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ROYAL COMMISSION: Solutions for the bigger picture of aged care

The first Royal Commission into Aged Care Quality and Safety panel workshop for the year kicked off in Adelaide, which put propositions and suggestions to industry professionals and advocacy groups about redesigning the aged care system.

Commissioner Tony Pagone QC opened the Royal Commission for the new year, introducing a new workshop format for hearings. [Source: Aged Care Royal Commission]

This round of hearings has a different format to previous Commission hearings, and will be conducted as a discussion workshop.

While last year’s Commission was focused on what issues there were in the aged care industry, the 2020 hearings will now be looking into solutions, fixes and models to improve the sector.

The workshops have a panel of professionals from across the industry providing their feedback. Each session will have different panellists, although, some panellists will appear more than once depending on the topic.

Within those topics are further questions around the viability and potential success of propositions the Commission are considering for their Final Report recommendations.

Bigger Picture

The first session was about the future structure of aged care and what that might look like in the long run.

All panellists were in agreeance that medical professionals and others in the industry should actively be suggesting and providing gateways to aged care services.

A suggestion to make access to care easier, panellist David Tune AO PSM, Independent Chair of the Aged Care Sector Committee, proposed a similar model to the National Disability Insurance Scheme, where participants can still use their funding with non-NDIS providers.

Glenn Rees, Chairman of Alzheimer’s Disease International, believes there needs to be more direction with what to do next when accessing aged care, and agrees that the introduction of care navigators, suggested by the Commission, could help.

“On people with dementia specifically, they’re left post-diagnosis in an absolute vacuum. There is no guarantee, there is no structure… I think in the case of people with dementia you do need a structure that takes them from the point of diagnosis to a navigator who can help plan and direct the services,” says Mr Rees.

Patricia Sparrow, Chief Executive Officer (CEO) of Aged and Community Services Australia  (ACSA) adds that referral to simple aged care related services should be accessible through multiple sources in the community.

Also in discussion was the possibility of increased and improved data collection for informing future quality care.

Michael Lye, Deputy Secretary of the Ageing and Aged Care, Department of Health, says better data collection can show where the gaps are in care and give a basis for how the industry can improve.

“If you’re going to have a continuum of care for older Australians, [then] you need to understand what’s happening in their lives and the pathway that that will take, and their movement between systems,” says Mr Lye.

“I think that any additional data that we can collect to help inform good service delivery is well worth pursuing.”

Information, Assessment, Navigation 

In the second session, there was a lot of debate around the navigation model and how that would work with funding, its independence, and how involved should family and informal carers be.

This navigation discussion included streamlining the Aged Care Assessment Team/ Service (ACAT/S) and Regional Assessment Team (RAS).

Panellist Ian Yates AM, Chief Executive of Council on the Ageing (COTA) Australia, says that COTA would want the assessment process to be combined, however, care finding, or navigation, is something that could come later.

He adds that he believes the assessment should be paid for by the Commonwealth and needs to be “independent of service providers”. 

This comment was backed by another panellist Professor Michael Fine, Department of Sociology at Macquarie University, who says, “We just don’t want good businesses being tainted by the accusation that they’re over-servicing or providing services where they’re not needed.”

Mr Yates was also concerned about the added input that could come from family, friends or informal carers, since COTA deals with a lot of elder abuse cases, including inheritance protection by families.

He believes that a care finder, if implemented, should be able to facilitate the process of a guardianship order in cases of elder abuse.

Panellist Dr Ricki Smith, CEO of Access Care Network, was of the opinion that a care finder, or navigator, could help push consumers in the right direction when making decisions about aged care services they may require.

“[Access Care Network’s] role today is to work independently with people, identify what their goals are... But having identified their goals and identified where the needs are, our role is to facilitate access to service, when service is required,” explains Dr Smith.

“I think the complicating factor today is that we have two assessment workforces [ACAT/RAS] and we have two different funding mechanisms that get in the way of that.”

When asked about the best way to provide navigator services, panellist Nicholas Hartland PSM, First Assistant Secretary at the In Home Aged Care, Department of Health, suggested a mixture of face to face assessments and available shopfronts.

He adds that navigation should be available in existing face to face services, like community centres.

Entry Level Support

In the last session for the day, there was conversation around what entry level support is, with one topic examining whether home care services was causing dependence instead of independence.

Panellist Dr David Panter, CEO at ECH, and LASA Board member, says that access for extra help around the home, or “low level services”, needs to have a fairly low bar so people who have finally built up the courage to access these service are not put off.

He adds that South Australian service provider, ECH, often has discussions with clients families about not doing their jobs properly, even though the company focuses on working with the client for re-enablement or reablement.

He believes that people need to get involved in the service they are receiving at home, saying, “We need to get the early adoption of these services, because if we don’t, then we know that potentially people will decline and be in even greater need.”

Other panellists were in agreeance with this suggestion, including Paul Sadler, CEO of Presbyterian Aged Care, and Professor Fine, who was present on the previous session.

Jane Mussared, CEO of COTA South Australia, says that there needs to be an independent service working with the individual to find them the best option, without outside bias coming into play.

“We often think that enablement is very much a – or reablement - is a physical process. Taking someone’s agency and decision-making away is disabling them,” says Ms Mussared. 

“In the pursuit of reablement, we have to make sure that we retain the choice and control, which should be the overarching principles here…

“This should be accompanied by somebody actively working with that person who is independent of the service system, to make sure that that person’s agency, that person’s choice and decision making is not overridden.”

February 11 is the last day of this round of Royal Commission workshops. The next workshop will be on February 21 in Adelaide, discussing the future of the aged care workforce.

What do you believe should be considered in the bigger picture of the aged care system? Tell us below in the comments.


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