By Chief Advocate Ian Henschke
The Royal Commission into Aged Care Quality and Safety completed its first round of hearings last Friday, having canvassed a broad range of issues in its first two weeks.
The closing address presented by Counsel Assisting the Commission, Dr Timothy McEvoy QC, was an eloquent and powerful summation of the problems that had converged to put serious strain on the provision of aged care.
He listed them in the following order:
1. The scale of the problem - he said it encompassed several factors, the most important of which was population growth.
2. He spoke of the increasing number of people with dementia, stating the population of people over 85 would double by 2056. The number of people living with dementia now was 436,000 and that would rise to 1.1 million by 2056.
3. He said as people aged, they desired to be cared for in their homes and at the moment there were significant delays in that happening.
4. There were serious workforce issues. These involved the skills base and payment for work. Dr McEvoy added this required further inquiry.
5. There were impediments to gaining care from the system. Older Australians were being directed to the public health system rather than getting the aged care they needed. There was also a problem with access to GPs.
6. A range of perspectives surrounded the economics of the workforce supply issue, sustainability and the adequacy of the rate of return on investment. Scrutiny would be given to them later in the year.
The issue of staff ratios was revisited, and Dr McEvoy said this “will be one of the issues the commission needs to address”. He said we had the first basis for a methodology to create a ratio.
“It’s a valuable starting point but needs refining,” Dr McEvoy said. “But to leave the issue up in the air is not an attractive option.”
He said, “higher needs mean higher care”.
Funding a central issue
Dr McEvoy also referred to the evidence of Canberra woman Ms Margot Harker, who had a stroke at 64 and needs ongoing home care after a long period of rehabilitation. She has received care for almost eight years but it’s not adequate.
“She was able to show even a level 4 package was not enough,” Dr McEvoy said. “She needed Commonwealth home support and a level 4 package to stay in her home. Her evidence focussed on the issue of consumer-directed care and highlights the flaws in the market.”
Dr McEvoy said 902 entities, individuals, and institutions operated 2672 services providing residential aged care. There were 200,689 funded places with an occupancy rate of 92% and most residents were over the age of 85.
We were told clinical care needs were becoming more acute and funding was a central issue. While bed numbers increased 20% between 2015 and 2018, another 83,000 beds would need to be provided in the next 10 years.
Dr McEvoy said the average age of a person accessing the Commonwealth Home Support program was 75 years, while the average age of a home care package recipient was 80 to 81 years.
Home care queue "a profound failure"
We learnt people were waiting much longer for home care packages than they were advised when approved for assistance.
National Seniors Australia CEO Professor John McCallum was quoted by Dr McEvoy QC as saying, “the queue for home care was a running sore and a profound failure”.
The Royal Commission heard from Mrs Kaye Warrener, of Adelaide, who told of her husband Les, 78, waiting for 453 days for a level 2 package. And it still hadn’t arrived. Les had a quadruple bypass in 2008, has prostate cancer, cellulitis in his legs and arthritis in his hands. His condition meant he needed to sleep in a chair, but his arthritis also meant he was unable to manipulate the chair.
The Royal Commission was told residential care accounted for $12.2 billion in funding in the 2017/18 year from a total of $18 billion spent on aged care.
Dr McEvoy said residential care was the most costly form of care and the age care funding instrument needed further inquiry.
In summary, we were told the system needed a “fundamental overhaul”. Eighteen months after the Carnell Patterson report was delivered, its 10 recommendations had only been partly implemented.
Given this, there appeared to be a suite of regulatory framework issues that were an ongoing concern.
People needing help cast as a burden
The Commission also was told that despite having a new commissioner for quality and safety and complaints, it appeared there was “not a radically different approach to the issues”.
Dr McEvoy reminded Commissioners Richard Tracey and Lynelle Briggs that “older Australians are entitled to the level of care and respect which the system too often denies them“. The system, too, often failed the people who needed help, and the dominant narrative cast them too often as a burden. He said we needed a cultural change.
Dr McEvoy cited the example of Barrie Anderson, who had been caring for his wife Grace for the past 19 years after her diagnosis with dementia at the age of 66.
“The simplicity of his message (about home and residential care and the critical role of the carer) – ‘try and walk in Grace’s shoes’ belies its force,” Dr McEvoy said.
We were reminded that the commission had received 1200 submissions, and that submissions could be made until at least the middle of the year.
Some providers were put on notice because Dr McEvoy said the largest ones had been asked to provide details of areas where they had failed in safety and care by 8 February. So far, only 90 out of 100 had responded.
Dr McEvoy said that on 18 March the commission would return to Adelaide to focus on home care.
A further round of hearings would begin on 6 May, with a special emphasis on residential care quality and safety issues surrounding dementia.
Dr McEvoy closed by reminding the commission that Mr Gerard Hayes, the president of the Health Services Union, had given a powerful insight into the way we treat older Australians.
Mr Hayes had said on Anzac Day each year, they dressed the older residents for the one day of the year when we make an effort to remember those who served their country.
Dr McEvoy said the obligation was to “not stop remembering but none of this will happen if we do not commit to this ourselves”.
For more information about the Royal Commission hearings, go to https://agedcare.royalcommission.gov.au/hearings/.