The Royal Commission into Aged Care has found significant fault in the aged care system as a whole and uncovered neglect, abuse, indifference, and poor leadership. It says one third of aged care residents received substandard care

While money alone does not solve these problems, current expenditure on aged care is about half that of the average spent by OECD countries with Denmark and Sweden expenditure at 4% of GDP, funded by a universal tax base. 

The inescapable challenge is that Australia spends less than half of what comparable countries do on aged care, at 1.2% of GDP versus an OECD average of 2.5%.

 Australian Aged Care Collaboration (representing the not-for-profit aged care providers).

More staff, more training, higher wages and better oversight are needed for this. The Royal Commission concluded that an extra $10 billion a year would be required.

The Federal Government responded to the Royal Commission’s final report on the day the 2021-22 budget was handed down. See here for our take on the budget for aged care.

What’s needed urgently

A universal right to high quality, safe and timely support and care, free from mistreatment and neglect, inhumane treatment and any form of abuse
Aged care services as a right rather than capped arbitrarily
Supports for people to live as independently as possible, at home or in residential care
Mandatory minimum qualifications and national registration for aged care staff
Care delivered by a qualified, well-trained, well-paid workforce of nurses, personal carers, allied health and palliative care teams, all with a good understanding of dementia care.
One registered nurse on site at all times, an appropriate mix of skills and daily minimum staff time of at least 200 minutes for each resident.
An increase in overall funding of $10 billion a year
Home care packages that are assessed independently and not capped
An independent Inspector-General of Aged Care for better oversight
An NDIS-style program for over 65s for rehabilitation and disability
A reduction in the over-reliance on chemical restraints
A stop to the flow of younger people with disability going into aged care by providing specialised accommodation
Quality of care indicators to be made publicly available and include staff hours, standardised statements of care for home care, and more transparent financial reporting. 

Aged care can also be substantially improved by:

Community-based residential and home services that are inter-connected, auspiced by local government and with local government playing a role in oversight 
Residential aged care that is, as far as possible, home-like, familiar, stimulating, and welcoming for visitors, informal carers, children and animals. 
Music, the creative arts, access to gardens, fresh air and sun – all essential for well-being
A greater integration of aged care with health care system and hospitals better equipped and trained for geriatric care
A rehabilitation first approach so exercise and activity, function and autonomy are maintained for as long as possible
Standards set for dementia-friendly building design and layout 
Aged care staff who are patient, kindly and trained in best practice in working and communicating with people with dementia and other cognitive impairment
A systematic, sector-wide approach to addressing linguistic and gender diversity and using inclusive practices
Respect for end of life decisions made by people in aged care
A simpler and fairer approach to means testing
Stronger governance, regulation of the quality of care, prudential regulation, and an independent mechanism to set prices and a system for filling gaps in services. 
Establish a council of elders with membership to include diverse voices with lived experience of aged care
Adopt principles of collaboration and co-design to inform, guide and review aged care reforms.

The issues

Home care

There are ~120,000 people currently on waitlists for home-based care. This is a disgraceful lack of services. It also results in people being forced into residential care prematurely and is arguably a significant factor in Australia’s disproportionately high ratio of people in residential care.

There is a current shortage of home care support staff and monitoring and oversight of home care has been found wanting. After years of neglect, addressing this shortcoming should be a high priority for Government.

Low wages and Covid

Personal care workers make up 70% of the aged care workforce and are paid barely above the minimum wage. 29% of the personal care workforce have no formal qualifications. Nurses are paid less than their counterparts in other health sectors.

Due in large part to low wages, the aged care sector relies heavily on migrants and international students on temporary and bridging visas. The Covid disruption made their migration status precarious and led to a ban on working at more than one home and shortages of staff in residential aged care.

Staff and residents in aged care were disproportionately affected. 682 residents died in aged care, 75% of all Covid-related deaths in Australia. More than 2,000 staff were infected. Lack of infection control, PPE and training in its use were key factors and experts agreed the pandemic exposed systemic weaknesses.

Navigating the system

Victorian Parliament research paper on residential aged care in Victoria, in response to an interim report of the Commission, said the system was difficult to navigate and confronting for older citizens, there was a lack of accessible public information about how to choose a home or identify those that are substandard, there is a lack of transparency and the workforce is under pressure where intense, task-driven regimes govern the lives of both those receiving care and those delivering it. There is severe difficulty recruiting and retaining staff, poor pay conditions, stymied innovation, patchy education and training, no defined career path for staff and deficient leadership. 

Diversity

Over 30,000 Australians were born in non-English-speaking countries, one in eight residents in aged care has a preferred language other than English and these numbers are set to increase. Little is known about how well their needs are met in aged care.

Profit and loss

The residential aged care sector is dominated by private not-for-profit providers – mostly church-related – followed by a growing number of large private for-profit companies and a small number run by state governments. 60% of providers now report operating in deficit and the Commission found a steady decline in reported profits from 2017 to 2019. That said, profits were substantially higher in the for-profit sector. This could be due to the generally larger scale of residential aged care developments, however, critics say deregulation and encouragement of private sector investment has led to ‘dumbed down care’. State government operations are significant loss makers with higher staff numbers.