Policy Alert: Final Report of Royal Commission into Aged Care Quality and Safety: Care, Dignity and Respect

The Government released the Final Report of the Royal Commission into Aged Care Quality and Safety on 1 March 2021. The substantive report, titled Care, Dignity and Respect contains seven volumes with 143 recommendations.

The Final Report concludes:

“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.”

Commissioners call for fundamental reform of the aged care system and 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.”

This would be delivered through a new Act, based on human rights, as the foundation of the proposed new aged care system. It is critical that this legislation gives older people control of their own care decisions and create enforceable rights and protections for older Australians receiving aged care. Other key recommendations include:

  • 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.
  • A new aged care program that is responsive to individual circumstances and provides a care structure based on social supports, respite care, assistive technology and home modification, care at home and residential care. The new program would provide greater access to care at home, including clearing the home care waiting list.
  • Professionalising the aged care workforce through changes to education, training, wages, labour conditions, registration, and career progression.
  • 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.

The Royal Commission concludes that the Australian Government, which has policy and administrative responsibility for the aged care system, has “over many years had the means available to achieve effective leadership of the aged care system but failed to do so”. It has called for more active and effective leadership and governance at a systemic level to ensure the delivery of high-quality aged care. Commissioners had different perspectives on the degree of independence from government of the entity that should implement reform and govern a reformed system.

Given that provider governance and management directly impact all aspects of aged care, there are also several important recommendations to improve governance, transparency, and accountability at the provider level. Commissioner Briggs considers that providers have been “critical contributors to the systemic problems in the aged care system” and notes that “providers will need to lift their game to meet these new requirements”. COTA Australia agrees and will be looking for government to work with us to develop a plan to transition out of the system those providers which are not able to step up within a reasonably short timeframe.

Both Commissioners also called for funding to meet the actual cost of high-quality care and for the costs of delivering it to be independently determined, while differing on some of the detail of how this should be done. On the question of financing, both Commissioners supported consideration of a levy on taxable income to finance aged care while differing on how such a levy should be designed. Commissioners considered that the aged care should become a system of universal entitlement to high quality and timely care based on assessed need, and that consequently there should be no user contributions towards care (as distinct from ordinary costs of living or accommodation).

Differences of view on system governance and financing flow through to several other recommendations. There are also other areas where there are differences of opinion on reform directions.

While alternate solutions to reform challenges have been provided by the two Commissioners, COTA Australia does not see this as any barrier to commencing urgent reform. Both Commissioners argued for major transformation of our aged care system.

In terms of concerns, COTA Australia’s view has not changed greatly from our response to the Counsel Assisting recommendations last November. These concerns are:

  • Insufficient emphasis throughout the report on consumer empowerment, choice, and control as a key outcome of reform.
  • Care finders and case managers not being able to act fully on behalf of the consumer because they are not independent from government and providers.
  • Ensuring that full transparency and accountability of service performance and cost is implemented.
  • Confusion regarding the policy rationale, direction for, and implementation of ‘system governor’ arrangements.
  • Failure to address a sustainable way forward on how the system should be financed including how users should contribute in a way that is simple to administer, easy to understand, fair and meaningful for consumers.
  • Insufficient priority given to enhancing control for older people and their families in residential care by enabling bed licences to be allocated to the consumer instead of the provider.

It is critical that the Australian Government commits publicly to a clear path for reform which begins immediately, and which lays out the sequencing of and timeframes for reforms. COTA Australia is assessing the timetable and implementation schedule for reform provided in the Final Report to inform advocacy decisions leading into the May Budget.

The key initial priorities for COTA Australia include implementation on:

  • A plan and timetable to clear the Home Care waiting list.
  • Workforce reform, particularly mandated increases for quality staffing, including a star rating system.
  • A new Act, based on human rights, empowering, and protecting consumers.
  • Greater transparency across the whole system including publicly available information on service provider performance, quality and safety measures and costs.
  • A stronger regulator with increased capability and capacity to act quickly against poor providers, address poor leadership and service culture, lack of clinical governance and low staff numbers.