and will be an important health prevention intervention.”

“If the government acts on this report, it will mean funding dental care for older Australians as well as some fundamental systems can finally be put into place to ensure better dental care for those in residential and home care,” said Federal ADA President, Dr Mark Hutton. 

Other oral health recommendations in the commissioners’ final report are:

– including oral care as a core competency in the Certificate III qualification,

– that residential aged care should include allied health care, including oral health practitioners, 

– an urgent review of the Aged Care Quality Standards so they include ‘best practice oral care’, and

– ensuring there are sufficient numbers of workers to carry out proper daily oral care.

“The fact is, Australians are living longer – often well into their eighties – and keeping their teeth for longer too. But with a longer life span comes more complex oral health needs. Rates of gum disease and dental decay are highest in the over 65s, for example,” said Dr  Hutton.

“Coupled with this are long waiting lists in the public dental system, poor value for money for private health insurance cover for dental work, and almost non-existent provision of oral care for those in aged care – a perfect storm for rotten dental health for older Australians.”

The ADA is now urging the government to implement the recommendations. 

“Failure to act on the report would be tantamount to the government saying it doesn’t care about older Australians,” Dr Hutton said.

Dieticians needed, with 68% of residents malnourished

“Too often we heard that residential aged care providers failed to meet the nutritional needs of people for whom they care and that they provided poor quality and unappetising food,” the commissioners wrote in the final report.

“A lack of assistance to eat and drink, leading to malnutrition and dehydration, was a common issue raised by witnesses and in submissions. 

“Studies have revealed that as many as 68% of people receiving residential aged care are malnourished or at risk of malnutrition.”

“Engaging at least one dietitian at every aged care home, and a stronger focus on food and nutrition with the increase to the Basic Daily Fee, are just some of the recommendations provided in the Commission’s Final Report,” said a statement from the Dieticians Australia.

“Good food and nutrition are vital to healthy ageing – for both physical and mental health,” said Robert Hunt, CEO of Dietitians Australia.

“With a quarter of online submissions to the Commission referring to nutrition and malnourishment, we’re pleased to see food and nutrition, and support from a dietitian, given the priority it deserves.”

“We know that undertaking a food-first approach to reducing malnutrition would save more than $80 million which would otherwise be spent on costly malnutrition treatment,” he said. 

“Collaboration between dietitians, chefs and the whole care team allows older Australians access to food that is nutritious, familiar, appetising and appropriate for their needs.

“This ultimately results in better health and quality of life for those in aged care. It’s a win-win for all involved.”

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  1. Bring aromatherapy back into Allied Health. The immediate responses from care recipients include:
    Less muscular tension
    Pain relief
    Enjoyment
    Appears and reports feeling relaxed
    Reports soothing
    Reports enjoying the tactile and social contact
    A space to self express

    These are the responses I receive and document constantly. Anecdotal evidence is important and it reflects what the care recipients enjoy, benefit from and want.

  2. Allied health care needs to be on a needs basis. There is absolutely no necessity for full time dietitians, dentists, optician or other.
    Consumer based care is the government mantra and now, without funding, there is a call for additional costs.

    There is one overriding issue that is unanimous in the Royal Commission and that is that the residential sector is grossly underfunded with Home operations going broke trying to deliver services.
    Let’s fix that!

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