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Royal Commission into Aged Care Interim Report – stakeholders respond

The Aged Care Royal Commission Interim Report has prompted calls for a ‘massive overhaul’ of the aged care sector, involving ‘fundamental reform and redesign’ and ‘an urgent injection of funding’.

In the report, the Commissioners, the late Richard Tracey and Lynelle Briggs, describe the aged care system as “a shocking tale of neglect” and “a sad and shocking system that diminishes Australia as a nation”.

They describe the many problems that older people and their families have in trying to get access to aged care services, service shortfalls, the dispiriting nature of residential care, serious substandard care and unsafe practice, an underpaid, undervalued and insufficiently trained workforce, and isolation of young people with disabilities.

The report identifies three areas where immediate action can be taken:

  • to provide more Home Care Packages to reduce the waiting list for higher level care at home
  • to respond to the significant over-reliance on chemical restraint in aged care, including through the seventh Community Pharmacy Agreement
  • to stop the flow of younger people with a disability going into aged care, and speed up the process of getting out those young people who are already in aged care.

In responding to the report in a radio interview with Neil Mitchell, 3AW, Prime Minister, Scott Morrison, promised that more funding will be available for aged care by Christmas:

We will be making a response on those issues [mental health and aged care] before the end of the year. One of the reasons I’ve been waiting for this report is because I wanted that to inform the final decisions we were going to make around in-home aged care funding before we finalise the mid-year update.

I spoke again to the Treasurer, the Finance Minister, last night and the Minister, Richard Colbeck. We have been looking for that input from the Royal Commission to inform this next set of decisions.

The other two things that I’ve seen come out of this, there’s also the issues around the over-medication…the chemical restraint. And there have already been some things that’s been done in all these areas. But there’s so much more to do, which is what the Royal Commission is highlighting.

……We’ve got to acknowledge the problem. We know there’s a lot more work to do and we’ve got to create a new culture of respect for older Australians, which is what I said when we first announced this.

I think that’s at the heart of what the report says…it doesn’t matter whether it’s public, private or not for profit. We have seen abuses and we’re seeing substandard care across all fields. So, I mean, you’ve got to address the issues in each of those sectors.”

Minister for Health and Aged Care, Greg Hunt, and Minister for Aged Care and Senior Australians, Richard Colbeck, released a joint statement outlining the Federal Government’s commitments thus far in aged care and expressing their shock at the Report’s findings:

The interim report and the Royal Commission’s hearings to date tell us some aged care providers are falling far short of delivering the safe, high-quality care expected by senior Australians and their loved ones.

We acknowledge that the Government also has work to do and will consider and act on the Royal Commission findings, whilst noting significant reforms are in progress…

We are shocked by the stories that have arisen but we must and we will learn from them – bringing Australians together to ensure as a community we are providing the care and respect senior Australians deserve.

At the same time, it is also clear there are many aged care providers and workers who are delivering outstanding care.”

Selected responses to the Report from stakeholders,  peak bodies, the media and Twittersphere are below.


Council on the Ageing (COTA)

Aged Care Royal Commission Interim Report provides Government the mandate to commence transformation by December MYEFO

Australia’s peak body of older Australians, Council on the Ageing (COTA) Australia, today congratulated the Royal Commission into Aged Care Quality and Safety on its “Interim Report: Neglect”, which has recognised not only the neglect of older people within the aged care system, but also the neglect of successive Governments, that have failed to implement many recommendations from over 18 government inquiries.

COTA Australia Chief Executive, Ian Yates, welcomed the Royal Commissions’ confirmation that neglect, abuse and poor care are more widespread than governments and many providers have been prepared to accept, but which COTA has called out over many years.

He also welcomed the Royal Commission’s finding that aged care needs fundamental reform and redesign, indeed major transformation, for which COTA has repeatedly called.

Respect for older Australians a cornerstone of achieving better outcomes

“This cruel and harmful system must be changed. We owe it to our parents, our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more.

“We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them.

COTA Australia in particular welcomes the Royal Commission’s recognition that older Australians are neglected not only within the aged care system which supports around 1.3 million older Australians each year, but also in the negative attitudes towards older people within the broader community.

“COTA agrees with the Royal Commission that older Australians should be more valued by the wider community. It’s not just about loving your grandparents, Australians need to also reach out as a community and support their elderly neighbours and fellow citizens, many of whom are still waiting to receive care they’ve been assessed as needing and won’t even be in the formal care system,” Mr Yates said.

“Part of this respect includes ensuring the Federal Government stops neglecting aged care when it comes to Budget decisions both in December’s MYEFO and the Federal Budget next May.

“If the government is taking the Royal Commission seriously and is also serious about respecting the many people and experts who have given their time to the process so far, then they cannot ignore this report and must commit more funds in the forthcoming MYFEO.”

While some actions will need to wait for the Final Report of the Commission in a year’s time, the Interim Report identifies urgent need to act in three areas.

Urgent injection of funds for Home Care Packages 

Mr Yates said that the government must take on board the Royal Commission’s finding that home care waiting times over 12 months have created an “unsafe” system and must urgently inject urgent funding of $2 – 2.5 billion per year to reduce the home care waiting time to acceptable levels.

“While the Government will need time to consider the total report, the inescapable message from the Royal Commission is that hundreds of millions of dollars are needed towards Home Care Packages – now, this year, not in 2020.

“COTA has repeatedly advocated that older Australians must not wait longer than three months for care and the Department of Health told the Royal Commission this would cost between $2-2.5 billion per annum to achieve,” Mr Yates said.

On a recent ABC Q&A program Minister Colbeck said that target should be no more than 60 days.

“Too many people are dying waiting for care or are being forced into residential aged care when they choose not to be there and should have real choices about where they live as they age. “

Reduce over-reliance on chemical restraint in aged care now

The Royal Commission has also identified that the use of chemical restraints in aged care is shockingly widespread and immediate action can and must be taken to reduce the overuse of chemical restraint by providers and doctors.

“Within a few years, with an improvement in skills, clinical governance systems and staffing across aged care we believe it must be eliminated entirely,” Mr Yates said.

COTA will continue to engage with Government and the Senate to improve the regulations so that they ensure chemical restraint is a last, not first choice for aged care workers, and requires active, informed consent.

“The Government’s recent regulations on chemical restraint are a step forward but need improvement to ensure that chemical restraint is always a last resort, and used only for a short time,” said Mr Yates

“Government needs to implement measures to improve not only the prescribing behaviour of GPs, but also the number of times aged care staff decide that chemical restraint should be used for individual clients once it has been prescribed.”

Confirm the timetable for removing Younger People with a Disability from Nursing Homes 

COTA Australia backs the call from the Young People in Nursing Homes National Alliance that Government should immediately adopt the Commission’s Report’s timeframes that no new young Australians should enter residential aged care from 2022, and that by 2025 all young Australians who do not wish to will no longer reside in aged care.

“The funding of the NDIS presents a unique opportunity to provide appropriate accommodation alternatives to younger Australians with a disability. We support the Commission’s timeframe and call on the Government to make this commitment,” said Mr Yates.

COTA commends the Commissioners 

“The Commissioners must be commended for the way they have taken on board the many voices and  experiences of people using aged care and their families in a system that views aged care as a transaction rather than a relationship or even care; is designed around process rather than good outcomes; and lacks transparency,” Mr Yates said.

“There are clear structural reforms that are needed but cultural change is absolutely critical as well, from the level of governance and senior management down.

“That includes looking at the way we view aged care as a profession. The Interim Report explains just how that workforce is under pressure, underappreciated and lacking in key skills.”

Mr Yates thanked the Commissioners for their time and effort in producing such a thorough report which shows great empathy for people accessing aged care and working in the sector.

“In particular, we record our appreciation of Commissioner Richard Tracey’s contribution to the Interim Report prior to his recent passing.”



The Consumers Health Forum of Australia

Neglect and harm: aged care needs a massive overhaul

The story of neglect and harm detailed in the Interim Report from the Royal Commission into Safety and Quality in Aged Care leaves the Government no choice but to take immediate remedial action the Consumers Health Forum said today.

“Everyone who reads the report will be shocked at the scale of the problem. Even those who have been highlighting the problems for years will be looking at this with some disbelief” the CEO of Consumers Health Forum, Leanne Wells, said in response to the Interim Report.

“Many will be asking themselves, how could Australia as a civilised society have allowed this to happen? It is clearly a failure across the system, with apparent willingness to turn a blind eye and pretend the cases that were highlighted by advocates were the exception and that overall the standard of care was high. The extent of the neglect documented in this report dispels that myth.”

“It is important that the three areas identified by the Royal Commission as being most urgent are addressed immediately”’ said Ms Wells.

The Government could easily and quickly increase the number of Home Care packages, the only real barrier to that happening is the willingness of the Government to do it.

The overuse of chemical restraint and other related issues about medicines overuse and misuse in aged care must be addressed. This could be through the 7th Community Pharmacy Agreement currently in negotiation as well as other new programs. Many organisations including CHF have put forward ways to increase the role of pharmacists in better medication management and review in both residential and home care. With funding these could be implemented quickly.

Younger people with disabilities should not be going into aged care simply because there is no other solution: this is the antithesis of person-centred care. It is time to put in place a better approach. Many experts have proposed robust solutions: it is now incumbent on the Government, working with key stakeholders, to put some of these into action.

Beyond these three areas, CHF agrees with the Royal Commission and several other commentators, many of whom are among our members, that there needs to be a long-term structural reform of the sector. These solutions need to be led by the  Government, but they need to be designed and implemented with everyone involved putting the needs and wants of the  older people using these services at the centre of any reforms”.

“The community will want greater visibility of the state of play and performance of the aged care system. They will demand that reform include greater accountability and stronger measures to deal with poor care and neglect. They will demand that Government do everything it can to make sure that the older people who need support and care are safe and get the care they need when they need it.”

CHF’s submission to the Royal Commission can be found here.


The Australian Healthcare and Hospitals Association

Australian Government must fund more home care packages to meet overwhelming levels of unmet need

‘The Commonwealth must take immediate action to reduce the waiting times for Australians approved for home care packages’, says Australian Healthcare and Hospitals Association (AHHA) Acting Chief Executive Dr Linc Thurecht.

‘Australians who have been assessed as needing aged care services, should not be left waiting in a queue.

‘We have more people waiting for home care packages at their approved level, than are currently receiving packages.

‘Waiting times for those in the queue are too long. The median wait time has continued to increase and it is now 137 days, with many waiting more than a year for higher level care. One quarter of people waiting for a level 4 package are waiting three years.

‘Australian research has shown that shorter wait times for home care packages are associated with people living longer and being able to stay in their own homes.

‘Being unable to access aged care services, or care that is at the appropriate level, has broader impacts outside the aged care sector, with greater burdens placed upon carers, families, communities and the health sector.

‘The Interim Report by the Royal Commission described access to home care and the national prioritisation queue as a ‘cruel and discriminatory system’ and neglectful.

‘Previous reviews have recommended phasing out supply caps for aged care places. For these reforms to be considered and sustainably implemented, we need investment to increase workforce capacity within the sector and better data to measure and monitor unmet need and equity of access.

‘The Interim Report also highlights that there are 6,000 Australians who are aged under 65 years and are living in residential aged care. This is inappropriate—residential aged care is not suitable for younger people.

‘Young people living in residential aged care typically have a complex illness or disability, high care needs and high acuity. Young people living in residential aged care also have social and cultural needs, which often differ from older residential aged care service users.

‘The needs of young people are not always met by residential aged care facilities due to a lack of capability and specific resources.

‘No younger Australians should be entering residential aged care, instead they should receive care in more appropriate settings.

‘The Commonwealth must take action to ensure that younger Australians with high care needs are appropriately supported by the NDIS, in a timely manner, and are not left to languish in residential aged care.

Aged care workforce issues must be addressed without delay

The Australian College of Nursing has welcomed the interim report by the Royal Commission into Aged Care Quality and Safety and called on the Commonwealth to act on its findings without delay.

“I understand the Royal Commission’s work is ongoing and it has not yet handed down its final report and recommendations, but as the Commission’s own background paper pointed out earlier this week, this is far from the first inquiry into aged care or the first set of recommendations for improvements,” Australian College of Nursing CEO, Adjunct Professor Kylie Ward FACN said.

“Evidence to date has overwhelmingly focused on workforce shortages and skill mix and this needs to be addressed.

“In the past week, the Commonwealth positively responded to the majority of recommendations handed down by the House of Representatives Standing Committee on Health, Aged Care and Sport in its Report on the Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia.

“However, they did not fully commit to its proposal that residential aged care facilities have one registered nurse on duty at all times. ACN believes having at least one registered nurse on duty 24 hours, seven days a week is vital to the provision of quality aged care.

Between 2003 and 2015, the number of residential aged care places increased by 30 per cent and dependency levels of residents rose from 64.4 per cent assessed as high care to 89 per cent.

“Caring for older Australians is complex. They often have chronic conditions and co-morbidities and require a number of medications each day. Yet the number of Registered and Enrolled Nurses in full time equivalent positions in residential aged care facilities (RACF) has fallen by 13 per cent since 2003,” Adjunct Professor Ward said.

The impact nurses and advanced practice nurses can have in aged care is significant.

A case study review of nurse practitioners in aged care found that just an additional 10 nurse practitioners in aged care would result in 5,000 avoided emergency department visits.



The Society of Hospital Pharmacists of Australia

Interim report strengthens call for embedded aged care pharmacists

The Royal Commission into Aged Care Quality and Safety interim report has identified over-reliance on chemical restraint in aged care, as one of three areas of action, strengthening calls from the Society of Hospital Pharmacists of Australia (SHPA) to embed high quality clinical pharmacy services for aged care residents.

Released today, the Interim Report: Neglect also noted an urgent need for aged care residents to receive more frequent medicines reviews from a pharmacist.

SHPA Chief Executive Kristin Michaels says the report marks an important milestone in improving medicines safety for some of Australia’s most vulnerable.

‘In evidence, the Royal Commission heard the boundary between treatment for an illness and for restraint can become blurred, which can have heartbreaking consequences.

‘As referenced by SHPA member Dr Juanita Breen in hearings, specialty geriatric pharmacists are uniquely positioned to determine if antipsychotic medicines prescribing is appropriate and in accordance with professional or government guidelines, and thus determine if they are being used therapeutically, or for chemical restraint.’

Ms Michaels says medication management reviews are crucial to aged care, given 91% of aged care residents take at least five regular medicines and 65% take more than ten regular medicines, every day.

‘Through other recent research we know only 29% of aged care residents have access to medication management review, regardless of frequency, so this is a timely reminder of the challenge ahead of us.

‘The interim report considers mechanisms to support pharmacists to be involved in the implementation and monitoring of recommendations made during the review process. This is best achieved through embedding pharmacists directly into the aged care setting to ensure their expertise is most effectively harnessed to implement recommendations and reduce medication-related harm.’

Ms Michaels says embedding pharmacist roles in aged care requires funding and investment both within and beyond existing pharmacy renumeration programs, such as Community Pharmacy Agreements.

‘Trialling embedding pharmacists into aged care settings is supported by Commonwealth Chief Medical Officer Professor Brendan Murphy given the benefits demonstrated, and SHPA commends the $3.7 million investment by the Federal government to trial this in the ACT.

‘Further, preliminary Victorian evidence on a clinical pharmacy model in a home nursing service indicated a return on investment of $1.54 for every $1 spent on embedding pharmacists to improve medication management.


The Australian Medical Association (AMA)

Aged Care Royal Commission confirms the worst

The Royal Commission into Aged Care Quality and Safety’s interim report has confirmed everybody’s worst fears about the poor care, neglect, and abuse that has been occurring unchecked in Australia’s aged care system for years.

AMA President, Dr Tony Bartone, said today that the Royal Commission’s report is a call for action – urgent action.

“Care can’t wait. We have to put the care back into aged care,” Dr Bartone said.

“The Royal Commission has exposed numerous examples of neglect, abuse, mismanagement, under-resourcing, and under-funding in aged care.

“It has also given us insights into the failures of successive Governments to fix the system.

“The background papers and reports produced by the Royal Commission have highlighted how Australia compares poorly internationally in terms of staffing in aged care, and it makes for troubling reading.

“Tragically, it has told us that in a single year an estimated 16,000 people died waiting for a home care package.

“The wording of the interim report comes as no surprise to AMA members who work in aged care and witness the aged care crisis daily.

“A lack of funding, low support from providers, and little action by Government has led to the current crisis.”

Dr Bartone said the AMA welcomes the call for immediate action to reduce the waiting times for home care packages.

“The AMA has been calling for this for some time,” Dr Bartone said.

“Funding is needed to clear the backlog of almost 120,000 people waiting for a home care package at their approved level. It is unacceptable that people have to wait for over 12 months for a Level 4 home care package.

“A call for the reduction of over-reliance on chemical restraints is welcomed by the AMA.

“Our longstanding position is that restrictive practices should always be considered a last resort – where and when any potential risk or harm caused by the restraint itself is less than the risk of the patient not being restrained.

“The decision on the use of restraints should always be made on a case-by-case basis.

“However, there must be a balance between the need to ensure the older person’s safety, and the safety of those around them, including other residents and their families and friends, while respecting their right to dignity and self-determination, including acknowledging previously expressed or known values or wishes.

“But clearly, as part of reducing the inappropriate use of chemical restraints in aged care, there must be sufficient numbers of staff and an appropriate mix of skilled staff available at all times.

“Registered nurses must be available on site 24/7 to ensure appropriate care, including the safe administration of medicines, is provided for elderly and frail patients.

“Staff must be trained to better care for residents living with dementia. Currently, that training is inadequate.

“There is plenty of evidence that improved dementia management and behavioral training for nursing and personal care staff will lead to reduced prescription of antipsychotic medications.

“Staff also need training to understand the ethical, medical, and legal issues and responsibilities when using restraints. The AMA has called for a mandatory minimum qualification for personal care attendants.”

Dr Bartone said that a safe and quality skills mix of medical, nursing, and care staff, and minimum staff-to-resident ratios must be priorities.

“It is totally unacceptable that in 21st century Australia more than half of all aged care residents live in facilities that have unacceptable staffing levels,” Dr Bartone said.

“We have a sad and unacceptable situation where more than 80 per cent of staff say they don’t have time to provide social and emotional support to the residents.”

The AMA also welcomes the call to stop the flow of younger people entering aged care. Aged care facilities are not appropriate places for younger people.

Dr Bartone said that doctors who visit aged care facilities and witness the environment experienced by young people consider it demeaning and humiliating.

“The Government must urgently explore other options and provide alternatives for younger people with disabilities who are currently residing in residential aged care facilities,” Dr Bartone said.

“The Royal Commission has done an excellent job bringing to light the national shame of what is happening in aged care. We applaud the work of the Commission – but we cannot wait another year or more to start to fix things.

“The Government must act now – immediately. It cannot hide. No ifs, no buts, no more excuses. Our parents, our grandparents, our friends and loved ones deserve better. Care can’t wait.”



Dementia Australia

The Interim Report, ‘Neglect’, tabled today in federal parliament by the Royal Commission into Aged Care Quality and Safety has affirmed the key challenges people living with dementia, their families and carers have consistently flagged through their own experiences.

Dementia Australia CEO Maree McCabe said for many years people impacted by dementia have contributed to reviews, reports, advisory panels and committees, and they have also made significant contributions to the work of the Commission to date.

“This Interim Report has validated their shared concerns that systemic change is required, workforce capacity and culture needs serious attention and tackling age and other forms of discrimination is vital to ensure the future aged care system is able to support people impacted by dementia,” Ms McCabe said.

“Further, as the Report recommends, Dementia Australia urges the prioritisation of those areas flagged as requiring an immediate response rather than waiting for the handing down of the Final Report.

“An instant injection of funding to tackle the Home Care packages wait list of more than 120,000 people is crucial to so many people living with dementia, who are waiting to receive the support to which they are entitled.

“A coordinated and comprehensive approach to take decisive action to reduce the use of chemical and physical restraint is also essential.

“And urgent changes to the health system and residential aged care can also be introduced now to provide appropriate services and support for the 27,000 Australians living with younger onset dementia.

“Underpinning all of those things is a need for sufficient staff with adequate training to ensure safe and quality care for people living with dementia.

“I commend the work of the Commission to date and especially acknowledge the contribution by Commissioner, the late Hon Richard Tracey AM RFD QC, in addition to Commissioners Lynelle Briggs AO and the Hon Tony Pagone QC.

“Their leadership and dedication to listening, learning and a commitment to change has been inspiring.

“We look forward to a comprehensive focus on the issues important to people living with dementia, their families and carers in the Final Report and we reaffirm our commitment to being part of the solution through the whole-of-system reform and redesign that will be recommended in November 2020.”

For All Dementia Australia comments and submissions to the Royal Commission please visit https://www.dementia.org.au/royal-commission.

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