With the Royal Commission’s formal proceedings set to resume in less than a week, the Counsel Assisting will be testing propositions on a range of areas from the Commissioners’ consultation paper released in December 2019 towards creating a system that:
- Centres on the individual
- Is easy to access and navigate at any stage of care needs
- Focuses on prevention and reablement
- Enables older people to keep living independently at home longer
- Has a professional and skilled workforce
- Cuts down on red tape – while delivering safe, quality services
- Supports those who can’t afford to pay for care – but ensures those who can make a fair contribution
- Delivers ‘joy’ and protects people from social isolation
To recap the 18 December 2019, 220th edition, the Commissioners had proposed a new model separating care from accommodation with three separate streams (pictured above):
- an entry level support stream, an investment stream and a care stream, to support many older people living at home
- an investment stream to fund prevention and reablement measures to rehabilitate people, provide respite and delay the move into residential care
- a care stream delivered at home or in less institutional forms of residential care
This would be accompanied by individual funding matched to people’s care needs and wider availability of nurses and allied health staff across all parts of the system.
Here’s some ideas on what the participants could end up discussing:
A system that centres on the individual:
The Royal Commission’s Interim Report slammed the ways the current system minimises the voices of older people and their families.
The Commissioners concluded that the older person should be at the centre and their rights, choices and dignity supported.
This is no easy task with Australians living in rural and remote areas, younger people in residential care, Culturally and Linguistically Diverse (CALD) individuals and Aboriginal and Torres Straits Islanders people all at a disadvantage.
Expect talk around whether the aged care system should be funded differently for different groups and locations and how this could realistically be achieved – is pooling resources with other health services an option?
Could care recipients pick their own supports and how could this be managed?
A system that is easy to access and navigate at any stage of care needs:
The Commissioners have made it clear that accessing the system needs to be much simpler – whatever stage of care people require and wherever they live.
That means better information from My Aged Care and face-to-face support – so there is likely to be discussion around both the need for care coordinators and system navigators.
Does Australia need a network of aged care access centres? Should these face-to-face services be returned to the local government level – and how could this be done when most councils have exited aged care services? Or should the local GP be the point of contact?
ACATs should also rate a mention. The Commissioners have stated that aged care assessment teams should have both clinically skilled and multi-disciplinary staff to assess older people for higher-level services.
Who should be conducting ACATs – hospitals or outside operators? Again, should GPs be involved?
A system that focuses on prevention and reablement:
We know the Royal Commission is keen to head off the inevitable increase in demand for aged care services from Australia’s ageing population.
Early interventions, such as education, exercise, nutrition and rehabilitation programs, health assessments, home modifications and assistive technologies, before someone embarks on the aged care journey could all form part of the answer.
How would these be paid for – and again would funding be assigned to the individual?
There will be also more demand for dementia care and both short- and long-term aged care services – so anticipate a look at more flexible care and funding options that could cater to these needs.
A system that enables older people to keep living independently at home longer:
The Commissioners are already pushing the Government for action on home care waiting times to allow more people to stay at home.
It’s expected the Commission will be looking for ideas to deal with the fallout from the need for a massive increase in the number of Home Care Packages. This could include growing the home care workforce, providing more flexibility in how people use their funding and offering supports to people in community housing and retirement villages.
The need for a Level 5 package – or completely uncapping home care funding – and reallocating unspent funds could also be up for a hard look.
A system with a professional and skilled workforce:
The issue of a workforce that is under pressure, under-appreciated and sometimes unskilled has been a constant in every hearing.
The Commissioners have stated that quality of care depends on carers and their working conditions. Does this mean staffing ratios are needed?
Targeting students for a career in aged care, training models, aptitude tests, national accreditation, a register of care workers, professional development and boosts to wages could also all be on the cards.
Putting the emphasis on reablement also shifts the focus to nurses and allied health services and their role in keeping older people healthy.
New models that increase their numbers, the use of in reach services and telehealth are sure to be part of the conversation.
A system that cuts down on red tape – while delivering safe, quality services:
The Interim Report targeted the ‘bureaucratic spaghetti’ that underlies the sector for failing to provide transparency or incentives for providers to improve.
Up for possible consideration is the use of different regulatory approaches for different services plus the need to adapt the regulations and consumer protections as more services move into the home.
There is also a question mark over the new Aged Care Quality Standards and whether they are too vague.
A system that supports those who can’t afford to pay for care – but ensures those who can make a fair contribution:
While it has yet to be canvassed in formal hearings, financing is a major issue that will inevitably come up.
With the Australian National Aged Care Classification (AN-ACC) still in its early stages and the Commissioners advocating tailored funding, this suggests an examination of different funding models.
Should the system move to block or individualised funding like the NDIS and who would foot the bill? And does there need to be a comprehensive study of what it costs to deliver services in aged care?
A system that delivers ‘joy’ and protects people from social isolation:
Commissioner Lynelle Briggs has advocated hard on the need for aged care services to not only cater for the last few months of a person’s life but also the last ten to 15 years.
This points to a look at keeping older people active and engaged and how these social supports would be covered – would the Government (and taxpayer) need to pay?
Are there any other points you think should be raised at the workshops?
