Fifty sexual assaults on aged care residents every week: call for sweeping change

The damning figures were laid bare by senior counsel Peter Gray, QC, and Peter Rozen, QC, in final submissions and recommendations to the Royal Commission into Aged Care Quality and Safety.

The submission said the evidence before the Royal Commissioners supported a finding that the level of substandard care being delivered in the current aged care system is far too high.

"Abuse is the most extreme category of substandard care and includes the use of restraints, both physical and chemical, and assaults, physical, sexual and emotional," said Counsel.

"Of the in excess of 10,000 public submissions received by the Office of the Royal Commission, a number of themes emerged in which people making submissions raised concerns about neglect, emotional abuse, physical abuse or assault, restrictive practices, financial abuse, and sexual abuse or assault.

"The Commissioners received many disturbing accounts raising allegations of abuse of people living in residential aged care at the hands of caregivers and fellow residents."

After more than two years of hearing which included harrowing stories of abuse and neglect of the some of the country's most vulnerable people, Counsel Assisting have made 124 recommendations for sweeping change in the sector in a 500 page submission to the Royal Commissioners.

Among the recommendations are a new Aged Care Act based on human rights; a new planning regime for aged care which provides demand-driven access rather than the current rationed approach; a new and independent process for setting aged care quality standards; a new and enforceable general duty of care on approved providers of aged care; mandated staffing ratios in residential aged care; compulsory registration of personal care workers; an independent pricing authority that will determine aged care prices and an independent Australian Aged Care Commission that will be responsible for administering and regulating the aged care system.

Recommendations also include a seniors' dental benefit scheme, improved access to medical, allied health and mental health services, restrictions on the prescription of antipsychotic drugs, mandatory minimum qualifications and compulsory national registration for personal care staff, a one month time frame for the allocation of a new home care package at the assessed level; and the provision of qualified 'care finders' to provide assistance on a local, face-to face basis, to people seeking or receiving aged care services.

On aged care staffing the recommendations include the provision of registered nurses, enrolled nurses, and personal care workers for at least 215 minutes per resident per day for the average resident from July 1, 2022, with at least 36 minutes of that staff time provided by a registered nurse (increasing to 44 minutes after July 1, 2024). In addition, from July 1, 2022, the minimum standard should require at least one registered nurse on site per residential aged care facility for the morning and afternoon shifts (16 hours per day), increasing to one registered nurse on site per residential aged care facility at all times from July 1, 2024.

Leading Age Services Australia (LASA) which represents aged care providers throughout Australia has said it broadly supports the reform roadmap set out in Counsel Assisting's submission.

Chief executive Sean Rooney said there were three main positive themes in the package delivered to the Royal Commission: Better quality outcomes for people receiving care, more care services aligned to quality of life outcomes and practical time lines for implementation.

"The recommendations proposed by Counsel Assisting today address a number of key structural problems that have stopped older Australians from getting the level of care and support they deserve for far too long," he said.

"Our preliminary view is that proposals for fundamental reform of aged care institutions - including the creation of an independent pricing authority, inspector general, and overarching commission with responsibility for funding and regulation - would help remove politics from the aged care system and ensure decisions are based on evidence, and the best interests of older Australians.

"We welcome the increased focus on the collection of quality indicators and the outcomes for older Australia to support choice and accountability at the system and provider level.

"Counsel Assisting has also proposed clear timeframes and transitional arrangements, which will be crucial to avoiding further delay in achieving the reforms that older Australians need."

However he said: "We need to better understand the potential for any possible unintended consequences of proposed personal liability measures for directors and executives and other governance and reporting requirements.

"Pushing out small providers with excessive compliance won't help choice and discouraging good directors won't help quality."

The United Workers Union said the recommendations to adopt minimum staffing levels in residential aged care would be "transformative" for aged care workers and residents.

"But there is a need for many of these recommendations to be accelerated. The disaster in aged care is happening right here, right now," said UWU aged care director Carolyn Smith.

"Right now, we are dealing with workers who face shifts where they are left to care for 18 residents by themselves.

"In a survey released in July this year 75 per cent of 1000 aged care workers said they did not have enough staff to provide quality care.

"In early results of a survey of more than 2000 aged care workers we are working on now, every indication is things are getting even worse. Now, more than 80 per cent of workers say they simply do not have enough staff to provide quality care to their residents."