Costs, conflicted opinions and ageism could prevent aged care reform after damning royal commission report

Experts worry exorbitant costs could prevent many of the aged care royal commission's recommendations from being implemented. Source: AAP

Academics have welcomed the aged care royal commission's final report but predict that cost will prevent many of its 148 recommendations from ever being implemented.

Experts say progress in reforming Australia’s ailing aged care sector in the wake of the royal commission could be thwarted by the exorbitant costs required, conflicting opinions of the royal commissioners, and inherent ageism in both government and society.

Following a two-and-a-half-year federal inquiry, the report released on Monday made 148 recommendations designed to address the “neglect and abuse” of older Australians.

While the commissioners Tony Pagone QC and Lynelle Briggs QC agreed on the need to transform the aged care system, they offered slightly different recommendations regarding governance and how best to raise the billions of dollars required.

Mr Pagone calls for an independent body of government to administer aged care while Ms Briggs suggests the sector should remain centrally managed. The commissioners agree a levy could be used to support the overhaul but Mr Pagone suggests a system based on the principle of universal care - similar to the NDIS - could help finance the sector.

Experts believe the conflicting messages may ultimately lead to government inaction. 

Professor in Ageing and Health at the University of Sydney Lee-Fay Low describes this lack of agreement as “the biggest challenge of the report”.

“I was excited by these recommendations ... if all 148 got implemented, we would have one of the best aged care systems in the world and that would really improve lives. But I was devastated at the same time because there wasn’t agreement; many of those recommendations would not be implemented,” Prof Low told SBS News.

"Because there are split recommendations, I think the government has an excuse to do less. It’s really an excuse to think about it more and talk about it more and not change things.”

Associate Professor Ralph Hampson at the University of Melbourne agrees the disagreements have diluted the report's message, which he says is “disappointing”.

“I read it and thought, wow, now the government almost has to have another inquiry to decide which model to go with. I think both commissioners give a good argument. [The government] might cherry pick from the two commissioners' different findings but I think the challenge for the government is to take a position and do something," Dr Hampson told SBS News. 

Both Dr Hampson and Prof Low believe the responsibility for aged care, like education and healthcare, lies firmly with the government.

“There are multiple recommendations around integration with primary care and state health, and having a federal department involved means it’s more likely that the integration is successful,” Prof Low said.

“The cost and delays associated with setting up an independent body I don’t think are worth the possibility without much guarantee of improvements in governance. We had a new independent quality and safety commission a few years ago and it didn’t really improve quality of care.”

Professor in Ageing and Health at the University of Sydney Lee-Fay Low.
Prof Lee-Fay Low says costs may prevent some of the aged care royal commission's report recommendations from being implemented.

Certainly there were many positive aspects to the report, Dr Hampson and Prof Low said, such as recommendations around the quality of care, the wellbeing and rights of older people, the employment of more allied health workers in both home care and residential care settings, and the mandatory training of staff.

The 1997 Aged Care Act will also be overhauled, coming into force no later than July 2023, to ensure older Australians receive high-quality support and care.

In response to the report, the Morrison Government on Monday announced it will spend $452 million to fix Australia’s aged care system.

The package includes $18 million towards tougher oversight of the government's home care packages, $32 million for the Aged Care Quality and Safety Commission and more regulation on the use of restraints in care, nearly $190 million on residential care providers and $90 million to create a fund to help facilities facing financial challenge.


Questions around costs

But experts believe high costs and industry pressure will also prevent the implementation of many of the report's recommendations.

Private providers, for example, may argue against mandatory staff training for fear it will cut their bottom lines.

They've historically fought against nursing staff ratios for the same reason, clashing with industry bodies that hoped ratios would be included in the royal commission's recommendations.

Dr Hampson was surprised they were not.

“It was surprising that they didn’t regulate staffing ratios, and certainly many were hoping for that. But then, just putting ratios in place doesn't fix all the problems of the system," he said.

“There has always been controversy between self-regulation versus government regulation and again the commissioners have left that up to the government to decide ... and the government has to brave and courageous in actually making a decision.”

Associate Professor Ralph Hampson at the University of Melbourne.
Dr Ralph Hampson believes the government must be brave and make some big decisions in the wake of the aged care royal commission recommendations.
Dr Ralph Hampson

The other fundamental question is around funding. The government is expected to provide a comprehensive response to the report in the May budget, including details of a possible levy to raise funds from taxpayers.

Many aged care advocates, along with Mr Pagone, support an aged care system in which everyone gets what they are entitled to regardless of income - as opposed to the current aged care system, which is means-tested.

Such a system may dramatically increase quality of care, and decrease wait times for home care packages.

But the costs would be extreme.

“We’d love an NDIS-style system but I’d struggle to see the Morrison Government agreeing to fund that,” Prof Low said.

Dr Hampson believes the idea of an NDIS-type system for aged care is worth investigating and the costs should be explored. 

But he believes there are fundamental questions around how much the community - and the government - is willing to spend on older people.

Ageism, say Dr Hampson and Prof Low, remains rife.

“Older people are not prioritised on the government agenda,” Prof Low said. “We need public appetite to support a levy or to pressurise the government to take up these recommendations."

Dr Hampson says drumming up public support for a levy may not be easy - because everyone likes to think they won't need aged care.

“No one wants to go into a nursing home and everyone has a fantasy that they’re not going to need it. A lot of us think this isn’t going to happen to me, but the reality is if you live long enough, you’re going to need the aged care system.”

“Unless we as a community take this seriously and actually demand something of government, we’ll just get more of the same.”

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