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Aged care report marks the start of big change

The royal commission’s report suggests up to 30 per cent of residents have suffered through sub-optimal care. A staggering number. A major factor contributing to this egregious failure is the structure and function of the workforce. Simply put, there are not enough people working in aged care, and not enough with the right skill set.

There are not enough people working in aged care, and not enough with the right skill set.

There are not enough people working in aged care, and not enough with the right skill set.Credit:Getty Images

A contemporary aged care system requires a workforce that knows how to manage people who are 80 years and older, who are living with dementia and several other chronic diseases, who are approaching the end of their life, who live in a communal setting with competing needs, who are highly vulnerable to abuse and neglect. Caring for this population requires a bigger, better trained and appropriately compensated workforce.

Substantial changes are needed. The royal commission’s final report and recommendations make for a solid start. Recommendations 75 to 87 address issues directly impacting on the personal care workforce. Interestingly, the commissioners did not fully agree on five. The commissioners call for better workforce planning, registration, a minimum mandatory standard of training for personal care workers and better pay. However, this does not go far enough.

While personal care workers do require better training to manage the complex health, wellbeing and individual needs of residents, the major issue is that their work is heavily task-oriented – that is getting a resident showered, toileted and dressed rather than spending time ensuring the dignity of a person or assisting residents to participate in roles that make a life worthwhile.

This is addressed in recommendation 86, which sets a minimum amount of time to be spent with every resident. While there are recommendations for more training on dementia and palliative care, it was very disappointing that there is no mention of training in respecting the rights and choices of older people. Also, the training needs of the non-clinical staff such as the cleaners, kitchen and laundry hands who interact on a daily basis with residents with dementia do not appear to have been mentioned.

It was very disappointing that there is no mention about training in respecting the rights and choices of older people.

It was very disappointing that there is no mention about training in respecting the rights and choices of older people.Credit:Dean Mitchell

The workforce external to an aged care home, including the medical specialists, general practitioners and allied health professionals, were addressed in recommendations 56 to 71. These highlighted and begin to address the existing discrimination and lack of access to health services for older people in care homes. Improving mental health access and a senior dental benefits scheme are most welcome. Greater challenges that still need to be met are making a reality of the recommendations for a new model of care, requiring better co-operation between general practitioners, medical specialists and the public hospital.

Nurses need better training to equip them to assess, deliver and evaluate the specific care required by an older person. The COVID-19 pandemic highlighted how as we get older our bodies and types of diseases that affect us change. I had hoped that the commissioners would have recommended that all nurses in aged care have a formal qualification in the care of the older person.

Nurses need better training to equip them to assess, deliver and evaluate the specific care required by an older person.

Nurses need better training to equip them to assess, deliver and evaluate the specific care required by an older person.Credit:Getty Images

Similarly, I expected a need for a formal aged care management qualification for nurses who are responsible for an aged care home as it is one of the most difficult services to operate well. A positive organisational culture, staff attitudes and teamwork require a motivated, responsive, kind and knowledgeable leader. Aged care must foster an environment where all staff can call out neglect, abuse and substandard clinical care. We know this is possible, and we have the tools to develop those skills in people because we have achieved this in our hospitals.

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We start fixing aged care with more nurses and more personal care workers who are better trained and better paid for their services. Just be aware this is not enough. As Winston Churchill may have said about this the final report, “[it] … is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

Joseph Ibrahim is a professor and head of the Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University.

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