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Final Royal Commission submission and proposed recommendations cause a stir

The Royal Commission into Aged Care Quality and Safety received Counsel Assisting's final submission and proposed recommendations for the aged care sector on 22 October, outlining numerous important, and long waited, reforms for the industry.

The submission from Counsel Assisting included 124 proposed recommendations. [Source: Aged Care Royal Commission]

The proposed recommendations have caused a stir online, and while many proposals were expected, other proposals have been criticised for not appropriately addressing big issues in the sector.

Counsel Assisting Peter Gray QC and Peter Rozen QC provided the submission and recommendations to Commissioners Tony Pagone QC and Lynelle Briggs AO.

The submission includes a total of 124 recommendations and some of the biggest areas covered by Counsel Assisting include:

  • A new Aged Care Act updated to provide high quality, safe and timely support to older people who need aged care services

  • Registration of all personal care workers by 1 July 2021

  • Establishment of an independent aged care commission which would regulate the entire sector

  • Nursing homes will have minimum staffing time standards of at least 215 minutes per resident per day with at least 36 minutes provided by a Registered Nurse (RN)

  • Integrated long term support and care for older people

  • Establishment of an Australian Aged Care Pricing Authority to determine all funding for specific aged care services

  • Implementation of an Inspector-General of Aged Care to monitor and report on the administration and governance of the aged care system

  • Amalgamation of the Commonwealth Home Support Programme, Home Care Packages program and Residential Aged Care program

  • The Aged Care Assessment Team/Service (ACAT/S) and Regional Assessment Service (RAS) to be replaced with a single assessment process

  • Urgent review of the Aged Care Quality Standards

  • Develop stronger aged care services for Aboriginal and Torres Strait Islander people

  • Reduced use, or prescription, of physical or chemical restraints

  • Immediate changes to the basic daily fee by increasing the amount by $10 per resident per day

  • Star rating system for people seeking aged care services

Delivering the final submission, Counsel Assisting Rozen says, "Discovering the nature and extent of substandard care in an aged care system should be quite straightforward. In Australia’s aged care system it is exceedingly difficult.

"...The weight of the evidence before the Commission supports a finding that high quality aged care is not being delivered on a systemic level in our aged care system and the level of substandard care is unacceptable by any measure."

Commissioner Briggs pushes back against independent commission

One of the recommendations proposed a fully independent aged care commission that would oversee the entire aged care sector, including payment of subsidies to providers, regulation of providers, and registration of service providers.

This suggestion was rebuked by Commissioner Lynelle Briggs AO, who believes there were no reasons provided for why this commission should be created, especially if it is going to take a lot of resources and funding to establish.

Commissioner Briggs says, "The independent commission that you describe in your submissions is quite an extraordinary proposal and, indeed, some might even call it courageous. I would really like to hear the public's views as to whether taking the core Government aged care instrumentality out of the public service and making it independent of the Executive Government and the Minister would be in the best interests of older Australians.

"In our system of Government, Counsel, it is important that the ministers are accountable to the Parliament for the performance of their responsibilities… I am yet to hear you present arguments, Counsel, as to how the Commission model will improve the quality and safety of care for older Australians or how any such benefits would outweigh the very substantial costs and disruption involved in such a radical transformation of the Government's administrative machinery.

"The new Commission would require, as you say, new legislation and a new source of funding. If it is located outside of Canberra, as you propose, that complicates things by [the] requirement of a completely new workforce, creation of new systems and processes, and land and building acquisition. This would take many years to set up as we have experienced with the NDIA."

Commissioner Briggs added that establishing an independent commission would lead to a massive churn and turnover of experienced staff, all while recommending other urgent and important reforms for the aged care sector.

Civil penalties for contraventions of general duty by providers

There were angered responses to some of the recommendations around penalties which highlighted that people in residential aged care who experience a breach by an aged care provider of general duty for high quality and safe aged care can only seek civil penalty for the contravention.

Recommendation 109: Civil penalty for certain contraventions of general duty and Recommendation 110: Private right of compensation for certain contraventions of the general duty, covers the rights of older people when it comes to poor care or harm from their provider.

Twitter user, Stewart Johnston, expressed his anger at this ruling, which may mean that people who are abused while staying in aged care might not have a criminal trial.

Mr Johnston, whose own mother experienced abuse inside Adelaide nursing home, Oakden Aged Care, condemned the proposed reform.

He says, "Neglect, mistreatment, abuse, malnutrition and sexual abuse are all criminal offences in every community across the nation unless you reside in residential aged care. Just let that sink in. Any suggestions that civil not criminal action is reforms required is abhorrent." [sic]

This recommendation also follows statistics read out by Counsel Assisting Rozen early in the opening submission, stating that there are an estimated 50 sexual assaults a week in residential aged care across the country.

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