Lessons learned: what can we take away from the first year of the Royal Commission?

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With 2019 ending – and formal hearings for the Royal Commission not set to resume until February 2020 – now is the time to look back at the year.

I have some points to make:

The Commissioners are now fully to grips with the sector:

We have seen Commissioners Lynelle Briggs and the late Richard Tracey – and now Tony Pagone – become more engaged in asking questions – and making points – as the year has gone on.

They are now experienced and understand the issues at hand.

Importantly too, the Commissioners have also shown they understand the power of the media.

Commissioners Briggs and Tracey harnessed strong language in the Interim Report to push the Government for action on the three areas they deemed most urgent: home care, chemical restraints and younger people in residential care.

It worked – the Government is now progressing reforms on all three.

To this end, Commissioners Briggs and Pagone have now personally issued a consultation paper outlining a new model which we know from Commissioner Briggs’ comments at community forums, they believe could be implemented in three to five years.

The Counsel Assisting are now testing ideas for the future:

The eight members of the Counsel Assisting team have also hit their stride and are now actively testing propositions for this future model.

From initially quizzing witnesses on their ‘wish lists’, the Counsel Assisting are now floating their own ideas – presumably sourced from the research and policy team at the Commission.

They have also shown they are open to adapting these concepts – at both the Mudgee hearings and the recent Canberra hearings, the Senior Counsel admitted they needed to go back to the drawing board and continue to work on the best way forward.

Everything comes back to governance, leadership and culture:

Even though governance was only the focus of the Hobart hearings, these themes permeated the year – and made it clear that ‘care’ – whether ‘good or bad’ – starts at the top.

Providers and facilities who didn’t show strong governance, leading by example and an investment in their people came out second best – or worse.

Expect these issues to remain high on the Commission’s agenda in 2020.

Boards and directors in the firing line:

It was the year that boards and directors were educated on where their responsibilities lie.

No aged care board could emerge from 12 months of the Royal Commission without an understanding that they must be accountable for the care provided to their residents, clients and their families.

The issue of financial and criminal penalties for senior management emerged during the Darwin hearings and never left – this will be another issue that is guaranteed another airing.

Finances are now looming large:

It’s the issue that didn’t make the agenda for the formal hearings this year – but regardless still dominated the discussion.

The message from direct experience witnesses was: why are we paying all this money for ‘care’ when Mum or Dad is not receiving it?

Contrasting this opinion was the idea that people need to contribute more to their care – and that if Australians want to receive ‘quality’ care, then they must pay for it.

Finances will be canvassed in 2020 so anticipate seeing these two opposing arguments come to the fore.

A sector increasingly short on cash:

The funding of the sector is another topic the Royal Commission will broach in the New Year – and it can’t come soon enough for many providers.

In recent months, we have had the costs of the Royal Commission continue to add up, LASA flag that 197 providers are on the brink of financial collapse and the Aged Care Financing Authority (ACFA)’s own Chair warn that the sector may be financially unsustainable.

Evidence from the Department of Health has shown that the regulator appears unconcerned about the viability of providers, labelling it an “issue for management.”

But if frail, older people are again forced to find new facilities because their provider has closed its doors, we could see another ‘Earle Haven-style’ media frenzy – the last thing the Government wants, or providers need.

A solution is required – and soon.

Aged care on the public’s mind – yet to be leveraged:

Media coverage of the Royal Commission has spurned an array of headlines – mostly negative – that have seen aged care move up in the community consciousness.

The Q&A panel in October again helped to raise the problems in the sector to a national level – but we have yet to see this morph into a real campaign to drive reform.

Will this groundswell find new support in the New Year?

Staff and management are struggling but there is some optimism for 2020:

Providers and staff shared with The Daily COMMISSION their increasing difficulties in managing poor mental health, attracting staff to a sector in the public spotlight and dealing with experienced staff exiting the sector.

This will continue to be a challenge in 2020 – but we have also heard some optimism for the future and the changes to come.

Many rejected Commissioner Lynelle Briggs’ concern that the sector lacks the “energy and excitement” for reform but pointed to the increasing regulations as stymieing both enthusiasm and innovation.

Regulators being increasingly tough on providers:

Facility managers and CEOs throughout the 2019 hearings have pointed to the Aged Care Quality and Safety Commission (ACQSC) and the Department of Health being increasingly hard on providers in their accreditation audits and quality assessors being “punitive” in their visits.

The year also saw a slew of new regulations introduced, including the new Single Aged Care Quality Standards, the Charter of Aged Care Rights, amendments to the Quality of Aged Care Principles 2014 minimising the use of physical and chemical restraints, adding to their regulatory burden.

Again, this will be an issue that carries on into the New Year – with the prospect of more red tape to come.

The Government is focused on home care, not residential care:

While Prime Minister Scott Morrison delivered a temporary funding boost to residential care providers (announced the day before the first round of hearings in Adelaide) early in the year, the focus of funding has been on home care with 10,000 new packages released in February ahead of the Federal Budget and a further 10,000 in response to the Interim Report.

This reflects the growing importance of home care, with the number of providers offering packages moving past the number of residential care providers for the first time in November.

This emphasis on keeping older people at home was echoed in the Royal Commission, with the new model being put forward by the Commissioners squarely directed at delivering services and supports into the family home.

But the Government is still rolling out record numbers of aged care beds:

Despite this, the 2018-19 Aged Care Approvals Round (ACAR) was the largest one ever, with 13,500 new residential aged care places.

This week, Minister for Aged Care and Senior Australians, Richard Colbeck, announced that the 2020 ACAR will open in March 2020 and close in May 2020, with 10,000 aged care beds, 750 short-term restorative care places; and up to $60 million in capital grants on the line.

They have a point. As I noted in the 4 December 2019, 210th edition, there will still be 1.5 million Australians aged over 85 by 2047 – and they will not all be able to live at home.

Finally, the Royal Commission’s Final Report will be a game-changer:

The Royal Commission’s Interim Report in October made it clear: a fundamental redesign of the system is needed.

Commissioner Lynelle Briggs has been increasingly vocal on the need to turn the system “upside-down” – and that their final recommendations will make sweeping changes to the way aged care is operated in Australia.

“We feel so great is the change is needed in this sector, we want to create a complete plan for what’s needed,” she told the Rockhampton community forum.

It all sets the scene for a fascinating 2020 – join me then on 21 January 2020.

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