industry & reform
The federal secretary of the union , Annie Butler , said : “ The Morrison Government must now act ; every day the Government delays taking action to address dangerous understaffing in nursing homes and community care is another sad day that vulnerable residents will continue to suffer .”
Aged care provider HammondCare , which assisted the royal commission through submissions , appearances and roundtables , said frontline aged care workers deserve to be paid on par with health and disability workers .
HammondCare chief executive Mike Baird added that the aged care sector as a whole must become more responsive to the consumer .
“ We also support a star-rating system to shine a light on providers and help guide consumers as they decide on the appropriate level of care and services .”
FOUR CONCERNS FOR IMMEDIATE ATTENTION In their report , Briggs and Pagone singled out four concerns for immediate attention : food and nutrition , dementia care , the use of restrictive practices , and palliative care .
Food and nutrition : The commissioners noted that many witnesses gave evidence about the inadequacy of the quality and quantity of food in residential care .
They pointed to a representative study of 60 Australian residential aged care services conducted in 2017 that concluded more than two thirds ( 68 per cent ) of residents were malnourished or at risk of malnutrition .
“ The current Aged Care Quality Standard for meals stipulates that ‘ where meals are provided , they are varied and of suitable quantity and quality ’. This leaves much to the discretion of the provider and is not easily enforceable . How ‘ varied ’ do meals have to be ? What does ‘ suitable ’ mean ?”
Briggs and Pagone said a critical first step would be to improve nutrition using funds gained through the elsewhere recommended immediate conditional increase in the Basic Daily Fee of $ 10 per resident per day .
Dietitians Australia said : “ With a quarter of online submissions to the Commission referring to nutrition and malnourishment , we ’ re pleased to see food and nutrition , and support from a dietitian , given the priority it deserves .”
Dementia care : When it came to the second of the four areas for urgent action , dementia care , the commissioners offered this :
“ Our inquiry has revealed that the quality of aged care that people living with dementia receive is , at times , abysmal .”
They said the commission heard time and time again that staff members do not have the time or the skills to deliver the care that is needed .
“ All mainstream aged care services should have the capacity to deliver high quality aged care for most people living with dementia – dementia care should be core business ,” the report read . “ This includes having the right number and mix of staff who are trained in dementia care , having the right physical environment ( in residential care ), and having the right model of care .
“ We recommend mandatory dementia training in residential aged care and in care at home .”
The final report also recommended the establishment of a comprehensive and accessible post-diagnosis support pathway for people living with dementia and their carers and families .
Dementia Australia chief executive Maree McCabe said within the 148 recommendations were 14 key areas with a specific focus on dementia , including an assessment of the impact of dementia-specialist support and a review of aged care standards as they relate to quality dementia care .
McCabe echoed the words of people with the lived experience of dementia in saying , “ if you get dementia care right you get it right for everyone ”.
Restrictive practices : The final report called the overuse of restrictive practices in aged care a “ major quality and safety issue ”.
“ Urgent reforms are necessary to protect older people from unnecessary , and potentially harmful , physical and chemical restraints ,” it read . “ A strong and effective regulatory framework to control the use of restrictive practices should be implemented as a matter of priority .”
It recommended that the government amend the Quality of Care Principles 2014 ( Cth ) to provide that the use of restrictive practices in aged care must be based on an assessment by an independent expert .
“ It should be subject to ongoing monitoring and reporting , with a behaviour
“ We have made changes to raise standards and we are continuing to do so . We are committed to doing better .
support plan lodged with the Quality Regulator ,” the report read .
At a press conference on the release of the final report , Minister for Senior Australians and Aged Care Services Richard Colbeck said the government will further establish clear new obligations and guidelines around the use of restraint to protect older Australians receiving care .
“ A Senior Restraint Practitioner will be appointed to the Commission to lead an education campaign for the sector and general practitioners , to minimise the use of restraint , and bring practice into line with those in the disability sector .”
Palliative care : The commissioners said a number of their recommendations will contribute to ensuring high quality palliative care becomes “ core business ” for aged care services .
“ These include a right to fair , equitable and non-discriminatory access to palliative and end-of-life care , improved access to specialist palliative care services and requirements for regular staff training . Urgent consideration should also be given to how palliative care is reflected in the Aged Care Quality Standards .”
Palliative Care Australia chair Professor Meera Agar said : “ Over a third of Australians will die in residential aged care , yet up until now , palliative care has never been considered core business in aged care .
“... we now have a very strong case to convince governments that we need to improve palliative care in aged care .”
NO EXCUSES In his preface to the report , commissioner chair Pagone quoted Uncle Brian Campbell , who said :
“ I ’ ve sat with Royal Commissions into deaths in custody . I ’ ve sat with the Bringing Them Home hearing ; right ? And out of all of them hardly anything gets done , and is this one going to be the same ?”
Pagone said the chairs ’ disagreement about the best way for improvement to be achieved is not a justification for doing nothing . ■
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