The royal commission began its final hearings today, with lawyers describing a system that too often delivered “substandard care”, where abuse of older people was “rife” and a “national shame”.
“The evidence before the royal commissioners supports a finding that the level of substandard care being delivered in the current aged care system is far too high,” said counsel assisting the Royal Commission into Aged Care Quality and Safety, Peter Rozen.
In its most extreme cases, substandard care appears in the form of abuse, and the most “concerning” abuse was sexual abuse, Mr Rozen said.
The commission received 588 submissions containing allegations of sexual abuse.
In 2018-19 there were 790 reports to the Australian Department of Health about sexual assault, or on average two every day.
But Mr Rozen said the actual number was likely to be far higher, because assaults perpetrated by a resident with cognitive impairment did not need to be reported at the time.
A KPMG report commissioned by the royal commission to estimate data on assaults that were exempt from reporting found there were an estimated 2,520 resident-on-resident incidents involving sexual contact in 2018-19, or 50 per week.
“It is… entirely unacceptable that people in residential aged care face a substantially higher risk of assault than people living in the community,” Mr Rozen said.
“As disturbing as these figures are, the evidence of the lack of follow up by the Australian government department that receives the reports is, if anything, worse,” he said.
Mr Rozen said there was a “surprising absence” of quality indicators in aged care, in contrast with the health system, which has a long history of measuring quality.
Lack of curiosity
The absence “says much about the maturity of the sector and the lack of curiosity of the government that funds and regulates it.”
The regulator, the Aged Care Quality and Safety Commission, also shows a “lack of curiosity” and has “a focus on processes rather than outcomes”, he said.
The “systemic failures” in Australia’s aged care system are the result of attitudes towards older people and towards aged care in general. Funding and financing and inadequate governance and regulatory frameworks are also to blame. The government has also often failed to take opportunities to improve, though plenty have been presented.
Counsel assisting Peter Gray QC made 124 recommendations to the commissioners, including:
- New laws for aged care based on a human rights approach
- An independent Australian Aged Care Commission that will be responsible for regulating the aged care
- A new Aged Care Advisory Council
- A new Inspector General of Aged Care
- Mandated staffing ratios in residential aged care
- An independent pricing authority to determine aged care prices
- Compulsory registration of personal care workers
- A demand-driven approach to aged care rather than the rationed approach we have today
- A new, independent process for establishing aged care quality standards
- A new enforceable general duty of care on approved providers
- A recommendation that people under the age of 45 should not be housed in residential age care
- ‘Care finders’ to help families find the right care
Commissioner proposes Department of Health and Ageing
Commissioner Lynelle Briggs, who was formerly a public servant, called the recommendations “courageous”. She said they would be “radical”, expensive and take a great deal of time to implement.
“I am yet to hear you present arguments, counsel, as to how the commission model will improve the quality and safety of care for older Australians,” she said.
She suggested the Department of Health has not had the resourcing to administer aged care properly, and leaving aged care to market forces had also been detrimental.
But she said there was “growing determination” to fix the system and there was now more “ambitious leadership”. She proposed a new ‘Department of Health and Ageing’ that would report to Cabinet.
Ms Briggs said both proposals should be put to the people to decide which they think is the most suitable.
Thanks to those who shared stories
Mr Rozen said it was not easy to find out what was going on behind in the scenes in aged care, and statements from witnesses were essential in gaining a complete picture of the state of the industry.
Over the course of the royal commission, there have been 97 days of hearings, and 641 witnesses provided evidence.
“We salute the courage of these witnesses for sharing the most intimate details of their lives to inform this inquiry,” Mr Rozen said.