Counsel Assisting the aged care royal commission are now making final submissions to the royal commissioners including 124 recommendations to overhaul 18 aspects of the aged care system from its principles and design to funding, workforce and more.

The headline recommendations presented to the Royal Commission into Aged Care Quality and Safety by Counsel Assisting Peter Rozen on Thursday morning include:

  • a new act based on human rights principles
  • an aged care planning regime that provides demand-driven access rather than the current rationed approach
  • a new and independent process for setting aged care quality standards
  • a new enforceable general duty of care on approved providers of aged care
  • mandated staffing ratios in residential aged care
  • compulsory registration of personal care workers
  • an independent pricing authority to determine aged care prices appropriate to the provision of high quality and safe aged care services
  • an independent Australian aged care commission responsible for administering and regulating the aged care system.

The published submission includes 20 recommendations related to funding to be presented on Friday including changes to indexation processes and for the government to offer providers an immediate but conditional $10 boost to the base residential aged care subsidy.

The $10 boost should be given after each provider gives written evidence on the adequacy and cost of the goods and services it has provided to meet the basic living needs of residents and in particular their nutritional requirements, according to the submission.

This week’s submissions are based on the full work of royal commission proceedings, which has included 97 days of hearings and the evidence of 641 witnesses including 113 aged care recipients and their family members, Mr Rozen highlighted.

The undertaking has also involved 13 round tables, visits to 34 aged care services and 14 research papers since Prime Minister Scott Morrison called for the royal commission just over two years ago.

At least one in five people receiving residential aged care have experienced substandard care.

Peter Rozen
Peter Rozen

Mr Rozen said the weight of the evidence before the commission supports a finding that high quality aged care is not being delivered on a systemic level and that the amount of substandard care is unacceptable.

“At least one in five people receiving residential aged care have experienced substandard care. [T]he findings that we urge commissioners to make about the nature and extent of substandard care are important because they are required by the terms of reference.

“But equally they inform many of the recommendations that we submit should be made to address the identified deficiencies in the aged care system to which we will shortly turn,” Mr Rozen told the hearing.

Peter Gray

Senior Counsel Assisting Peter Gray told the hearing that the new aged care system as matter of principle should be about supporting people to live well into their old age wherever they live.

Aged care recipients should also be encouraged to continue to enjoy the rights of social participation that are accessible to members of society generally.

“And this should all be reflected in legislation which establishes a rights-based approach to aged care marking out clearly defined rights to be enjoyed by those who are applying for or receiving aged care. And those rights should include the rights and carers,” Mr Gray told the commissioners.

It’s been my experience that clearly defined policy principles can galvanise reform.

Lynelle Briggs
Lynelle Briggs

Royal commissioner Lynelle Briggs told Counsel Assisting that policy principles were a related matter that should underpin all of the work done in aged care.

“It’s been my experience that clearly defined policy principles can galvanise reform. They are critical for leaders in articulating a future vision, and are a key litmus test for the successful implementation of reforms,” Ms Briggs told the hearing.

Ms Briggs said policy principles that have occurred to her over the course of the royal commission include that the new aged care system must:

  1. put people first and the needs of older people should drive aged care
  2. be equitable, giving older people fair and equal access to high quality aged care
  3. be effective and deliver the best possible outcomes for older people
  4. be ambitious and be the very best it can be, not simply seek minimum requirements
  5. be accountable, which means, open, honest, and answerable to older people, and the wider community for decisions, actions and consequences
  6. be sustainable and funded to the level necessary to ensure high quality aged care, and both the funding and design of the system must be resilient and enduring.

Ms Briggs said she saw policy principles as critical and welcomed the views of counsel assisting and other interested parties on the policy principles in submissions.

RC seeking final submissions

Tomorrow’s hearing will include more information on the submissions the royal commissioners are seeking including what should be submitted and by when.

Other recommendations

Other recommendations to be presented by Counsel Assisting on Thursday and Friday include:

  • a new aged care program that combines all current programs into one with a common set of eligibility criteria, single assessment process, entitlement to support as assessed and certainty of funding based on need
  • allied health care included in residential care
  • a dementia support pathway
  • regulation of the use of chemical and physical restraints in residential aged care including provisions to expose the provider to a civil penalty if breached
  • expanding the suite of quality indicators in residential aged care and implementing reporting and benchmarking of provider performance against the quality indicators
  • the development of an aged care national minimum dataset
  • improving the design of aged care accommodation include small home models
  • getting young people out of residential aged care facilities
  • fund approved funding residential aged care through a casemix classification system, such as the Australian National Aged Care Classification (AN-ACC) model
  • enablement incentives incorporated into the rules, principles and funding eligibility for residential aged care
  • establishment of enforceable prudential standards
  • requirements for providers to report outsourced care arrangements
  • greater weight attached to the consumer experience
  • a better complaints process
  • a star ratings system based on objective and measurable indicators that allow older people and their families compare quality and safety performance of providers.

Access Counsel Assisting submissions here.

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