The Royal Commission into Aged Care Quality and Safety was established in October 2018 and through the course of its inquiry received over 10,000 submissions from individuals, family members, advocates and organisations make submissions, including VCOSS.
The delivery of the final report of the Royal Commission comes with great emotion and expectation for older people, their families and loved ones, particularly those who bravely shared their personal experiences and ideas for change, and all Australians who want to see a safe, high quality support system for older people.
The Commissioners made 148 recommendations in their final report. While we continue to work through the detail of the final report, we summarise below some of the key recommendations.
A new rights-based Aged Care Act
The Commissioners recommend a new Aged Care Act be established, with a focus on the protection and promotion of the rights of older people to access to quality, safe and timely support, enjoy social participation and dignity, exercise self-determination and live free from harm, mistreatment and neglect (Recommendations 1, 2 and 3). As stated by the Commissioners:
“For too long, legislation has focused on the funding requirements of aged care providers rather than the genuine care needs of older people.”1
The Act would set out the rights of older people to access care in a significant shift away from the current ration-based system.2
A comprehensive, national approach to ageing
Australia needs a long-term plan for how housing, health and community-based aged care services will meet the changing needs of our ageing population. Recommendation 4 provides a vehicle for this. It calls for an integrated system for the long-term support and care of older people, to be delivered through the creation of a new National Cabinet Reform Committee on Ageing and Older Australians, established between the Australian and State and Territory Governments, with immediate work to develop a 10-year strategy in consultation with older people (Recommendation 4).
More choice and better access to services
The Commissioners recommend a range of reforms to improve access to support, including:
- the replacement of existing assessment programs and services with one assessment process by July 2023 (Recommendation 28)
- addressing the Home Care Package waiting list by:
- clearing the waiting list by December 2021
- publicly reporting on progress in clearing waiting list from 31 March 2021
- approving new Home Care Package applications within a month from January 2022 to July 2024
- establishing a short-term program to help people connect to providers (Recommendation 39)
- replacing the Aged Care Provision Ratio (“a tool for limiting and apportioning subsidies”) with a needs-based planning regime by July 2024 (Recommendation 41)
- the implementation of grant-funded programs by July 2022 for:
- early and more frequent respite support (up to 63 days per year) in-home and centre-based (Recommendation 32)
- social supports to reduce and prevent isolation and loneliness, including centre-based activities, delivered meals and transport – coordinated locally and provided by councils, community organisations and businesses (Recommendation 33)
- assistive technology and home modifications (Recommendation 34)
- a star rating system to share performance information for people seeking care (Recommendation 24).
Through a range of measures, the Commissioners outline an agenda to ensure no young people enter aged care from January 2022, and no young people live in aged care from January 2025 (Recommendation 74). The Commissioners also recommend measures be taken to ensure every person receiving aged care who has a disability can access equivalent supports to those that would be available under the NDIS for people aged under 65 with the same or similar conditions (Recommendation 72).
The Commissioners also provide commentary on the need for greater oversight and stewardship of the increasingly marketised aged care sector, which has become dominated by large for-profit providers and lost focus on its values and social ‘mission’ to provide safe and high quality care.
Advocates and system navigators to support people to access services that meet their needs
The Commissioners recommend funding for a new workforce of personal advisers for older people, their families and carers, called ‘care finders’ from July 2023 (Recommendation 29). Care finders would help people to find information, identify and link into options and act as a case manager. The Commissioners also recommend further consultation to determine the extent of unmet demand for advocacy services, and in light of findings, increased funding to establish a sustainable funding base. In the interim, additional funding should be provided by July 2021 to enable at least 5 per cent of older people to access advocacy services, to increase education and systemic advocacy, and to support the capacity of the advocacy network through training and consistent guidelines and processes (Recommendation 105).
Support for carers of older Australians
The Commissioners recommend strengthening support for carers by ensuring carers are identified during assessment processes and referred to respite and other supports. They call for better links, referral and information sharing between My Aged Care and the Carer Gateway (Recommendation 42).
Carers’ rights to access support for themselves and those they care for would be enshrined in the new Act proposed by the Commissioners. This has been welcomed by Carers Australia:
“The Commission has highlighted a clear common theme in what the community expects from the aged care system which includes the desire for a good quality of life and ageing at home. This can only be achieved if informal carers are supported in their role with readily available respite, training, and support services.”3
A community-based Carers Hub network is also proposed.
Commissioner Briggs also proposes the Government examine the potential impact of amending the National Employment Standards to provide for an additional entitlement to unpaid carer’s leave, with results of this investigation made public by 31 December 2022 (Recommendation 43).
Safe, high quality, person-centred residential aged care
There is a suite of recommendations to improve oversight and regulation of the quality and safety of residential aged care including:
- new provider approval requirements by July 2024 (Recommendation 94)
- accreditation requirements for high-level home care services by July 2024 (Recommendation 93)
- protection for whistle-blowers through the new Act (Recommendation 99)
- a new and expanded incident reporting scheme (Recommendation 100)
- greater monitoring powers of Quality Regulator to conduct inquiries, enter premises and access documentation (Recommendation 97)
- a wider range of enforcement powers to issue infringement notices, banning orders, suspend or remove people responsible for non-compliances and/or revoke a provider’s approval (Recommendation 103)
- Improved complaints management through a Complaints Commissioner responsible for handling complaints, referring and coordinating complaints, and promoting open disclosure and better practice in complaint handling (Recommendation 98).
Minimum staff time quality and safety standards
The Commissioners recommend the introduction of minimum quality and safety standards relating to staff time and skills mix for approved residential aged care providers. It is proposed that from 1 July 2022, a minimum staff time standard of 200 minutes per resident per day for the average resident is recommended, with at least 40 minutes of that staff time to be provided by a registered nurse. In addition, the standard should require at least one registered nurse on site per facility for the morning and afternoon shifts (16 hours per day). These timings and shifts are proposed to increase from July 2024 to a minimum of 215 minutes per resident per day for the average resident, at least 44 minutes of that staff time provided by a registered nurse, and a requirement to have at least one registered nurse on site per residential aged care facility at all times. (Recommendation 86). It is also recommended providers be required to report quarterly staffing hours by July 2022 (Recommendation 122).
Restricted prescription of antipsychotics in residential aged care
The Commissioners express concern about the overuse of medication or chemical restraint via inappropriate use of antipsychotics. They recommend that the Pharmaceutical Benefits Scheme Schedule is amended by November 2021 to enable only psychiatrists or geriatricians to initially prescribe antipsychotics as a pharmaceutical benefit, and to enable general practitioners to issue repeat prescriptions of antipsychotics as a pharmaceutical benefit for up to a year after the date of the initial prescription.
A skilled, experienced and valued workforce
The Commissioners make a range of recommendations to attract, retain and upskill the aged care workforce, which needs to grow to over 800,000 people by 2050 to meet the demands of the ageing Australian population.4 Key recommendations include:
- the establishment of an Aged Care Workforce Planning Division to undertake long-term workforce planning and modelling and develop an interim workforce strategy and framework, informed by a workforce census every two years, consultation with the education and training sector, and a focus on addressing service coverage in thin markets (Recommendation 75)
- a review of the aged care qualifications and skills framework, occupational groups and job grades, competency and accreditation requirements, job titles and definitions (Recommendation 76) and of certificate-based courses for aged care (Recommendation 79)
- collaborative work to map aged care career pathways and deliver a national multimedia awareness campaign (Recommendation 76)
- the introduction of Certificate III as the mandatory minimum qualification required for personal care workers performing paid work in aged care (Recommendation 78)
- the establishment of a national registration scheme for the personal care workforce (Recommendation 77)
- fast-tracked development of accredited, nationally recognised short courses, skills sets and micro-credentials for the aged care workforce (Recommendation 81)
- funding for teaching aged care programs, in collaboration with educational institutions and facilitating placements for students (Recommendation 83) and a scheme to reimburse providers for the cost of education and training of their direct care workforce (Recommendation 114)
- the introduction of policies and procedures to preference direct employment of staff (Recommendation 87).
The Commissioners also recommend the Government, the Aged Care Pricing Authority, employee representative organisations and employers collaborate to apply and vary wage rates and awards to reflect the work value of aged care workers, seek to ensure equal remuneration for men and women workers, and ensure pricing reflects the costs of delivering high quality and safe care (Recommendations 84 and 85).
Better access to health services
To support the health of older Australians, the Commissioners recommend short-term changes are made to the Medicare Benefits Schedule to improve access to medical and allied health services (Recommendation 61) and the establishment of a new Senior Dental Benefits Scheme from January 2023, to fund dental services for people living in residential aged care, people who receive the age pension and/or qualify for the Commonwealth Seniors Health Card. Dental benefits are proposed to be set at a level that minimises gap payments and to subsidise the additional costs related to outreach services and travel to remote areas (Recommendation 60).
Clearer roles and responsibilities between governments
The Commissioners recommend the National Health Reform Agreement is amended to include a specific statement of roles and responsibilities of aged care providers, States and Territories in relation to health care (Recommendation 69), similar to the Applied Principles and Tables of Support established to support interfaces with the National Disability Insurance Scheme (NDIS).
Further policy directions
Achieving the transformational change required to improve and reform the aged care system will take commitment and investment. The Commissioners note in their summary:
“Over the last several decades, successive Australian Governments have brought a level of ambivalence, timidity and detachment to their approach to aged care. Responsibility for critical governing functions of setting goals, close monitoring and timely interventions has not been articulated adequately.”5
While the Commissioners provide alternative recommendations in some areas of the final report, they both strongly conclude that fundamental change is needed.6 The positioning of aged care as a lower priority, and insufficient and insecure funding that focuses on restraining growth in expenditure, must be addressed.
A strong governance approach
The Commissioners present different approaches to future governance of the aged care system –Commissioner Pagone recommends an independent statutory body, the Australian Aged Care Commission, is established to act as system governor, administrator and regulator (Recommendation 5), whereas Commissioner Briggs recommends these responsibilities remain with a reformed department.7 The Commissioners also recommend an independent review of the Aged Care Quality and Safety Commission by May 2021, with findings to be addressed by January 2022 (Recommendation 104), as well as more public reporting from the Commission or its successor body (Recommendation 105).
Adequate and sustainable funding
The Commissioners made separate recommendations in relation to how aged care should be funded. Commissioner Pagone recommends a Productivity Commission investigation into financing of the aged care system through an Aged Care Levy (Recommendation 138) and Commissioner Briggs recommends the introduction of a 1 per cent flat rate levy on taxable personal income by July 2022 to establish an aged care improvement levy (Recommendation 144). Both Commissioners recommend individuals who assessed as needing certain supports should not be required to contribute to the care-related costs (R 125). Commissioner Pagone and Commissioner Briggs provide different proposals for co-contribution and means testing for individuals accessing residential aged care (Recommendations 128, 129, 140, 141). The question of funding should not undermine the urgency with which governments need to act.
Additional measures that support people to age-in-place
The recommendation to immediately address the Home Care Package waiting list will support more older people to age in place, and support carers in their caring role – however, other measures will be important in supporting people to live at home for longer, including improved access to affordable and accessible housing, reducing poverty and disadvantage, promoting health and wellbeing services and building social and community connections.
To read the Royal Commission’s full report, summary and recommendations, visit the Aged Care Royal Commission website.