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ROYAL COMMISSION: Government repeating the same mistakes as in 2006

The Royal Commission into Aged Care Quality and Safety hosted a panel of industry experts who are actively attempting to address the issue of younger people with disability living in residential aged care (RAC) facilities, with the Government receiving scathing criticism about their current action plan.

On today's panel at the Commission was Dr Bronwyn Morkham, National Director of the YPINH National Alliance and Luke Bo’sher, Chief Executive at Summer Foundation. [Source: Aged Care Royal Commission]
On today's panel at the Commission was Dr Bronwyn Morkham, National Director of the YPINH National Alliance and Luke Bo’sher, Chief Executive at Summer Foundation. [Source: Aged Care Royal Commission]

The three-person panel consisted of Dr Bronwyn Morkham, National Director of the Young People in Nursing Homes National Alliance (YPINH); Luke Bo’sher, Chief Executive at Summer Foundation, and Shane Jamieson, Manager of Youngcare Connect at Youngcare.

All three experts did not have a positive opinion about the Government and their current Younger People in Residential Aged Care (YPIRAC) Action Plan, which was described as “repeating” the mistakes of the past.

Dr Morkham says, “We have heard this week in the Commission, that senior Government officials admit they have manifestly failed to deliver the solution to this problem so far. Yet we are being asked to trust them again with this action plan.

“With regard to the current action plan and the younger people in residential aged care initiative in 2006, we are seeing the same mistakes being reiterated.

“Aged care is the default option now for young people looking to be discharged from aged care… Unfortunately the fact that residential aged care can have a bed available is a very attractive opportunity for a hospital that doesn’t provide accommodation.

"We, simply, haven’t had the services and supports available to avoid that yet, and having that pipe-line straight into residential aged care has proved irresistible. It’s also systematic of a deep system inertia... The pipe-line is there, because there are no other options.”

Dr Morkham also confirmed with Commissioner Lynelle Briggs AO that this situation has become worse since the National Disability Insurance Scheme (NDIS) moved from State responsibility to the Commonwealth Government.

Mr Bo’sher mentioned that the action plan put in place six months ago has created no real progress and no targets.

All panellists were disappointed they were consulted in the process of the action plan, yet it seems none of their suggestions had been taken onboard.

Market providers is taking responsibility for housing not Government

All three experts highlighted the current issue they have with the YPIRAC Action Plan, which is not taking responsibility for housing people with disability and instead making it a market issue to develop and fix.

Dr Morkham says, "The almost complete reliance on the market to solve this problem when the market doesn’t have an understanding at all about the nature of the problem and what’s needed. It’s still very segmented and I think if we continue to rely on the market we’re doomed to fail. 

"The market needs to be directed by the NDIS about where it should look, not just “Build, and they will
come”, not just assume people are going to be grateful for anything that they’re offered, but directed to look at the model of care that needs to accompany the development of that housing. 

"That’s absent at the moment. So the NDIS needs to take a much heavier hand with managing the market and the providers that respond to that."

Mr Bo’sher agreed, saying, “I think there’s a big danger in rushing into government commissioning housing solutions if we don’t know, as Dr Morkham said, what the needs and preferences are of this group. 

"We need to understand that first and then that will spur significant development in the housing market, and where the market isn’t responding then it’s entirely appropriate and important for government to be able to come up with responses in those thinner markets.

"What is the person’s disability, what’s their support needs, what are their housing needs and preferences, and what does a good outcome look like for this person, that is just fundamental information that is needed in the housing market."

The disability service provider Mr Jamieson works for, Youngcare, are providing housing to people with disability, but admits that it is difficult to do because of the lack of information around what people want.

Mr Jamieson also says that identifying people early on to work with them in creating an appropriate house solution can be an issue in itself.

"As a provider, we’ve got a very vested interest in making sure that it’s the right outcome for them longterm, because we want them to get a great outcome that is going to support their needs, not just now but into the future and that; so it’s important, that we do get it right," says Mr Jamieson.

"I think we will get better at it and quicker, and we need to get a whole lot better at it as a sector, because there’s an awful lot of people that are waiting to move into housing... If we go too fast at this stage, they’re going to remain empty, because we’re not confident that we will have people achieve Specialist Disability Accommodations (SDA) for what it is, that we build right now.

"For far too long aged care has been considered the provider of last resort. But it’s become the provider of practice because that’s the go-to option and that’s not good enough. 

"I think more than anything attitudes need to change, attitudes systemically need to change to getting it right, to consider that a person that has an exacerbation in their health needs or has a new diagnosis, it should not be considered that aged care is appropriate for somebody under the age of 65 at all."

Providers don’t have confidence people will enter their housing

Mr Bo’sher mentioned one problem with the action plan, besides the lack of scope and targets, is its reliance on market providers to build when those providers aren’t receiving any reassurance that the housing will be filled by people with disability.

"The amount of specialist disability accommodation that’s being built doesn’t meet the needs of the group at the moment,” says Mr Bo’sher.

"So we need to think carefully about why that’s the case and I would suggest that the single biggest reason that we’re not seeing the amount of specialist disability accommodation being built is that providers of housing are not confident that if they build that housing that young people will be able to move into that housing instead of moving into aged care. 

"If we think about that situation at the moment, right now, today, there are empty SDA places that young people in hospital at risk of aged care or in aged care, wishing to get out of, could move into. They could move into those places tomorrow. Those places exist, they’re accessible places with support that would meet these people’s needs. 

"The challenge is that those young people in aged care don’t know where those vacancies are and those providers that have places that young people in aged care could move into can’t connect with the young people in aged care."

Many young people are being left in aged care with out of date NDIS plans that have not been enacted for the last 12 months, with Mr Jamieson saying they have found many people in this situation at nursing homes.

He adds that many young people in aged care with a disability are not aware there are many available housing options that have not been offered.  

Lacking transitional housing is creating a gap

The panel agreed that no transitional housing for people with disability is causing a huge fundamental problem in the system, which is resulting in people being placed in aged care.

Dr Morkham says, "We want the Government to establish a dedicated interim-housing funding stream to do just that. We can’t afford to wait. If we’re serious about stopping this, we need that dedicated funding right now, and we would call on the Federal Government to make that available as a priority.

"Unless we have transitional housing in place, and when I talk about transitional housing I don’t mean we’re building that, we can take advantage of opportunities that already exist. Without that interim option, it means people will live in hospital and hospitals are dangerous places. If you’re healthy and well, they’re dangerous places to be. 

"You can acquire dreadful infections that are untreatable. It’s not good. You can become de-conditioned and institutionalised if you live for a long time in a hospital."

Mr Bo’sher described transitional housing as the “glue in the system that's missing.” 

"The [transitional home] itself needs to have a strong focus on rehabilitation and on building people’s capacity, because what we don’t want is to create alternative versions of aged care where we’re just housing people and calling it transitional housing and calling it a disability service when, in fact, it has all the characteristics of aged care, that it’s a large congregate model with no focus on capacity building,” Mr Bo’sher adds.

Government doesn’t seem to care

When asked about whether creating “bricks and mortar” was a priority to fix the issue, the panel didn’t necessarily agree, saying it was only one important part to solving the problem, but it seems that the only focus from Government has been on the physical aspect.

Dr Morkham says in her final statement, “We’ve got an action plan you have when you don’t have a plan at all, really. We have an action plan that has no funding, no measurement, no real targets, nothing in there to say there’s any desire to do anything immediately whatsoever. 

"The action plan has been revealed to be not fit for purpose whatsoever and if we’re going to continue down that path we need to completely rethink what we’re doing and how we’re going to do it... There is a complete lack of will to do anything at all from those government officials. 

"I didn’t hear any clear indication of what they think we need to do or how we might approach it, how they’re going to involve these young people and their families and their communities in solving the problem and I didn’t hear anything about a desire to start right now."

Dr Morkham is also appalled by the NDIS and how it estimates whether someone is eligible for the service.

She states that any health event that results in a disability or loss of function is something the NDIS needs to respond to and it is simply unacceptable to ignore someone because they have a terminal illness.

The second round of Melbourne hearings will take place on Monday the 7th of October. 

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