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It's about “Care, Dignity and Respect”: Royal Commission calls for fundamental reform

Two-and-a-half years after Prime Minister Scott Morrison announced a Royal Commission into Aged Care Quality and Safety following an ABC Four Corners investigation into the sector, the Government has released the Royal Commission's Final Report.

The Weekly Source (The Business of Ageing) has provided this helpful summary of the 2,000-plus-page report – which runs to five volumes and is tellingly titled ‘Care, Dignity and Respect’ – outlining 148 recommendations designed to “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 Commissioners have agreed on the majority of the recommendations, including reforms such as:

  • A new Aged Care Act.

  • A new Aged Care Program combining the CHSP, home care and residential care.

  • A single streamlined process for accessing aged care services.

  • A System Governor to oversee the system.

  • An Inspector-General of Aged Care to identify and investigate systemic issues and to publish reports of its findings.

  • A transition to care at home.

  • Care that is based on need, not rationing.

  • Increased support championed by Commissioner Briggs for the development of ‘small household’ models of accommodation.

  • A more restorative and preventative approach to care, with increased access to allied health care in both home and residential aged care.

  • Equity for people with disability receiving aged care.

  • No younger people 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 skill mix and daily minimum staff time for registered nurses, enrolled nurses and personal care workers for each resident, plus 24/7 RNs (not mandated minimum nurse-to-resident ratios).

  • New approval requirements for providers including home care operators plus graded assessments against the Quality Standards and performance ratings.

  • A new Complaints Commissioner.

  • Civil penalties of providers that breach the general duty to provide high-quality care.

  • Wider enforcement powers for the quality regulator.

  • Improving aged care through data, research and technology.

  • Immediate changes to the Basic Daily Fee.

  • Amendments to the Viability Supplement.

  • An independent Pricing Authority to determine the costs of delivering services.

  • A new funding model for care at home based on individualized funding or a case-mix model.

  • Case mix-adjusted activity-based funding in residential aged care.

  • Incentives for an enablement approach to residential care.

  • Fairer means testing with no co-contributions for care (as compared to costs of living and accommodation), social supports, domestic assistance and respite care.

  • Improved prudential regulation and financial reporting.

However, Commissioners Tony Pagone QC and Lynelle Briggs AO have differing recommendations on a number of key issues including oversight of the sector and critically, funding.

“Many of our recommendations and observations are made jointly, but there are some instances where we make differing recommendations and observations. We have agreed, with some misgivings and not without anxious consideration, to make some separate recommendations and to express different views where we diverge. But we both strongly conclude that fundamental change is needed,” Commissioner Pagone writes.

These include:

  • Oversight of the sector – Commissioner Pagone, a former Federal Court judge, backs the Counsel Assisting’s Independent Commission model presented during the final hearing, while Commissioner Briggs, a former senior bureaucrat, supports a revamped Department of Health and Ageing.

“The adoption of one model over the other will have consequences for many, but not all, of the recommendations we make,” Commissioner Pagone states.
  • Capital financing for residential care – both Commissioners recommend the phasing out of Refundable Accommodation Deposits, but Commissioner Pagone says that an Australian Government-backed loan facility should be temporary during the transition period to new arrangement – Commissioner Briggs argues the Government should establish an ongoing aged care accommodation capital facility.

  • A new aged care financing system – the Commissioners agree on the introduction of a levy on taxable income to finance aged care, but differ on its design with Commissioner Pagone suggesting it should be 1% of taxable personal income and hypothecated so it can only be spent on aged care services. Commissioner Briggs however advocates for an ongoing, non-hypothecated levy to meet the costs of the Royal Commission’s recommendations.

  • A new primary care model to improve access – Commissioner Pagone says the Government should only trial a program for six to 10 years starting from 1 January 2024, while Commissioner Briggs says the Government should simply implement it by 2024.

The Commissioners are clear that they do not expect their differing recommendations to prevent the Government from reforming the system.

“Our disagreement about the best way for improvement to be achieved is not a justification for doing nothing,” Commissioner Pagone writes.

Speaking on Monday following the report’s release, Prime Minister Scott Morrison said the report provides the Government with what it needs to know to “bring about the generational change that is needed.”

You can read all of the 148 recommendations made here or an in-depth introduction and overview of the report here.


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