Two new major reports for the Royal Commission into Aged Care Quality and Safety by Flinders University researchers show that Australia is lagging well behind other overseas countries when it comes to aged care funding, staffing and innovation. The reports identify many opportunities for improvement. They reinforce the major problems, and the need for major changes to be made to Australia’s aged care system, that have been highlighted over and over again by many experts and aged care advocates.
One report examines how aged care is delivered in 22 countries and the types of innovative approaches used. Denmark and Sweden are identified as countries with good quality long term care systems. Both have government expenditure on long term care for older people greater than 4 per cent of GDP. Both countries fund long term care through local authorities with federal grants and local taxes. The focus is on providing long term care in people’s homes with a moderate proportion of care recipients in residential care institutions.
In contrast, Australia spends around only 1.2 per cent of GDP on long term care – sadly among the lowest of the countries in the study. The big difference between Australia and other countries is our approach to long term care. The researchers found that the best performing countries focus on “ageing in place” whereas we focus on residential care. Around 45 per cent of Australia’s long term care recipients are in residential institutions.
The report focuses on staffing levels in our residential institutions which are – unsurprisingly – at the lower end of the range internationally – for both total staffing and nursing. The report rightly recommends increased transparency in staffing levels and mandatory training or registration of care workers to improve professionalism and care. Mandatory staffing ratios – as are in place in hospitals and day care centres – would help address that issue.
Australia scores less well than many for quality of coordination between long term care and other services including health care. This is not surprising given the appalling care I often see in my work representing families of aged care residents and those shared at Royal Commission hearings.
Many other better performing nations have multiple levels of responsibility for regulation of quality. Here we have a single central regulator, the Aged Care Quality and Safety Commission, which lacks independence and has a poor investigative model and a multiplicity of functions.
An increasing number of countries use mandatory reporting and provide public quality of care data to empower consumer choice and drive improvements in quality. We have no such system in Australia which leaves aged care facilities able to hide poor performance and older people and their families in the dark when comparing facilities.
The report authors note the need to think of a care system from the social rather than just economic perspective. The problem is our Aged Care Act. It is weighted in favour of providers and has promoted the privatisation of services, allowing profits to prevail over quality of care. It needs to be rewritten, before funding is increased to the sector.
One of the reports examines approaches to aged care that are not widely available in Australia. The Commission is discussing models for and approaches to care at an upcoming workshop in Adelaide. Models being discussed are increased support for home-based care and informal carers; individualised training for people with dementia living at home and their carers; system navigators to facilitate streamlined access to care for people with dementia or other chronic health conditions; small, domestic residential care homes; respite services aligned to people’s backgrounds, such as farm settings for people with dementia living in agricultural areas; telehealth communications; and ‘health smart homes’ which monitor a person’s health conditions and signs they need assistance. This is important work and these initiatives will improve care for older people.
But, here we have more reports reinforcing the issues highlighted in the Commission’s hearings and the countless inquiries and reports produced over the past two decades. Our aged care system is broken and better performing countries have different approaches to aged care provision, staffing, and regulation. The Government must start to act on these matters before the Royal Commission’s final report is handed down at the end of the year.
This opinion piece appeared in the Newcastle Herald on Saturday 8 February 2020.