A minimum staffing standard and funding that meets the cost of high quality care are among almost 150 recommendations the royal commissioners have made to fundamentally reform an aged care system they say is failing because of poor quality providers and systemic flaws in design and governance.

After 28 months, 23 public hearings involving 641 witnesses and over 10,500 public submissions, Royal Commissioners Tony Pagone and Lynelle Briggs presented the Final Report of the Royal Commission into Aged Care Quality and Safety to Governor-General David Hurley on 26 February.

In the eight-volume report titled Care, Dignity and Respect, which was tabled in Parliament on 1 March, the commissioners called the level of substandard care concerning and unacceptable.

Tony Pagone

“The extent of substandard care in Australia’s aged care system reflects both poor quality on the part of some aged care providers and fundamental systemic flaws with the way the Australian aged care system is designed and governed. People receiving aged care deserve better. The Australian community is entitled to expect better,” they found.

The commissioners said it was also difficult to measure the precise extent of substandard care and that must change.

“Australians have a right to know how their aged care system is performing; their government has a responsibility to design and operate a system that tells them; and aged care providers have a responsibility to monitor, improve and be transparent about the care they provide.”

They make 148 wide-reaching recommendations, with many building on those counsel assisting proposed during the hearings, including:

  • a new Aged Care Act that puts older people first
  • an aged care program responsive to individuals across social support, assistive technology, respite, home care and residential care
  • a restorative and preventative care approach that includes increased access to allied health care
  • a minimum quality and safety standard for staff time and skills from nurses and personal care workers in aged care homes including at least one registered nurse at all times
  • changes to education, training, wages and labour conditions to professionalise the workforce
  • the registration of personal care workers
  • a new aged care levy to deliver sustainable funding
  • funding that meets the actual cost of high quality care as determined by an independent pricing authority
  • simplifying personal contributions and means testing, removing co-contributions, and phasing out Refundable Accommodation Deposits
  • increased support for development of small household models of accommodation.
Lynelle Briggs

As foreshadowed at the final hearing, the commissioners offer divergent views and alternative options in some of their recommendations such as system governance but say they agree on the majority of recommendations.

Mr Pagone said he and Ms Briggs agreed “with some misgivings and not without anxious consideration” to make separate recommendations and express different views where they diverge.

“But we both strongly conclude that fundamental change is needed. In the end, the differences between us may add to the strength of the reforms which are to be made,” Mr Pagone wrote in the report.

Ms Briggs said they elected to provide two options for the governance of the aged care system, which necessarily flows through into other recommendations.

“However, this is a secondary issue to the quality and safety task at hand, which dominates our recommendations and, importantly, on which we agree,” Ms Briggs wrote.

Govt committs $450M for immediate response

Releasing the report on Monday, Prime Minister Scott Morrison said it was comprehensive, candid, passionate and ambitious and provided all the things parliament needed to know to bring about the generational change required.

“The royal commission has now set out a very important roadmap which I think will establish generational change in this country,” he told reporters.

The government has committed $452.2 million as part of an immediate response package, which includes:

  • $32 million toward strengthening residential aged care quality and safety including an additional 1,772 quality audits in residential and home care
  • $280 million for temporary financial support for residential providers
  • $92 million to grow a skilled aged care workforce including by attracting 18,000 jobseekers
  • $30 million to strengthen provider governance including training for all board members

These immediate steps provide additional financial assistance for residential providers so they can improve care start building the much needed workforce, Mr Morrison said.

Other recommendations

The royal commissioners also recommend:

  • an integrated system for the long-term support and ongoing community engagement
  • a system governor to provide oversight and shape the system
  • an inspector-general to investigate and report on systemic issues
  • a plan to deliver, measure and report on aged care quality including independent standard-setting, a duty of care on aged care providers, and star ratings
  • accessible information about care options and services, and care finders to support people to navigate the system
  • an Aboriginal and Torres Strait Islander aged care pathway to provide culturally safe and flexible aged care wherever people live
  • a new primary care model with access to multidisciplinary outreach services and a Senior Dental Benefits Scheme
  • strengthened provider governance arrangements to ensure independence, accountability and transparency
  • a strengthened quality regulator
  • equity of access to services for older people with disability and measures to ensure younger people do not enter or remain in residential aged care
  • ongoing monitoring and reporting arrangements to support effective and transparent implementation of the recommendations.

The royal commissioners have recommended that the Australian Government report its response to their recommendations to Parliament by 31 May.

Read the final report here.

Continue to follow Australian Ageing Agenda in the coming days and weeks for many more stories on the royal commission’s final report and recommendations.

Main image: Prime Minister Scott Morrison releasing the final report of the aged care royal commission on Monday 1 March.

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