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If aged care needed an event to highlight the myriad shortcomings outlined extensively during the Royal Commission into Aged Care Quality and Safety, COVID-19 was it.
One year after the Commission’s final report titled Care, Dignity and Respect was handed to the government, the pandemic continues to emphasize the workforce supply crisis, ongoing concerns about regulation and quality oversight, and unsustainable funding models.
The 2022 Federal Election campaign has directed an extra spotlight on the much-needed aged care system reforms. So far promises have been made to address ways to: increase the workforce; increase funding transparency; introduce a dedicated Aged Care Complaints Commissioner and be able to apply civil penalties for any aged care provider who punishes residents, families or workers that complain.
Against this backdrop, it’s worth revisiting the Royal Commission’s main findings.
Aged Care Royal Commission recommendations
The 2000-plus-page report by the Royal Commission is the blueprint for any future reforms. The 148 recommendations are a call to rewrite the Aged Care Act to “assist older people to live an active, self-determined and meaningful life in a safe and caring environment that allows for dignified living in old age”.
The recommendations include:
- Professionalising the aged care workforce through changes to education, training, wages, labour conditions and career progression
- Creating better quality and measurement reporting through developing and publishing a system of star ratings
- An immediate increase to the Basic Daily Fee
- Developing a new Aged Care Program combining the Commonwealth Home Support Program (CHSP), home care and residential care
- Care that is based on need, not rationing
- A single streamlined process to accessing aged care services.
While it may not be obvious given the strain on the sector during the pandemic, there has been some progress since the report’s release in March 2021 and the government’s response two months later.
Early signs of reform
Progress has been helped by two federal budgets and a commitment to spending about $18.3 billion over the next four years on the five key areas identified by the government in the areas of home care, residential care quality and safety, residential care services and sustainability, workforce and governance.
Understanding and navigating an overly complex aged care system was one of the concerns identified from the outcomes of the Royal Commission.
The government responded by announcing increased access to free consumer information services and the introduction of face-to-face assistance for seniors at all 80 Services Australia centres by December 2022. This roll-out has started in some centres.
Food quality and nutrition in residential care is another area of concern and one that the government partly addressed with an extra $10 a day per resident. This was payable to facilities that could show improvements in care and services.
Support for home care falls short
Given most people’s preference is to remain living independently in their own home, there has been considerable pressure to increase the level of services available through the various government programs including Commonwealth Home Support Program (CHSP) and the Home Care Packages Program.
The Royal Commission’s report recommended that the home care package waiting list be cleared by 31 December 2021 and be kept clear by ensuring that new entrants are offered a package within one month of their assessment.
This hasn’t happened, however part of the response to the Royal Commission was the immediate commitment of $7.7 billion to home care reforms, including 80,000 additional home care packages (40,000 in 2021–22 and 2022–23) and $10.8 million to support the design of a new Support at Home Program.
The 40,000 home care packages in 2022–23 will enable about 275,600 people to access a package by 30 June 2023.
The new Support at Home Program currently being developed will be introduced from July 2023. A key element to the government’s response to the Royal Commission, it consolidates the current CHSP, Home Care Package Program and Short-Term Restorative Care Program.
Further responses to the Royal Commission
Understandably, it will take some time to implement all recommendations in the Royal Commission, but action taken includes:
- The establishment of the National Aged Care Advisory Group and the Council of Elders to ensure tangible outcomes and support for the implementation of the reforms
- In-person help at many Services Australia centres, local care finders and a regional network pilot to assist with the navigation of the aged care system
- More than 33,000 extra training places for people who want to work in aged care, and 191 registered nurses have joined the new Aged Care Transition to Practice Program
- 115 scholarships to increase the knowledge and skills of nurses working in aged care
- Additional home care pages to reduce the national waitlist and provide additional help
- Greater transparency in home care funding
- An extra $10 per residential care resident per day to improve care and services, especially food and nutrition
- Mandatory reporting of care staffing minutes to make sure senior Australians get appropriate care
- Introduction of the Serious Incident Response Scheme
- The establishment of a new workforce advisory service to support providers, and give free, independent and confidential help with workforce planning
- The establishment of the Business Improvement Fund to help residential aged care providers to improve their financial viability.
In addition, still more measures to support the sustainability of the sector are currently before parliament. The Aged Care and Other Legislation Amendment (Royal Commission Response No.2) Bill 2021 reforms include:
- The introduction of the funding model for aged care, the Australian National Aged Care Classification (AN-ACC) to be introduced from 1 October 2022 to replace the existing Aged Care Funding Instrument or ACFI model
- A registration scheme which will provide a nationally consistent pre-employment screening for aged care workers of approved providers to replace existing police checking obligations, and an expansion of the Serious Incident Response Scheme to home and flexible care from 1 July 1 2022
- A star ratings system to start in late 2022
- A new Support at Home Program starting July 2023 will consolidate the existing Commonwealth Home Support program, Home Care Package Program and Short-Term Restorative Care Program
- Innovative, dementia-friendly accommodation design, and dementia education and training.
The shortcomings of Australia’s aged care system were displayed in stark relief during the pandemic, highlighting the need for urgent reforms recommended by the Aged Care Royal Commission. Some of the recommendations have been implemented and more are in the pipeline. But for older Australians and their families, change can’t come quickly enough.