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A ‘cruel and harmful system’: The royal commission interim report

The Royal Commission into Aged Care Quality and Safety has released its interim report, and although it did not make any recommendations – it is saving those for the final report due next year – it laid down the gauntlet to the Government and the aged care sector with a few suggestions of things to start working on.

Titled simply Neglect, the language used by the commissioners was blunt and to the point, shorn of any 'legalese'. The foreword to the report described the current model as a “cruel and harmful system” that must be changed.

“We owe it to our parents, our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more,” it read.

Much of the report is a round-up of the evidence given so far with initial observations from the commissioners. Divided up into three hefty volumes it identifies systemic problems in need of “fundamental reform and redesign”.

The current system is “designed around transactions, not relationships or care”, it said and “minimises the voices of people receiving care and their loved ones”.

The system is also hard to navigate, ill-informs consumers and has a workforce that is “under pressure and under-appreciated and that lacks key skills”.

Residential care strips residents of their humanity, they become “just another body to be washed, fed and mobilised, their value defined by the amount of funding they bring with them. They become infantilised, lose autonomy, and are prevented from making decisions or doing physical things that were routine when they lived at home, on the grounds that they ‘could hurt themselves’.”

The commissioners believe that the sector “lacks fundamental transparency” and called out certain providers who have appeared at the commission as “belligerent in their ignorance of what is happening in the facilities for which they are responsible”.

The government too is in the commission’s sights for its lack of transparency around the numbers on complaints and assaults in aged care, and for empowering a regulator that “is unfit for purpose and does not adequately deter poor practices”.

“The regulatory regime appears to do little to encourage better practice beyond a minimum standard. We were flabbergasted to hear that, until recently, it was routine practice for large sections of the reports of accreditation audits of services conducted by the Aged Care Quality and Safety Commission to be generated by computer assisted text.”

The good practices of some providers and staff were acknowledged in the report, however, the report says these examples of “passion and dedication” are succeeding in spite of the aged care system, not because of it.

The aged care system needs a “reality check” and to focus less on acting like an “industry” and a “market” force which views people as “clients” and “consumers”.

The report identified three areas that need “urgent” attention.

  • to provide more Home Care Packages to reduce the waiting list for higher level care at home
  • to respond to the significant over-reliance on chemical restraint in aged care, including through the seventh Community Pharmacy Agreement
  • to stop the flow of younger people with disability going into aged care, and expediting the process of getting those younger people who are already in aged care out.

“We see no reason to delay action in these areas,” the commissioners wrote. Translation: act now.

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