Royal Commission releases multiple papers on aged care

The second background paper focusses on the adjustments needed to cope with future aged care demands, the third background paper investigates dementia care, treatment along with its physical and social consequences, whilst the fourth paper looks at the physical and chemical restraints used on elderly people in residential care.

The paper was prepared for the Commissioners and public by Dr David Cullen and the support of Royal Commission staff.

This series of background papers the Royal Commission has released does not represent a direction or position of the Royal Commission in relation to aged care. Any of the views expressed in these papers are not necessarily the views of the Commissioners.

Second background paper: Future aged care requires adjustments

The second background paper, Medium and long-term pressures on the system: the changing demographics of aged care, has outlined the significant future adjustments needed to support Australians elderly.

They have estimated that Australians aged 85 years or more will increase to over 5.8 million people, or 3.7 percent of the population, by 2050.

Currently, there are just over 503,685 elderly people, or 2 percent of the population, with the suspected increases to be quite significant.

Older Australians are living for longer, however, the paper speculates the changes won’t be greater than those that have occurred already over the last 40 years.

The paper says, “These changes in the level, structure and duration of demand for aged care will impose significant adjustment pressures on the aged care sector.

“The total supply of care will need to increase, with large absolute rises being required in the level of provision in each part of the aged care spectrum.

“At the same time, the structure of supply will need to shift, with larger increases in community care on the one hand and high-level care on the other.”

The paper explores issues associated with the changing demographic profile, including changes in disease patterns and dependency, rising dementia incidence, changing expectations and expanding the cultural profile of Australia.

Other things that were analysed in the paper included current arrangements, future pressures and greater needs for preventative and restorative health.

The paper believes there is a likelihood of pressure from changing costs for different types of care, as well as a decrease in available informal care due to low birth rates, resulting in fewer adult children available to provide such care.

Also noted is an increase in demand for community care with fewer children to help look after aged parents, the cost of community care is expected to increase.

Examining the changing aged care workforce, the paper states the need for the industry to have a more flexible framework so care is centred around the individual and a broader range of care options is provided.

“Demographic, social and economic pressures will impose a large and continuing burden for adjustment on the aged care sector,” says the paper.

“While the absolute scale of service provision will need to increase sharply, the nature and composition of supply will also need to change and far-reaching innovation will be required if community expectations are to be met.”

Third background paper: Dementia treatment, care and consequences

The third background paper, Dementia in Australia: nature, prevalence and care, finds best practises throughout all stages of dementia will benefit people with the disease.
People with dementia respond well to exercise, eating well, and staying as independent and socially connected as possible, with caring and supportive relationships, and meaningful activities provided in safe and pleasant environments.

The paper suggests a broad agreement for best practises and implement multiple approaches to reach this goal, including a supportive physical environment; an educated and experienced workforce in people with behavioural dysfunction; a broader program of therapeutic and meaningful activities from health professionals; individualised and multidisciplinary assessment and care planning; and timely assessment and care planning from a multidisciplinary team.

“Dementia is a significant issue for the Australian community, and particularly the aged care and health systems,” says the paper.

“Misunderstandings about dementia are common and knowledge about dementia treatments among the Australian public is reported as poor.”

Australian elders biggest cause of disability is from dementia. The disease contributed to 15.8 percent of all deaths in Australia in 2015. Over 52 percent of people living in residential care had dementia in 2016.

The paper aims to provide a high-level introduction to dementia and reviews the findings of broad-reaching Australian and international research, demographic reports and literature.

It also addresses a number of issues, including what is dementia; what are the physical and social consequences of dementia; how prevalent dementia is in Australia; dementia care research results; support for families and carers; and the dementia workforce.

Timely diagnosis for dementia makes a significant impact in primary care and positive outcomes of a person-centred or small domestic model of care for dementia sufferers.

The paper outlined that the highest prevalence and incidence and biggest at-risk group for dementia and younger onset dementia are Aboriginal and Torres Strait Islander people.

Also explored in the papers research was the need for improved dementia-specific staff training.

The third background papers research was in response to issues to be raised at the upcoming Royal Commission Sydney hearing on May 6.

Fourth Background Paper: Physical and chemical restraints in aged care

Restrictive practises used within aged care facilities was the main topic within the fourth background paper released by the Royal Commission, mainly highlighting the impacts it has on the rights and dignity of elderly patient’s.

The paper, Restrictive practices in residential aged care in Australia, outlined the restrictive practices used without consent by aged care workers, which has caused concern in the public eye with its impact on the liberty and dignity of aged care patients and its infringement on the individual’s legal rights.

Physical and chemical restraint use in aged care has shown accounts of overuse and misuse of psychotropic and other medication and physical restraints throughout Australians aged care facilities and services.

The paper states that an inquiry into restraint use in residential aged care needs to be looked into, along with best delivery of person-centred care services to people in aged care facilities and the legal frameworks required to ensure safety and quality of residential care services.

Restrictive practices are in reference to interventions, either physical or pharmacological, that restricts an individual’s free movement or decision ability.

The paper says, “Restrictive practices are commonly referred to in the context of residential aged care as practices that control the behaviour of a resident, which may occur with the intention of reducing risks to a resident or others,” the paper notes.

“Physical and chemical restraint can have significant adverse effects on a resident, both physically and psychologically. There are also fundamental questions about their effectiveness.”

Acknowledged in the paper is the evidence of strategies used to mitigate the need for restraints by tackling the cause of challenging behaviour.

These methods include improving residents environment to reduce fall risks or confusion; implementing sensory stimulation or relevant therapies; keeping familiar staff around; individual care routines; increased staff interaction; and in-depth medical examinations with medication reviews.

To read about the first background paper released back in February, click here. 

The Royal Commission third round of hearings resumed in Sydney yesterday and will be running over the next two weeks.