When the Royal Commission into Aged Care Quality and Safety was announced, for those of us invested in the sector, there was hope.
Hope that our exhausted voices were at last being heard, hope that the veil over the sector would be lifted and a reality, very different to that portrayed by proprietors, would be exposed for public scrutiny.
Testimony was given that shocked the general public. Nightly news bulletins broadcast the horrors of neglect and abuse, dehydration, malnutrition, chemical and physical restraint, the ignored concerns of relatives, staff shortages, and inappropriate staff skill mix.
The hope was that the industry would be reformed and our older people provided with the support and care they deserve.
A hastily convened press conference was held to officially release the final report of the Royal Commission, with insufficient time for journalists to read the report and formulate questions. It was an indicator of the careless and dismissive attitude of government towards the sector.
Then COVID-19 arrived.
Despite the vulnerability of older people living in residential aged care articulated in the report, they were initially left in the care of a workforce that was unprepared, who worked across multiple facilities and who were not supplied with the personal protective equipment to keep themselves and residents safe.
A report from the International Long-Term Care Policy Network in London demonstrated how unsafe residents were, with 75 per cent of COVID-19-related deaths in Australia occurring in residential aged care. This compared unfavourably with 49 per cent in Sweden and 34 per cent in the United Kingdom.
Promises that aged care staff would be vaccinated as a priority and would be required to work in only one facility were demonstrably unreliable with the arrival of the Delta variant.
The rhetoric sounded caring, but promises were not enacted. The aged care sector had become invisible and vulnerable again.
The Royal Commission recommended that the Aged Care Assessment Team (ACAT) and the Rural Assessment Service (RAS) become one entity with a single assessment process but that the assessment process be independent of the providers of services and residential care.
Unfortunately, the government is using this opportunity to promote privatisation of the assessment process. This is of grave concern. It was just over 12 months ago that, after much lobbying, the government backed down from privatising this very effective assessment process.
Privatisation means taking the assessment of frail older people away from skilled and experienced geriatricians, registered nurses and allied health professionals.
According to the Australian Medical Association, it means the removal of $130 million from the public health system and put into the pockets of the private sector, as well as the removal of the independence of assessment that currently exists.
There are changes happening in residential aged care because of the Royal Commission, but they are not what was expected by the general public, aged care workers and the residents.
These involve the increase in documentation and regulatory compliance. So rather than the provision of professional support from skilled and experienced registered nurses, educators and clinical mentors, aged care facilities are responsible for increasing levels of documentation.
Chemical restraint and physical restraint have rightly been made more difficult to apply, however, what is there to take the place of restraint? Where are the specialist staff to develop programs and interventions to prevent the incidents?
Instead of skilled support for care staff managing these complex situations, there is a Serious Incident Scheme where documentation is required and police are called to manage incidents of violence and aggression.
As a result of the scrutiny and the amount of documentation, aged care facilities are refusing to take any person with a history of aggression, who are vulnerable to a fall, or who have a disability and is under the National Disability Insurance Scheme (NDIS). Older people who are eligible for the NDIS require double the amount of accountability.
Sadly, the abuse and neglect in aged care facilities continues.
In their frustration with the lack of action by proprietors and government, aged care advocates and employee groups have established Aged Care Watch, a website where complaints can be shared and linked geographically so families and prospective residents can read about the facility they are considering from a different viewpoint than that of the proprietor. To date there are more than 2000 entries.
The Royal Commission into Aged Care Quality and Safety provided hope, but government responses to recommendations and initial inaction to COVID-19 demonstrate the need for continued advocacy for older people and vigilance of the sector.
It is difficult to remain hopeful of impactful, person-focused, change.
- Maree Bernoth, Associate Professor of Nursing in the Charles Sturt School of Nursing, Paramedicine andHealthcare Sciences.