Dec 20, 2018

Royal Commission Says Game On

All eyes are on the Royal Commission as the nation waits for it to come up with solutions that will eradicate, once and for all, the problems that are plaguing the aged care industry. However, should the Royal Commission be scrutinising an industry that has been scrutinised by so many reviews whose recommendations have not yet been implemented by government? Is it even relevant seeing that the government knew long back, through various enquiries, that the system was heading for trouble and did not do much about it till there was trouble? I am not saying the Royal Commission should not be poking the industry with their big stick. After all they are already on the ground. I simply believe that they should be looking to the industry to help them to perform a root-cause analysis and to find sustainable solutions.

The Royal Commission, whose key task is “to help build a national culture of respect for ageing and older Australians” is going to work through Christmas because they are starting their hearings in January 2019 and must submit a interim report by October 31, 2019. With their final report due on April 30, 2020. The Commission is going to be viewed as the Grinch who stole Christmas for many aged care agencies as they have already sent a letter to the largest 100 aged care agencies in the nation, asking for information that is due on January 7, 2019! Smaller agencies will soon get their own letter asking for information that will be due some time in February 2019. It’s going to be a busy Christmas for the aged care industry!

I have written extensively on the Disability, Aged Care and the Health Systems over the past two years. Now it is time to sit and wait to see if this Royal Commission goes beyond their brief to make real governmental systemic changes! It is my hope that they will fix, or recommend fixing, the system by knocking down the silos, reuniting aged care and disability and implementing integrated care. If we are going to re-establish trust as the Prime Minister intends, then we must have real transformation in the aged care system!

First, the Royal Commission, together with the industry, should come up with a clear analysis of the problems that are bothering the industry. From the reports that we have had in the past two decades it is clear that the standards of care have dropped and there is gross negligence and gross abuse of elderly people. The nation has clearly shown that there is total lack of respect for older people. The root causes of these issues should be identified, analysed and understood. Then the focus should be on implementing change.

Corporations that run aged care facilities must take a shared responsibility for the mess that the industry is in. They pushed for deregulation since the 1990s when aged care facilities were privatised and since deregulation the facilities that they operate have degenerated to neglect and abuse of elderly Australians. What is required is more regulation! It is hoped that the Royal Commission will come up with the standards of care that are deemed to be acceptable which can then be the basis for judging the standards in aged care facilities. Otherwise, how do they tell that care at certain facilities is below standard? Government, which shares the responsibility for the current mess, must adopt those standards and make them into law. I believe that any facility that is found to be giving care that is below standard should be closed and the patients must be moved to other facilities.

No facilities should be allowed to give “staff shortage” as an excuse. Corporations can create an industry council that creates training, oversees the training and certification of care givers and insist that all care givers meet the training requirements. The council should also have a code of conduct and a code of ethics for its members. Meanwhile the corporations can outsource care givers from other countries. While they are at it, they must ensure they train and recruit proper case managers so that there is sufficient quality case management and care coordination. While we are still on staff shortages, why can’t they have proper staff retention strategies and show their workers that they value them?

One of the problems facing aged care facilities is the GPs’ frustration with aged care facilities. This can easily be corrected by the government increasing the remuneration for GPs who visit patients in aged care facilities and by the facilities themselves having systems that support GPs during visits. That should include access to patient files online for phone visits. Once GPs become involved in aged care again, they will insist on better quality care and safety for their patients.

While the Royal Commission looks at quality of care in aged care facilities, they should recommend that, where possible, older people must age in place because research has found that those who age at home are happier than those who age in old age facilities. They can recommend that corporations follow the business model of the American-style home care system and create laws and policies around that model. The Royal Commission should recommend investment in home care. There should be sufficient money to make homes age-friendly with reachable cupboards, wheelchair ramps and support rails in bathrooms. There should be sufficient money to pay for care givers, GPs and nurses.

There should be investment in telehealth. Every old person aging at home should have wearable devices, a computer and internet access so that communication remains open and the elderly can be visited online. Patients and their carers use the computer to input vital signs, number of steps walked, medicines taken and food intake. GPs can keep track of vital signs and call their patients whenever certain vital signs flag a problem.

Not to be forgotten is the use of the whole community to look after the elderly. It has been found that the elderly fare better when they are allowed to age at home because they are close to their friends, neighbours and families. These valuable people must also be trained in home care-giving for the aged so that they can help whenever they visit. Care for the aged at home should be a community effort.

Integration of care still remains a workable option. It is hoped that the Royal Commission will recommend integration of social care, health care and aged care at government level. That will make navigation of the system easier as elderly people will have a one-stop-shop for all the services that they require. As part of the integration efforts, they should centralise digital files for patients and make them accessible by all health care and social care givers. Then GP offices can be made central to aged care so that they react through telehealth whenever an elderly person is in trouble and avoid unnecessary hospitalisation.

Everyone is hoping for total transformation of the aged care industry! The Royal Commission must remind the nation that each elderly person is someone’s beloved parent, grandparent, aunt or uncle. Age, disability and illness does not make them less human. The Commission must then transform the aged care industry in such a way that facilities become safe again and quality care is taken for granted. They must make sure that those aging at home receive good care continuously from all angles to prevent unnecessary hospitalisation. It is still possible to provide the right care at the right place at the right time for aging Australians!

 

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  1. Whilst I believe a Royal Commision is long overdue and very necessary, their is an endemic failure amongst for profit providers that should be addressed immediately, I have worked as a residential care worker for a number of years now and have constantly argued for ratios in private providers, have seen continence pads locked in cupboards, Kylie’s removed off beds due to ‘laundry costs’ amongst other cost cutting measures over the years, but now the latest is not to replace am and pm staff who are absent,not being allowed to replace them with agency if they can’t fill the roster, the other morning am shift had to work one short due to absence and not replace with agency, so I figure if companies aren’t replacing absent staff their is little hope of ratios being agreed to, inspite of the considerable funding they receive.. Aged care had been and always will be are part of society that is hidden whilst it is in the hands of companies who’s bottom line is profit and not care.

    1. Chris unfortunately it is not isolated to just the ‘for profit providers’. I truly believe from my perspective the problem is complex and interrelates to a assessment and funding issue to be fair to those providers. Many individuals placed in n RAC could be better off at home on a Level 5 HCP as recommended in the Tune Report.

  2. Aged care needs to have a Government Regulation made law that an adequate Staff to Resident ratio is guaranteed. This staff to patient ratio needs to be the minimum required and not set by the establishments but by the Government with consultation to specialists in this field.
    The Government needs to provide adequate funding to ensure staff training and staff ratios are implemented.
    The number of Registered Nurses on duty at large establishments should be relative to the number of residents and the number of floors/areas. One RN should not have to cover several levels with large numbers of residents. In Aged care a delay can be life threatening as many residents do not have much time left.
    Also not for profit institutions should be required to show that money earned through bonds, fees etc. in Aged Care facilities is used for the betterment of residents and staff in these facilities and not siphoned off to other avenues.

    1. Frances I agree a matrix is needed to determine that the right skill mix is on duty at the right time. Yes, funding is a driver to this that needs considered as well as role delineation. To ensure the right skill level is doing the right job to ensure cost effectiveness whilst maintaining quality and safety. Unfortunately, the Workforce review that has been done recently still needs work to be done and rolled out to make all of this a reality.

  3. Each aged care facility to be built on an “at home” model with gardens that the residents can tend to with a gardner. Birds and animals which the residents can help care for. Kitchens built in such a way that residents can assist in preparing meals and washing up etc. Let the residents be involved just as they would be in a home environment. This would mean that the people had a reason to get out of bed in the morning and were tired at nighttime. People, generally, don’t want to be in a “cafe” everyday. Let them wander into the kitchen and get what they want for breakfast -under the supervision of someone – a bit like the modern boarding school for children. Get rid of the “Instution model”!.

    1. There is some evidence to support this type of model of care in some instances. Unfortunately it is not suitable nor safe in many instances. We are starting to see what I call shared independent living, where a few aged move in together and quasi pool their Home Care Package to ensure they get the services required.

  4. Richard you write from an industry perspective and not from the perspective of the residents and the community. The government and industry have been closely entwined for the last 20 years and this is why we have such an awful system. Industry and government have been avoiding data and then deceiving themselves and citizens ever since.

    There is no prospect that they will be able to address the fundamental structural problems in aged care – this relationship. The risk is that the Royal Commission will be persuaded that they can. The danger is that this will be treated as purely an industrial issue and not a whole of society one. The USA and the UK have deeply flawed systems. We should learn from their failures and stop copying them.

    The values of empathy and altruism on which care depends are products of actively engaged functional communities in which people engage with and understand one another. These have been seriously eroded under a system that since the 1980s has seen any sort of restraint by society on the way the market operates as counterproductive.

    The care and support of vulnerable people is the responsibility of every citizen and of every community and that has been taken away from them. They have been pushed aside. Their roles have been appropriated by the market and teams of managers.

    The argument is that anyone who provides care to a community is acting as an agent of that community and should be directly accountable to them. What is required is a restructuring of the aged and disability sectors in and around communities in ways that gives them control over their agents so that they can partner with them and insist that their values, and not those of the deeply flawed aged care roadmap become the foundation on which care is built.

    Most communities have medical, nursing and other experience to build on. Aged Care Crisis argues that we should start with an empowered local visitors scheme and then rebuild and support empowered communities around them, progressively delegating responsibility.

    The problems in society are system wide, country wide and global. Many are analysing and calling on community to take charge and address the problems. Aged care and disability are only extreme examples. They are embedded in our communities so are the easiest to address.

    1. Michael if only we could go back to the days when the community looked after each other. Yes, that is when many of the problems begun in my experience and opinion. Local solutions for local problems back than had resolutions that worked community by community. One good think is that funds now get assigned to individuals versus providers.

  5. I agree with Mr Hoskins evaluation of the needs requiring attaention in the Aged Care sector.
    One of the vital needs are ..caters that speak, and understand English.
    Another..we, the general public + those who work in the sector, should have job tenure, and safety should they need to become ‘whistleblowers’.

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