The year in review for the Royal Commission

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January

7 January – the deadline for the largest 100 providers to provide submissions on their cases of substandard care for the past five years to the Royal Commission passes.

9 January – the Royal Commission makes its first public call for submissions.

17 January – the ABC’s 7:30 Report airs a story led by investigative journalist Anne Connolly on physical and chemical restraints in aged care as part of its ongoing investigation into the sector that shows video and photos of residents with dementia strapped to their chairs in a Sydney facility.

18 January – Minister for Aged Care Ken Wyatt issues a statement, promising chemical and physical restraint in aged care homes will be “better regulated”.

18 January – the Royal Commission holds its preliminary hearing in Adelaide. The Commissioners (pictured above) reveal the Top 100 providers have self-reported between 20,000 and 30,000 separate cases of substandard care reported with only 83 delivering their submissions on time.

February

8 February – the deadline for the remaining 1,900 providers to make their substandard care submissions to the Royal Commission passes.

10 February – ahead of the first round of hearings, the Federal Government promises a $320 million increase to the aged care general subsidy between 20 March 2019 and 30 June 2019 – the equivalent of $1,800 per resident and the largest ever one-off boost to funding at 9.5%. They also pledge another $282.4 million for 10,000 Home Care Packages (HCPs).

11-13 February – the Royal Commission’s first Adelaide hearings into the current aged care system opens with evidence from Oakden whistleblower Barbara Spriggs and her son Clive (pictured above).

Counsel Assisting reveals just 900 of the 2,000 providers asked to detail cases of substandard care to the Commissioners have so far responded while only 800 public submissions have been made.

COTA Australia CEO Ian Yates tells the Commission the aged care facilities, along with prisons, are the only institutions we have left, and funds should be allocated so good providers can expand and bad ones will be forced to exit the system.

The Australian Nursing & Midwifery Federation’s Federal Secretary Annie Butler also puts forward a new staffing mix model based on their research – with a $5.3 billion price tag.

18-22 February – the Adelaide hearings continue with a look at the current system as Counsel Assisting reveal 10 of the Top 100 providers still needed to send in their submissions with 1,200 public submissions now made.

Department of Health Secretary, Glenys Beauchamp tells the Commission that the 2016-17 cuts to ACFI were the result of anomalous increases in subsidies because some providers were ‘gaming the system’.

LASA CEO Sean Rooney denied his organisation was only concerned about its members, not care, while the Director of Aged Care at Catholic Health Australia Nicolas Mersiades called for the deregulation of aged care and higher consumer contributions.

22 February – the Royal Commission announces its first community forums.

27 February – the new SA Liberal Government says it will put $14.7 million towards a new ‘Oakden’: an 18-bed specialised facility to care for South Australians suffering extreme behavioural and psychological symptoms of dementia (BPSD) at the Repat Health Precinct in Adelaide.

28 February – the listed providers’ half-year results show Estia has spent $1.2 million on the Royal Commission, while Regis had outlaid around $800,000.

March

1 March – the Commission stages its first community forum in Bankstown in western Sydney.

1 March – figures from the Department of Health show 35% of ACFI claims were cut in 2017/2018 amid claims of providers still ‘gaming the system.

However, CEO of the Not For Profit Allambie Heights Village Ciaran Foley says he estimates providers are underclaiming by between $1 and $2 billion per year because of the onerous, complex nature of the ACFI system.

COTA CEO Ian Yates predicts an extra $5 billion a year will be needed to meet the demand for Home Care Packages, and increased remuneration and staffing numbers.

5 March – the Commission’s second community forum is held in Bendigo.

5 March – the Government reveals its largest-ever allocation of 13,500 new residential aged care places in the 2018-19 Aged Care Approvals Round (ACAR) as the national aged care occupancy rate hits a low of 90.3%.

13 March – Wollongong plays host to the Commission’s third community forum with Commissioner Lynelle Briggs telling the audience not to be afraid to go to the media and some of the Counsel Assisting in attendance.

18-22 March – the second Adelaide hearing of the Royal Commission focus on home care. Senior Counsel Assisting Dr Timothy McEvoy QC reveals the Commission has now received 1,700 public submissions with only one of Top 100 provider submissions still outstanding.

An anonymous witness from the Approved Provider Program section in the Department of Health gives evidence that eight out of 10 new home care provider applications are “bottom feeders” who are only out to make money.

Meanwhile, the Department’s First Assistant Secretary for In Home Aged Care, Fiona Buffinton (pictured above) says it is not appropriate for home care providers to be holding onto unspent funds and accruing interest on them – despite the Department designing the system with the idea that recipients would hold onto 10 to 20% of their funds.

Ms Buffinton’s evidence also reveals the mean waiting times for home care in 2017/18 were seven months for Level 1 packages; 13 months for Level 2 packages; 16 months for Level 3 packages; and 22 months for Level 4 packages – and it would take $2 to $2.5 billion a year to clear the waiting list.

Dr McEvoy steps down from the Royal Commission after the hearings to accept an appointment as a Judge in Melbourne’s Family Court.

22 March – COTA CEO Ian Yates warns the audience at the 2019 LEADERS SUMMIT that the Sydney hearings in May will include some ‘horror stories’ (this proves to be the case).

25 March – staff at Healthdirect Australia learn the Government has dumped the not-for-profit company from its website contract following Friday’s evidence by the Department of Health that they are moving to a new supplier and website launching in the middle of this year.

April

2 April – the Federal Government ‘pre-empts’ the Royal Commission by announcing amendments to the Quality of Care Principles 2014 to cut down on the use of physical and chemical restraints and ensure they are only used “as a last resort” starting 1 July 2019.

4 April – the Federal Budget delivers $5.9 billion for the Commonwealth Home Support Programme (CHSP) and another two years’ certainty to continue beyond its June 2020 cut-off, but no other major aged care measures.

4 April – Whiddon Group CEO Chris Mamarelis has an editorial published in The Sydney Morning Herald calling for a new aged care model geared towards reablement, restorative care and quality of life.

5 April – the Royal Commission joins Facebook.

5 April – a Senate Estimates hearing hears the Department of Health is moving to a “much greater focus on reablement” for the 800,000-plus consumers on the Commonwealth Home Support Programme (CHSP) over the next 12 months.

6 April – the Disability Royal Commission receives 3,700 responses to its terms of reference over its 15-day consultation period compared to 4,800 over nine days for the Aged Care Royal Commission.

8 April – the Australian Financial Review reports the Federal Government made a late decision to withdraw an extra 10,000 HCP’s from the Budget on top of the 10,000 places announced in February. Health Minister Greg Hunt’s office denies the claim.

8 April – Aged Care Minister Ken Wyatt (pictured above) ‘kicks the bucket’ for up to $350,000 for COTA to help more people make submissions to the Royal Commission, plus another $2 million for the Older Persons Advocacy Network (OPAN), to deal with the increase in complaints since the Royal Commission got underway.

11 April – the Senate inquiry into the events at Oakden – instigated in June 2017 by then-Senator Nick Xenophon – releases its final report, making 14 recommendations – including that the Government “clarify” that residential care providers ultimately hold a duty of care to all residents and that duty of care for regulation of all care in residential care rests with the Aged Care Quality and Safety Commission (ASQSC).

16 April – the ABC delivers on its promised investigation into sexual assault in aged care, airing a Background Briefing program titled ‘The sexual abuse scandal nobody’s talking about’, three weeks out from the next Royal Commission hearings on dementia care and restrictive practices (it is later revealed the case study in the program was investigated by police who found no case to answer).

18 April – The Australian’s Social Affairs writer Rick Morton publishes an exclusive saying Department of Health figures showed 16,362 people on the national home care queue had been forced into residential care (our query to the Department shows 14,700 of these people would have had access to some form of government-funded home support).

20 April – a small study into New Zealand’s historic $2 billion equal pay deal for aged care staff in 2017 that saw 55,000 female staff receive pay rises of between 15 to 50% shows providers there are still struggling to attract and retain staff.

27 April – a survey by market research consultancy CoreData published in the Fin Review shows trust in the banks fell 40% in 2018 following the banking Royal Commission’s April 2018 hearings, while super funds lost 30% of the public’s confidence.

28 April – Labor leader Bill Shorten promises a 20% wage rise for childcare workers – $537 million over four years – if he wins the May 18 election. He later rules out extending this increase to aged care, despite pressure from the nurses’ unions (and loses the election anyway).

May

1 May – the Royal Commission releases a background paper on the changing demographics and dynamics of aged care. Written by NDIA Chief Economist Dr David Cullen, it says over half of older Australians can expect to go into residential aged care.

1 May – a Criminal Code and Other Legislation Amendment Bill 2019 is passed in Queensland to expand the definition of murder to include “death…. caused by an act done, or omission made with reckless disregard to human life”, raising concerns providers charged with murder if a resident who left their facility was killed, for example, by being hit by a car.

2 May – the Federal Government announces $34 million for an Aged Care Centre for Growth and Translational Research recommended by the Aged Care Workforce Taskforce led by Professor John Pollaers in its June 2018 strategy report ‘A Matter of Care’ ahead of the Federal election.

3 May – the Commission holds its fourth community forum in West Melbourne, where Commissioner Briggs reveals the Commission has now received almost 3,700 public submissions.

3 May – before the Sydney hearings, the Commission releases two background papers on restrictive practices in residential aged care in Australia and dementia in Australia and its nature, prevalence and care.

6-8 May – the Sydney hearings begin with an inquiry into dementia care and residential care. Senior Counsel Assisting Peter Gray QC (pictured above) reveals that over 112,000 cases of substandard clinical care have been reported to the Commission so far by 981 providers – an average of 114 incidents per provider over the five years or 22 cases a year.

The hearings’ first case study focuses on the case of 72-year-old Terrence Reeves, who was subject to physical and chemical restraints while a resident at the Garden View aged care home in Merrylands in western Sydney. His story had been featured on the 7.30 Report program in January after his daughter contacted the ABC’s aged care investigation unit.

Two further case studies on anonymous female residents at Anglicare’s Brian King Gardens aged care facility and Columbia Aged Care’s Oberon Village draw attention to the issue of care for people with dementia.

Among the evidence, Counsel Assisting alleges that the resident manager at Brian King Gardens had been ‘gaming’ the ACFI system by providing the resident with unnecessary physiotherapy.

The Counsel also grilled the Executive Director of the new Aged Care Quality and Safety Commission and two witnesses from the Department of Health on whether the amended Principles on chemical and physical restraint would be effective and monitored carefully – with the suggestion being that they would not.

10 May – the Commission notches up 3,850 submissions and 2,122 phone calls to its dedicated 1800 phone line – an average of around 250 submissions a week since the March hearings.

10 May – the Counsel Assisting team expands from six to eight with the addition of Peter Rozen QC, Richard Knowles and Zoe Maud.

13-17 May – the Sydney hearings continue to explore dementia care and residential care.

The final case study in the second week looks at Mrs DE, a 70-year-old resident at Bupa Aged Care’s Willoughby facility in Sydney, and the palliative care she received. Counsel calls out Bupa for not putting forward witnesses at the facility who were still in their employment.

The Federal Government’s Chief Medical Officer, Professor Brendan Murphy, also gave evidence that just 10% of psychotropic medication was justified, while Monash University Professor Joseph Ibrahim argued there has been no action on the issue in 15 years.

23 May – Anglicare files further evidence with the Royal Commission denying Counsel Assisting’s claim of ACFI gaming, showing 0% of their ACFI claims had been downgraded since 2013.

24 May – the Australian Nursing & Midwifery Federation (ANMF) releases a 36-page report they commissioned the Tax Justice Network (TJN)’s Jason Ward to write, alleging six private operators – TriCare, Arcare, Aegis, McKenzie, Hall & Prior, and Thompson – are using complex corporate structures and strategies to minimise their tax.

The move comes one year after its first Tax Justice Network-commissioned report resulted in a Senate inquiry into the financial and tax practices of for-profit aged care providers.

28 May – Assistant Minister for Agriculture and Water Resources Senator Richard Colbeck is named Minister for Aged Care and Senior Australians in Scott Morrison’s new Ministry taking over from Ken Wyatt, who becomes Minister for Indigenous Affairs.

28 May – Estia announces it expects to spend another $1.4 million on the associated costs of the Royal Commission for the 2019 financial year – on top of the $914,000 it had spent up to 31 December 2018.

30 May – aged care advisors Ansell Strategic make a submission to the Royal Commission, claiming the Australian Nursing & Midwifery Federation (ANMF)’s research partner on their staffing mix model, Flinders University, had admitted there was “little evidence” to back the $5.3 billion model.

June

5 June – the Australian Nursing & Midwifery Federation (ANMF) issue a statement to clarify “misinformation” around aged care staff ratios that appears directed at the Ansell Strategic submission.

7 June – the Royal Commission marks 100 business days since its preliminary hearings. I flag that the Commissioners may be preparing to ask for an extension – and the Interim Report will not contain any recommendations.

COTA CEO Ian Yates says many in the sector are not talking to the Royal Commission – either because they don’t know what is coming up in the hearings or are being approached at short notice, leaving them little time to prepare.

8 June – public submissions to the Royal Commission hit 4,200 while phone calls top 2,200.

13 June – the Department of Health unveils its new $63 million beta website for MyAgedCare.

14 June – data from the Australian Institute of Health and Welfare (AIHW) shows the number of new admissions into aged care jump 42% in the past 10 years – but the number of new people moving permanently into residential care has only increased by 4%. Instead, home care has increased 130%, transition care 97% and respite care by 40%.

15 June – StewartBrown’s latest Aged Care Financial Performance Survey for the nine months to March 2019 reveals over 45% of aged care facilities are now operating at a loss, with 67% of regional, rural and remote providers in the red.

17-19 June – the Royal Commission heads to Broome for hearings on access and inclusion in aged care.

18 June – following the hearings, the Commission hosts its fifth community forum in Broome.

20 June – the Commission releases a background paper on ‘Advance care planning in Australia’.

25 June – the Royal Commission notches up over 4,500 public submissions.

24-28 June – the Perth hearings put the spotlight on person-centred care, advanced care planning and palliative care services with two case studies – the first on Noleen Hausler who placed a video camera in her late father Clarence Hausler’s room at Japara’s Mitcham aged care facility in September 2015 and the second on Shannon Ruddock and her father Vincent Paranthoiene who passed away in 2017 at Calvary Hospital in Kogarah, NSW, after being a resident at Alkira Gardens aged care facility in the Sutherland Shire.

Japara’s former Executive Director Julie Reed has a fiery encounter with Senior Counsel Assisting Peter Rozen QC over her handling of the alleged assaults and decision not to report the case to the Department of Health, while Japara’s CEO and Managing Director Andrew Sudholz denies the organisation has systemic issues around staff on resident assaults.

The former CEO of the SA-based Not For Profit ACH Dr Mike Rungie also tells the Commission there are no incentives to innovate in the Australian aged care system – which leads Commissioner Briggs to question why the sector is not championing reforms itself.

Dr Lisa Trigg (pictured above), the Assistant Director of Research for Data & Intelligence at Social Care Wales, also makes a convincing argument for how providers can some strategies to encourage “more of the good and deter more of the bad” – and singling out Mr Sudholz as an example of ‘what not to do’.

She points out too there is no information available in the public domain for Australians to identify good providers – which suggests the Commissioners could see a star ratings system as the solution.

July

1 July – 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; and the mandatory National Aged Care Quality Indicator program all come into force.

3 July – the Daily COMMISSION notches up its 100th edition.

5 July – additional statements from Japara staff provided to the Commission suggests Senior Counsel didn’t have full details on the Japara case study in Perth when they alleged the provider had not taken seriously the complaint of Noleen Hausler. They reveal there was no apparent thought that the incident was required to be reported within the 24 hours.

8-12 July – the Commission’s hearings on access to aged care and clinical care are held in Darwin, examining two case studies: Shirley Fowler, a resident of IRT’s William Beach Gardens home in the NSW Illawarra; and the late Annunziata Santoro, who lived at the Assisi aged care centre in Rosanna in Melbourne.

Counsel Assisting are particularly critical of Assisi for its “unwillingness to accept responsibility” and not putting forward two former facility managers as witnesses.

Assisi’s Chair Don Smarrelli OAM offers a “well and truly overdue” apology to Ms Santoro’s family, but can’t explain the deficiencies in her care.

Former journalist for the ABC, Channel 9 and Channel 10 Lisa Backhouse also delivers an impassioned argument for criminal and financial penalties for poor care by providers as well as mandated staff-to-resident ratios and video surveillance in residence rooms.

11 July – 70 residents are evacuated from two aged care facilities at the Earle Haven retirement village at Nerang on the Gold Coast (pictured above) when staff call 000. The media is flooded with images of staff from the facility manager HelpStreet ransacking equipment (It is eventually revealed that HelpStreet, was in dispute with owner, People Care, over unpaid bills and termination of its contract to run the facilities).

15-17 July – the Cairns hearing continues to look at access to aged care and clinical care with a third case study involving the case of the late Bertha Aalberts who resided at MiCare’s Avondrust Lodge in Carrum Downs, Victoria.

MiCare comes in for harsh assessment after its Residential Services Manager reveals its board had discussed not making a submission on its cases of substandard care to the Royal Commission – with Counsel suggesting Ms Aalberts’ case should have been included despite falling outside of the 30 June 2018 cut-off.

The second day of hearings sees the most media attention since the Royal Commission’s first hearing in Adelaide thanks to an appearance of celebrity chef Maggie Beer who speaks about her aged care foundation.

But it is the CEO and Founder of NewDirection Care and 2019 Telstra Australian Businesswoman of the Year Natasha Chadwick who makes a real impact, saying she finds quality assessors are now engaging in “punitive” behaviours because the Government and regulators has lost trust in providers.

18 July – the day after the hearings, the Commission heads to Townsville for its sixth community forum.

19 July – Queensland Premier Annastacia Palaszczuk announces nurse-to-resident ratios will be made mandatory for the state’s 16 public aged care facilities – and all private aged care homes will be asked to publicly report their staffing information under legislation put forward by the State Labor government as a push for “transparency” in the wake of Earle Haven.

22 July – South Australian Independent for Mayo Rebekha Sharkie again puts forward a Private Member’s Bill to mandate a requirement for aged care providers to publicly disclose their staffing ratios after introducing a similar bill in August last year – plus a new bill to require all aged care workers and volunteers to undergo screening and be registered on a national database (as of the end of the year, both Bills are still before the House of Representatives).

26 July – before the Mildura hearing, the Commission releases a background paper on ‘Carers of older Australians’.

30 July – LASA and accounting and advisory firm Grant Thornton announce a series of CEO workshops around Australia to develop a vision for the future of aged care in Australia to be submitted to the Royal Commission.

August

2 August – ahead of the regulation hearings, the Commission releases a background paper titled ‘Legislative framework for Aged Care Quality and Safety Regulation’.

2 August – the Royal Commission announces that the 11 July events at the Earle Haven Retirement Village will be a focus of the Brisbane hearings.

5-9 August – the Brisbane hearings inquire into the regulation of aged care.

Senior Counsel Assisting Peter Gray QC slams the fact no aged care providers had their accreditation revoked between 2014/17 as “surprising” given the “astonishing” number of cases of substandard care, abuse and neglect – noting the system seems directed towards managing providers back to compliance instead of managing ‘bad’ providers out.

The Earle Haven case study makes national headlines with People Care owner Arthur Miller revealing he didn’t warn the Department of Health of his decision to terminate the HelpStreet agreement for two days on advice from his lawyers, while founder and CEO of HelpStreet Global Kristofer Bunker admits that his lawyers emailed People Care the day before the closure demanding Arthur Miller pay $2.7 million to resolve the dispute – but denies the decision to leave the agreement was made the day before the 11 July closure.

Unsurprisingly, Counsel Assisting interrogates the Aged Care Quality and Safety Commission (ACQSC, formerly the Quality Agency) and the Department of Health over its failure to pick up “red flags” and manage People Care out of the industry, given its 12-year history of non-compliance and sanctions and “high” rates of chemical and physical restraint at the facility in the lead up to the closure.

The MiCare case study on Mrs Bertha Aalberts at Avondrust Lodge also returns with Senior Counsel critical of the response of the ACQSC and the Department who concede the facility was only sanctioned over Ms Aalberts’ care because of a complaint by her daughter.

In response, the Department’s Director of the Compliance Centre East Elsy Brammesan PSM agrees sanctions that would affect directors or others involved in the management of approved providers would be “amazing” and take the measures that the Department can impose on providers to “the next step”.

Japara also receives another mention with the Commission looking at the response of the regulator to the mandatory reporting of 20 suspected or alleged cases of physical and sexual abuse at three Japara facilities that were not referred on by the Department for further action – with the suggestion being that the regulator should have investigated incidents more closely.

However, it was two other witnesses who grab the spotlight.

Poet and creative writing professor Sarah Holland-Batt (pictured above) criticises the Aged Care Complaints Commission (ACCC)’s handling of a 2017 complaint she lodged over the abuse of her 82-year-old father in an aged care facility and the ACCC’s lack of ‘teeth’ in calling providers to account.

Professor Ron Paterson ONZM – who co-authored the independent Review of National Aged Care Quality Regulatory Processes into Oakden with Kate Carnell published in October 2017 – also warns the current regulatory system of managing providers back to compliance holds ”grave dangers” and says the regulator should scrap the idea of a conditional revocation for providers.

12 August – the Commission stages its latest community forum so far in Adelaide, the only forum to be led by Commissioner Richard Tracey. The Commissioner pledges better qualifications, training, pay and career path for staff to loud applause (sadly this would end up being the last time the Commissioner appeared at a public event for the Royal Commission).

19 August – the Royal Commission goes north for its eighth community forum in BrisbaneCommissioner Lynelle Briggs confirms finances will not be examined by the Royal Commission until 2020 and the Interim Report will not contain any formal recommendations.

20 August – the following day, the Commission holds a smaller community forum in Rockhampton where Commissioner Lynelle Briggs promises the Final Report will recommend great changes to the aged care system 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 tells the crowd of 80 locals.

20 August – the Royal Commission announces the Hobart hearings will examine the operations of “selected” aged care providers – suggesting providers themselves will be under the microscope for the first time.

22 August – the Queensland Parliament moves a motion to push out the reporting date for its separate inquiry into the aged care system, end-of-life and palliative careand voluntary assisted dying for four months – from 30 November 2019 to 31 March 2020.

23 August – the new independent NSW Ageing and Disability Commissioner Robert Fitzgerald AM warns retirement village operators they must stamp out elder abuse in villages as it looks to crack down on abuse in people’s homes.

23 August – the Victorian Labor Government announces it will undertake a food audit of meals served in state-run hospitals and aged care facilities, fulfilling its pre-election commitment to raise the standard of meals.

24 August – the Federal Government says 90% of banking Royal Commission’s 54 Government recommendations will be introduced by mid-2020 – just one year away – after it is accused of dragging its feet on reforms.

28 August – the Earle Haven Retirement Village lodges plans to build eight new independent living units – just seven weeks since the 11 July shutdown of its two aged care facilities.

29 August – the Minister for Aged Care Senator Richard Colbeck gives the opening address at the Health Metrics 2019 World Conference in Melbourne, pointing to the need to collect and analyse data, the importance of culture and the need for innovation.

The Minister adds it is important that the sector not emerge from the Royal Commission with a negative perception.

“We need to make very brave political decisions and make them early in the process,” he concludes.

29 August – I reveal HelpStreet is still advertising for allied health staff in Australia and UK despite its Global CEO Kristofer Bunker’s evidence to the Royal Commission that his demand for $3 million from People Care was driven by concern that HelpStreet was in danger of going into administration (HelpStreet’s local branch finally goes into administration seven weeks after the events of 11 July).

30 August – the Department of Health lodges its opposition to the Queensland Government’s plan to introduce mandatory nurse-to-resident ratios for its 16 state-run aged care facilities, saying the Bill “appears to create a reporting burden on providers, with no clear benefits to consumers, and no relationship to regulatory functions”.

September

3 September – aged care advisory firm Ansell Strategic predicts the Federal Government will provide a short-term funding boost to the sector after the Commissioners hand in their Final Report in April 2020 (this deadline later changes to November 2020), but warns more needs to be done to avoid costs exceeding funding in the long-term.

The firm cites the fact none of the three major listed providers – Regis, Estia and Japara – would have reached guidance without the one-off subsidy of $320 million for providers between 20 March 2019 and 30 June 2019. The same report also shows only 2% of providers are planning to redevelop their homes, raising concerns about long-term planning for new facilities.

3 September – Bupa acknowledges the lower occupancy and higher costs from the fallout from the Royal Commission have hit hard with its underlying profit dropping 45% in total in Australia and New Zealand in 2019. My analysis shows our market still makes up 37% of their revenue however – making it unlikely they would exit the sector.

4 September – the Queensland Government introduces its Health Transparency Bill – with mandated staff ratios for public aged care facilities – to Parliament.

9-11 September and 13 September – Melbourne holds its first round of hearings, looking at younger people in residential care.

Led by a solo Commissioner Lynelle Briggs, both Senior Counsel Assisting Peter Rozen QC (pictured above) and the Commissioner blast the Government for failing to provide alternative options for the 6,000 younger people living in residential and accept responsibility for their inaction.

Commissioner Briggs famously labels the current system for younger people a “national disgrace” – a line that is picked up by media nationally.

The Department of Health rejects this assessment – but the Department of Social Services puts a bill to move the 6,000 people out at $700 million-$800 million to up to $1 billion a year. The Counsel Assisting concluded the hearings by calling for all people under 65 and residential care to be removed by 2025.

11 and 12 September – the Queensland aged care, end-of-life and palliative care inquiry holds two days of hearings into the events of Earle Haven (their final report, tabled on 28 November, concludes the events “should never have happened” and blames the Federal Government for giving People Care “a string of second chances”). Appearing at a later hearing, People Care owner Arthur Miller says he will no longer run aged care facilities.

13 September – the Royal Commission is extended by six months with its Final Report now due on 12 November 2020 (the deadline for the Interim Report remains unchanged).

Aged Care Minister Richard Colbeck also announces the appointment of a third Commissioner, the Hon Gaetano (Tony) Pagone QC, a retired Federal Court Judge with a passion for social justice and advocacy.

13 September – the Royal Commission notches up its 50th sitting day since the preliminary hearing in January.

I estimate the current costs of the Royal Commission for the sector to be around $60 million based on its 200,000 beds and the cost of staff resources and legal fees – and suggest the real winner for the spending is the Government because the resulting 2% drop in occupancy equates to 3,600 beds or $328.5 million that the Government doesn’t need to pay – more than the cost of the Royal Commission.

16 September – accounting and advisory firm Grant Thornton makes a submission to the Royal Commission based on its August workshops with providers, saying providers want a “radical redesign” of the aged care system, but without a concrete plan to implement its ideas.

16 September – the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability holds its first public hearing with plans to run for three years of hearings and community forums.

17 September – Prime Minister Scott Morrison says the Government wants to ensure the results of the Royal Commission are fully implemented – but dodges a question on regulatory failure from Labor – during a tense Question Time.

During the same session, Health Minister Greg Hunt states that there has been a 7% reduction in the home care waiting list in three months and increasing home care packages is one of the government’s “biggest priorities”.

24 September – the Commonwealth makes a submission to the Royal Commission in response to the Earle Haven case study, conceding that powers to sanction board directors and CEOs for non-compliance “could be beneficial”.

However, a further submission from the Government on the regulation of aged care defends the timeframe for its reform agenda – and suggests sector ‘fatigue’ is in part to blame for the slow pace of change.

24 September – both Houses of Parliament pass the Aged Care Amendment (Movement of Provisionally Allocated Places) Bill 2019 to allow approved providers to move provisionally allocated places from one region to another within the state or territory – providing more flexibility for providers and where they build new beds.

25 September – StewartBrown’s Grant Corderoy makes the point that the listed providers – Estia, Regis and Japara – are only allowing for refurbishments every 20 to 30 years when he argues facilities need refurbishment every 8 to 12 years, raising questions about whether they should be saving more cash for future refurbishments.

28 September – the latest home care data package report reveals the number of home care providers continues to grow to 929 as of 30 June 2019 – a rate of one new provider a week since 31 March 2019.

30 September – the Australian Medical Association (AMA) and the Australian Nursing & Midwifery Federation (ANMF) launch a joint campaign in Canberra to push for action on aged care reforms including 24/7 RN coverage and minimum staff-to-resident ratios before the Royal Commission’s Final Report in November 2020.

October

2 October – aged care management specialist Pride Living makes a submission to the Royal Commission, noting the return on equity in aged care dropped 42% between 2014 and 2018 and arguing the regulations on accommodation must change to encourage new investment in the sector.

3 October – the Commission visits Tasmania for the first time for its 10th community forum in Launceston, with Commissioner Lynelle Briggs revealing the Royal Commission’s Interim Report is ‘done and dusted’ – but without recommendations and only covering up until the Cairns hearings on quality of life in mid-July.

5 October – the Royal Commission extends the deadline for public submissions to 30 April 2020.

7 October – the ABC’s Q&A program takes on aged care, asking the question: is our aged care system fit for purpose?

Featuring the Minister for Aged Care, Sen Richard Colbeck, Leading Age Services Australia (LASA) CEO Sean Rooney, celebrity chef Maggie Beer, Royal Commission witness Sarah Holland-Batt, and Shadow Minister for Ageing, Julie Collins, the panel sees Mr Rooney defend the sector whilst the Minister states “to his mind 30 to 60 days should be the maximum period of waiting” for home care.

7 October – the Royal Commission joins Twitter.

7-11 October – the second round of Melbourne hearings focus on diversity in aged care, including culturally and linguistically diverse people, LGBTI groups, Aboriginal and/or Torres Straits Islander people, care leavers, veterans, and the homeless or those at risk of homelessness.

New Commissioner Tony Pagone joins the proceedings from the Tuesday as Senior Counsel argues that people with diverse needs are being left at risk of isolation and neglect by the current aged care system.

The evidence shows the Department of Health doesn’t ensure providers are developing aged care beds for residents from diverse groups and took a year to start work on fixing the issues around information sharing identified in the 2017 Tune Review, prompting Commissioner Lynelle Briggs to call out the regulator.

11 October – the Royal Commission begins publishing public submissions for the first time.

11 October – the Royal Commission pre-empts the workforce hearings in Melbourne by releasing its first research paper ‘How Australian Residential Aged Care Staffing Levels Compare with International and National Benchmarks’.

Prepared by a team from the Australian Health Services Research Institute (AHSRI) at the University of Wollongong, led by Professor Kathy Eagar, the comparison finds over 50% of Australia’s 180,000 aged care residents are in homes with staffing levels that would be rated 1 to 2 stars (unacceptable levels of staffing) under the United States five star rating system.

14 October – the Royal Commission announces the passing of Commissioner Richard Tracey AM RFD QC aged 71 while receiving treatment for cancer in California.

14-19 October – the Commission holds its third round of Melbourne hearings, exploring the aged care workforce.

The evidence includes case studies on Menarock Aged Care’s Greenway Gardens facility – which was sanctioned for not meeting outcomes including staffing – and Japara and its handling of the case of a worker at its Bayview facility who was a subject of multiple allegations of mistreatment in 2015-16.

It was Commissioner Lynelle Briggs’ question to a panel of aged care provider CEOs around the recommendations to come out of the Royal Commission however that were the most telling.

She asked whether the sector has “energy and excitement” to make the Royal Commission reforms happen as the panel pointed to the need to increase the leadership capacity of the sector.

The hearings close with Senior Counsel Assisting Peter Rozen QC facing off against the Department of Health over why the Government didn’t provide a formal response to John Pollaers’ Aged Care Taskforce Workforce report and calling for the Government to step up and take proper “accountability” for reforms.

19 October – the former Chair of the Aged Care Workforce Strategy Taskforce Prof John Pollaers OAM (pictured above) calls for the Royal Commission to re-evaluate the staffing model put forward by the University of Wollongong in its independent research for the Commission, describing it as “outdated” and undervaluing PCWs and allied health.

Evidence submitted to the Royal Commission by the Commonwealth also shows then-Aged Care Minister Ken Wyatt had believed the 14 strategic actions of the Aged Care Workforce Strategy Taskforce – handed to the Government in July 2018 – could be advanced quickly (they have not).

23 October – the Chair of the Aged Care Financing Authority (ACFA) (and the former adviser to Treasurer Peter Costello) Mike Callaghan AM PSM tells a Senate Estimates meeting the sector may not be financially sustainable with a “sizable proportion” of providers making a loss and some smaller providers exiting the sector.

However, Department of Health witnesses at the same hearing label the viability of providers an “issue for management” and reveal the Department doesn’t collect data on the number of providers who have contacted them with concerns about their finances.

And Aged Care Minister Senator Richard Colbeck says he has seen little of the evidence presented to the Royal Commission’s formal hearings since being appointed to the role in late May – almost five months ago.

28 October – ahead of the Interim Report, the Commission releases its background paper ‘A History of the Aged Care Reviews’, which examines 18 major aged care reviews and enquiries completed since 1997 and the Government’s response to each.

It concludes consecutive Australian Governments have categorically failed to take up reforms and recommendations aimed at delivering safety and quality of care.

29 October – the Royal Commission marks 200 business days since the preliminary January hearing.

30 October – private operators Allity and The Astoria Group announce they are closing two aged care homes in the NSW Central Coast – traditionally considered a retirement and aged care heartland – with the Royal Commission, the new Quality Standards and the challenges of redeveloping ageing stock appearing to be the cause.

31 October – the Royal Commission calls for written submissions on ‘new thinking’ on how to solve the sector’s workforce issues with a deadline of 6 December.

31 October – the Royal Commission into Aged Care Quality and Safety’s Interim Report is released.

Titled ‘Neglect’, the Commissioners conclude aged care in Australia “is a sad and shocking system that diminishes Australia as a nation”, noting the responses from providers to the Commission’s request for information about cases of substandard care resulted in 275,000 instances over the five years to June 2018 being reported.

They conclude the system needs a fundamental redesign – not just ‘patching up’.

“In due course, we will recommend comprehensive reform and major transformation of the aged care system in Australia. We will chart a new direction for the sector, bringing a clear sense of purpose and of quality, and a renewed focus on compassion and kindness.”

In the Report, the Commissioners flag three areas of immediate action by the Government: more home care packages; reducing chemical restraint in aged care; and younger people in residential care.

November

4-6 November – the Mudgee hearings examine the provision of aged care in regional areas.

11-15 November – the Royal Commission has hearings in Hobart, shining a spotlight on two aged care providers: Tasmania’s largest not-for-profit Southern Cross Care (Tas), and Bupa, which has just one facility in the state and their governance arrangements.

While Senior Counsel Assisting Peter Rozen QC say the hearings are not aiming to look for “root causes” of aged care failures, SCC (Tas)’s CEO Richard Sadek does not come out well after admitting the provider has still not established a clinical governance committee – one year after sanctions against its Yaraandoo facility (he steps down from his role shortly after the hearings conclude).

Bupa also comes in for a tough time, with Senior Counsel pointing to “apparent failures of governance” that resulted in nursing staff being cut from the facility despite a history of difficulties in sourcing staff and clinical care issues dating back to at least 2014.

Bupa’s managing director Carolyn Cooper admits the board of its Australian aged care business was only made up of executive management until August this year and its governance structures failed to support residents and families, leading Senior Counsel to push for aged care boards to have a formal duty to ensure their organisations provide safe and quality care.

Commissioner Lynelle Briggs also questions whether the industry is being proactive to improve its governance – and asks if internal and third-party audits are needed to ‘health check’ providers.

18 November – LASA identifies 197 aged care providers are on the brink of financial collapse and calls on the Government for a $1.3 billion injection of funds by Christmas to give providers a short-term fix.

19 November – executives warn of poor mental health, providers overwhelmed by the recent number of regulatory changes and experienced managers leaving the sector in the wake of the Royal commission with some feeling like their life’s work “has been for nothing’.

I predict an exodus of experienced CEOs from the 800 residential operators in the sector – up to 60% – within three to five years.

20 November – the Daily COMMISSION reaches its 200th issue.

25 November – the Federal Government announces a $537 million package to respond to the three key issues pinpointed by the Commissioners in the Interim Report including another 10,000 home care packages, funding to improve medication management programs and reduce the use of chemical restraint; dementia training; and funds to help meet new targets to remove younger people with disabilities from residential aged care – the equivalent of providing six dollars a day to aged care residents.

25 November – the Royal Commission holds its 11th community forum in Canberra.

Commissioner Lynelle Briggs says she is “pretty happy” with the $537 million announced by the Prime Minister and flags star ratings and the role of boards will feature in the Final Report.

27 November – Minister for Aged Care Senator Richard Colbeck (pictured above) tells the Senate the Government will not rapidly roll out more home care packages because of the risk of “shonky players” entering the system highlighted in the Interim Report.

“It talks about concerns about significant growth of home care packages and creating a circumstance like the Labor Party created when they put the pink batts program into place – there was so much capacity put into the market that it brought in shonky players and ended up leading to four deaths,” he says.

27 November – the Royal Commission hosts its 12th community forum in Newcastle.

Commissioner Lynelle Briggs tells the audience the aged care system can be redesigned within 3 to 5 years – and CEOs and directors need to get on board.

“We intend quite significant changes and without the support of the leaders of organisations they won’t go very far. Everyone has to come together and say we need to fix it.”

27 November – the 2018-19 Report on the Operation of the Aged Care Act 1997 reveals the number of home care providers has overtaken the number of residential care providers for the first time – 928 home care operators compared to 873 residential providers.

The residential aged care occupancy rate also drops below 90% to 89.4% for the first time – leaving a massive 22,260 beds empty as of 30 June 2019.

December

3 December – advisory and online software provider Mirus tells me that the Government’s residential occupancy figures may not be accurate – because the Government relies on Medicare reports which are the number of licenses allocated to a facility and the number of residents, but many providers have beds offline for refurbishment or are running a smaller facility to reduce costs so the numbers don’t always match up.

Aged care providers also turn to sales staff for the first time with ads for sales managers to address declining occupancy and profitability.

6 December – the Commissioners (pictured above) release their first consultation paper on the redesign of the aged care system, putting forward a new aged care model that separates care from accommodation and calling for submissions on whether it is a viable solution.

7 December – the aged care peak bodies and major providers make a last-ditch attempt to force the Government’s hand on funding before Christmas, calling on the Government to boost funding into the sector in the Mid-Year Economic and Fiscal Outlook (MYEFO) or face up to 50,000 beds in strife in 2020.

Other providers ask if these funds should be directed towards a 15% increase in staff wages to stem the flow of workers from the sector.

9-13 December – the Commission holds its final hearings for the year in Canberra looking at the interface between aged care and health care, with Counsel Assisting pointing to aged care providers holding responsibility for securing healthcare services for residents.

Department of Health Secretary Glenys Beauchamp returns to the witness box and butts heads with Senior Counsel Assisting Peter Gray QC on a range of topics – including the accuracy of the Government’s own data and its failure to identify how many aged care residents are in need of GP services.

A panel of geriatric medical experts also tells the Commission that Australia is five to 10 years behind other countries on collecting data in residential care and will need to make a serious investment to meet the same standards of clinical information required to improve quality of care.

The hearings wrap up with Senior Counsel pressing for the Commonwealth, States and Territories and providers to work together to fix these failings and Commissioner Lynelle Briggs raising the idea of an additional commitment in the National Health Reform Agreement to set down providers’ responsibilities for health services in aged care facilities.

16 December – the Government ignores the sector’s pleas for emergency funding, providing just $87.3 million in ‘new’ funding in the Mid Year Economic and Fiscal Outlook (MYEFO) to respond to the Royal Commission’s Interim Report – including $13.6 million to help its own Department of Health meet the costs of the Royal Commission.

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