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New royal commission research highlights Australia’s shortcomings

The royal commission has announced its return for 2020 with a workshop-style hearing starting in Adelaide and running over two days from 10 February.

This announcement coincided with the release of two background papers, conducted for the commission by Flinders University, which show that Australia is behind a number of OECD nations when it comes to spending, staffing and innovation in aged care.

The research looked at international systems and innovations in aged care and has identified many opportunities for improvement in Australia. The first paper examined aged care systems in 22 countries while the other focused on innovative models of aged care.

The authors identified approaches that could benefit the Australian system such as telehealth communications, training that supports people with dementia living at home and their carers, and remote support of independent living through ‘health smart homes’.

Ageing in place

According to the reports, the big difference between the Australian aged care system and its international counterparts is our approach to long term care. The Flinders researchers found that the best performing countries focus on ageing in place, whereas Australia seems focused on residential care.

Flinders academic Dr Suzanne Dyer worked on both papers and said that supporting older Australians to age as they see fit is key to any changed aged care system post-royal commission.

“There is no simple solution, but most people wish to remain in their own homes as they age and be supported to do this. Many other countries appear to provide a greater proportion of their long-term care as home care. There are a range of strategies used by other countries which aim to increase the autonomy of an older person and reduce the reliance on institutional care,” Dyer said.

Long-term spending gap

The expenditure of GDP on long-term aged care has been an issue raised by many in the sector and the Flinders team found that when compared to other nations such as Denmark or Sweden –who spend four per cent of their GDP – Australia is trailing, spending only 1.2 per cent.

Compounding this problem, Australia employs less staff in long-term care that many of the countries studied.

“Overall staffing levels in residential care appear to be lower in Australia than in the USA, Denmark, New Zealand, Switzerland and Germany and nursing levels lower than in the USA, Canada, Germany and Switzerland,” the report stated.

The research suggested that the aged care system needs to address a number of issues regarding its workforce, including transparency of staffing levels, increased professionalism of the workforce and mandatory training or registration of care workers.

Many of the countries studied use a ‘professionalism-based approach’ to aged care regulation, which the researchers said could lead to better outcomes here in Australia.

“Professionalism-based quality regulation systems, such as in Switzerland and Germany, generally have standards negotiated between multiple parties involved in long-term care. There is an emphasis on the role of professional organisations, particularly health professions, in setting quality standards and self-regulation,” Dyer explained to Aged Care Insite.

“The professional or provider organisations have most of the responsibility for upholding standards and the governments less responsibility. Japan has a professionalism-based system and in this country we see certification of home care workers with mandated minimum training standards and mandated staff-to-resident ratios in residential care for different types of staff including therapists and social workers.”

A new outlook needed

The reports noted that fundamentally we need to look at the philosophical ways in which we view aged care. Unlike many other nations, we do not enshrine human rights protections for older Australians.

The report noted: “Australia lacks explicit incorporation of human rights principles into aged care regulation. Notable examples of other countries’ approaches include prohibition of physical restraints in residential aged care according to specific guidelines as a condition for certification in Japan and a Resident’s Bill of Rights, the principles of which (including reablement) are incorporated into the Long-Term Care Act in Ontario.”

Among a number of suggested areas of change for the sector, the researchers said “there is a need to think of the system of care from more of a social, rather than just economic, perspective”.

Working toward a solution

The royal commission workshop will be held over 10 and 11 February at the Adelaide convention centre, where a panel of witnesses along with the counsel assisting and the commissioners will discuss and test propositions and ideas in preparation for the final report, due in November this year.

This more informal set up will not be held in a hearing room or court-like setting and will focus on the redesign of the aged care system.

The commission said that future workshops may be scheduled at a later date.

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