A health department bureaucrat has been asked by a royal commissioner to explain whether the 6000 young Australians with disability who are currently in aged care facilities have been ignored and forgotten by government policy.
Nicholas Hartland, First Assistant Secretary in home aged care in the Department of Health, faced tough questioning at The Royal Commission into Aged Care Quality and Safety in Melbourne on Monday, which focused on young people in aged care.
The commission heard an average of 42 people under 65 enter residential care each week; equal to six every day and 2000 a year.
Many of these have an injury or illness, or complex care requirements, with the most common reasons for admission including dementia, cancer, cerebrovascular and neurological conditions.
Commissioner Lynelle Briggs said there didn’t appear to have been “a lot of will within the system” to try and stem the flow or to move young people with disability into more appropriate arrangements.
“Do you think they’ve been forgotten?” she asked Dr Hartland.
“I don’t think I would say that young people in residential aged care have been forgotten or left out of policy debates but it is going slower than we would have liked,” he replied.
“But it would be true to say, wouldn’t it … that young people with disabilities have been somewhat neglected if not left isolated, not given rehabilitation that might enable them to live a more fruitful life than they can in a institution fundamentally designed for people many years older than themselves?” Commissioner Briggs pressed.
Dr Hartland was also grilled by Counsel Assisting Peter Rozen QC, who questioned the government’s failure to establish a database of all young people living in aged care despite this being recommended in a 2015 Senate report.
Dr Hartland said this hadn’t occurred because the government had been focusing on establishing the NDIA.
Mr Rozen also asked about the lack of specific targets in the government’s national plan to move young people out of residential aged care by 2025.
He also asked if it was “just a coincidence” that the plan was announced last October, one month after the Royal Commission was announced.
Dr Hartland said that was a question better addressed to the Department of Social Services.
‘I just want to get out’
In other other evidence on Monday, Lisa Corcoran, who was moved from hospital to an aged care facility in 2013 at the age of 37, told the commission she hated living there and couldn’t wait to move into supported accommodation, which is currently being built under the NDIS.
Ms Corcoran told a harrowing story of her daily experiences in the facility, including having to fight to be washed more than once a week, how her vegetarian preferences weren’t respected and how she spent days sitting her room
She also watched older residents die around her and saw a body with its head in a bag being removed at lunch “when everyone was eating lunch”, and said she had been sexually assaulted, punched and pinched.
Ms Corcoran said she felt as if she was not respected.
“We’re all humans and humans crave respect. I feel like I have lost that,” she said.
“My goal is to get the f*** out of the nursing home,” she said.
Flawed government policy
Mr Rozen said the commission had received 6022 submissions to date, 10 per cent of which raised concerns about younger people with disability in residential facilities.
Many were referred there from hospital, where they are often seen as “bed blockers”, he said, and referrals were often “perfunctory” and performed with little oversight.
More than 20 per cent of younger people referred to aged care spent less than six months there, suggesting it was being used as a transitional or palliative option.
Of the some 2000 young people who exited aged care in 2018, 60 per cent died and 10 per cent went home to their families. Only a small proportion moved to a more appropriate location.
Mr Rozen said there were many drivers of people entering aged but it was also the “result of an environment that fails to recognise their needs”
He said there was “nothing inevitable about ending up in aged care” but rather was the result of government policy and “nonsensical funding arrangements”.
He also said the situation was exacerbated by a “tension” between the aged care and disability systems, with 2500 people with disability supported by a HCP rather than the NDIS.
Residential care was inappropriate for young people, linked to functional decline and was also an infringement of fundamental human rights, Mr Rozen said.
However, Dr Hartman told the commission aged care was likely to remain a provider of last resort, especially in rural and regional areas.
“Will aged care continue to remain a provider of last resort in some areas, including rural and remote? I think the honest answer would be … I don’t think that it’s going to be easy to have supported disability accommodation in every area of Australia,” he said.
“That’s something that I think most people in rural Australia would find very disturbing,”Commissioner Briggs said.