This article is more than 10 months old

This article is more than 10 months old

Scott Morrison has promised extra aged care funding to flow before Christmas after the system was branded “cruel and harmful” by the aged care royal commission’s interim report, with services that are fragmented, unsupported, underfunded and often unsafe.

In a report titled Neglect released on Thursday, the commission has called for an urgent overhaul of the sector, saying it is neglecting the needs of Australia’s older, vulnerable citizens and is “unkind and uncaring”.



Outlining a litany of problems in the sector fuelled by a culture of ageism, commissioners Richard Tracey and Lynelle Briggs have described the aged care system in Australia as “a shocking tale of neglect”.

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“The neglect that we have found in this Royal Commission, to date, is far from the best that can be done. Rather, it is a sad and shocking system that diminishes Australia as a nation,” a statement from the commissioners says. Tracey died earlier this month.

The report says that urgent action is needed in three areas and calls for: more home care packages to reduce the waiting list of 120,000, a response to the significant over-reliance on chemical restraints in the sector and removal of young people with disabilities from aged care.

On Thursday the aged care minister, Richard Colbeck, fronted the media with no additional commitments to improve the system, but on Friday Morrison told 3AW Radio the government will address those three urgent priorities by year’s end.

Morrison said he had waited for the report to inform “final decisions we were going to make around in-home aged care funding before we finalise the mid-year [economic] update”.

Morrison said he had already consulted Colbeck, the treasurer and finance minister and committed that money will be available by Christmas.

The prime minister said he “couldn’t agree more” about the need to keep people out of aged care and cited the work of Youngcare, which builds homes for young people with serious disability, suggesting “we need more of that”.

On the need for home care packages, the commission report says the system is “unfair”, with funding needed to allow people to live safely at home.

“By any measure, this is a cruel and discriminatory system, which places great strain on older Australians and their relatives,” the report says.

“It is shocking that the express wishes of older people to remain in their own homes for as long as possible, with the supports they need, is downplayed with an expectation that they will manage. It is unsafe practice. It is neglect.”

The report also highlights concerns about the country’s “ageist” mindset, saying this culture had led to an indifference to how older people were treated, with the conversation about aged care too often about burden, encumbrance and obligation.

“As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities,” the report says.

“Sadly, this failure to properly value and engage with older people as equal partners in our future has extended to our apparent indifference towards aged care services.

“Left out of sight and out of mind, these important services are floundering.”

Slamming the system as fragmented, unsupported and underfunded, and usually poorly managed, the report says that many residential aged care homes are also unsafe and “seemingly uncaring”.

Describing evidence that the commission has heard since February as “difficult to tell and difficult to hear”, the commission’s report says it has heard stories of “unkindness and neglect” but the extent of substandard care is difficult to quantify.

“However, the combined impact of the evidence, submissions and stories provided to the Royal Commission leads us to conclude that substandard care is much more widespread and more serious than we had anticipated,” the report says.

More than half of the online submissions to the commission raised issues about substandard care, mostly relating to neglect, dignity, personal care, clinical care and medication management. Concerns were also raised about nutrition, malnourishment, emotional abuse, physical abuse or assault, discrimination and restrictive practices.

A little over 1000 providers responded to the commission’s survey on substandard care, self-reporting 274,409 instances of substandard care over the five year period to June 2018, including almost 112,000 occasions of substandard clinical care.

Pointing to “shocking evidence” of unacceptable practices in the sector, the commission says the major issues brought to the inquiry’s attention include inadequate wound management, poor continence management, “dreadful” food, high incidence of assault, the use of physical restraints and sedatives, and patchy and fragmented palliative care.

“It is shameful that such a list can be produced in 21st century Australia,” the report says.

The commission also raises concerns about the poor regulation of the sector and the lack of transparency on behalf of industry.

Providers come under fire for not responding adequately to complaints, with evidence suggesting the complaints process was “hard to access, slow to act and often effectively unresponsive”.

Some providers have proven to be defensive and “occasionally belligerent in their ignorance” of what is happening in their aged care homes.

Compounding the problem of poor care is a system lacking “fundamental transparency”, the report says, with very little information about complaints or performance made available to the public.

“The number of complaints against them are not published. The number of assaults in their services are not published. The number of staff they employ to provide care are not published.”

The report says the regulatory system in place to ensure safety and quality in the sector is also inadequate, with little to encourage practice beyond a minimum standard.

“We have heard evidence which suggests that the regulatory regime that is intended to ensure safety and quality of services is unfit for purpose and does not adequately deter poor practices. Indeed, it often fails to detect them.”

Staffing problems are also severe, with difficulties finding people who want to work in a sector marked by heavy workloads, and poor pay and conditions. The report also notes a lack of leadership, patchy education and training and a system that signals working in aged care “is not a valued occupation”. Cases where staff and providers are providing “exemplary care” are happening “despite the aged care system in which they operate, rather than because of it”.

According to the commission, the way the system has been framed as a “market” where old people are treated as customers who can shop around for a service is a fundamental failing.

It says that many older people are not in a position to negotiate prices, services or care standards.

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“The notion that most care is ‘consumer-directed’ is just not true. Despite appearances, despite rhetoric, there is little choice with aged care. It is a myth that aged care is an effective consumer-driven market.”

Despite the call for urgent action and funding, aged care minister Richard Colbeck would not guarantee any additional funding saying only that the findings had given him the “imprimatur” as minister to push the case internally.

“The commission makes … some comment about what’s required in that space. I will use the imprimatur of the royal commission to carry all of those things forward with my colleagues,” he said.

Aged care spending totalled $18.1 billion in 2017–18, with spending estimated to grow by $5 billion to $23.6 billion over the next five years.

While the government had been bracing for “difficult” evidence, he said he had been shocked at the commissioners’ findings.

Labor’s shadow ageing minister Julie Collins said the report was a “heartbreaking and shocking” reminder of the unacceptable state of Australia’s aged care system.

“It is shameful that in a wealthy country like Australia older people can’t get the care they need,” she said.

“The Morrison Liberal government must immediately act on the royal commission’s urgent advice. Older Australians and their loved ones cannot wait one more day for action.”