There is a “pipeline” of young people moving from hospital to residential aged care, and often other options are not even considered, the royal commission has heard.
Every week in Australia, on average 42 younger people enter residential aged care, the equivalent of six per day or 2,000 every year. Most are sent to aged care after being discharged from hospital.
“The ‘pipeline’ is an express route into aged care,” said Dr Bronwyn Morkham, National Director, Young People in Nursing Homes National Alliance.
When hospitals need to find accommodation for younger people who are being discharged, residential aged care has become the default option, Dr Morkham said.
“Having the pipeline straight into residential aged care has proved irresistible,” she said.
“It’s also symptomatic of a deep systemic inertia. There has been a complete reliance on aged care… Other options are not even looked for. Aged care is now the default option of young people being discharged from hospital. We’re seeing this more and more.”
“There are no other options,” Dr Morkham said.
Part of the problem is the approval for a bed in residential aged care can be achieved quickly and easily within two to three days, whereas creating a plan for the NDIA can take well over six months to complete.
The NDIA process is “glacially slow”, said Luke Bo’sher, chief executive of the Summer Foundation.
Dr Morkham agreed with Commissioner Lynelle Briggs that the default to aged care situation has worsened since the responsibility for it was moved from the states to the Commonwealth.
No data on young people living in residential aged care
The royal commission heard that more information is needed about the population of young people living in residential aged care.
Mr Bo’sher said more data is needed to “understand who needs support” and to be able to determine and evaluate policy settings.
A Senate inquiry in 2015 recommended comprehensive data be collected for this group, “but there has been no movement on this at all”, said Dr Morkham.
“Wranglers” needed to help navigate complex system
The royal commission also heard advocates, or “wranglers”, are required to help young people with disabilities and their families navigate the hugely complex system.
Dr Morkham said the young people and their families need to be involved in the conversation, and she stressed the importance of understanding their “aspirations” and “needs”.
She said the royal commission is a “great opportunity” and recommended that governments work “collaboratively” to deliver the support that is needed.
Commissioner Lynelle Briggs said nobody is looking for “other options” when it comes to young people living in residential aged care.
Government’s plans insufficient
Counsel assisting the royal commission, Richard Knowles, said the government’s plan to get younger people out of aged care does not go far enough and will not be soon enough.
He said it was unlikely to reach its goals anyway. The government’s plan was referred to as a ‘Claytons action plan’, in other words, a plan you have when you don’t have a plan.
He noted the lack of urgency associated with the government’s plan, and the apparent “lack of will by government” to instigate effective change.
The government’s plan is to support the 6,000 people under the age of 65 currently living in residential aged care to find alternative housing by 2025. The government also has a target of halving the number of people entering aged care every year, which currently stands are 2,000, also by 2025.
The plan is based on the National Disability Insurance Scheme supporting younger people to move into specialist disability accommodation provided by the market.
Dr Morkham, said, “We’ve been somewhat disappointed and quite appalled that there’s no resourcing in the action plan, the targets are not acute enough, there’s no modelling.”
Mistaken expectations about aged care
Counsel assisting the royal commission, Richard Knowles, said there is a mistaken expectation that, in residential aged care, a person will be able to receive 24 hour nursing care. However, nurses only account for 15 per cent of aged care staff, while personal care assistants account for 72 per cent.
Mr Knowles said there is an urgent need to improve pathways out of hospital and to improve data collection.
“People get lost,” in the residential aged care system, he said.
He said the commission supports calls by witnesses to halve the number of people moving into residential aged care by 2022, and to have no young people living in residential aged care at all by 2025.
Current situation “cannot go on”
Mr Knowles became emotional when he said around 30 young people would have entered residential aged care in the five days of hearings, and he thanked the witnesses for their account. The problems “simply cannot go on,” he said.
“The problems… should be addressed now as a national priority,” Mr Knowles said. “It requires an end to decades of empty rhetoric and blame shifting.”
Commissioner Brigss said the hearings this week told a “sorry story”.