With the recent announcement of a Royal Commission into Aged Care, debate is raging in the aged care sector and beyond as to whether it is really needed.
On one side of the argument is the view that we have had numerous reviews and inquiries over the past two or three years and so we already know what the problems are and have recommended solutions. Some believe if we spent the money that the Royal Commission will cost implementing these recommendations, we would go a long way to solving the problems. There is also the concern that existing recommendations and reforms will be stalled. For example, the recent Aged Care Workforce Taskforce has done a great job in identifying the workforce issues that the sector is facing and recommending practical strategies. These should be implemented.
On the other side of the argument, the view is that we still don’t know the extent of problems in aged care. There are clearly inadequacies in care, well documented by programs such as Four Corners on 17 and 24 September, but we don’t know how widespread these problems are.
There is also the question as to whether for profit businesses should be in the aged care sector at all. Is the profit motive consistent with excellence in care, given staffing is the greatest cost in aged care and generally good staff (motivated, well trained and adequately resourced staff) equal good care. Is there adequate transparency in how the considerable government investment in this sector is spent?
It is important that policy and practice are based on good evidence and, in my view, there are areas where the Royal Commission can improve our evidence base. The acts and failures to act portrayed in the Four Corners reports constitute elder abuse. Elder abuse is defined as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (WHO, 2018). Failure to adequately attend to an older person, to provide food and drink, to attend to their continence needs or over medication by aged care providers are forms of abuse according to this definition. Surely residential care staff and providers are in a relationship of trust.
Most international studies of elder abuse have failed to include abuse that occurs in care homes so we have little understanding of the prevalence of these types of abuse or the factors associated with it.
The Royal Commission provides the opportunity to better understand this and to identify the factors associated with it. Is it (as the Four Corners program suggests) due to inadequate staffing levels, or lack of staff training? Is it due to cultural or expectation mismatch between staff and residents or lack of support, recognition and adequate pay for staff working in this sector? Are the problems more systemic, due to inadequate government funding or funding being directed into profit rather than care?
These and many other questions can be addressed by the Royal Commission. Hopefully the Royal Commission will extend its terms of reference to home care as well. Home care workers often work independently, without much day to day support or oversight so it is even more difficult to know whether abuse is occurring and if so, why it is the case.
A further question that I would like to see included is the question of quality of life. When I visit care homes I rarely see the types of neglect reported by the ABC. However, I do see older people sitting passively, asleep or bent over in front of the television. They may have been showered, dressed, provided with a full and nutritious diet but they are bored, lonely and possibly depressed. There are some great models of care (both in Australia and internationally) that promote participation and quality of life in aged care. Hopefully the Royal Commission will help to lift the sector to this standard.
Last week I conducted my own vox pop. On Friday, I was at a Roundtable on Aged Care mainly attended by aged care providers, union representatives and advocacy groups. There did not seem to be much appetite for a Royal Commission when the question was raised. On Sunday, I was at a 95th birthday party with about 20 people aged between 80 and 96 years. This group, perhaps with the possibility of entering residential care on the horizon, were very keen to see a Royal Commission into Aged Care.
On balance, I’d go with the older people.
Associate Professor Briony Dow is the Director of the National Ageing Research Institute. She oversees a range of both social and clinical gerontology research programs, including her own research into elder abuse and carer mental health.