On Sunday 16 September, Prime Minister Scott Morrison announced the establishment of a Royal Commission into the Aged Care sector. The Prime Minister said, “This Royal Commission will primarily look at the quality of care provided in Residential and Home Aged Care to senior Australians, but also include Young Australians with disabilities living in Residential Aged Care settings.”

    In his first three weeks in the job, this was the briefing that he “could not get past”, calling out a disturbing trend of non-compliance, abuses and failures of care. The Prime Minister cited confronting statistics like:

    • A 177 per cent increase in services with serious risk identified in the past year.
    • A 292 per cent increase in services with significant non-compliance, with one service being shut down by the Department of Health every month.

    Further, the Aged Care Complaints Commissioner’s 2017–18 annual report also showed that the Commissioner referred 1,073 cases to the Australian Aged Care Quality Agency, a rise of 130 per cent over the previous year. A record number of complaints were received by the Commissioner (5,779).

    Opposition leader Bill Shorten supported the proposed Royal Commission telling media there’s no doubt in his mind “that the aged care system is in crisis”. However, he caveated his support saying “the Royal Commission should not be an excuse to delay doing what we know already needs to happen - we know what needs to happen”.

    Terms of Reference?

    Terms of Reference for the Royal Commission will be announced following a consultation period. In an open letter to the ‘Aged Care Workforce’, Minister for Senior Australians and Aged Care Ken Wyatt AM MP wrote the government “expect” the Royal Commission will cover:

    • The quality of care provided to older Australians, and the extent of substandard care;
    • The challenge of providing care to Australians with disabilities living in residential aged care, particularly younger people with disabilities;
    • The challenge of supporting the increasing number of Australians suffering dementia and addressing their care needs as they age;
    • The future challenges and opportunities for delivering aged care services in the context of changing demographics, including in remote, rural and regional Australia; andv
    • And other matters that the Royal Commission considers necessary.

    Since the government’s announcement, they have received over 3,000 submissions on the Royal Commission’s Terms of Reference (ToR) from community groups, residents, their families, aged care providers. Submissions closed midnight 25 September.

    As part of the ToR consultation, Minister Wyatt said he had met three times with representatives from consumers, families, workforce, peak bodies, large providers, and the National Aged Care Alliance. Wyatt will hold four roundtables in Sydney this week – two with consumer representatives, one with aged care workers, and one with providers.

    The Australian Federation of Disability Organisations urged the government to include people with disability within its ToR. “We offer our expertise in assisting the Morrison Government to ensure the Royal Commission terms cover not only aged care but all areas for people with disability who continue to be mistreated and silenced,” CEO Ross Joyce said in a statement.

    ‘No-one cares’

    ABC’s 4Corners aired their investigative feature ‘No-one Cares’ the day after the Royal Commission was announced. They asked audience members to contact them about their experiences with aged and received over 4,000 responses from families, staff and industry members. Host Sarah Ferguson said, “In the responses we received from across the country it’s clear that hurt comes in many forms… not just the horrific tales that have captured headlines but every day stories of neglect and inattention, poor quality food, lack of personal care, boredom and heart-breaking loneliness.”

    Hidden camera footage revealed one instance where an elderly woman who required assistance standing up and was left helpless in the dark for over three hours before carers came to her aid. Her son told 4Corners, “When I watched the video I thought, "At least my mum can still communicate, and she's still able to say, 'Hey, this is happening to me.'" I can't even imagine what's happening to those people that can't talk anymore.”

    Amongst the responses, some 1,300 aged care staff contacted the show identifying what they called “common issues” in an industry they say is in crisis. Those issues range from staff to patient ratios, overuse of medication for the management of people with dementia and egregious rates of malnutrition.

    On Monday 24 September, Dementia Australia CEO Maree McCabe GAICD called on the government to prioritise a systemic focus on education for the aged care workforce to manage the multiple complex conditions of many clients in care.

    “With more than 50 per cent of people living in residential aged care living with dementia, and many more in early or undiagnosed stages, it is essential that developing and implementing national quality standards in dementia care is escalated to a high priority level in all national and state planning,” McCabe said.

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