The conditions for radical reform of aged care are now present, NSW Ageing and Disability Commissioner Robert Fiztgerald has told a key aged care conference.
The moment is with us, the politics are right,” Mr Fitzgerald told the ACSA National Summit in Canberra on Wednesday.
“There are two ways public policy occurs. Either because there are bright, intelligent people capable of leading that reform, the second is crisis.
“You’ve got all the elements, you’ve got all the evidence, you’ve got the insights of royal commissions and other inquiries. You’ve got your own intelligence. We’ve been through a pandemic, which has focused these issues, and the politics are right.
“So if I’m any strategist at all, your moment has come.”
Commissioner Fitzgerald said the two biggest barriers to meaningful reform included workforce issues and financing.
“Those issues remain exceptionally perplexing, and those two issues are really, really significant,” he said.
Learn from the NDIS
Commissioner Fitzgerald said in designing the new Care at Home System it was important to learn from the failures of the NDIS model, which was based on providing blocks of service for a fee.
“One of the tragedies of the NDIS is that it’s transactional,” he said.
“You need to create a system that is relational, not transactional. If we don’t the home care system will fail, it will be flawed like the NDIS.
“It is incomplete if we simply have a model that has turned every aspect of a person’s life into two hour blocks for which there is a particular fee.”
The provider market
There should be a range of providers under the new system, Commissioner Fitzgerald said – including for-profit, not for profit, mutual and government.
“This notion that we can simply open up a market, and let it rip, has been shown to be fundamentally flawed, and governments need to reassess in the light of overwhelming evidence that that does not deliver for the wellbeing of the group as a whole,” he said.
“If we want a quality system in which the values and the incentives that operate within the system are aligned, you need that mixture.”
However the market-based approach would not work for some people and shouldn’t be required in all cases, including First Nation’s people, older people experiencing homelessness and mental illness, and thin markets.
Common funding approach
Commissioner Fitzgerald acknowledged the push from the Support at Home Alliance for a common funding approach across residential and home care.
He said he supported this in some areas but would be concerned if social support, including respite, equipment, community transport and general care, were included.
“There is actually no reason to put them in at this point in time,” he said.
“It will over complicate the system. My advice is you do not have to put everything into the marketised model to start with. Learn the lesson of NDIS.”
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In February 2016, a male patient of the South Australian government-run Oakden Older Persons Mental Health Service, located in Adelaide, South Australia, was referred to the Royal Adelaide Hospital after it was discovered that he had very significant bruising to his hip for which there was no satisfactory explanation. The man’s family made increasingly higher level complaints about his treatment.[4]
A 2018 Senate inquiry revealed that several incidents at the home were referred to police, and coronial inquiries into the deaths of residents were initiated.[5] The Independent Commissioner Against Corruption (ICAC) in 2018 reported damning findings of maladministration against five individuals and Oakden. Former South Australian mental health minister Leesa Vlahos was severely criticised by the ICAC Commissioner.[6][7] His report portrayed some of the most vulnerable members of society as “poorly cared for, forgotten and ignored”.[8] Oakden closed in 2017[9] after it was revealed that a patient with Parkinson’s disease was beaten by another resident at the Oakden nursing home at least thirteen times between December 2016 and March 2017 and did not receive medical care, despite the matter having been reported to the Australian Aged Care Quality Agency.[10]
On 25 July 2016, the ABC News current affairs program 7.30 broadcast hidden video camera evidence of the aggravated assault of an 89-year-old resident in September 2015. The video showed a staff member at the Mitcham Residential Care Facility eating the resident’s food, flicking his face, force-feeding him, and pinning him down, prompting calls to legalise the installation of cameras in the private rooms of aged care facilities.[11]
In September 2018, the current affairs program Four Corners broadcast a special investigation into the aged care sector and the abuse and neglect of the elderly in nursing homes.[12][13][14][15] The Prime Minister Scott Morrison announced that his government would make a recommendation to the Governor-General that a Royal Commission into aged care be established.[16]
Terms of reference
On 6 December 2018, the Administrator of the Government of the Commonwealth of Australia, Paul de Jersey AC issued Commonwealth letters patent appointing The Hon. Richard Ross Sinclair Tracey AM RFD QC and Ms Lynelle Jann Briggs AO as Commissioners and detailing the Commission’s terms of reference.[17]
The Commissioners were appointed to be a Commission of inquiry, and required and authorised to inquire into the following matters:[18]
- (a) the quality of aged care services provided to Australians, the extent to which those services meet the needs of the people accessing them, the extent of substandard care being provided, including mistreatment and all forms of abuse, the causes of any systemic failures, and any actions that should be taken in response;
- (b) how best to deliver aged care services to:
- i. people with disabilities residing in aged care facilities, including younger people; and
- ii. the increasing number of Australians living with dementia, having regard to the importance of dementia care for the future of aged care services;
- (c) the future challenges and opportunities for delivering accessible, affordable and high quality aged care services in Australia, including:
- i. in the context of changing demographics and preferences, in particular people’s desire to remain living at home as they age; and
- ii. in remote, rural and regional Australia;
- (d) what the Australian Government, aged care industry, Australian families and the wider community can do to strengthen the system of aged care services to ensure that the services provided are of high quality and safe;
- (e) how to ensure that aged care services are person‑centred, including through allowing people to exercise greater choice, control and independence in relation to their care, and improving engagement with families and carers on care‑related matters;
- (f) how best to deliver aged care services in a sustainable way, including through innovative models of care, increased use of technology, and investment in the aged care workforce and capital infrastructure;
- (g) any matter reasonably incidental to a matter referred to in paragraphs (a) to (f) or that [the Commissioners] believe is reasonably relevant to the inquiry.
