Funding model still in limbo in Royal Commission’s final report

Royal Commission Chair, the Honourable Tony Pagone QC, and of Commissioner Lynelle Briggs AO.

Australia’s $1 billion royal commission into aged care has failed to map out a consistent path to regulate and pay for quality and safe care.

The two-year inquiry, which received more than 10,000 submissions from around the country, today released its awaited final report and recommendations in its 340-page report, Care, Dignity and Respect.

These included a five-year roadmap for a new needs-based system for aged care, overturning the current system of funding provision that the inquiry has found delivered “substandard” care to 30 per cent of people.

Among its recommendations are a new Aged Care Act to regulate the sector for the next generation, expanding the quality indicators system, more regulation of “restraint” medication use, a public rating system for aged care facilities, better designed facilities, at least 200 minutes direct care per resident including 40 minutes from a registered nurse by 2022, and the registration of carers.

But the Commission, led by Lynelle Briggs and Tony Pagone QC, spilt when determining the optimal regulatory model for the future – one of the most contentious issues facing operators.

Mr Pagone said there was strong agreement between them that there have been “many failures and shortfalls”.

“We agree that fundamental reform to the Australian aged care system is required, but we differ sharply in our opinion on certain aspects of the arrangements necessary to give effect to our common purpose of the new aged care system,” he said.

He put forward a framework for an independent regulatory system, separate from the government, to oversee a more effective and caring aged care system.

“The current aged care system and its weak and ineffective regulatory arrangements did not arise by accident,” he said.

“The move to ritualistic regulation was a natural consequence of the Government’s desire to restrain expenditure in aged care. In essence, having not provided enough funding for good quality care, the regulatory arrangements could only pay lip service to the requirement that the care that was provided be of high quality.”

Commissioner Briggs, however, put forward a strong argument for a government-run system, at odds with her fellow inquiry chief.

“In my view, only Government can do this in a system as large, complex and fragmented as the aged care system,” she said.

“Only Government can wield the resources and system oversight to make it happen. Only Government has the cut-through capability to motivate and direct transformational change of the magnitude we recommend. Not the private sector, not the insurance sector, and not a progressively privatised administration, distant and unaccountable to the community. Only the Government; just as only the Government delivers Medicare and the social security system.”

The final report highlighted the enormity of the challenge.

It found “unacceptably high levels of substandard care”, including assaults as high as 13 per cent to 18 per cent in residential aged care, “clear overuse” of physical and chemical restraints.

About half of people were concerned about staffing, including understaffing, unanswered call bells, high rates of staff turnover, and agency staff not knowing the residents and their needs.

The inquiry recommended minimum quality and safety standards, including for staffing.

This includes 40 minutes of care by a registered nurse each day and 200 minutes of care by 2022, and 215 minutes of care per day by 2024, of which 44 minutes are provided by registered nurses.

It also recommended that by 2024, the standards should require at least one registered nurse on site at all times for residential aged care.

Higher pay was also recommended, noting “wage increases should be an explicit policy objective of aged care funding”.

Under the plan, personal care workers would be required to be registered under a national scheme. This would include a mandatory minimum Certificate III, ongoing training, minimum English skills, criminal history checks and a code of conduct.

High quality palliative and dementia care training is also a centrepiece of the commission’s report.

The final report can be viewed here

and an executive summary here

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