All eyes are on the Royal Commission as the nation waits for it to come up with solutions that will eradicate, once and for all, the problems that are plaguing the aged care industry. However, should the Royal Commission be scrutinising an industry that has been scrutinised by so many reviews whose recommendations have not yet been implemented by government? Is it even relevant seeing that the government knew long back, through various enquiries, that the system was heading for trouble and did not do much about it till there was trouble? I am not saying the Royal Commission should not be poking the industry with their big stick. After all they are already on the ground. I simply believe that they should be looking to the industry to help them to perform a root-cause analysis and to find sustainable solutions.
The Royal Commission, whose key task is “to help build a national culture of respect for ageing and older Australians” is going to work through Christmas because they are starting their hearings in January 2019 and must submit a interim report by October 31, 2019. With their final report due on April 30, 2020. The Commission is going to be viewed as the Grinch who stole Christmas for many aged care agencies as they have already sent a letter to the largest 100 aged care agencies in the nation, asking for information that is due on January 7, 2019! Smaller agencies will soon get their own letter asking for information that will be due some time in February 2019. It’s going to be a busy Christmas for the aged care industry!
I have written extensively on the Disability, Aged Care and the Health Systems over the past two years. Now it is time to sit and wait to see if this Royal Commission goes beyond their brief to make real governmental systemic changes! It is my hope that they will fix, or recommend fixing, the system by knocking down the silos, reuniting aged care and disability and implementing integrated care. If we are going to re-establish trust as the Prime Minister intends, then we must have real transformation in the aged care system!
First, the Royal Commission, together with the industry, should come up with a clear analysis of the problems that are bothering the industry. From the reports that we have had in the past two decades it is clear that the standards of care have dropped and there is gross negligence and gross abuse of elderly people. The nation has clearly shown that there is total lack of respect for older people. The root causes of these issues should be identified, analysed and understood. Then the focus should be on implementing change.
Corporations that run aged care facilities must take a shared responsibility for the mess that the industry is in. They pushed for deregulation since the 1990s when aged care facilities were privatised and since deregulation the facilities that they operate have degenerated to neglect and abuse of elderly Australians. What is required is more regulation! It is hoped that the Royal Commission will come up with the standards of care that are deemed to be acceptable which can then be the basis for judging the standards in aged care facilities. Otherwise, how do they tell that care at certain facilities is below standard? Government, which shares the responsibility for the current mess, must adopt those standards and make them into law. I believe that any facility that is found to be giving care that is below standard should be closed and the patients must be moved to other facilities.
No facilities should be allowed to give “staff shortage” as an excuse. Corporations can create an industry council that creates training, oversees the training and certification of care givers and insist that all care givers meet the training requirements. The council should also have a code of conduct and a code of ethics for its members. Meanwhile the corporations can outsource care givers from other countries. While they are at it, they must ensure they train and recruit proper case managers so that there is sufficient quality case management and care coordination. While we are still on staff shortages, why can’t they have proper staff retention strategies and show their workers that they value them?
One of the problems facing aged care facilities is the GPs’ frustration with aged care facilities. This can easily be corrected by the government increasing the remuneration for GPs who visit patients in aged care facilities and by the facilities themselves having systems that support GPs during visits. That should include access to patient files online for phone visits. Once GPs become involved in aged care again, they will insist on better quality care and safety for their patients.
While the Royal Commission looks at quality of care in aged care facilities, they should recommend that, where possible, older people must age in place because research has found that those who age at home are happier than those who age in old age facilities. They can recommend that corporations follow the business model of the American-style home care system and create laws and policies around that model. The Royal Commission should recommend investment in home care. There should be sufficient money to make homes age-friendly with reachable cupboards, wheelchair ramps and support rails in bathrooms. There should be sufficient money to pay for care givers, GPs and nurses.
There should be investment in telehealth. Every old person aging at home should have wearable devices, a computer and internet access so that communication remains open and the elderly can be visited online. Patients and their carers use the computer to input vital signs, number of steps walked, medicines taken and food intake. GPs can keep track of vital signs and call their patients whenever certain vital signs flag a problem.
Not to be forgotten is the use of the whole community to look after the elderly. It has been found that the elderly fare better when they are allowed to age at home because they are close to their friends, neighbours and families. These valuable people must also be trained in home care-giving for the aged so that they can help whenever they visit. Care for the aged at home should be a community effort.
Integration of care still remains a workable option. It is hoped that the Royal Commission will recommend integration of social care, health care and aged care at government level. That will make navigation of the system easier as elderly people will have a one-stop-shop for all the services that they require. As part of the integration efforts, they should centralise digital files for patients and make them accessible by all health care and social care givers. Then GP offices can be made central to aged care so that they react through telehealth whenever an elderly person is in trouble and avoid unnecessary hospitalisation.
Everyone is hoping for total transformation of the aged care industry! The Royal Commission must remind the nation that each elderly person is someone’s beloved parent, grandparent, aunt or uncle. Age, disability and illness does not make them less human. The Commission must then transform the aged care industry in such a way that facilities become safe again and quality care is taken for granted. They must make sure that those aging at home receive good care continuously from all angles to prevent unnecessary hospitalisation. It is still possible to provide the right care at the right place at the right time for aging Australians!