Aged Care Royal Commission – Overview of recommendations
Aged Care in Australia has been plagued with poor health care standards, low staff ratios, under-resourcing and high waiting lists for numerous years. The outbreak of COVID-19 in Australian residential aged care facilities in 2020 triggered an urgent Royal Commission into Aged Care Quality and Safety (Commission).
In March 2021, the final report and recommendations from Commission were delivered to the Commonwealth Government. It is a large and complex report spanning eight volumes, more than 2,500 pages and includes 148 recommendations.
The key sections that have implications for doctors include:
• improved quality standards;
• improved access to aged care;
• changes to the requirements to workforce; and
• changes to funding arrangements for aged care.
In the recent Federal Budget statement, the Commonwealth Government accepted all recommendations and allocated $800 million to address the key priorities of:
• food and nutrition;
• workforce and staff ratios; and
• changes to Medicare rebates related to aged care.
The recommendations will fundamentally change the delivery of care in the aged care setting with major impacts for patients, doctors, other health care workers and institutions. Many of the recommendations place more emphasis on high quality care for older people and increased accountability for providers of aged care including government-run aged care services, not for profit providers and for-profit providers.
Over many years, we have lobbied for the Government on several issues that we are proud to have secured in the recommendations.
• Immediate action to address the area of the food and nutrition
• Improve the training and support for palliative care
• Increase access to subsidised telehealth
• Expand the multi-purpose service model of aged care in regional, rural and remote Australia
• Fund mental health services and dental health services in aged care
• Improve services for older people with a disability
• Remove younger people from aged care
• Change the MBS system to include health assessments, mental health assessment and treatment plans and allied mental health practitioners.
• Control the use of restrictive practices
• Change staff ratios
• Change eligibility assessments
• Introduce multidisciplinary outreach services in aged care
• Improve access to medication management reviews
• Clear the home care package waitlist
• Increase accountability for providers of aged care services and stronger enforcement measures for those who breach the required standards
• Expand the Rural Health Outreach Fund to six priorities (chronic disease management, eye health, maternity and paediatric health, mental health, geriatrician services, medical specialist services)
However, we do not support the following recommendations.
• A new model of primary care where general practices could apply to the Australian Government to become accredited aged care general practices and could enrol people receiving residential care or personal care at home who choose to be enrolled with that practice
This is unnecessary as GPs already work in aged care and are qualified to provide high-quality health care. A new accreditation is adding undue bureaucracy when an appropriate medical accreditation already exists and works.
• Restrict the use of antipsychotic medication in residential aged care
This will add undue limitations and care options for patients that rely on these medications for daily comfort and quality of life. It also limits a GP's ability to prescribe suitable medications and forces the patient to see a specialist that will incur additional cost and access issues.
• Increase the daily level of care to 200 minutes of care per day of which 40 minutes are provided by registered nurses by 2022 and 215 minutes of care per day of which 44 minutes are provided by registered nurses by 2024.
While this change is essential, overdue and necessary, it is unachievable to increase the staff ratios and care time to the rates recommended within three years. The existing staff and care times are so woefully low and limited that it will take significantly more time, long-term staff training and considered policy changes to realistically achieve this goal.
Improving the aged care sector will take significant commitment, investment and institutional change. We will continue to monitor the roll-out of the recommendations and advocate for positive change for our members and the community.
We have prepared the following summary highlighting key sections of the recommendations that impact the medical profession.
Read the AMA's Putting health care back into aged care report