Hearings of the Royal Commission into Aged Care Quality and Safety were held in Adelaide during February and March with more than 28 key witnesses taking part.

The first public hearings in February focused on key features of the aged care, quality, safety and complaints system, how that system works in practice and at a general level. During March the focus was on aged care in the home.

Underlying themes and issues

Senior Counsel Assisting, Mr Peter Gray QC, said the following issues were highlighted by the evidence presented at the hearings:

• How the current aged care system is failing to meet community expectations.
• The impact of Australia’s changing demographics on the aged care system.
• Specific clinical concerns arise in caring for older people, including the skills required of doctors, nurses and personal care attendants.
• Creating an aged care sector which properly cares for Australians with dementia.
• The current aged care funding model and proposed alternate approaches to managing the funding of aged care.
• The importance of an aged care system which values the choices of individuals receiving care and is people-centric.
• Aged care staff resourcing, quantity and quality.

The stats speak for themselves

The number of Australians over 85 is expected to double by 2066, according to Justine Boland of the Australian Bureau of Statistics. Their number will increase from 2.2% to 4.4% of the population.

The number of people with dementia continues to increase. Dementia Australia Chief Executive Maree McCabe said there were about 436,000 Australians living with dementia today and by 2050 that number would surge to 1.1 million.

Mr Paul Versteege, Policy Manager of the Combined Pensioners and Superannuants Association, said that the inability to access aged care because of the vast undersupply of places and packages is itself a safety issue. The Commonwealth Department of Health spent about $18 billion on aged care in 2017, with $12.2 billion of that going to residential care. Over 83,500 beds will be needed in the next 10 years, according to Mr Richter of the Aged Care Guild.

Associate Professor Edward Strivens, President of the Australian and New Zealand Society for Geriatric Medicine, told the Commission that psychotropic drugs (antidepressants, antipsychotics and sedatives) are often the first port of call to restrict or sedate movements. He said they should be used as a last resort and the reasons behind behaviour needed to be looked at.  “When all you have is a hammer, every problem looks like a nail,” Associate Professor Strivens told the Commission. Medications were also causing more falls, strokes and deaths.

International studies have found that about 80% of residents are prescribed psychotropic medications, with 10-20% efficacy rate. Last month, Commonwealth Minister for Aged Care Ken Wyatt announced new regulations around the use of physical and chemical restraints in nursing homes.

Aged and Community Services Australia Chief Executive Patricia Sparrow said the workforce needed to triple by 2050 in order to meet the needs of an ageing population. Attracting, retaining and training staff is problematic. Staff are underpaid; remuneration and funding are said to be inadequate.

Elder abuse is an important area to be addressed by the Royal Commission. The Department of Health confirmed there were 3,773 reported assaults in 2017/18, with those numbers likely the tip of the iceberg according to Paul Versteege.

Home care

The Adelaide Aged Care Royal Commission heard evidence regarding the difficulties in accessing Commonwealth funded Home Care packages. These assist with household modifications such as shower fittings plus shopping, groceries and medication supply. Average waiting periods are 18 to 24 months, which Professor McCallum of Seniors Australia described as a “running sore” and “profoundly critical failure.” A person assessed by the Aged Care Assessment Team at Level 2 might require Level 4 assistance by the time the package arrived.

Dr Sarah Russell of Aged Care Matters this month published ‘Older People Living Well

with In-Home Support’. The report documents her research on the Commonwealth Home Support Programme and has feedback from recipients of home care. Dr Russell identified several systemic problems with home care packages, including:

• Inability to access reliable information
• High fees
• Unclear financial statements
• No benchmark for costs (e.g. hourly rates)
• Lack of audits
• Poor quality of some services
• Poor communication
• Staffing issues – inadequate training, insufficient numbers, high turnover of case managers and support workers
• Ineffective complaints system
• Policy of full cost recovery

Future hearings in 2019

The Aged Care Royal Commission will conduct hearings in all capital cities, plus several regional locations, from May through to December. The location of each hearing will be announced progressively during the year as arrangements are finalised.

Catherine Henry Lawyers look forward to the Commission examining these important issues further. Be sure to follow along as we provide regular updates on our blog page.