The Royal Commission into Aged Care Quality and Safety kicks off on Friday with the first preliminary public hearing in Adelaide.

At the hearing, the commissioners will set out their vision for the Royal Commission, including conduct, and Senior Counsel assisting the Royal Commission will make a brief opening statement. No witnesses will be called. We’ll have to wait till February for that. Public submissions will be accepted until at least the middle of the year.

Not surprisingly, there has been little of the sort of outrage we saw when the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry was announced – and indeed during the debate over whether it should happen at all. In hindsight, that inquiry was entirely justified, although no one realised quite how much it was needed at the time.

I suspect that, like the Hayne inquiry, no one realises how much we need this one, either.

CoreData will be providing updates and insights as the inquiry unfolds. We’ve been researching older Australians since 2002, and have taken a keener interest in the aged care sector since the industry began undergoing deregulation.

Recently, we’ve produced whitepapers on the state of the sector, a report on consumer brand perceptions and research into the aged care decision journey.

So what is this Royal Commission all about and how did we get here?

The commission was born of recognition that older Australians not only “deserve high quality care in a safe environment that protects their wellbeing and dignity”, but are an increasing proportion of our population, meaning the number of people accessing care is growing.

The inquiry covers all forms of Commonwealth-funded aged care services, and all aspects of the quality and safety of aged care services. The commissioners have also been told to have regard to:
• the critical role of the aged care workforce, and need for close partnerships with family, carers and others providing care
• the wide diversity of older Australians and the barriers faced in accessing and receiving high quality care, taking into account the increasing incidence of chronic and complex conditions
• how people transition from other care environments or between aged care settings – including primary health care services, acute care and disability services
• good practice and innovation
• the findings and recommendations of previous relevant reports and inquiries

What would be “good” outcomes of the royal commission?

More highly trained staff
Addressing the skills shortage so that staff are fully qualified to provide the level of care that customers deserve and family members expect.
Empowered customers
Ensuring people are able to choose the care that best suits their needs, rather than being forced down the only path they can afford to take.
Improved industry reputation
Creating a sector respected for the important service it provides and the quality of care, making it a more attractive job path for young, educated people, reducing the reliance on unskilled workers to meet the demand for carers, and giving people more confidence when placing family members into care.
Healthcare prioritised
Creating an environment where providers are incentivised for keeping people living happy, healthy lives for longer (rather than the current model in which quick turnover of beds is the most financially sustainable outcome for providers).
Innovation in dementia care
Fostering innovation in technology and design so dementia patients are able to remain in home care for longer, and when in residential care, the environments have more regard to allowing patients to live well despite the disease.

 

Terms of reference

The inquiry will cover six key matters:

1. Quality

The quality of aged care services provided to Australians, the extent to which those services meet the needs of the people accessing them, the extent of substandard care being provided, including mistreatment and all forms of abuse, the causes of any systemic failures, and any actions that should be taken in response

While it’s impossible to predict what’s to come, it is safe to expect that some of the stories that will be shared throughout this commission will cast doubt in the minds of Australians about the sector’s ability to provide the quality of care they would hope to achieve for themselves and their loved ones.

One would hope, however, that by surfacing instances of substandard care or even abuse, we will be able to address any systemic failures that have allowed them to occur, thereby improving the quality of aged care for future generations.

2. Delivery

How best to deliver aged care services to:
(i) people with disabilities residing in aged care facilities, including younger people; and
(ii) the increasing number of Australians living with dementia, having regard to the importance of dementia care for the future of aged care services;

According to Alzheimer’s Australia, the number of Australians with dementia will rise to 760,000 in the 20 years to June 2036, placing it at the forefront of the nation’s aged care problem.

Care for dementia sufferers costs on average $55,904 in a residential setting in the first year – well above a yearly stream of daily accommodation payments. The cost of care rises exponentially as symptoms and the condition deteriorate, usually resulting in a need for 24/7 care and assistance.

Exploring more innovative ways to deliver aged care to sufferers of dementia is a critical part of the commission’s scope.

Alzheimer’s WA is providing leadership in this area, via the Dementia Enabling Environments project, which aims to facilitate the creation of supportive environments for people with dementia, as well as its consultancy arm.

3. Accessibility

The future challenges and opportunities for delivering accessible, affordable and high quality aged care services in Australia, including:
(i) in the context of changing demographics and preferences, in particular people’s desire to remain living at home as they age; and
(ii) in remote, rural and regional Australia;

CoreData’s 2018 Australian Aged Care: An Industry in Flux whitepaper, found the trend towards home care continues, with the number of Australians accessing home care increasing by 8.5% in the year to June 2017, compared to just 2.4% growth in take up of residential care.

However, our primary research into the aged care journey decision process suggests resistance to change and a desire to maintain independence are key barriers faced by partners and relatives when attempting to find the right care for their loved ones.

This becomes even more challenging when the individual is facing cognitive decline, as is the case with dementia, and is not able to remain in their home.

The challenges of affordability and accessibility are exacerbated by the difficulty providers face in attracting and retaining enough skilled workers to service the demand. CoreData’s whitepaper found while nearly two in three aged care facilities with direct staff cite a skills shortage, this figure rises to 87.7% in very remote areas.

4. The system

What the Australian Government, aged care industry, Australian families and the wider community can do to strengthen the system of aged care services to ensure that the services provided are of high quality and safe;

Collaboration is essential to finding the right solutions for the delivery of high quality, affordable aged care to Australians.

When cases of substandard care are inevitably raised throughout the commission, attention must be placed on not only what we can do to ensure it doesn’t happen again, but why it occurred in the first place.

The skills shortage, coupled with the pressure on providers to meet the Aged Care Quality Standards, makes providers potentially vulnerable to breaches of their compliance obligations without immediate and continued workforce training.

As was seen in the fallout from the Hayne commission, there is no quick fix to dealing with shortcomings. The commission’s recommendations will likely focus on cross-sector partnerships and steps that can be taken as a broader community, as well as by individual providers.

5. Person-centred care

How to ensure that aged care services are person-centred, including through allowing people to exercise greater choice, control and independence in relation to their care, and improving engagement with families and carers on care-related matters;

In a consumer-directed care environment, person-centred care is essential for providers to offer care solutions that meet Australians’ evolving needs.

In a recent roundtable we held with a number of key aged care providers in WA, it was considered important to preserve the right of free choice for the individual in care to maintain their independence.

One CEO mentioned the need to spark a conversation in the community around the dignity of risk; a believe that people need to be able to take risks without providers or families imposing restrictions that limit their free will.

6. Sustainability

How best to deliver aged care services in a sustainable way, including through innovative models of care, increased use of technology, and investment in the aged care workforce and capital infrastructure;

Moving forward, Australians will likely need to pay more from their hip pockets for care. Government assistance at the current levels is not considered sustainable, and yet innovation is required to ensure this does not make the sector even less affordable or accessible to the everyday person.

Technology has a key role to play in the delivery of care, in partnership with humans, and ability to predict and track changes in human behaviour and monitor health.

If, like us, you’re keen to follow the proceedings and will not be in Adelaide on Friday, you can access a live streaming of the hearing through the Royal Commission’s website. A transcript will also be available on the site following the hearing.