Governance, funding, new models of care: where to now for the Royal Commission?

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The Royal Commission has promised a series of hearings in the first half of 2020 to build on some of the issues raised in 2019 (pictured above) including:

  • funding and financing and the impact it has on how care is delivered.
  • integration and transition between different parts of the aged care system, including home, residential and respite care.
  • governance and accountability.
  • fostering innovation and improvement in aged care.
  • models for the delivery of aged care.
  • system architecture and design to support a good quality of life for people using aged care services.
  • how to deliver aged care in a sustainable way.
  • designing a future aged care system that puts older people first.

See below for my thoughts on the topics that could come up.

Funding and financing and the impact it has on how care is delivered:

The big one for providers. While Commissioner Lynelle Briggs had stated that financing was not a major part of the Royal Commission’s Terms of Reference, the current financial pressure in the sector means this could be one of the most interesting hearings to date.

The sector has been crying out for cash – but the Royal Commission’s Interim Report made it clear the Commissioners would not recommend emergency funding, saying the “limited interventions” would not be enough to deliver an aged care system that met the needs of older people.

Evidence to the Royal Commission has already shown the current funding model is not fit for purpose – but will the Commissioners also find the Australian National Aged Care Classification (AN-ACC) currently being trialled is not up to scratch?

The Commission’s latest research paper on aged care systems in other countries has also shown a clear preference for increased funding for home care and payments for family carers – will these be on the table?

Finally, the Commission must address the question: should the consumer (who can afford to pay) pay more?

Providers know the answer – will the Commissioners come to the same conclusion?

Integration and transition between different parts of the aged care system, including home, residential and respite care:

One of the major criticisms of the Interim Report was the failure of the aged care system to allow older people to move between home care, residential care and respite care without a pile of ‘bureaucratic spaghetti’ and stress for care recipients and families.

Expect the Commission to canvas more portable models of funding – so consumers can take their funding with them – plus better supports for carers.

With the Government’s recent decision to publicly tender ACAT teams this year still fresh in people’s minds, the role of aged care assessments are also sure to get an airing – including how they can be used to provide early intervention and reablement as well as refer people to services.

Governance and accountability:

A recurring theme throughout the Royal Commission hearings so far and one that will continue to dominate in 2020.

Despite the Hobart hearings looking closely at the role of governance, leadership and accountability in the failures in care at Bupa South Hobart and Southern Cross Care (Tas), the Commissioners have promised selected providers will continue to be put under the microscope.

Will the question of criminal liability for CEOs and boards remain a hot topic? And which providers will be called out in front of the Commission?

Fostering innovation and improvement in aged care:

After a year of hearings looking at what is wrong with the system, there will be a welcome change as the Commission turns its attention to what is right.

We know that for every ‘bad’ headline, there are providers out there going above and beyond. I predict there will be an array of innovative ideas examined – especially those aimed at quality of life, social isolation and providing ‘joy’ in aged care.

Models for the delivery of aged care:

Fulfilling Commissioner Briggs’ pledge early in 2019 to turn the system upside-down, the focus of the Royal Commission’s upcoming February workshop will be the redesign of the aged care system.

More discussion on this next week, but models that are based around keeping people living independently at home, are centred on reablement and prevention and provide consumers with more choice around their care are certain to be up for discussion.

System architecture and design to support a good quality of life for people using aged care services:

While the system has come in for a constant drubbing over the course of the Commission’s hearings, there’s been little examination of how all the parts come together.

A new aged care system requires a new purpose and a new structure.

What role will the Government, providers and the consumer play – and could providers renegotiate their relationship with both?

How to deliver aged care in a sustainable way:

Mike Callaghan, the Chair of the Aged Care Financing Authority (ACFA) warned last year that the sector was on the verge of being financially unsustainable.

Ways to keep operators – especially those in rural and remote areas – viable as well as ways to meet the demand for services as the ‘Baby Boomer’ generation ages will be key talking points.

Designing a future aged care system that puts older people first:

Perhaps the most important point underlined in the Interim Report. The Commissioners made it clear that any new system must prioritise care recipients, and by extension their families.

This will apply to the structure, funding and goals set down for this new model.

What else will be in the Commission’s sights?

Hearings and workshops aren’t the only source of evidence for the Commissioners.

Community forums will also take place in a range of city and country locations, while submissions are still being accepted until 30 April – three months away.

There is also a considerable amount of research by the Commission due for release, including on:

  • community attitudes to ageing and aged care.
  • the quality of life, satisfaction with care and extent of sub-standard care in both home care and residential care.
  • understanding the cost of care and how much it costs to deliver an acceptable standard of care.
  • the accessibility of aged care services in rural and remote areas.
  • the extent of differences in the care experiences of people with low income or wealth.
  • financial analysis of the state of the aged care industry and its different segments.
  • modelling the economic and budgetary implications of various scenarios and structural options for aged care.

It all points to a busy – and potentially transformative – year for the Royal Commission and the sector.

What are your thoughts? Do you feel there is an area that has been missed?