A Systemic Shift: Why the Aged Care Royal Commission Needs to Dig a Little Deeper

A Systemic Shift: Why the Aged Care Royal Commission Needs to Dig a Little Deeper

By: Australian Healthcare Week

In early 2017 the South Australian Chief Psychiatrist uncovered abuse and neglect of residents and patients at the Oakden Aged Care Facility dating back over a decade. The site was promptly decommissioned and residents transferred to nearby care providers.

Sadly the Oakden incident isn’t the only of this sort on Australian shores with reports of some of our most vulnerable members of society strapped to chairs for 14 hours at a time, or left waiting in beds for a nurse to hoist them out for hours on end. The conditions prompted Prime Minister Scott Morrison to announce a Royal Commission into the state of aged care last October.

With the Australian public recently exposed to a raft of stories of less than acceptable care practices, the Royal Commission into Aged Care Quality and Safety is now leading an investigation into these claims.

The Royal Commission into Aged Care Quality and Safety is one of more than 20 such inquiries into aged care stemming back to 1997. This latest inquiry, announced late last year will no doubt highlight the systemic problems that have been previously reported.

The purpose here isn’t to name and shame, but to ensure the Commission – with its interim report due in October this year and a final report due in April 2020 – understands the root cause of the problem, and not just the problem itself.

Glossing Things Over

Following the broadcast of a story about the use of chemical and physical restraints in some nursing homes, the Morrison Government, the day before the royal commission hearings were to begin, announced a funding package for the $22 billion aged care sector.

"The Morrison Government is making a further significant investment in aged care, with $320 million for residential aged care and an additional 10,000 homecare packages across all levels as part of a new $662 million package to support older Australians," a February 10th statement from the PM and Aged Care Minister Ken Wyatt said.

As the ABC, who first blew the whistle in a big way with their Four Corners expose Who Cares? Last year notes though; “’the payment has been variously described by the Government as one to "help increase support,” as one which "equates to an average additional $1,800 per permanent resident" and as "an up-front payment to support all providers in the care of their residents over the next 18 months, while the royal commission goes about its work.”

But what it is at its most basic level is a once-off cash injection, given to nursing home operators without any strings attached…” Sources in the sector say there is no real long-term change you can achieve with a one-off payment.

On top of the $20 million investment the federal government is aiming to crack down on elder abuse with a new national hotline and $18 million over four years for frontline services trials designed to support victims.

Taking this one step further, in South Australia at least five aged care facilities managed by SA Health will have CCTV cameras installed later this year in an Australian-first trial of new safeguards for people in care.

Detecting excessive noise and movement, the $500,000 Federal Government investment will see cameras monitored 24/7 by a third party contractor in a year-long trial for residents and families that have provided consent.

The Crux of the Problem

While these initiatives are certainly a step in the right direction, their impact is both hindered and limited if the root cause isn’t identified and addressed.

While the Aged Care problem in Australia can’t be boiled down to one single element, one of the key issues raised during the Royal Commission has been how restricted nurses are in the time they can spend providing clinical care to residents due to other demands.

Do you take an aged care resident in urgent need of the toilet to the bathroom or attend to the insistent buzzing of another who needs your help? These are the decisions that aged care nurses face every day and since the announcement of the royal commission into the sector last October things are only getting harder.

Chronic understaffing has always been a problem in the aged care sector and this is only getting worse. Anyone working in Aged Care and Home Care would agree that times are changing and changing quickly and aggressively. Some things will remain constant though: it’s still all about delivering quality services and caring for people.

However, a number of major challenges are either here right now or on the horizon, especially as the governance of nursing is lacking. Speaking to HelloCare at Australian Healthcare Week earlier this year, Kylie Ward, CEO of the Australian College of Nursing pointed out that while we’ve seen an increase in unregulated healthcare workers – up to 70% of the aged care workforce, we’ve also seen a decrease in registered nurses over the last 10-15 years from 21% to 15%

By 2031, almost one in five people will be aged 65 and over. If the system does not change by then, poorly equipped and uncoordinated services will fail our most vulnerable. Health carers need to be trained in dealing with the issues of the ageing population, and we need to be able to identify appropriate models of care that reflect the whole person’s needs.

The 2020 Workforce

According to the Productivity Commission Inquiry Report ‘Caring for older Australians’ (2011) “The aged care system suffers key weaknesses… [with] workforce shortages exacerbated by low wages and some workers [having] insufficient skills.”

Adding to this is mounting pressure. Over the next 35 years, it is expected that the aged care workforce will need to nearly triple in size in order to be able to continue to provide support for consumers of aged care. As demand for aged care services increases, so will demand for a well-trained, responsive and diverse aged care workforce.

With the predicted decline in the informal carers’ workforce coinciding with an increased demand for aged care services, people will have to rely more heavily on formal aged care services, resulting in increased pressure on the system.

In fact, according to the recently published AHW State of the Industry Report, 57% of those Australian Healthcare professional surveyed reported feeling the pinch of an aging population, while a further 12% estimate that it will become a challenge in the coming years when it comes to strategic workforce planning and delivering safer care.

As outlined in the Strategic Roadmap for Aged Care, Government and providers will need to work collaboratively in order to address the challenges facing the aged care workforce into the future. Clearer roles for government and the aged care sector are necessary, with government focused on ensuring major policy levers (e.g. education, employment, immigration) consider the needs of care industries. Measures will need to be in place to support and recognise the importance of informal carers, and continue to help ensure families undertake a caring role that suits them.

Ultimately there is no single answer to our nation’s aged care problem. The Australian population is on a rapidly aging trajectory so where do we go next?

As the workforce shrinks and demand increases we need to begin looking at more innovative solutions. While it’s still early days government policy reforms like those sure to come about from the recently announced Aged Care Royal Commission, digital technologies, wearable devices and smart modular housing provide the biggest opportunities to revolutionise aged care in 2020 and beyond.

These innovations, coupled with improved workforce planning strategies, workforce upskilling and training, and greater recognition and leadership opportunities will shift the aged care sector towards being considered a desirable and rewarding place to work, with providers attracting and maintaining a well-led, flexible and responsive workforce.

Interested in Learning More?

If you’re interested in learning more about how aged care providers are transforming their workforce and business strategy in the wake of the Royal Commission, join us at the Aged Care Summit running at Australian Healthcare Week 2020. Email us for more information about early release tickets.