Royal commission interim report: Sector reacts

The royal commission's interim report, titled simply Neglect, paints a grim picture of a sector devoid of caring and emotion and concerned only with the idea of itself as an “industry” that has “consumers” whose value is “defined by the amount of funding they bring with them”.

According to the report leadership is lacking at the top of a workforce that endures severe recruiting and retention difficulties and where “workloads are heavy. Pay and conditions are poor, signalling that working in aged care is not a valued occupation.”

The Australian Nursing and Midwifery Federation (ANMF) said yesterday that the “history of aged care in Australia is a story of woeful and increasing neglect”.

ANMF federal secretary Annie Butler said: “The Report outlines a shameful abrogation of duty by successive governments and many sections of the industry. And, frankly, an appalling lack of respect, regard and care for our elderly by the Australian community.

“There is no need for Government to continue to be ‘missing in action’ in addressing critical workforce issues. The Commissioners have clearly identified that ‘staffing is a critical element in ensuring the quality and safety of those in care. Services must have the right number of staff with the right skill mix, with compassion and empathy combined with knowledge of aged care and the illnesses and conditions of those in care.’

“The aged care workforce has held the system together for too long, workers can’t sustain their efforts much longer – action is needed now,” she said.

The Australian College of Nursing has called for a rule stating that one RN must be on duty at all times in Residential Aged Care Facilities.

“Caring for older Australians is complex. They often have chronic conditions and co-morbidities and require a number of medications each day. Yet the number of Registered and Enrolled Nurses in full time equivalent positions in residential aged care facilities (RACF) has fallen by 13 per cent since 2003,” said ACN chief executive, Adjunct Professor Kylie Ward.

United Voice welcomed the royal commission emphasis on workforce issues, pointing to a recent survey in which one-in-four workers said they would leave the sector in the next five years, and they called out the current aged care minister for his lack of engagement with the sector.

Carolyn Smith, United Voice’s national director of aged care said: “The issues of chronic understaffing and crushing workloads have reached crisis point. Elderly Australians and the workers that care for them cannot wait another day. United Voice calls for Minister Richard Colbeck’s silence on these issues to end immediately. Funding to aged care cut by the Coalition Government must be restored. Otherwise we have a sector that cannot provide quality care – and the crisis will continue.”

The interim report called out the general disrespect older Australians face in our society, commenting that “the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation.”

The Council on the Ageing (COTA) agreed, and its chief executive Ian Yates said that older Australians are neglected in federal budgets time and again.

“COTA agrees with the Royal Commission that older Australians should be more valued by the wider community. It’s not just about loving your grandparents, Australians need to also reach out as a community and support their elderly neighbours and fellow citizens, many of whom are still waiting to receive care they’ve been assessed as needing and won’t even be in the formal care system,” Yates said.

“If the government is taking the Royal Commission seriously and is also serious about respecting the many people and experts who have given their time to the process so far, then they cannot ignore this report and must commit more funds in the forthcoming MYFEO.”

Yates wants an urgent funding injection of $2.5 billion to ease the home care package crisis, something that the Australian healthcare and Hospital Association (AHHA) has also called for in its post report statement.

Acting chief executive Dr Linc Thurecht said that the waiting times for homecare are increasing and at 137 days, it is far too long.

“Australian research has shown that shorter wait times for home care packages are associated with people living longer and being able to stay in their own homes.

“Being unable to access aged care services, or care that is at the appropriate level, has broader impacts outside the aged care sector, with greater burdens placed upon carers, families, communities and the health sector.

“The Interim Report by the Royal Commission described access to home care,” he said.

Thurecht also argued that the numbers of those under age 65 living in aged care is equally neglectful and immediate action should be taken to remedy this. Currently, there are approximately 6048 people under 65 living in residential aged care.

Craig Gear from the Older Persons Advocacy Network (OPAN) said that the focus on chemical restraints in aged care is something his network has campaigned on for many years.

“Evidence has shown that issues in aged care, such as chemical restraint, are not going to be eliminated or even minimised without further reform and action. But these claims are nothing new – OPAN members have been lobbying for reform for many years,” Gear said.

“We are supportive of direction on restraint, and welcome action on that as well as on the other issues of abuse occurring within home care. There must be more transparency about what is occurring within aged care, especially in residential aged care facilities.”

Jo Ibrahim, head of the Health Law and Ageing Research Unit at the Department of Forensic Medicine at Monash University, agreed that chemical restraint has been an issue known for the past 20 years and wont change overnight, so he is glad that the commissioners showed “courage” in identifying this as an area for reform, now.

“The cultural issues around restraint or restrictive practise is something that isn't going to occur overnight and so work can be started on that, so examine it promptly and examine the underlying factors and start addressing those.

"I think it's reasonable. I think my note of caution is that people think that's the only thing that needs to be done and that's not the case at all. What they've said is that we should start now and not wait,” he told Aged Care Insite.

Ibrahim was impressed that the report threw up a few happy surprises in the form of areas for “urgent action”.

“I was surprised because I wasn't expecting that they would have any recommendations. I think that point about not waiting is a really important one in that what's happened in the past is we wait until the end and then discover that the changes that are needed are going to take a long time. And so I think they're right to be saying we've got to be doing something now.”

As for whether the government might take notice of these concerns, on past form Ibrahim is unsure.

“I think that both parties and governments in the past have sat around waiting and when they finished waiting, they haven't actually done anything. And the commission's paper highlighting the 18 inquiries that have been done over the last 20 years clearly lays it out to the public that when the government says they're waiting to the end and they're waiting to do nothing, and I think we need this reaction to address these and that would get us prepared for the recommendations that come next year,” he said.

Leading Aged Services Australia (LASA) chief executive Sean Rooney commended the report as a “beacon for immediate reform” and said that LASA is “100 per cent” behind the need for urgent reform.

“This is a once-in-a-generation opportunity for change and is too important not to get right,” he said.

“Our sector must regain the trust of the Australian community by working together to solve the problems because how we care for our elders speaks to who we are as a nation.

“As the report concludes, we must work together as a nation to ensure that older people are a critical part of our present, a valued part of our community.”

The Royal Commission starts again on November 4 in Mudgee, NSW.

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