The Report of the Royal Commission into Aged Care unsurprisingly reported the need for increased staffing and the better training of staff among other recommendations. The issue of low skilled, low paid and inadequate staffing has been raised in all 18 reports into Aged Care over the last 24 years.
Aged care is a feminist issue. Two out of three residents in residential aged care is female and aged care workers are overwhelmingly female, low paid and in insecure and low skilled work. As Meredith Burgmann pointed out recently, aged care is an issue for almost all women, not only the recipients and paid providers of care, because women do much of the back-up caring of family members as unpaid labour. Read her article here
The final report highlights the need for a new Aged Care Act to underpin reform. In contrast to the Howard era Act which focussed on rationing aged care, the new Act proposed would set out the rights of older people, including their entitlement to care and support based on their needs and preferences.
This would be a significant shift away from the current ration-based system, and would bring aged care more in line with the principles of Medicare.
The final report calls for much stronger governance, regulation of the quality of care, prudential regulation, and an independent mechanism to set prices.
Residential care facilities would need to ensure minimum staff time with residents. By July 1 2022, this would be at least 200 minutes per resident per day for the average resident, with at least 40 minutes of that time with a registered nurse. Requirements would increase over subsequent years.
Even so, facilities reaching this standard would still be seriously below par on international comparisons with comparable countries.
Facilities would be required to report staffing hours provided each day, specifying the breakdown of residents’ time with personal care workers versus nursing staff.
The strongest recommendations are those aiming to enhance the capability and work conditions of formal carers. It calls for better wages and a new national registration scheme for all personal care workers, who would be required to have a minimum Certificate III training.
The final report makes a series of complex recommendations about fees and funding, with the commissioners diverging in view as to the specific arrangements. This augurs ill for any genuine Government commitment to establishing a sustainable funding system via a Medicare type levy for example.
Disappointingly the Report puts a great deal of faith in better regulation , higher levels of transparency and more rigorous reporting and accountability to drive improvements in a ‘quasi- market system’, without questioning the efficacy of the market itself. It is worth noting that during the recent Covid19 outbreaks in Victoria residential aged care run by the Victorian government did not have any Covid19 out breaks whereas the privately run institutions did. Many of the current problems with Aged Care arose after the privatisation of the institutions by the Howard government in 1997. Could the care model be out of step with the maximisation of profit? The Report fails to pursue this critical question and in this respect could help sustain the woefully inadequate status quo.