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

The Royal Commission into Aged Care Quality and Safety released its interim report yesterday 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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  1. The Interim Report of the Royal Commission into Aged Care Quality and Safety highlights issues in a wide range of areas that the Commission has investigated in its hearings, public forums, submissions and research to date. This report makes no recommendations and foreshadows that the Final Report in November 2020 will recommend major reform and redesign of the aged care system in Australia. The industry would agree and supports the Commission’s work in creating a national conversation about how to provide aged care better.
    However, it is disappointing that the Commissioners have chosen to frame the Interim Report in negative and alarmist language with a title of “Neglect.” This is designed to attract media attention and get traction where it has been difficult to spotlight aged care and generate community interest in the past.
    As can be seen from the quotes from the Report there are many generalisations about the industry and the care provided in statements that are not accurate or true. The Commission has heard from a limited cohort of residents, staff and families and has heard about the terrible issues that a number of people have faced. To extend this statement to the silent majority of residents and staff is inaccurate, unfair and biased reporting.
    The Commission has heard from a limited number of people at the Hearings. The majority of residents who live in aged care [such as our homes] are living a good life to the best of their ability and capacity with the support of families, friends, staff and a range of lifestyle options. Residents who are content are not likely to put their hand up to give evidence in a court room that would be difficult to access and be confronting for them.
    The Report states that the Commissioners have only visited 24 aged care homes, which is a small minority of 0.8% [of 2,672 homes]. This is therefore a missed opportunity to visit people who are living well in aged care homes and to speak with them in their own home, which is where a conversation needs to occur. The Commission has failed to take this opportunity and therefore cannot generalise about neglect and poor care across the industry, as it is simply not true.
    The challenge for the Commissioners in the next 12 months is to come to our homes and meet with our Residents and speak with them at their Resident Committee meetings to hear about their daily lives, how they view the aged care industry and what their experience in aged care is like.

    • While it must be particularly difficult to read the report if you are working in an Aged Care facility providing truly good,holistic,respectful care,I think it is critical that we all take on board the well researched and evidenced findings of this report.And truly take in the findings,without an attititude of defensiveness.
      The report very clearly is levelling blame at the ‘system’ that dehumanises the individual lives of an older person, rather than simply laying the blame at the door of those who work day in,day out at these facilities.
      Language is important…messages are conveyed both directly & subtly in the words used.
      The report needs to be a wake-up call to us all.
      To me, the essence of the issues are encapsulated in the term Aged Care ‘Industry’
      Using the word Industry immediately dehumanises.
      Either we drop that third word altogether, or it is replaced with perhaps either ‘System’ or ‘Service’
      To me that simple change with widespread Media coverage explaining the rationale, would be a powerful first step in getting wider society on board,in support of the changes so badly needed.