2021 provides a historic opportunity to reshape aged care and this is how it can happen, write Stephen Teulan and Nikita Weickhardt.

In the last week of February the Royal Commission into Aged Care Quality and Safety will issue its final report. When that document is made public, will the recommendations create an agenda for aged care over the next decade or will they gather dust like some other reviews of this sector?

Stephen Teulan

Already we have some idea what to expect. The interim report was released in October 2019, and this past October the Counsel Assisting put forward 124 recommendations for the consideration of the Royal Commissioners.

To get some expert opinion on what comes next, Nous Group interviewed leaders in aged care. We spoke to people working in aged care provision, in government regulation and in sectoral advocacy.

Because of the sensitivity of the issues involved we agreed to protect their identity, but the insights they offer are valuable for anyone keen to understand how aged care can seize this historic opportunity.

The leaders we spoke to overwhelmingly support the thrust of the 124 recommendations proposed by the Counsel Assisting. Sifting through the recommendations, they identified five that would make the greatest difference to the quality of care received by older Australians:

  1. A new Aged Care Act based on human rights principles that emphasise that older people have the right to a meaningful life attracted strong support.
  2. There is consensus on the importance of a skilled, resourced, well remunerated and responsive workforce to meet the needs of older people. The Counsel Assisting has called on the Department of Health and the Aged Care Workforce Industry Council to lead the sector in designing and planning workforce strategies, reviewing competencies and developing a workforce structure with clear career pathways.
  3. There is a strong case for making home care packages available according to need. Immediately increasing the availability of home care packages, and by the end of 2021 allocating a package to everyone on the waiting list who does not have a package at the level they have been approved, would be life-changing for older Australians who have spent up to 12 months on a waitlist.
  4. Enabling people living with dementia, their carers and families to receive the support and care they need has been described as a recommendation that will make the biggest impact on the quality of care. The proposal is for establishing a comprehensive, clear and accessible post-diagnosis support pathway for people living with dementia and their carers and families.
  5. Increasing transparency of service attributes and performance has strong support.Graded assessments of service performance against Aged Care Quality Standards combined with developing and publishing star ratings for service quality and safety, staffing levels and consumer experience would make providers more accountable and increase consumer confidence in care.
Nikita Weickhardt

The aged care leaders are confident those five areas would have the greatest whole-of-system impact on the quality of outcomes for older Australians.

But their confidence is subject to some contingencies:

  1. Aged care funding is constrained and the system is under additional strain due to the resources required to respond to COVID-19. So there is concern whether required funding will be provided and whether the sources of that funding will be identified and secured. The funding envelope and the contribution from government and other groups, including consumers, is unclear. This results in concern about the level of funding available and whether it will be sustained.
  2. Among the 124 proposed recommendations was the establishment of an implementation unit within government. Aged care leaders argued for the Royal Commission to prioritise and sequence the recommendations, to define the governance for the changes and identify who will drive them.
  3. Aged care leaders said it was important the final report included actions aimed at supporting disadvantaged groups, without which there could be an undersupply and lack of diversity of services. Relevant groups include Aboriginal and Torres Strait Islanders; culturally and linguistically diverse people; regional, rural and remote communities; LGBTI people; and people at risk of homelessness.
  4. To deliver on the recommendations in the proposed five years, the final report needs to describe clear steps to engender the cultural change required in aged care organisations, governments and the public that addresses the ageist mindset that undervalues older people and limits their possibilities.

Finally, the aged care leaders we interviewed identified three additional areas that the final report ought to include:

  1. The Royal Commission’s interim report said many deficiencies in aged care were known to the providers concerned and to the regulators before becoming public, yet little had been done to address them. The final report should not only detail how the system will be governed but also describe the consequences of non-compliance beyond the potential application of a civil penalty by a court.
  2. The aged care leaders said Counsel Assisting’s recommendations focused on regulating the sector as it is today and not on how it will look tomorrow. While the issues in residential aged care need to be addressed, questions that ought to be considered are:
    • What are benchmark examples of integrated accommodation and care models and how can these be enabled?
    • What other funding models enable a sustainable, community-based aged care sector?
    • Are there better forms of respite and associated funding models?
    • How does the sector shift its workforce focus from what we have now to building the workforce for the future?
  3. The aged care leaders noted that the pandemic has demonstrated that an effective health system depends on an effective aged care system. There needs to be formal recognition that the systems are interdependent and that the national, state and territory governments all have a role in enhancing the health and aged care interface.

The Royal Commission presents a unique opportunity to reset the sector. The participants are ready and aware of the pressing need to change. There is a sense of expectancy and urgency. As one leader told us, “There is a preparedness and willingness to actually do something.”

How we take advantage of this opportunity will depend on prioritising the areas of change that will make a difference and satisfying the “ifs” – the provisos that will facilitate the successful implementation of the key recommendations. If that can occur, the lives and care of older Australians will be improved dramatically.

Stephen Teulan is a Sydney-based Principal and Nikita Weickhardt a Melbourne-based Director at Nous Group, an international management consultancy.

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