Home care has been identified as one of three areas requiring immediate action in the interim report of the Royal Commission into Aged Care Quality and Safety which described the aged care system as “a shocking tale of neglect”.
In their report, tabled in parliament on Thursday, Commissioners Richard Tracey and Lynelle Briggs said they had heard and read a great deal of evidence about the heavy toll on older Australians of the long waiting times for home care packages.
“It is shocking that the express wishes of older people to remain in their own homes for as long as possible, with the supports they need, is downplayed with an expectation that they will manage,” they said.
The report calls for significant additional funding now and in the future to increase access to home care.
“In order to keep older people safe in the their homes, significant additional funding needs to be provided for home care packages both immediately and into the future in order to ensure that supply meets community expectations,” it says.
The three-volume report, titled simply Neglect, said home care was of central importance for the future of aged care in Australia being a mode of care that helped people live out their lives where chose with a level of independence and social connection.
Unable to deal with demand
However, the commissioners said the aged care system was unable to deal with the level of demand for home care services.
Waiting times of up to 12 months or more for high care Level 4 Home Care Packages were unacceptable, they said, citing evidence that more than 16,000 people had died waiting for a package they never received in the last year.
The commissioners noted they had heard evidence about fees and charges, unspent funds, quality and safety, consumer directed care, home care workers, and sanctions and safety compliance in the home care sector.
“We are in no doubt that the current aged care system is not able to deal with the level of unmet need for home care services and the demographic pressures behind it. It is clearly unacceptable for there to be more people waiting for Home Care Packages than are receiving them. It is unsafe. It is neglect,” they said.
“This situation has contributed to unnecessary and premature deaths; has driven some people into residential aged care and has placed terrible pressure on informal carers. It cannot be allowed to continue.”
A ‘cruel and discriminatory’ system
It also noted concerns about quality and capacity associated with the rapidly increasing home care market and the workforce implications of the swelling numbers of packages, as well as poor regulation of home care.
“We have been alarmed to find that many people die while waiting for a home care package. Others prematurely move into residential care. By any measure, this is a cruel and discriminatory system, which places great strain on older Australians and their relatives.
“It is unfair. Older people should receive the home care services they need to live safely at home.
“Funding should be forthcoming from the Australian Government to ensure the timely delivery of these services.”
The report also raises concerns about quality, saying that at the end of June 2019, 159 approved providers had not had a quality review for any of their active home care services.
The Commissioners said they had also frequently heard that the assessment process was convoluted and that confusion surrounded the criteria used to place people in the queue for Home Care Packages.
The Commonwealth Ombudsman received 164 complaints about the Australian Department of Health, with 44 per cent relating to My Aged Care and concerning the allocation of Home Care Packages and Packages being allocated and then withdrawn.
People were also suffering serious delays in receiving letters from the Department, which often unnecessarily complex and poorly written, and there was a lack of follow up from the department after Home Care Packages were approved.
Government put on notice
Aged care minister Richard Colbeck, who at the LASA conference early this week indicated the government would use the interim report as an imprimatur for change, said the government had been put on notice.
“I said to industry last week that it would put us all on notice,” he told the ABC on Thursday. “It has done that in spades. It’s put the government on notice, it’s put the industry on notice, but as importantly as it’s put the entire community on notice.”
Opposition spokeswoman on ageing Julie Collins said Labor concurred with the finding of the Royal Commission that there was no higher priority than immediately acting to fix Australia’s home care crisis.
LASA CEO Sean Rooney, who released LASA’s own 16-point pathway to reform at the peak’s annual conference, said “our sector is steadfast in our commitment to do better and to hold to account any individual or organisation that is either unwilling or unable to meet industry standards and community expectations”.
ACSA CEO Pat Sparrow said it was no surprise that there were failures in aged care.
“We are living longer than ever before and our health needs are increasingly complex. The system wasn’t set up for this,” she said.
COTA CEO Ian Yates said probably the most damning finding of the Royal Commission was the government’s failure to act despite the recommendations of numerous previous reports.