It's been over two years in the making, but finally the Aged Care Royal Commissioners Tony Pagone and Lynelle Briggs have presented their final warts-and-all report which has proved a damning indictment on a sector whose sole purpose should be the compassionate and quality care of some of our most vulnerable people.
Titled Care, Dignity and Respect, the Royal Commissioners call for fundamental reform of the aged care system: "The extent of substandard care in Australia's aged care system reflects both poor quality on the part of some aged care providers and fundamental systemic flaws with the way the Australian aged care system is designed and governed.
"People receiving aged care deserve better. The Australian community is entitled to expect better," they write.
The Royal Commissioners say that for too long the legislation that governs aged care in Australia has focused on the funding requirements of aged care providers rather than the care needs of older people.
They propose a clearly articulated purpose for the new aged care system: "To deliver an entitlement to high quality care and support for older people, and to ensure that they receive it.
"The care and support must be safe and timely and must assist older people to live an active, self-determined and meaningful life in a safe and caring environment that allows for dignified living in old age."
The Royal Commissioners make 148 wide-ranging recommendations, including:
- A new Aged Care Act that puts older people first, enshrining their rights and providing a universal entitlement for high quality and safe care based on assessed need.
- An integrated system for the long-term support and care of older people and their ongoing community engagement.
- A System Governor to provide leadership and oversight and shape the system.
- An Inspector-General of Aged Care to identify and investigate systemic issues and to publish reports of its findings.
- A plan to deliver, measure and report on high quality aged care, including independent standard-setting, a general duty on aged care providers to ensure quality and safe care, and a comprehensive approach to quality measurement, reporting and star ratings.
- Up to date and readily accessible information about care options and services, and care finders to support older people to navigate the aged care system.
- A new aged care program that is responsive to individual circumstances and provides an intuitive care structure, including social supports, respite care, assistive technology and home modification, care at home and residential care. In particular, the new program will provide greater access to care at home, including clearing the home care waiting list.
- A more restorative and preventative approach to care, with increased access to allied health care in both home and residential aged care.
- Increased support for development of 'small household' models of accommodation.
- An Aboriginal and Torres Strait Islander aged care pathway to provide culturally safe and flexible aged care to meet the needs of Aboriginal and Torres Strait Islander people wherever they live.
- Improved access to health care for older people, including a new primary care model, access to multidisciplinary outreach services and a Senior Dental Benefits Scheme.
- Equity of access to services for older people with disability and measures to ensure younger people do not enter or remain in residential aged care.
- Professionalising the aged care workforce through changes to education, training, wages, labour conditions and career progression.
- Registration of personal care workers.
- A minimum quality and safety standard for staff time in residential aged care, including an appropriate skills mix and daily minimum staff time for registered nurses, enrolled nurses and personal care workers for each resident, and at least one registered nurse on site at all times.
- Strengthened provider governance arrangements to ensure independence, accountability and transparency.
- A strengthened quality regulator.
- Funding to meet the actual cost of high quality care and an independent Pricing Authority to determine the costs of delivering it.
- A simpler and fairer approach to personal contributions and means testing, including removal of co-contributions toward care, reducing the high effective marginal tax rates that apply to many people receiving residential aged care, and phasing out Refundable Accommodation Deposits.
- Financing arrangements drawing on a new aged care levy to deliver appropriate funding on a sustainable basis.
The Royal Commissioners recommend ongoing monitoring and reporting arrangements to support effective and transparent implementation of their recommendations.
However the two Commissioners have disagreed on how best to govern the sector and how best to raise the billions of dollars in additional funds needed.
Commissioner Pagone has recommended the establishment of an Australian aged care commission, separate from the Department of Health, so aged care administration can be "independent of ministerial direction", while Commissioner Briggs called for aged care to remain within a rebranded department of health and aged care. She also called a new independent sector watchdog.
On the question of funding both Commissioners recommended a levy to boost funding with Commissioner Pagone recommending a special Medicare-style levy, with money raised to solely go towards aged care while Commissioner Briggs recommendeds a general levy to boost tax revenue and thus increasing the amount available for aged care.
Prime Minister Scott Morrison has pledged a further $452.2 million package as an initial step in responding to this final report.
He said the government's response would be driven by the principle of respect and care and through the lens of five broad pillars:
- Home Care,
- Residential aged care quality and safety,
- Residential aged care services and sustainability,
- Workforce, and
He said it was clear from the Royal Commission's work that while significant progress has been made, "there is a clear roadmap to improve respect and care for our older Australians".