All care: Royal Commission looks to aged care overhaul

In its Final Report, "Care Dignity and Respect" the Royal Commission into Aged Care Quality and Safety has highlighted current systemic issues and offered 148 recommendations intended to overhaul the operation of the aged care sector in Australia. The recommendations are intended to place older Australians at the centre of the aged care system, to address a systemic problem of ageism identified by the Royal Commission, and to replace this with culture of respect for older people.

Following detailed investigation including harrowing accounts of failures of care, the Commissioners are agreed on the need for new legislation to replace the Aged Care Act 1997, to enshrine principles of health, safety and wellbeing of older Australians. This is to be based on an entitlement for older Australians to high-quality, individual care and support whether they are seeking aged care, or receiving it, with support also extended to those providing informal care for older people in the community.

While agreed on the need for better governance going forward, the Commissioners have highlighted the complexity of the issues they have considered by making substantially differing recommendations for the future governance and regulatory structure for aged care.

Commissioner Pagone favours governance for aged care that is independent of government. He has recommended the establishment of the Australian Aged Care Commission, which is to have responsibility for administration of aged care funding and regulation. This model would see the appointment of commissioned officers with defined responsibilities for quality of care, safety standards and pricing. In practice, implementation of these recommendations may result in a structure similar to the Australian Securities Investment Commission or Australian Competition and Consumer Commission.

Acknowledging that the considerable shift in aged care service delivery will require significant investment of taxpayer funds and that this should have Ministerial oversight, Commissioner Briggs supports a Government Leadership model. This model would see a Cabinet Minister and the Commonwealth Department of Health and Aged Care retain responsibility for the stewardship of the aged care system, with a changed policy mandate and priorities.

While these differing recommendations result in a choice for Government about the eventual structure to be implemented, the Commissioners are united in:

• their call for reforms that will improve quality of services and further strengthen the regulation and scrutiny given to aged care service provision;
• their view regarding the need for workforce changes, including changes to staffing numbers and minimum qualifications for staff providing aged care services;
• calling for better integration of the Aged Care system with the health, housing and community sectors;
• urging Government to take more of an active role in system governance, rather than leaving improvements in outcomes to the market; and
• their acknowledgment that the necessary changes will result in increased cost (although disagreeing on how that increased cost should be funded).

In coming editions of Insights we'll be featuring articles discussing specific issues covered by the Final Report and how implementation of the Royal Commission's recommendations designed to improve the quality of care provided to older Australians will translate in the sector in terms of its operations, regulation and funding.