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Inquiry told aged care regulations too ‘rigid’


Regulations need to allow for greater consumer choice in residential aged care so the industry can provide individualised care, the aged care royal commission has heard.

National director of UnitingCare Australia Claerwen Little told the Royal Commission into Aged Care Quality and Safety on Wednesday that current aged care regulations failed to factor in whether residents have certain wants or wishes for their care.

Claerwen Little

“At the moment the regulations really bind up a system and the service so they can’t necessarily provide more choice for the individual,” Ms Little said.

Residents want to have a say in their care, including when they get up and what they wear and eat for breakfast.

“The regulations as they stand at the moment are very rigid,” she said.

The current regulations do not provide flexibility for the wants and desires of residents, Ms Little said.

“We have a regulatory environment which is incredibly hard in which to create an environment where choices can be exercised in that way, mainly because it is a regulatory environment that is essentially about punishment and not about flexibility within the care setting, especially residential care,” Ms Little said.

The future regulatory framework needs to be much more flexible, she said.

“It needs to be a continuous improvement process that is based on outcomes and based on the needs of the individual, rather than the needs of the system.

Ms Little also suggested there needed to be more options for people than the current three care and support programs and particularly between home care packages and residential aged care.

“We believe that there are many other options that can be developed between that [are] smaller settings. The residential aged care settings at the moment are predominantly large institutional settings,” she said.

“It’s time that the aged care institution is really unpacked and brought into a much broader range of smaller and more flexible options for people than just the three that exist at the moment.”

Pat Sparrow

On Tuesday, Aged and Community Services Australia CEO Pat Sparrow told the hearing that the regulatory system did not support dignity of risk.

“Dignity of risk is allowing people to make choices, to be safe in the environment but also to make choices that reflect what they want and need to do,” Ms Sparrow said.

She provides the example of a resident wanting to walk to the local shop to buy an ice-cream after dinner.

“Regulation sets up a concern that [something] may not be a safe thing for the person to do. But for that person that [something is] going to have an impact on their quality of life, and it gives them dignity about them having choice.

“We think there has to be safety for people but one of our jobs as providers should actually be to support people to have the quality of life that they want and those small examples about choices that people can make that give quality of life and meaning to them, we should be able to support them to do,” she said.

Systemic issues in the sector

Elsewhere on Wednesday, the CEO of fellow aged care peak the Aged Care Guild, Matthew Richter told the royal commission that the aged care sector is meeting the needs of many senior Australians, however there are systemic issues that need to be improved.

“I think there are a number of symptoms that this system is approaching a tipping point and we need to refocus it and as has been mentioned by some others re-balance it,” said Mr Richter, whose organisation represents large for-profit residential providers.

Matthew Richter

He said one of the biggest system issues is a lack of information for consumers almost at any point of the very complex and complicated journey.

To address systemic issues, the Aged Care Guild is partnering with consumer ratings website CarePage to develop a $100,000 prototype of an online system to combine consumer feedback.

He said it would include net promoter scores, clinical indicators and recommendations for services.

The peak is aiming to have the tool developed within the year, Mr Richter said.

Staff turnover on the rise

During Mr Richter’s evidence Senior Counsel Assisting Dr Timothy McEvoy questioned the “striking” turnover rates of nurses at the majority of the Aged Care Guild’s member organisations.

The average employment period of new graduate nurses decreased from 2.35 years in 2013-14 to 1.69 years in 2015-16 and 1.32 years in 2017-18, Mr Richter said in his witness statement.

On addressing the issue, Mr Richter pointed to the industry council it was establishing with fellow aged care peaks ACSA and Leading Age Services Australia to oversee the implementation of the sector’s workforce strategy developed by the Professor John Pollaers-led Aged Care Workforce Strategy Taskforce.

“We’ve been working to help John Pollaers try and get that council formed and working as quickly as possible so that strategy doesn’t sit idle any longer.

“We’ve had some members involved in the formulation phase of it in terms of the strategy now,” Mr Richter said.

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6 Responses to Inquiry told aged care regulations too ‘rigid’

  1. W E Sullivan February 22, 2019 at 1:31 pm #

    We all want what’s best for those we love. Well, how about this for a novel idea. Children, grandchildren, siblings, agree on a roster. Eveveryone takes a turn looking after grandma or granddad. Sits with them all day a couple of days a week while the aged cate workers do all the hard work. You just have to keep them company. How hard is that? Really? Who knows you might even like it. Yes it might mean you miss out on that trip overseas for a year or two but you’ll regret it later if you don’t. It’s easy. You’ll be glad you did.

  2. kylie wise February 22, 2019 at 1:37 pm #

    C’mon AAA, it’s a Royal Commission. You have an obligation to accurately report the proceedings.

    This piece simply cherry-picks the transcript to put a positive spin on the testimonies. It gives the impression the Aged Care Guild is proactively working to improve the sector. Anyone watching the hearing would have a different view.

    Mr Richter was on the back foot from the outset. His verbal comments contradicted his written statement and the assisting counsel repeatedly exposed the Guild’s ineptitude and inaction. He rambled off-topic and had to be directed to answer counsel’s questions on several occasions, eventually conceding that his members weren’t really doing anything of substance to address these problems.

    Deceptive and opaque practices are largely responsible for the mess we’re in. This type of reporting only perpetuates that behaviour. Please try to break the habit

  3. Ottonie Oswald February 22, 2019 at 7:36 pm #

    Yes, WA Sullivan, I have worked in Aged Care with people with dementia. That is exactly what is needed. Most of the people I have nursed were lonely, and generally the nurses are too busy with physical care to give them the company they crave.

  4. Staff with no name February 23, 2019 at 5:04 pm #

    Missing the point again. Stop asking people who do not work in the sector what is needed to ensure a stable workforce. Unless you have been “on the floor” recently you have no business advising providers or anyone else about how to staff facilities and community organizations. As for regulations being too tight and resident/clients not having choice, again, where have you been? All students undertaking a Certificate 3 in Individual Support are taught that care plans are designed to be the choice of the resident/client not the provider, that is what person-centred care is about. It is the providers that make it impossible as facilities have to run on a schedule and the meals come out at certain times (god forbid someone wants to eat later that opens up a whole new can of worms with food temperature and safety), the personal care has to be completed before a certain time and most definitely by morning staff or the PM staff will not cope as there are even less of them. I could go on forever but unless staff can be given a voice and not be identified by their employers when doing so, you will never get the full story.

  5. PK1765 February 24, 2019 at 3:02 am #

    @WE Sullivan… and what about ALL the elderly that have no family to care for them… hmm there are quite a number that have not had children or whose child or children have died or moved overseas… who had no siblings thay are quite alone in the world… You need to get out of that cosy box you live in and join the real world!!

  6. Stacey Masters February 24, 2019 at 2:09 pm #

    I enjoy spending time with my parents who live in residential aged care in rural South Australia. However the suggestion that I can simply ‘keep them company’ while aged care staff do the work does not accord with my lived experience.

    My parents benefit from regular checks of their vision and dental health as well as specialist review and treatment of eye and skin conditions. In this respect, a dental outreach service has been a blessing.

    Both parents have moderate to advanced dementia and one is on anti-psychotic medication to ameliorate the behavioural and psychological symptoms. It was suggested that a geriatrician could visit the rural aged care facility but this did not eventuate and a private referral has now been arranged. I am grateful that the government-funded Dementia Behaviour Management Advisory Service (DBMAS) was able to provide telephone advice and onsite nurse assessment in the early weeks following my parents admission to residential aged care. DBMAS also provided me with support and information concerning the use of anti-psychotic medications for BPSD.

    Acute symptoms need to be considered in the context of a person’s medical history and thus I have also travelled more than 300kms to investigate abdominal pain resulting in a brief admission to acute care.

    I accept that residential aged care facilities are not ‘one-stop’ health care facilities but please do not assume that I am free to simply visit my parents.

    I also want to say something about end of life care.

    I am confident that my parents will receive skilled palliative care in their final days of life. I enjoy that confidence because my parents are in a state-run facility that is well supported by caring local GPs and has adequate numbers of registered and enrolled nurses. The GPs provide continuity of care and the facility has access to syringe drivers that can assist in the provision of continuous pain relief and other drugs to minimise suffering during the dying process, if required. I do not know how many other residential aged care facilities in Australia enjoy this level of medical and nursing support to adequtely care for residents at the end of life and am pleased that the Royal Commission will further explore this.

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