There is no slowing down of news for the industry as we head towards the close of 2019. October saw more Royal Commission news top the headlines, with the very sad passing of Commission Richard, the appointment of a new Commissioner, more hearings and the release of the anticipated Interim report. The Royal Commission saw Doctors, nurses, pharmacists and peak bodies to name only a few, once again call for urgent reform to be actioned now. Staffing ratios and the workforce featured very prominently in Octobers news; as did the issue of chemical and physical restraint, and of course, new tech updates. With no signs of slowing down for the year, let’s dive into the month that was.
ROYAL COMMISSION INTERIM REPORT RELEASED
Some of the biggest news for October, and much anticipated, was the release of the Royal Commission’s interim report. The interim report, titled ‘Aged Care in Australia: A Shocking Tale of Neglect’, was released to the public on the 31st October. Released in 3 volumes and with a 10 page forward, the report states to cover a great deal of the work completed by Commissioners Lynelle Briggs AO and Richard Tracey AM, RFD, QC up to September 2019 over nearly 800 pages. The reports also intends to set out what has been learned so far, what initial conclusions can be drawn from the past 10 months of the Royal Commission, and ‘outlines key areas’ that the Commission intends to tackle over the remaining 12 months of the inquiry.
Three areas were identified in the Report as requiring immediate and urgent action: Increased home care packages to tackle the current waiting list; changes to how chemical restraints are used; and removing younger people living with disabilities from an Aged Care setting.
The findings of the Report has been declared as a shock to the Minister for Aged Care, Richard Colbeck; whilst Peak Bodies have welcomed the report as an urgent signal that action needs to be taken immediately. You can read Aged & Community Services Australia’s (ACSA) response to the report here, and Leading Age Services Australia’s (LASA) response here.
In November, the Government responded to the report, announcing more than $500M in additional funding.
ROYAL COMMISSION UPDATE
Prior to the release of the Royal Commission’s Interim Report, October was a big month for the inquiry. As we reported in our previous Industry Update, Commissioner The Honourable Richard Tracey AM RFD QC sadly passed away after a short illness on 11 October. Commissioner Tracey worked on the Interim Report, finalising it alongside Commission Briggs, up until his sudden death.
In September, we saw the extension of the Royal Commission for an additional 6 months until November 2020, and in October came an extension to Public Submissions, which will now be accepted until April 2020. Submissions are now also available to view on the Royal Commission’s website here.
Two more papers were released in October; Research Paper 1 titled ‘How Australian residential aged care staffing levels compare with international and national benchmarks’, which we will dive into later in our reporting on Aged Care staffing and the workforce; and Background Paper 8, ‘A History of Aged Care Reviews’ released two days in advance of the interim report, giving an indication of what was to come.
Melbourne Hearings 2 & 3 were held in October, covering Diversity in Aged Care and the Aged Care workforce. Diversity in Aged Care was the focus of Hearing 2, with the Commission being told that if the system is designed to treat all care recipients the same way, then the risk of isolation and neglect for those with diverse needs is vast. The Commission heard witness statements from people with culturally and linguistically diverse (CALD) backgrounds; people who identify as lesbian, gay, bisexual transgender intersex (LGBTI); people who have previously experienced institutionalised care as a child, or out of home care arrangements; Aboriginal and/or Torres Strait Islander people; people who are homeless or at risk of becoming homeless; and veterans. The health department acknowledged that although Providers may be allocated special resources for special needs groups, there is currently no monitoring system in place that ensures that funding and resources are used to support these groups. Senior health department official Jaye Smith committed to have a follow up process in place for the next Aged Care Approvals Round (ACAR).
Hearing 3 focused on the Aged Care workforce, and began with Professor John Pollaers OAM, Chair of the Aged Care Workforce Strategy Taskforce. Professor Pollaers expressed concern that no response had been received about the recommendations in his report to improve the current issues facing the Aged Care workforce. This sentiment was reflected in Background Paper 8, ‘A History of Aged Care Reviews’, that finds that Australian Governments have not committed to exploring or actioning many of the recommendations from multiple public reports and inquiries into Aged Care for the past 22 years.
November has seen the hearing in Mudgee, focusing on the provision of Aged Care in regional areas; and the Hobart hearing focusing on the operations of selected Approved Providers. You can keep up to date with the hearing dates and topics here.
With a great deal of media reports surrounding the Royal Commission, the Aged Care Guide, Australian Ageing Agenda and The Weekly Source are excellent sources of information. You can also access live and past hearings via the Royal Commission webcast channel here.
DOCTORS & NURSES UNITE
October saw two medical Peak Bodies representing Doctors and Nurses, the Australian Medical Association (AMA) and the Australian Nursing and Midwifery Federation (ANMF) uniting to demand ‘urgent responses to what they describe as a crisis in aged care’. Both groups have asked for mandatory minimum staff-to-Resident ratios, investment and focus on Home Care, and Medicare rebates for GPs working in Aged Care, and for action to be taken immediately – not waiting until the Royal Commission is complete. The Aged Care Peak Bodies have welcomed the call for the reforms and urgency to act now from the medical Peaks, although do not agree that mandated staffing ratios are the best way to ensure adequately skilled workers are present in Aged Care Facilities. The ANMF have been campaigning for Staffing Ratios for Aged Care since early 2018.
You can read the original joint media release with the list of the urgent actions the AMA and ANMF have declared need to be addressed here.
NEW STANDARDS FOR DOCTORS IN RESIDENTIAL CARE
The Royal Australian College of General Practitioners (RACGP) have developed a draft set of voluntary standards, designed to support GPs when caring for Residents in care. The standards, titled ‘Standards for General Practice Residential Aged Care’ (Standards for GPRAC), intend to provide essential minimum requirements to support GPs when delivering care to Aged Care Residents, that may not be covered by the Aged Care Quality Standards. Although not seeking to replace the Aged Care Quality Standards, the voluntary standards are designed to ‘specifically address the barriers that limit the capacity of GPs to provide the best possible standard of care’.
The draft standards opened for feedback period of approximately 4 weeks.
To legal news this month, and a new amendment was introduced and read for the first time in October. The following Acts; Aged Care (Accommodation Payment Security) Act 2006, Aged Care (Accommodation Payment Security) Levy Act 2006, Aged Care Act 1997, were amended by the Aged Care Legislation Amendment (New Commissioner Functions) Bill 2019. The amendment transfers particular Aged Care regulatory functions and powers from the Secretary of the Department of Health to the Aged Care Quality and Safety Commissioner. The functions relate to the approval, monitoring and enforcement of regulatory compliance.
In October, the Australian Lawyers Alliance (ALA) released their position on the Aged Care Act 1997, calling for it to be rewritten in order to improve quality and safety in Aged Care. Publishing the article one day prior to the release of the Interim Report, the ALA believe that rewriting the legislation is a step forward in addressing key reform issues that need urgent action, such as regulation, staffing and clear data. You can view the ALA’s article here.
The federal government’s proposed Religious Discrimination Bill has been extremely controversial, condemned by state and territory commissions and the Australian Council of Human Rights Authorities. There is great concern on how the proposed bill could affect healthcare, including Aged Care Providers, if it is passed. A legal expert speaking to the Australian Ageing Agenda, has said the Bill could affect Aged Care Providers in terms of attracting and retaining staff, already an issue in the sector, among other serious concerns of discrimination towards other groups. You can read the proposed Bill here.
PROVIDERS RECOGNISED WITH NATIONAL AWARDS
October saw some of the amazing Organisations in the sector recognised for the work they do. ACSA’s National Awards in October, held during the ACSA National Summit, celebrated both Providers and individuals for their achievements and impacts on the industry. NSW-based RFBI was named ‘Provider of the Year’, and Feros Care ‘Regional, Rural and Remote Provider of the Year’. You can view the individual Award Winners here.
Aged Care Organisations were also recognised at the recent Australian Marketing Institute (AMI) Awards, with three Providers winning awards for business excellence. Peninsula Villages in New South Wales, Benetas in Victoria and Braemar Presbyterian Aged Care in Western Australia were acknowledged as an Outstanding Employer of Choice, Best Campaign and Western Australia’s Small Budget Marketing awards respectively.
In dementia news for October, a new world-first trial will run across 14 months in Perth, studying the effectiveness of cannabis improving quality of life and a range of symptoms for people living with moderate dementia. The University of Notre Dame is currently recruiting 50 participants, living in Residential Aged Care in Perth, aged 65 years or older and living with mild dementia. The hypothesis is that cannabis will treat a number of symptoms associated with dementia.
Another potential breakthrough in dementia is a new drug that could potentially halt the progress of early-stage Alzheimer’s Disease. The drug, aducanumab, has been the first to appear to significantly halt the progression of the disease, where all other medication currently on the market can only be used to ease symptoms of the disease. Currently being assessed by the US drug regulator, pharmaceutical company Biogen is hoping it will be approved for use for as early as 2020. Interestingly, the initial trial for aducanumab was halted after early results did not appear to affect symptoms, but re-established after it was discovered that higher doses and longer periods of the drug made a significant difference.
A Dementia Australia grant has assisted the Shoalhaven region of New South Wales to work on becoming a dementia-friendly community. The grant, a part of the Dementia-Friendly Communities program, supported HammondCare Nowra and the wider community to set up door-to-door visits, workshops, raise awareness and reduce stigma of dementia, just to name a few initiatives. Dementia Australia provides resources and information on dementia-friendly communities to ensure people living with dementia are supported to have quality of life.
In our last Industry Update, we reported on the amazing affects the ABC TV show ‘Old people’s home for 4 year olds’ has had, not only on the children and older people involved in the program, but also the wider Australian population. This month, we are happy to report intergenerational programs have continuing success and rising popularity throughout the country.
In another form of intergenerational learning, The University of Sydney has implemented the Gold Soul Companionship program, where four Health Science students are living in an Aged Care facility in exchange for time spent volunteering. The program means that the students have built strong relationships with Residents which has had very positive effects on their wellbeing, for both the students and the Residents. The program has also had a positive effect on Resident’s families and the staff. You can read further on the program in the Australian Journal of Dementia Care’s article here.
HEALTH, EXERCISE & AGEING
Maintaining a healthy and active lifestyle has long been encouraged for healthy ageing; and a program in Castlemaine, regional Victoria, has enabled older people to experience the sport of powerlifting. The average age of the class participants is 75, and is specifically designed for older people, including those that have cognitive impairment, had hip replacements and live with arthritis. The aim of the program is to increase strength, health and wellbeing, and enable participants to continue living independently without needing to go into Residential Care.
To more sport, and approximately 130 residents from 13 different Aged Care Facilities competed in a sporting carnival in Canberra in October. The ages of competitors ranged from 80 to 100, with high school and university students assisting on the day. Hosted by YMCA Canberra, the event looked to promote intergenerational socialising as well as health, fitness and activity.
Looking at the future of healthy ageing, the International Organisation for Standardisation (ISO) is developing a global standard for ageing societies. With the aim of improving wellbeing and healthy ageing, standard TC314 will focus on ‘dementia-inclusive communities, ageing workforces and carer-inclusive organisation’. You can read further on the development of the standard here.
AGED CARE WORKFORCE
The topic of the Aged Care workforce was once again extremely big in the news in October; with both Melbourne Hearing 3 focusing on the subject, and the Commission’s release of Research Paper 1 ‘How Australian residential aged care staffing levels compare with international and national benchmarks’. The Research Paper, conducted by the Australian Health Services Research Institute at the University of Wollongong, examined staffing benchmarks used in United States, British Columbia in Canada, Germany as well as those in Victoria and Queensland, in order to see how staffing compares. When applied to Australian data, it appeared that more than half of Australian Aged Care facilities measured poorly against the US rating system. Allied Health staff are not counted as a part of the US system. You can read the Commission’s wrap up of the report here. The ABC reported that 85% of witnesses named staffing issues as a problem to the Royal Commission.
A new report released by the 2019 New South Wales Aged Care Roundtable found that hospitalisations in Residential Aged Care increased as a result of staffing numbers, amongst wound care, medication errors and pain relief. You can view the roundtable report here.
A new joint study, conducted by University of NSW, Macquarie University and RMIT, has reported that Aged Care workers in Australia have ‘no time’ to be able to provide social and emotional support in line with Resident’s needs. The report, ‘Meeting the social and emotional support needs of older people using aged care service’, was released a week prior to the Royal Commission’s Interim Report, and followed the Melbourne Hearings where the Commission heard that staffing shortages were affecting an ability to provide high quality care. The report, commissioned by unions Health Services Union and United Voice, recommends a number of actions to be taken, including ensuring that Aged Care services are designed with psychosocial needs as a priority in service design, as well as sufficient funding to the sector to enable services to be provided to older people.
The release of the study ties into much of the themes of October news in the sector, which had a great deal of conversation surrounding the Aged Care workforce and staffing.
Health Services Union and United Voice also commissioned a national worker survey, with the results, and a 5-point plan to improve working conditions, released in October. The survey shows that 37% of respondents said they would not be working in the sector within 5 years, with understaffing, workload and stress and low pay influencing the factors for leaving. You can read the 5-point plan here.
The Commission heard evidence from peak bodies and unions about the issues facing workers in the sector; including staff shortages, low rates of pay, and heavy workloads. Professor John Pollaers, chair of the Aged Care Workforce Strategy Taskforce, also spoke at the Royal Commission in October, stating that there were many things that needed to be addressed by the Government in order to address the staffing issues in the sector. He also spoke about the lack of action taken by the Government on past recommendations.
To funding news, and the latest StewartBrown report has again shown that Aged Care Facilities’ average net profit continues to decline, despite the $320M funding boost in early 2019. The latest data covers the year 2018-19 and shows that costs are rising faster than the income being received. You can read the full report here.
The Aged Care Financing Authority (ACFA) has also stated that the sector may not be financially sustainable, a ‘significant concern’ to the agency, as the head of ACFA Mike Callaghan shared with a Senate committee in October. ACFA’s latest report from July 2019, can be viewed here.
Aged Care Pricing Commissioner, John Dicer, has also expressed concern about the decline in approvals for new rooms in 2018-19, suggesting that the drop indicates ‘tough economic times’. He has also warned that if new Facilities and rooms were not invested in soon, many older Facilities may no longer be financially viable over the next few years. View the Commissioners’ 2018-19 report here.
Minister for Aged Care, Richard Colbeck, addressed the issue of financial pressures in the sector at the recent LASA National Congress, stating that it is one of the reasons why research and piloting of a new funding tool is being undertaken.
A 101-page report, released in October by the Human Rights Watch, has looked at the use of chemical restraints on people living with dementia in 35 Aged Care Facilities, and recommended urgent action from the Government. The report, ‘Fading Away’: How Aged Care Facilities in Australia Chemically Restrain Older People with Dementia also recommends laws are put into place prohibiting the use of chemical restraints, with mandatory training provided to all staff to use alternative methods of de-escalating unwanted behaviour, minimum staffing levels are enforced as well as methods to ensure the rights of older people are protected. An easy-to-read version of the report is available here.
The report was followed by the Aged Care Quality and Safety Commissioner, Janet Anderson, reporting to a Senate estimates committee that complaints about chemical restraints had doubled in the last year. She also added that the number of complaints was still relatively low (122 in 2018-19).
After the release of the Human Rights Watch Report, an intervention program developed with the aim of reducing the use of antipsychotics in Aged Care Facilities, has had renewed calls for its roll out. Originally piloted in Tasmania, The University of Tasmania’s ‘Reducing Use of Sedatives program’ (RedUSe) had been rolled out across 6 states from 2014-16 with significant positive results.
RETIREMENT LIVING STANDARDS
A new set of Accreditation Standards have been released – for the retirement living sector. Co-owned and launched by Aged Care peak body LASA, and property sector peak body the Property Council of Australia, the Australian Retirement Village Accreditation Scheme (ARVAS) were developed to support the Retirement Living Code of Conduct. An independent accreditation provider, Quality Innovation Performance, will operated the scheme, which replaces the Lifemark Village Scheme and the International Retirement Community Accreditation Scheme. For more information on the ARVAS Standards, visit here.
TECH & INNOVATION
Another busy month once again for technology and innovation in the sector. Here’s a quick summary of the new tech and innovative ideas heading into the industry in the close of 2019:
- The pilot of a telehealth emergency response service has had significant positive results early on. The hospital-based outreach service for Aged Care is a study to improve the Northern Sydney Local Health District’s Aged Care Rapid Response Team’s (ARRT): with the aim of being able to ‘visit’, via video, more unwell Residents and reduce hospitalisation. You can view a video of the ARRT program here, or view the brochure of the program here.
- A cloud-based clinical care system is being used in a New South Wales Facility to reduce paperwork, improve documentation, and allow for more time caring for Residents. The Australian Nursing Home Foundation, a Provider of Aged Care services to Chinese and South East Asian communities, rolled out Person Centred Software’s Mobile Care Monitoring and Care App system in early 2019. View more information on the app here.
- PainChek is continuing to roll out nationally across Australia, and has recently partnered with Ward Medication Management (Ward MM) to deliver training for the app across Aged Care Facilities. The Federal Government announced that $5M would be put towards the roll out of the app across Australia earlier this year; and the Australian-based app is also making pathways into the Singapore and US markets.
- $1M is being spent on the development of software designed to support clinical decisions, and predict declining health in Aged Care. Telstra Health, RMIT and the Digital Health CRC will work on the software across the next two years, in order to reduce emergency hospitalisations as well as give more time for end of life plans.
- An innovative education program has shown significant results in improving care service quality, relationships and collaboration between families and care teams. The program, led by Professor Lynn Chenoweth at the Centre for Healthy Brain Ageing (CHeBA), UNSW in Sydney, targets relationships between family and staff to improve collaboration, communications and understanding.
- A new digital tool, the ‘Happy Life Index’, has been launched. The tool focuses on measuring Resident satisfaction in order to give Residents a voice, enabling Providers to gain greater insights, so they can continually improve services. Launched by CarePage and the Aged Care Guild, the tool will also enable anonymous feedback to be supplied. The founder of CarePage, Lauren Todorovic, said the Happy Life Index will also improve transparency around Aged Care services and empowers consumers. View more about the Happy life Index here.
- Research conducted by the University of Melbourne looks to assess how new technologies used by Aged Care Residents improve their quality of life and connections. Technologies such as virtual reality, video conferencing, robots and robotic pets are all being studied to discover both the positives as well as the challenges that they can have on the wellbeing of Residents. A survey that is part of the study can be taken here.
With so much technology and innovation happening in the sector around the world, it can be difficult to keep up with the ever-shifting world. However, a new report has declared that older Australians are well equipped to cope with technological change and ageing – only falling second in the world to Denmark.
INTERNATIONAL DAY OF OLDER PERSONS & NATIONAL CARERS WEEK
October held some important dates: The UN’s International Day of Older Persons (IDOP) on the 1st of October, and National Carers week. Both the day and week are significant dates in our Industry’s calendar, dedicated to acknowledging the amazing people who have contributed so much value to our society for so long; and the carers who put in so much work to assist in care, often unpaid. IDOP is also a time of raising awareness and advocating for the rights of older people, the 2019 theme being ‘The Journey to Age Equality’. Read more about IDOP here.
AGED CARE IN TURKEY
Turkey has been making news in the Aged Care world, becoming a leading country in ageing. Marking 2019 as the year of the older person, Kemal Aydin, who is the head of the country’s International Centre for Ageing and Development, aims to ensure that older people living in Turkey remain as a part of society. The ‘Peaceful Home’ project focuses on prioritising home care to ensure older people are able to stay in their own homes for as long as possible, and plans to establish a charity to help older people in need and build age-friendly cities.
|LISSIE LYONS – CHAMPION OF EDUCATION & MARKETING