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Royal Commission

Focus needed on the critical issue of quality of care for older Australians

The royal commission into aged care announced by the prime minister on Sunday is long overdue and not unwelcome.

My hesitation is because we need to know if the commission will focus on clinical care and not delay urgently needed reform on staffing levels and transparency of performance data.

Although the terms of reference are yet to be announced, the prime minister’s comments suggest it will focus on the quality of care provided in residential aged care facilities and in-home care.

The Minister for Aged Care recently ruled out the need for a royal commission. Some commentators suggest that the announcement has a lot to do with a two-part ABC Four Corners program that aired on Monday night. The program highlighted heartbreaking stories of neglect, abuse and negligence in aged care homes that occur across Australia.

Next week’s program will include a case study from the Hunter. A royal commission will put a spotlight on providers of residential aged care and in-home care. It will allow for a national conversation on what older Australians and their families expect in relation to aged care. This is important because both sides of politics have been relatively silent on the aged care crisis and real reform.

The federal government and many peak bodies have continued to assert, in the face of escalating aged care horror stories in the media, that we have a “world class” residential aged care sector.

There is huge variability in the standards of residential aged care. There are many facilities where residents and their families are happy with the quality of care. Like the banking royal commission, this commission will, sadly, unearth many horror stories.

What we don’t need is a commission that merely points out the obvious – there is a crisis in aged care. Over the past two decades there have been numerous reports and inquiries into aged care, but they haven’t focused on the critical issue of quality of care. We don’t need more window dressing such as the government’s recent bureaucratic “reform” to merge several under performing and toothless regulatory agencies.

Ultimately the quality of aged care comes down to staffing.  Numerous international studies demonstrate a clear link between mandatory staff ratios and good quality residential care. Yet providers are currently make staffing decisions without recourse to any regulatory standards.

South Australian MP, Rebekha Sharkie, has a Private Member’s Bill (Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018) before federal parliament to make providers publish staff-to-resident ratios by job description on the My Aged Care website. The government has referred the bill to a Standing Committee on Health, Aged Care and Sport inquiry. The government needs to go further and mandate minimum ratios as is this case in hospitals and child-care centres. Transparency of data needs to be the subject of regulation.

Government agencies and aged care providers collect data on staffing levels and other quality indicators including the incidence of pressure sores, falls, and medication errors, but it is hidden from the public. Such data helps people to make informed choices about how to provide the best care to those receiving aged care.

I share the Council on the Ageing’s worry that the commission could stall urgently needed improvements to the sector.  There is no confirmed start date for this proposed commission and these inquiries don’t move quickly.  There’s no reason why the obvious measures of staffing ratios and data transparency should be stalled by the commission.

The commission should review of the 1997 Aged Care Act. The act heralded a deregulated aged care sector which led private equity firms, foreign investors, superannuation funds and investment trusts in to the market. The dean of the University of South Australia’s law school, Wendy Lacey, correctly points out that under the act there is a complete absence of legal obligation on the part of facilities for minimum staffing requirements or to proactively promote the mental health and well-being of their residents.

Sensible regulation and transparency will reward good providers and jettison poor providers, who are more focused on profit than care, from the industry. Until we have aged care reform and better care, more older Australians will die before their time or be the victims of appalling neglect.

They deserve better.

This article was featured in the Newcastle Herald on September 18th,  2018.

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