A system in crisis

Neglect.

The word pretty much says it all. So much so it became the title of a report from the Royal Commission into Aged Care Quality and Safety, which made some rather damning statements about the sector.

“As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities,” the report says.

“The system lacks transparency in communication, reporting and accountability. It is not built around the people it is supposed to help and support, but around funding mechanisms, processes and procedures.

“Left isolated and powerless in this hidden-from-view system are older people and their families. ‘This is not a life.’ ‘This is not my home.’ ‘Don’t let this happen to anyone else.’ ‘Left in her own faeces, and still no one came.’ ‘Mum doesn’t feel safe.’”

You would not be crazy in thinking these statements were in response to the COVID-19 pandemic, in particular Victoria’s second wave, which resulted in a disproportionate number of deaths in aged care facilities. But you would also be wrong. They were from the royal commission’s interim report – from October 2019. The novel coronavirus wasn’t even born then.

Prime Minister Scott Morrison called for the royal commission earlier than that – in October 2018.

COVID-19 fuelling the fire

A year after the interim report, the royal commission put out a special report that put into consideration COVID-19’s impact on the country’s aged care facilities.

The commission was caught by surprise by the pandemic and had to adjust accordingly.

“When the Prime Minister [Scott Morrison] announced this royal commission in 2018, nobody could have foreseen that the aged care sector would find itself in the grips of a pandemic as we approach the end of our work,” the special report reads.

“Like others, we have had to respond to the changes brought about by the pandemic.”

The disproportionate impact of COVID-19 on the aged care sector cannot be underestimated.

As of 21 October, 683 of Australia’s 905 COVID-related deaths have come from people living in aged care facilities.

Even more shocking is that 653 of those 683 deaths come from Victoria, of which a significant proportion comes from its second wave that began in July.

Even more shocking after that is that 28 of the remaining 30 deaths in aged care are from NSW, most of which come from its first wave back in late March and early April. The remaining two deaths are from Queensland and Tasmania.

Following the royal commission’s inquiry into the aged care response to COVID-19, it identified four areas where immediate action should be taken.

First was ensuring enough staff are available to deal with external visitors. Second was an increased provision of allied health and mental health services to people living in aged care. Third was a national aged care plan for COVID-19 from the federal government as well as the establishment of a national aged care advisory body.

The last area of improvement was in the deployment of accredited infection prevention and control experts into residential aged care homes.

Aged care also became a major focal point in the 2020-21 federal budget. It allocated $408.5 million towards improving the aged care system. The major element of that allocation was the delivery of 23,000 home care packages with an estimated cost of $1.6 billion.

In response to the royal commission’s COVID-19 report, the federal government added another $1.6 billion towards the sector’s pandemic response. Other aged care initiatives include $29.8 million to implement the Serious Incident Response Scheme, $91.6 million over four years to create an independent assessment service for the new residential care assessment and funding tool, and $35.6 million over two years extending the Business Improvement Fund to help restructure residential aged care.

The chief executive of the Council on the Ageing, Ian Yates, broadly welcomed the federal budget, especially the additional home care packages, but also expressed disappointment there was no commitment or plan to get waiting times down to 30 days and ensure no one is prematurely forced into residential care.

“The new home care packages are a substantial step forward and to be applauded, as are the supporters of our ‘Safer at Home’ campaign who lobbied for this, but we still have a way to go and more will need to be done in the May 2021 budget,” Mr Yates says.

Long-term systemic issues

Coronavirus aside, the problems in aged care have been well-documented over a long period of time with successive governments of both persuasions unable to make any significant leeway in repairing the damaged system. The commission highlighted that the system has been the subject of more than 35 major public reviews over the past 40 years.

That doesn’t include the numerous internal reviews, studies and consultations commissioned by the Australian Department of Health.

The most notable bureaucratic change occurred in 2010 when the Commonwealth assumed full responsibility for the aged care system as part of the National Health Reform Agreement it negotiated with the states and territories. As for changes that help the older Australians under the system’s care, progress has been slow, and many of the government reviews over the past 20 years have identified the same problems.

“Underlying all of these failings is the fundamental reality of loss of autonomy, dignity and wellbeing that too many older people suffer when they enter the aged care system,” the commission said.

But perhaps the most searing indictment of the aged care system, of which there have been many, was the commission hearing that, on average, 50 people in residential aged care across Australia are sexually assaulted each week.

Counsel assisting the inquiry Peter Rozen QC told the inquiry that the commission received 588 submissions mentioning sexual assault. Further, it heard that 426 allegations of sexual assault in residential aged facilities were reported to the federal Health Department in 2014-15.

Mr Rozen called the finding “a national shame”.

“That number of 426 increased to 790 in the year 2018-19 … the increase in the reporting of allegations of assault was far greater than could be accounted for by the increase in the number of permanent residents over the same time period,” says Mr Rozen.

“Many witnesses have explained they placed their loved ones in residential aged care because they felt it would be safer for them, or because safety was a concern.

“It is therefore entirely unacceptable that people in residential aged care face a substantially higher risk of assault than people living in the community.”

The crisis continues

The commission has recommended the federal government report to Parliament on the aged care crisis by no later than December 2020.

Following that, and like pretty much everything else in response to the pandemic, the royal commission’s final report will be handed down on the postponed date of 26 February 2021, several months later than the original date of 12 November 2020.

Sweeping reforms to the system will be expected. Even before the handing down of the final report, 124 recommendations have already been put forward by the commission so far.

“We do this now because we do not know how long the pandemic will last. Its end is impossible to predict,” says the interim report.

“However, aged care residents continue to suffer and, tragically, some more may die as a result of COVID-19.”

Sadly, the aged care crisis looks set to continue for a while yet.