Royal commission extended six months, new commissioner named

Governor-General David Hurley has signed off on a request from the Royal Commission into Aged Care Quality and Safety for an extension of six months, Aged Care Minister Richard Colbeck has announced.

Colbeck also named an additional commissioner – retired Federal Court judge Gaetano (Tony) Pagone.

In a statement, Colbeck said:

“It is important that our aged care sector continues to provide high quality care and that we understand where we can make improvements.

“The government has continued to implement reforms while the commission progresses, as we said we would, including the commencement of new Aged Care Quality Standards and Charter of Aged Care Rights and strengthened provisions around the use of restraints.”

Initially, the commissioners were required to provide an interim report by 31 October 2019 and a final report by 30 April 2020.

‘At best a national embarrassment and at worst, a national disgrace’

On day two of the Melbourne leg of the royal commission, we gained a rare insight into the thoughts of the commissioners.

In a scathing indictment of the disability and aged care sectors, commissioner Lynelle Briggs called the system “a national disgrace”.

This came after yet another day filled with tales of poor treatment and mismanagement, this time involving younger Australians in aged care. In testimony given by the first assistant secretary in the home aged care division with the Commonwealth Department of Health, Dr Nicholas Hartland, he agreed that aged care was no place for the young.

“It’s been a somewhat intractable problem in aged care and there has remained around about 6000 young people in residential aged care, and I don’t think there’s anyone who would say that that’s on appropriate. It’s far too high a number,” he told counsel assisting Peter Rozen.

We heard from Hartland that $120 million dollars in funding aimed at reducing the instance of young people in aged care yielded only a drop from 6557 people to 6381. And even then, as Rozen pointed out, on closer inspection of the statistics from the start of this funding in 2006, there was actually an increase in young people entering aged care every year. A fact Hartland put down to population growth.

“I accept your point about the general increase in population during the period, but it’s a very poor outcome, isn’t it, for such a program? If that’s the best we can do as a nation with all our governments combined and significant resources being thrown at this problem, it’s not a good outcome at all, is it?” Rozen said.

At times Rozen and Hartland disagreed on the intentions and interpretations of statistics of the various departments, causing Commissioner Briggs to interject when it seemed that Hartland wasn’t getting to the issue at hand.

“It seems that because the numbers of young people with disabilities are pretty much stable around 6000, with a flow-in each year of around 2000, that there’s not been a lot of will within the system to try and stem that flow or, indeed, to try and help people move out to other more appropriate arrangements. Do you think they’ve been forgotten?” she said at one point.

Rozen later questioned whether the targeting of funds to a specific age group within the under 65s was an attempt to manipulate the overall statistics.

“A cynic, Dr Hartland, might observe that if you pick a relatively small group and put all your resources into that small group; it used to be under 50, it’s now under 45s, we’re talking about a few hundred people, if you put all your resources in there then you’re going to be able to claim a bigger percentage reduction in that cohort at the end of the relevant period,” he said.

Frustrated by Hartland’s response, Briggs again interjected. As Rozen concluded his questioning on day two, Briggs took Hartland to task before making her feelings clear.

“Young people with disabilities is a clear area where Social Services, NDIS, Department of Health, States and Territories and various other stakeholders need to be working together, rather than separately and doing buck passes. I don’t want you to comment on that, I just want you to understand that that would be the view of certainly this Commissioner,” she said.

“I put it to you, Dr Hartland, that the current system is at best a national embarrassment and at worst, a national disgrace.”

‘We don’t have to worry about him, he’s in aged care now’

Catherine Roche talked to the royal commission about her late husband, Michael Burge, who spent two years in aged care after he had a stroke aged 56.

She described the difficulties she had navigating the space between the aged care system and the disability system.

After the stroke, Michael spent time in a hospital rehab unit where Roche faced a “constant battle” to keep him there. The hospital put “enormous pressure” on her to move Michael to other accommodation, telling her that three months is the usual time allowed.

Michael would stay in rehab for nine months before Roche was forced to move him to aged care for lack of any other options.

Roche said that she reached out to “15 to 20” other rehab centres and approached community care to find alternatives for Michael, but felt that “when they heard that Michael had moved into the aged care, they quietly put his file away and basically said, ‘We don’t have to worry about him now. He’s in aged care’.”

After an initial period where Michael’s health improved, Roche said that the aged care environment began to take a toll on the young man. Most residents were older than Michael, and half of them had dementia, Roche said, so he struggled to find any common ground.

“Over time, what it meant was Michael became more and more isolated … He would just remain in his room day in, day out,” she said.

Unfortunately for Roche and her husband, when the stroke first occurred, the NDIS had yet to be fully rolled out. When it eventually reached their area, it was not a simple process, even for someone like Roche, who had experience with government and project management.

“[For] somebody who doesn’t have that work experience, I think it would be very difficult for them to actually meander their way through the miasma of getting funding,” she said.

In the end, Roche believes that had they not been forced to move Michael into aged care and had other options for his rehabilitation, “he would still be here today”.

“In my experience, case management is fundamental to helping younger people who have a disability. The biggest challenge I faced was a lack of a road map or any pathways for Michael other than aged care.

“In Michael’s case, aged care was clearly not an appropriate place for a younger person with a disability. Residential aged care facilities are seen as a place for people to be made comfortable as they prepare to die. Michael was not there to die – quite the opposite. He wanted to recover and recreate his life,” she said.