Mitchell, a former president of the Australian Council of Social Service, moved into the Melbourne facility two years before Prime Minister Scott Morrison announced a Royal Commission into Aged Care Quality and Safety in September 2018.
Since then, the Royal Commission has undertaken the “most in-depth and thorough examination of Australia’s aged care system”, Counsel Assisting Peter Rozen QC said while delivering more than 120 recommendations in October last year.
The inquiry heard from 641 witnesses, including residents, staff, families and experts, held almost 100 days of hearings, accepted more than 10,500 public submissions, and produced 38 reports and research papers, including a special report into COVID-19.
In its interim report, the Royal Commission found the aged care system had failed older Australians.
“It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them,” it said.
The commission’s final report will be handed to the government next Friday, and the Prime Minister has promised to respond by the May budget. Experts, workers and the sector want to see big changes to a system that is currently “a national disgrace”.
Time to Act
Geriatric medicine specialist Professor Joe Ibrahim, who has been looking at aged care resident aggression, suicide, preventable injuries and preventable deaths since 2014, says these are not new problems.
Many stem from the Aged Care Act of 1997, he says, which drove a more corporate style of practice focused on bottom lines and led to the reduction of nurses employed in the homes.
Ibrahim wants to see the Act torn up. “They’ve got to change the act governing aged care so it has a human rights framework,” he says.
The Australian Aged Care Collaboration – a new, unified force combining the country’s largest aged care peak bodies – also wants a new Aged Care Act that will address longstanding issues.
“We need to create a total overhaul of the system that designs a whole system around the needs of the individual and their rights,” says Sean Rooney, a representative of the new body and chief executive of Leading Aged Services Australia.
“And we’ve got to get this right, because not only do we have, you know, 1.3 [million] older people now receiving care in the system, but we’ve got an ageing population.”
Professor Henry Cutler, director of the Macquarie University Centre for the Health Economy, believes the key reform will be developing a consistent way to measure quality of care across aged care facilities, and ensuring the regulator has enough teeth to enforce standards.
At the moment, the government decides whether aged care providers meet accreditation standards. But there is no national quality framework people can use to compare residential care in a similar way to childcare facilities or even hotels.
“Because people don’t shop around, ie. they don’t attend different aged care facilities and experience the care within an aged care facility, they’re not really too sure as to what is good quality care,” he says.
“So it’s really important for quality to be measured so consumers can say, ‘hang on, I want to know what the facility down the road, how that compares to another facility up the road, because I can’t do that myself’.”
Rooney agrees quality should be a priority.
“We need to be really clear about what it is that we’re measuring with regards to outcomes for older people, and if we can be absolutely clear about that, then we’ll know whether we’re delivering value for money or not,” he says.
“But we also want to ensure that we’ve got the measures right that incentivise innovation and continuous improvement in quality, and not just have a regulator that’s just marking our homework.”
Putting the nurse back in nursing homes
Australian Nursing & Midwifery Federation federal secretary Annie Butler says the Aged Care Act has led to a gradual decline in regulatory mechanisms to ensure there were the right numbers of staff to ensure quality care.
Roughly 80 per cent of aged care residents have high healthcare needs, Butler says. Conversely, the number of nurses working in the sector has been steadily declining since 2003, according to the National Institute of Labour Studies.
On top of that, care workers who do the bulk of work with residents have little if any qualifications in the sector, as there are no consistent minimum qualification requirements.
“What we’ve seen is a composition of workforce change that does not leave people with enough high-level skills to ensure elderly people have their health needs met – coupled with the fact there’s just not enough [staff],” Butler says.
She’s aware of some facilities in NSW with no registered nurses on shift overnight, while other facilities might have one personal care worker looking after 10 to 20 dementia patients alone.
Merle Mitchell, who testified during the Royal Commission about a lack of compassion from staff, would like to see workers stay in aged care facilities for two nights and two days as part of their training.
“I think that would make an enormous difference to the service that could be provided,” she said. “Because then they would actually understand what it’s like to live in a place like this.”
Opposition health and aged care spokesman Mark Butler, who was Minister for Mental Health and Ageing during the Gillard government, says it’s widely accepted the biggest challenge in the sector is having enough qualified staff to care for older Australians.
“One of the first decisions of the Abbott government was to abolish a workforce compact I negotiated with aged care providers, unions and consumer groups to start to lift the qualifications and wages of aged care staff,” he said. “This short-sighted, ideological decision by the government has meant that the workforce challenges identified almost a decade ago have only got worse.”
Annie Butler (no relation) says the federation is pushing for staffing ratios, to ensure residents receive an average 4.3 hours of care per day – up from the current average of just 2.8 hours.
“We are just overflowing with research and evidence that shows if you increase staffing, and increase registered nurse staffing, you are going to have better outcomes for residents,” she says.
The price of reform
All these reforms will come at a cost.
The Australian Nursing and Midwifery Federation calculated their proposed staffing ratios would take five years to implement and require an added $5 billion in funding. The Australian Aged Care Collaboration worked out a further 88,000 places will be needed in residential aged care over the next 10 years, at a cost of $55 billion.
Mark Butler said Australians should have no faith in the government’s ability to fix aged care.
“Scott Morrison has neglected older Australians and the aged care system – it’s a national disgrace,” he says.
A spokesman for Health and Aged Care Minister Greg Hunt says the government has already begun work to improve the system, but acknowledges more reform will be needed.
“The Morrison government has been listening and consulting, and has commenced reform across the aged care sector to address priority areas, including those identified by the Royal Commission in its interim report and response to COVID-19,” the spokesman says. “For example, home care packages will increase from 60,308 in 2012-13 to 195,597 in 2023-24, an increase of 224 per cent.
“The government is also delivering record investment across the entire aged care system from $13.3 billion in 2012-13, to $24, $25, $26 and $27 billion over this year and the coming three years.”
The government will also “carefully consider” the Royal Commission’s recommendations and respond in the next budget.
Mitchell, with her years of experience working in social policy, says she has confidence the Royal Commission will make strong recommendations but is not so sure the government will implement them, after the October budget failed to deliver major reform despite recommendations in the Commission’s interim report.
“If they didn’t do it then, why would they do it now?” she says.
Leading Age Services chief executive Sean Rooney is more optimistic but says the country has “one shot” at fixing the system.
“This is not about politics. This is about doing what’s right. And the whole nation should be looking to every one of their elected officials to go ‘what are you doing about this?’,” he says.
“If a royal commission can’t solve this problem, I don’t know what can.”
Rachel Clun is a federal political reporter at The Sydney Morning Herald and The Age, covering health.