(Image: AAP/Joel Carrett)

After more than two years of hearings on the shortcomings of Australia’s aged care sector, a whopping 124 recommendations have been handed down to the Royal Commission into Aged Care Quality and Safety. 

The commission heard tales of abuse, neglect and sexual assault in an understaffed, underfunded and poorly regulated sector. When the pandemic hit, aged care homes struggled to cope resulting in the deaths of 683 people. 

The commission also heard 50 people in residential aged care are sexually assaulted every week. 

Crikey has made it our business to look into the state of aged care — here are some of the failures, and what needs to change.

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What went wrong? 

Chronic understaffing

The commission heard that 60% of Australian nursing homes are understaffed. In 2003, 36% of Australia’s nurses worked in the aged care sector. That proportion has fallen to less than one quarter.

Facilities have been encouraged to outsource services such as catering, laundry, cleaning and even accounting and insurance. Staff are becoming increasingly casualised, working short-hour contracts between multiple residential facilities. 

Poorly paid staff cancelled their shifts when active cases of COVID-19 spread through homes: within the first days of the pandemic, Sydney’s Newmarch House — where 71 residents were infected — lost 25% of its rostered shifts. 

Lack of regulation and transparency

Despite the new National Aged Care Mandatory Quality Indicator Program, identifying non-compliant and under-performing aged care providers is still tough, with the government keeping performance information confidential.

When outbreaks started spreading across homes, officials refused to reveal which nursing homes had outbreaks, and which ones didn’t comply with infection control guidelines.

Poor information

Guidelines on how facilities should prepare and respond to COVID-19 were found to be woefully inadequate. Neither state nor federal guidelines were developed in consultation with the aged care sector.

Poor guidelines also initially advised infected residents should only be transferred to the hospital “if their condition warrants”, making NSW Health reluctant to accept the need to transfer Newmarch House residents, likely contributing to the 19 deaths in that home.

How do we fix it? 

The commission held 97 days of hearings with 641 witnesses giving evidence. There were more than 10,000 public submissions made, almost half of which referred to substandard care. 

Senior counsel Peter Gray, QC and Peter Rozen, QC proposed 124 recommendations to address the sector’s multitude of failings. 

Improved, increased workforce

Along with mandated staffing ratios, counsel also recommended that from July 2022 at least one registered nurse should be on site at every nursing home during the day. The average resident should also get 215 minutes a day with staff. 

It also recommended an increase in award wages and better remuneration, along with dementia and palliative care training for workers. Compulsory registration of workers should also be enforced to ensure staff meet minimum standards. 

Address demands

Another recommendation was that the government consult with those in the sector to find out where more access to services is needed, including advocacy services

Counsel also suggested that access to aged care services, such as home care, is demand driven, with no cap on the available services and packages.

New legislation

A new Aged Care Act based on human rights principles should be enacted to protect the rights of older people. The legislation should promote transparency in the sector, allow older people to give feedback without reprisals, and allow equal access to support and care which emphasises restoration and rehabilitation. 

Better regulation

The government should also set up an independent office of the Inspector-General of Aged Care to oversee the implementation of recommendations. The Australian Aged Care Commission should also be the statutory regulator with increased powers to oversee providers, with more stringent financial and disclosure reporting requirements. 

An Aged Care Pricing Authority should be set up to determine “reasonable and efficient” costs for delivering services. 

More transparency

The report proposes a star rating system for nursing homes, with indicators on staffing levels, quality and consumer experience. Improved public awareness of aged care should also be promoted to help people plan for their own aged care needs. 

Diversity design

The commission also recommend new training requirements for staff on cultural safety and trauma; that Indigenous Australians have access to interpreters; and that services are available near their communities.

An Aboriginal and Torres Strait Islander Commissioner should also be appointed.