What’s next for the Aged Care Royal Commission in 2020

Key points:

• Royal Commission into Aged Care Quality and Safety will be starting back up in February
• Last year’s Commission focussed on problems, 2020’s hearings will be looking at solutions
• The aged care sector is currently waiting for the big shape up in November once the Final Report is released

The Commission will start hearings back up in February (first hearing on February 10) and run hearings to the middle of 2020, followed by the release of the Final Report in November.

Is has been a big undertaking with the Commission receiving a six-month extension, to the current November end date, to cover more ground.

So far, there have been 15 public hearings, 73 days of evidence, 4,728 exhibits and 504 witnesses.

This January has already seen submissions to the Commission rise by 7,485, with telephones calls to the information line reaching 5,217.

What we know so far?

As expected, the Interim Report released in October made a number of early recommendations as well as a snapshot of substandard aged care in Australia.

Commissioners called for three immediate changes to be actioned by the Government, including moving Young People with Disability out of aged care facilities, an increase to Home Care Packages and addressing the over-reliance on chemical restraints in nursing homes.

An extra 10,000 Home Care Packages were committed by the Federal Government in response to the Interim Report. The Coalition also strengthened their targets for moving people with disability out of nursing homes.

However, the Interim Report was scathing about the decades of inaction from the Government towards the whole aged care industry.

Many peak bodies came together in December to ask the Government to provide more funding to the sector ahead of an expected aged care crisis in 2020, which went unanswered.

What 2020 will bring

The Commission will be hosting more hearings up until the middle of the year. From there, the Commissioners will be preparing their Final Report, due for release in November.

At the moment, Commissioners are calling for more submissions around the design of the aged care system, that hearing will take place in February.

All of this year’s extra hearings, thanks to the six month extension, will inform multiple recommendations in the Final Report.

Industry peak body, Aged & Community Services Australia (ACSA) believes that 2020 will be focused on the wider issue of redesigning the aged care system with the Commission testing recommendations.

Chief Executive Officer (CEO) of ACSA, Patricia Sparrow, says, “We expect that 2020 will see the Royal Commission move from exploration of the issues that sparked its establishment and fact finding, to a focus on solutions, particularly in areas such as system stewardship, provider governance, market development, funding, workforce and quality of care.

“We’d like to see the Royal Commission take a holistic approach and address the range of issues and challenges facing the sector, so there’s plenty we’d like to see come from it. However, it must include a long-term plan for sustainable funding for high quality services.”

“We need the Royal Commission to address the underlying discrimination against older people generally and how that affects funding, regulation and policy. Ageism remains a fundamental problem for the aged care sector as the Commission has already highlighted; the next phase should give society a chance to highlight and eradicate it.

“This next phase will be critical to ensuring that the Commission’s final recommendations point the system in the right direction with a focus on quality and sustainability.”

Fellow industry peak, Leading Age Services Australia (LASA) agree that the next three months will be pivotal for the Commission with the closing of submissions at the end of April and final public hearings in the middle of 2020.

CEO of LASA, Sean Rooney, says they expect to hear about major issues ranging from central themes of funding and sustainability to the design of care systems, respect for older Australians and the paramount importance of quality and safety.

Mr Rooney adds that aged care staffing will continue to be a critical consideration, and more research and consultation papers will be published by the Commission regarding the future design of services.

“LASA wants to see an aged care system that will make Australia the best place in the world to grow old. That means fundamental changes to our age services system including uncapping supply, matching support to assessed need, and ensuring that funding is based on the measured cost of delivering high quality services,” says Mr Rooney.

“There should be more flexibility in how services can be delivered and a much greater emphasis on rigorous outcomes measurement at both a service and a system level. Key outcomes should include overall quality of life and also the protection of basic rights for all individuals receiving care.

“These and other reforms to system settings should translate into better outcomes for older Australians through more staff, better training and greater responsiveness to needs for re-ablement and other areas where existing practices can be improved.”

Mr Rooney says that LASA also wants to see a mature debate around who pays for the costs of high quality services, as the current system is unsustainable in Australia where the country only spends 0.9 percent of GDP (Gross Domestic Product) compared to the 1.5 percent average in other advanced countries.

Can we expect much improvement after Commission?

It is difficult to say. Once the Final Report has been released, the Government will decide what recommendations they want to implement after assessing the report.

Looking at past Royal Commissions over the last number of years, the response to Final Report recommendations has not always been swift.

The 2018-19 Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry did not have all of its recommendations implemented and many still have an in progress status.

In August of 2019, the ABC reported that the Government has only taken action on 15 commitments from the 76 recommendations. The Federal Government speculated that around 50 approved commitments will be in operation or given legislation by the middle of 2020.

Another Royal Commission, looking into the Protection and Detention of Children in the Northern Territory, had similar outcomes since finishing in 2017. One of the key recommendations, to shut down a Juvenile Detention Centre in Darwin, never occurred and the centre is still in operation.

Many industry experts are sceptical about the Royal Commission making a difference.

Professor Joseph Ibrahim, a physician in geriatric medicine and research, has shown scepticism about positive outcomes when facing the Royal Commission and on the ABC’s Q&A Program.

Many other researchers and geriatric professionals have expressed that the Government has been aware of issues in aged care, but still did not take action.

In the recent Interim Report, Commissioners stated, “It is impossible to escape that melancholy conclusion that aged care services and the people who receive them have simply not been seen as a priority by successive Australian Governments.”

Minister for Aged Care and Senior Australians, Senator Richard Colbeck, and Minister for Health, Greg Hunt, released a joint statement following the Interim Report, saying, “We acknowledge that the Government also has work to do and will consider and act on the Royal Commission findings, whilst noting significant reforms are in progress.”

LASA’s Mr Rooney has a lot of hope for the outcome of the Royal Commission and says, “This is an issue of national importance”.

“Without the Royal Commission, the sector would still be pushing for improvement but the Royal Commission can and should be harnessed as a once in a generation catalyst for positive change.”

ACSA remains optimistic, but says it also can’t look past the years of inaction.

Ms Sparrow says, “Over the years, there have been too many reviews and inquiries that have led to absolutely nothing and brought no real changes to the industry.”

“The industry is optimistic that the Royal Commission will finally give us real momentum for fundamental change in the system and help improve the quality of care older people receive across Australia.

“This Royal Commission needs to have full support from the Morrison Government and the sector, and the recommendations need to be funded and implemented, otherwise it will just be another inquiry that was done to save face.”

Expected recommendations in the Final Report

LASA predicts recommendations for:

• Changes to systems and processes to make aged care services more flexible
• Funding changes based on measuring the cost of delivering high quality care
• Increase in GDP spend on the aged care sector
• Better training opportunities for the workforce
• Increase to staffing in aged care

ACSA expects a recommendation focus on:

• Workforce – particularly training standards, worker registration, staffing levels/ratios
• Quality – including more on regulation and standards
• Funding and more services – particularly addressing home care waiting lists
• Interactions – more face-to-face interactions with older people from the moment they have contact with the system
• Governance – training and qualification requirements (potential penalties for Directors)

Talking Aged Care expects there will be recommendations for:

• Strategies to decrease the Home Care Packages waitlist plus an extra 10,000 Home Care Package commitment from Government
• Compulsory dementia training for all staff in aged care
• A reduction in chemical restraints along with stronger legislation preventing restrictive practices
• Aged Care Quality and Safety Commission will be required to strengthen their accreditation and sanctioning process
• ACFI to be reviewed to find a better model
• Nursing homes will be required to have skills mixes of staff on at all times
• Industry boost of money to prevent the liquidation of aged care facilities

What do you believe will be recommended in the final report? Tell us in a comment below.

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