We hereby, under the Constitution of the Commonwealth and the Royal Commission Act 1902, require that this Royal Commission inquire into: Loading a) Whether the profits of up to $25,000 per bed per year, which the top-tier private aged-care companies and some of the big not-for-profits are making, on margins of 20 per cent, is coming at the expense of care; b) Why, when the bulk of their funding comes from taxpayers, are the big, for-profit nursing home companies aggressively minimising tax? Multinational Bupa has complex offshore structures and related party transactions; Opal Aged Care uses inter-company loans at inflated interest rates; Allity has paid no tax for two years; and some of the richest family-owned operators do not even issue financial reports. Almost all nine big companies appear to use trusts as part of their company structures;

c) Are staff numbers in nursing homes sufficient since there is no minimum legal ratio of staff to residents, no minimum training requirement and no statutory requirement to have a nurse on duty at all times? Should there be minimum requirements, since nurses now make up only 24 per cent of staff (and shrinking), and "personal care assistants" are now almost three-quarters of all staff? The only current legal requirement is the unenforceable rule that staff numbers are "adequate"; Loading d) Is staff training and pay good enough, when the bulk of the students for the Certificate III qualification in aged care are doing courses that are shorter than the minimum 33 weeks full time recommended by the vocational education regulator, the Australian Skills Quality Authority, and when they earn about $18 to $19 per hour? e) Are we providing enough hours of care per day, when nursing home residents in Australia receive just 2.8 hours, compared to 4.1 hours recommended by the US Centre for Medicare and Medicaid Services? According to US studies, the Australian numbers are so low residents are likely to "needlessly suffer harm"; f) What can be done about food, when, according to industry auditors StewartBrown, the "best" homes also spent just $6.08 per day on food for each resident, and when cook and advocate Maggie Beer says she was "told by one cook in a master class that they had a budget of $4.50 per day for three meals plus morning and afternoon tea"? Dietitian Dr Skye Marshall found, "on average, half of all residents in aged care are malnourished".

g) Why are 70,000 people subjected to "chemical restraint" - that is, drugs used to calm dementia sufferers rather than activities, distraction and human contact – when only 10,000 to 15,000 get medical benefit from it. Loading Replay Replay video Play video Play video Loading h) Why are nursing homes not required to publish any information about the number of direct care staff per resident, their qualifications, the home's record of care, or its food and activities? All are obscured by commercial-in-confidence considerations and weak legislation. Why are they also not required to publish information on the number of pressure sores, medication errors, weight loss, falls, infection rates, restraints, admissions to hospitals; or about residents' dignity, privacy, freedom to make their own decisions? i) Should the government funding for nursing homes be devoted entirely towards care? As it stands, nursing homes can use public funds for any purpose – care, infrastructure, or executive salaries and dividends for shareholders. In reality, homes spend only about two-thirds of their government funding on care when the number of homes in breach of rules is rising fast and the number of homes identified as posing a "serious risk" to residents is up 177 per cent;

j) Are the accreditation standards sufficiently rigorous, and rigorously enough policed? Should standards be changed from loosely phrased "expected outcomes" to objective standards, for example, "all residents, especially in high care, should be fed their meals within 15 minutes of arrival in the dining hall"; "all residents of high care should have continence pads changed every six hours"? k) Should we hold managers and boards of nursing homes personally accountable when standards are not met, as recommended by a coroner who made a finding in May into the death of a resident at St Basil’s Aegean Village in Adelaide? The coroner said some personal risk to senior managers was needed for there to be public confidence in the system; l) Why is that complaints reports are not made public and the complaints commissioner is prevented by legislation and the Privacy Act from naming and shaming nursing homes that do the wrong thing?

m) Is the push for more market reform the way to go in future? The government's Aged Care Roadmap suggests removing regulation from nursing homes to create "diversity and choice … competition, innovation and responsiveness" in the system; n) Is the market approach to the home-care industry for aged-care services working? Anecdotally, big companies are gouging government funding and providing inadequate services with poorly trained staff in people's homes as well as in nursing homes; o) Is the legislation that underpins Australia's nursing home industry adequate? It was written by the Howard government in 1997 with the help of John Howard's friend and Liberal donor Doug Moran, a for-profit nursing home tycoon, who later boasted that he was responsible for much of it. Everyone thinks they're not going to get old, so no one's really bothered ... But we're making a bed that most of us will have to lie in. Monash University professor Joe Ibrahim.