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The royal commission report should give the Australian government a plan to fix aged care. Will they act on it?

Sarah Russell
·6 min read
<span>Photograph: Paul Miller/AAP</span>
Photograph: Paul Miller/AAP

On the eve of ABC Four Corners’ expose of the extremely distressing way older people were being treated in residential aged care homes, the prime minister, Scott Morrison, announced a royal commission into aged care.

The announcement surprised everyone, including then aged care minister Ken Wyatt. He had said a few days earlier that a royal commission would be a waste of time and money. “After two years and maybe $200 million being spent on it, (it) will come back with same set, or very similar set, of recommendations”.

Related: ‘Failing our older citizens’: most people willing to pay higher taxes to improve aged care

Like many of us aged care advocates, Wyatt argued we didn’t need an expensive royal commission to tell the government the aged care system was broken. We already knew that. Over the past 20 years numerous inquiries, reviews, consultations, thinktanks and task forces had produced mountains of evidence of inadequate personal care, negligence, neglect, abuse and assault in aged care homes.

Research has also shown the parlous state of home care. In addition to the long queue for home care packages, there is the commodification of older people, the rorting in the system, inconsistent quality of care, and support workers with minimal or no training being sent to the homes of older people.

Yet successive governments had ignored most of the recommendations of said inquiries and reviews. Will the findings of the royal commission into aged care quality and safety be similarly ignored?

The government and the regulator have known for years that high quality aged care was not being delivered on a systemic level. Although some aged care providers provide excellent services, others do not.

As for the ineffective regulation, how is it possible that two brothers banned from the poultry industry for 17 years after starving more than 1 million chickens were given an aged care licence, despite being bankrupt at the time and having no experience?

We urgently need a new Aged Care Act that focuses on the human rights of older people, not the profits of providers

Not surprisingly, the concerns most commonly raised in submissions to the royal commission were neglect, emotional abuse, physical abuse or assault, restrictive practices, financial abuse and sexual abuse/assault.

The counsel assisting the royal commissioners estimated that at least one in five people receiving residential aged care experiences substandard care. Imagine if one in five children received substandard care in childcare centres. We would all be marching in the streets.

After two years of heart-breaking evidence, including evidence from older people and families, there is a glimmer of hope that the royal commissioners’ final report, due on Friday, will provide the government with a plan to fix aged care. The real hurdle will be the government acting on the recommendations.

If nothing else, the royal commission has shown us that we need to listen, really listen, to older people and their families. Those with experiences of using the aged care sector hold the key to fixing the sector.

For too long, the government has ignored the views of older people. For example, in 2017, Wyatt invited me to a “Consumers in Aged Care Think Tank”. Sitting at the table were 17 chief executives, including CEOs of the government-funded consumer organisations National Seniors and Cota. Not a single older person receiving aged care services was at the table. Would Wyatt consider having a thinktank about provision of aged care in Indigenous communities without a First Nations elder at the table?

Historically, older Australians who use aged care services have never had a seat at the table. We saw evidence of this during the lockdown of aged care homes, where each provider made individual decisions, irrespective of the wishes of residents and their families.

More recently, six provider peak bodies formed a collaboration. Part of their narrative is saying that the sector needs more money. And yes, the sector does need more money. However, the government should not give more funding to aged care providers without fundamental reform of the system.

When three critical amendments to the Aged Care Legislation Amendment (New Commissioner Functions) bill 2019 were tabled, provider peak bodies lobbied against the financial transparency amendment by producing a “red tape” report. It claimed that sharing financial data with the public led to excessive costs.

Without financial transparency, the public has no way of knowing how providers spend billions of dollars of government subsidies. Do they spend our taxes on nursing care, meals and activities for residents or on sports cars for their executive team?

We urgently need a new Aged Care Act that focuses on the human rights of older people, not the profits of providers. This was the first recommendation of Counsel Assisting the royal commissioners. Let’s hope it is top of the royal commissioners’ recommendations too. Without a new Aged Care Act there can be no genuine reform.

One of the most common complaints heard during the royal commission is aged care homes do not employ enough staff. The current Aged Care Act (1997) states that providers are required to employ “adequate numbers of appropriately skilled and trained staff”. This lack of clarity enables providers to determine what is an “adequate number” and what is “appropriately skilled”. As a result, private providers can replace registered nurses with much less skilled staff.

Related: Aged care has been failing for years – coronavirus has merely highlighted systemic problems | Sarah Russell

The royal commissioners must recommend ways to ensure more staff are employed and that there is a mix of skills necessary to provide high quality care. At the very least, every aged care home must be required to have a registered nurse on site at all times.

A senior source in the aged care sector said it was “astonishing” that “even lower-skilled staff are being snuck into aged care under the cover of Covid-19”.

Other recommendations we hope to see are the disclosure of performance indicators, public access to spot-check reports and public reporting of complaints, including how they are managed and resolved. This will enable older people and their families to make informed decisions when choosing an aged care home.

Most importantly, the government must stop listening only to providers. It is only by including all stakeholders – older people, families, staff, advocates, providers, peak bodies, advocates, unions, academics, health bureaucrats, and politicians – that older people in Australia will receive the care and support they need.

Older people, families and friends, current and retired aged-care workers and others who are passionate about social justice have recently joined forces to lobby government for meaningful reform. It is beholden on the government to listen to us.