As the Royal Commission continues not much change has happened! Elections are over now what?
We are now 8 months into ‘The Royal Commission into Aged Care Quality and Safety’ and already have released four background pages, e.g. Background papers 1, 2, 3 and 4. They have requested information from aged care service providers and they have interviewed many of them. In about four months on the 31st of October 2019 the Commissioners are required to provide an interim report with a final report in about six months or by 30 April 2020. This whole process by the Royal Commission is an opportunity that may be once in a lifetime for real Aged Care Reform.
Quality and safety are not the only problems that the aged care industry faces. For example, there is the problem of government departments that operate as silos. The NDIS and Aged Care share many common beneficiaries, yet they operate separately. Already there are many elderly people who become disabled and cannot get into the NDIS, leaving them without funding for their disabilities. Yet, a disabled person who becomes old can continue benefiting from the NDIS and gets funding from My Aged Care. Also, elderly people have to deal with two or three government departments to get the services that they want. While getting funding for aged care from the Department of Health’s Aged Care Program, they still have to go to other government departments for their housing and other support that they need. So, the question remains, why do we have a group of disadvantaged elderly people who have fallen through the cracks? Why don’t we integrate some of the government programs? At least we could integrate the NDIS and Aged Care to make sure that all elderly people are taken care of.
Government should also merge some of its government departments that serve the same people. At the end of May 2019, the Prime Minister, Scott Morrison announced the formation of Services Australia, a centralised government service agency, that will replace the Department of Human Services. Services Australia will oversee “design, development, delivery, co-ordination and monitoring of government services, social security, child support, students, families, aged care and health programs.” One can only wonder whether the announcement is the beginning of the move to remove the silo system. If not, it is hoped that it will at least better integrate services and the sharing of information especially as the Australian Digital Health Agency moves full steam ahead. As reported in their news release, record numbers of pharmacies and 90% of general practitioners have signed up to My Health Record in the past year. These are all positive changes.
The question in every person’s mind is, “Will the recommendations of this Royal Commission be better to serve the consumers of government-funded services?” As of now, the government is funding 96% if the Aged Care being delivered. That raises more big questions in people’s minds such as, “If government is funding 96% of aged care, where does private health insurance come in?” “What are very high insurance premiums buying if the government is carrying the lion’s share of the burden?” “Or should the income testing fee cap be increased to allow for more contribution from those in homes that sought for their accommodation deposit not to exceed the $550,000 limit?”
The Royal Commission has no choice but to recommend changes because changes are already taking place in the aged care industry. Whereas, traditionally elderly people had no say in the nature of their care, today they are the ones who drive the aged care market. My Aged Care has given elderly people power and control so they are the ones who hold the purse and decide on who gets their money and for how much. Now aged care providers have to compete to win some of the business. The top organisations in the industry are already strategizing so that they can win the business, survive competition, and even grow. The rest do not seem to be planning for change and they are the ones who might struggle to survive.
The business model for aged care organisations must change as well. Whereas in the past aged care was far removed from healthcare, now it is becoming an integral part of healthcare. It is even amazing that most chronic and complex diseases are found in elderly people, and that most elderly people have at least one chronic disease, yet aged care was not linked to healthcare. Things are shifting and aged care is now the centre of a healthcare system that includes hospitals, general practitioners, aged care providers and healthcare providers. It now drives the other care businesses. It is a huge business opportunity for health care organisations. The business that will survive these changes are the ones that will survive into the future. Not only do they need to change their strategies, but they have to change their business models as well.
There is another change taking place in the aged care industry. More people are choosing to grow old at home with support. Others are persuaded to stay at home because there are not enough facilities that they want to call home. most facilities fail to be a home but just as the name implies it is a Residential Aged Care Facility. The implication is that organisations in the aged care industry must change their business models to include providing care at home and having a bed ready for the consumer when they choose to seek to be placed in a Residential Aged Care Facility. Those who do not move with the times will not survive. As eventually the care model will be fully Consumer Directed Care and the consumer will be the fund holder even for the residential side of aged care.
These changes must be taken into consideration when the Royal Commission makes its recommendations. No matter what setting a person is living in be it their Home, Retirement Living or an Aged care facility they have a right to good quality care and safety which require good care coordination and case management. Although Consumer Directed Care has been a directive, it will become real once the Aged Care Quality Standards are implemented from 1 July 2019. The Aged Care Quality Standards will demand change and accountability in the sector and all organisations will be expected to comply with them. Compliance will mean that the quality and safety levels expected will be in place.
Will Consumer Directed Care make the Royal Commission irrelevant? Not even! As of now, most elderly people do not have the capacity to take control and direct their care either due to mental degeneration or due to lack of knowledge. Most of them cannot tell how much money is available to them at any point of time, so how do they manage it? All their lives, they have been passive and silent recipients of aged care services and health care services, so how can they suddenly become active and bold recipients, to keep up with the shifting paradigm of care? Consumer directed care is a huge change that cannot be implemented in a day and expected to create better results without process management. Essential things such as creative communication, change management, consumer education and provider education have to be part of the change process. These are some of the areas that the Royal Commission must address in the recommendations come 31st October 2019. If they do not address them sufficiently, then Customer Directed Care will remain a pipe dream.
Quality case management and care coordination are also essential if we are going to provide quality aged care in Australia. The role of the case managers is to work with the elderly and their families to determine the old people’s needs, to develop individualised care plans and to implement those plans. They liaise with service providers, medical and allied health professionals and sometimes legal professionals to ensure that each aging person’s needs are met. They share information with everyone who is involved in an individual’s care so that the old person does not need to retell their story over and over again. The Royal Commission must make sure their recommendations include having developing enough quality case managers and care coordinators to look after all the elderly people.
Australians are not expecting yet another set of recommendations that cannot be implemented. There have been many of those in the past two decades. Now we expect recommendations and plans to manage the implementation of those recommendations and penalties for non-compliance. Now here is an elephant in the room: Of what value are all these changes if the problem of staff shortages persists? It has been established that Australia cannot produce enough doctors, nurses, allied health workers and care givers to catch up with the shortages. We have terrible patient-to-staff ratios. And the population of aging Australians is growing at alarming rates! There must therefore be a strategy to increase the number of trained personnel while temporarily bridging the gap with immigrants. Why don’t we look offshore for staffing solutions while changing immigration laws? I have been around the world and visited many countries and I would say one solution is to turn to our neighbour the Philippines which has developed a strategy to train and export its healthcare workforce.
Quality and safety issues have been plaguing Australia for many years and many recommendations for change have been made but hardly implemented. That is one of the problems that have contributed to the sorry state of affairs in aged care. I have no doubt that the Royal Commission into Aged Care Quality and Safety will come up with great recommendations. What I doubt is the ability of Australia to implement them. Quality and safety in the aged care industry is not something that can be implemented in isolation. Quality and safety are the results of a set of changes in different areas such as quality and safety standards, consumer education, service provider education, increased levels of training of relevant staff, including geriatrics in all medical training courses, importing of skills, changes in immigration laws, company business models, company strategies, funding, and many other areas. Therefore, the recommendations of the Royal Commission are expected to be comprehensive because they should touch on all these areas, and more. Only when all the recommended changes are implemented, will we have real quality and safety in aged care as a result. Then we can claim that we have had aged care reform.