A Charles Sturt University aged care expert said the findings of the Royal Commission into Aged Care Quality and Safety are useless unless politicians are held accountable.

By Associate Professor in the School of Nursing, Midwifery and Indigenous Health Maree Bernoth.

The final report entitled Care, Dignity and Respect holds so much promise, but the recommendations are of no value unless they are enacted through Federal Government policy.

The outcomes of the Royal Commission are welcomed by me after 15 years of advocacy, research and teaching in an effort to improve the aged care sector.

However, my optimism about achieving substantial change is tempered by the fact, over the past 15 years, we have had numerous inquiries and reports, numerous submissions written and appearances before enquiries - yet hopes of change dashed.

The Productivity Commission’s Caring for Older Australians report (2011) held promise of change but instead there was an exacerbation of abuse and neglect post the Commission. It is sad to realise that a number of recommendations from the 2011 report reflect those of the current Royal Commission.

There is much that is positive about the recommendations, but we cannot let the outcomes be mothballed like what happened with the 2011 Productivity Commission Report. The community must be aware of what is happening with the implementation of the recommendations and hold politicians accountable for the choices they make in changing the aged care system, ensuring the person is the focus.  

The Prime Minister, in his response to the report, has said that there will be an additional $32 million boost for the Aged Care Quality and Safety Commission, with an extra 1,500 inspections of residential aged care facilities. Yet, it is this organisation that has facilitated the wide variety in standards of care being delivered in our facilities. The Aged Care Quality and Safety Commission has not ensured older people are receiving quality care and in too many instances, are not safe.

For rural, regional and people living in remote areas, there are a number of positive outcomes that indicate that the Commissioners have listened and heard their sentiments.

The report says that people, no matter where they live, should have a universal entitlement to aged care. This means those in regional, rural and remote areas should have better access to aged care. Recommendation 54 is related to equity of access through the identification of where services are not adequate and where services need to be supplemented, which is to be overseen by a Systems Governor. Further, multipurpose services (MPs) and programs are to be maintained and extended. It is acknowledged that some MPs are housed in older buildings and some not suitable for people with a diagnosis of dementia. It is recommended that in these cases, capital works are undertaken.

The workforce to provide services and care is addressed in the recommendations. It is acknowledged that the aged care workforce is inadequate and is not supported by robust education. The recommendations focus on making education meaningful and ongoing, that care workers need to be registered with an authority and that more time (200 minutes from a care worker and 40 minutes from a registered nurse) allocated to providing care. This requirement will ensure an increase in the numbers of registered nurses.

What the recommendations are missing are initiatives to attract registered nurses and other skilled workers to smaller rural and remote communities.

Charles Sturt University academics and members of the University Division of Rural Health organised a community forum in Dubbo in 2018 to capture the voice of rural communities and develop a community submission for the Royal Commission. A mix of attendees from Dubbo, Wellington and Narrabri were there, which included care workers, First Nations peoples and older people. The forum contributed substantially to the Commissioner’s understanding of the experiences of rural older people and First Nations peoples. As a result, the report has also included recommendations related to respecting and supporting First Nation’s peoples directed by an action plan and diversity framework. There is commentary about the provision of an Aboriginal and Torres Strait Islander aged care pathway that is culturally safe and respectful. It includes the provision of culturally respectful education for all aged care workers and an employment pathway in aged care for First Nations peoples.   

The aged care system is a complex one and navigating through it to find support is not straight forward. The Commissioners have recommended that to address this complexity a single assessment process is instigated, and Commissioner Briggs recommends the provision of Care Finders to support those trying to find their way through the maze of the aged care system. The Care Finders will be with the older person and their family as they first encounter the system, as they engage with appropriate services and then ensure there is follow up and reassessment as is necessary.