Aged care Royal Commission delivers a worthy vision and prompts some tough questions

The 148 recommendations of the Royal Commission into Aged Care Quality and Safety offer a chance for older Australians to enjoy better lives and better care. To understand where we go from here, it is vital to understand just what the commission has recommended.

The recommendations emphasise the rights, needs and preferences of older people, their families and carers. They call for these to be enshrined in a new Aged Care Act, which would also set out providers’ duty of care. Key to achieving this is transitioning from a rationing model to an entitlement model, in which the type of service consumers choose is based on an assessment of their needs.

The commissioners call for a fundamental redesign of support for older people that integrates aged care, health care, housing and welfare. As they put it, “the aged care system should put older people first and it should be equitable, effective, ambitious, accountable and sustainable”. To that end, they propose changes to aged care policy of an unprecedented breadth and scale over the next decade.

Navigating the aged care system can be challenging for older people, so the commissioners recommend introducing face-to-face “care finders” to help them. The commissioners also recommend introducing more ways of getting information about a service, including a “star ratings” system based on the quality regulator’s assessment.

Other recommendations include tailored pathways of support for people living with dementia and for Aboriginal and Torres Strait Islander people. The commission also recommends giving greater recognition and support to informal carers of older people. Older people with a disability would have supports equivalent to those provided through the National Disability Insurance Scheme to younger people with a disability.

The commissioners also address the hurdles faced by many older people who prefer to receive care at home for as long as possible. After the current waiting lists are cleared, access to home care would be provided within 30 days of assessment. The funding in a home-care package would be up to the highest level of care funding in residential care, and consumers would not have to contribute to their care.

These recommendations would have a profound impact on older people who currently face long waits or find the cost of those services unacceptable. They would rebalance care provision between home and residential care.

For those who require residential aged care, the recommendations would facilitate a more personalised experience. They would involve smaller household models of care with required minimum staffing levels. All care staff would be registered and would receive regulated training and hold mandated qualifications. Linkages to primary care, palliative care and acute care services would be enhanced, while allied health and dental care would be improved. There would be greater controls on the use of physical and chemical restraints. Residents would not be required to contribute to the care component of the services they receive, but other means-tested arrangements would apply.

Aged care providers would be central to achieving these ambitions for older people and implementing many of the recommendations. They would face greater ongoing and annual requirements to report on care indicators, adverse events and performance, including compliance with staffing standards and the use of restraints. They would also be under increased scrutiny, with star ratings and strengthened prudential standards. Quality standards will be revised, and the quality regulator will have wider enforcement powers, including civil penalties for approved providers and directors.

Recommendations to enhance the financial sustainability of providers include an immediate government-funded increase of $10 per day in residential care for each resident (linked to demonstrated levels of purchased goods, particularly food), and maintaining a higher level of viability supplements for rural and remote service providers.

The commissioners also recommend improving the indexation of subsidies, increasing funding for education and training of staff, and increasing the level of capital grants. The future financial sustainability of providers would rest on the determinations of the recommended Independent Pricing Authority, which would set subsidies and user charges for the aged care system. These would be based on an analysis of the cost of providing care, including additional costs incurred by regional, rural and remote services.

The commission has also proposed significant changes to the governance and regulation of the system.

While Commissioners Tony Pagone and Lynelle Briggs disagreed on whether the governing body should be the Department of Health or an incorporated Australian Aged Care Commission, they agreed that the governing body should be far more active on key issues – planning for service access and management of the aged care market; system monitoring and reform; workforce planning; and setting and monitoring prudential standards – than the Department has previously been.

Under the recommendations, the Australian Commission on Safety and Quality in Health Care would revise the aged care quality standards and have ongoing responsibility for formulating quality and safety standards, guidelines and indicators for aged care. The Commissioners disagreed on where quality regulation should reside, with Commissioner Briggs recommending that a new independent Aged Care Quality and Safety Authority be established.

Also recommended was an Aged Care Research and Innovation Fund to promote research and innovation in aged-care service delivery, ageing and ageing-related conditions. The Commission has also recommended the creation of an Inspector-General of Aged Care to monitor and report on the administration and governance of the system, including the performance of the system governor, the quality regulator, the prudential regulator and the pricing authority.

The source of funding for the sector, including additional funding to achieve expanded and improved services, remains unclear. The Commissioners have not agreed on whether it should be through current government budget allocation processes or a dedicated tax levy.

The final report of the Royal Commission offers a transformational vision and plan to support older people, their families and carers. It is a worthy vision for an Australia that truly values its older citizens.

Questions remain about which bodies would be responsible for the governance of a new aged care system and how it would be financed. Confidence in the financial sustainability of providers, particularly residential providers, depends on trust in the future determinations of an Independent Pricing Authority and in the required funding being secured.

Beyond those considerations is the question of whether the Federal Government and providers have the capability and maturity to implement the scale and breadth of change envisaged. If these recommendations are accepted by the government, this will be critical in deciding how they are sequenced and implemented so that older people can experience the care and support they deserve.

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This article was previously published on the CEDA website and Australian Ageing Agenda.