“It’s not easy growing old. We avoid thinking and talking about it.” That’s how the interim report from the Royal Commission into aged care starts. Since it was released in October 2019, we’ve been hearing a lot about the sector, especially as its been significantly affected by COVID-19. In this episode of Squiz Shortcuts, we look at how the sector is set up, who’s responsible for it, and the massive challenges it faces.

How does the aged care system work in Australia?

Aged care is just one part of our health system. Navigating the health system in it’ entirely and working out who’s responsible for what can be a bit complicated, but in the case of aged care, it’s fairly straight forward. The aged care system caters for Australians aged 65 and over – and Indigenous Australians aged 50 and over – who can no longer live without support in their own home.

How is it funded?

The Federal Government is the primary funder and regulator of the system – they provide about 95% of the funding. Total government expenditure on aged care services was $21.6 billion in 2019-20.

What are the different types of aged care?

Care is provided in people’s homes, and in residential aged care facilities – nursing homes – or a combination of both. And that’s because people, their care requirements, and their personal situations are many and varied. And so the system looks to facilitate those situations. The latest numbers after from 2018, and at that time, more than 1.3 million Australians received some form of aged care.

When we talk about aged care, most of us might think of nursing homes, but the biggest part of the sector is home care. There’s about 250,000 people in permanent residential care. When it comes to home care, there’s varying degrees of assistance – some people just need help a couple of times a week and others need quite a bit of help every day, but there’s more than 800,000 older Australians accessing home care programs.

Who provides aged care?

There are not-for-profit, for-profit and government providers of services across both the home and residential care models.

Why is aged care becoming more of an important issue?

Aged care is a growing need in Australia, as like most developed countries, we have an ageing population due to to a decreasing birth rate and increasing life expectancy. The proportion of the population aged 65 years and over increased from 12.3% to 15.9% between 2009 and 2019, and that’s going to continue to increase in the coming years. That’s going to see aged care become more and more important. So there are more people going into a system that’s already under a lot of pressure.

What issues have been identified in the aged care system?

Over the last couple of decades there have been a number of flashpoints that put a spotlight on the care being provided for older Australians, but let’s zero in on the recent round. It really started in South Australia a few years ago. Systemic abuse in Adelaide’s Oakden aged care facility saw it close in 2017. Then Melbourne’s Allambee Nursing Home was likened to Guantanamo Bay, and an aged care worker was convicted for assaulting an elderly man at a facility on Sydney’s northern beaches in 2018. That saw a newly installed PM Scott Morrison announce the establishment of a Royal Commission into Aged Care Quality and Safety in September 2018.

What has the Royal Commission found so far?

In October 2019, the Royal Commission released an interim report that made for sobering reading. That report said it’s estimated that 22–50% of people in residential aged care are malnourished, that there was evidence of the widespread use of chemical restraints – that is residents are being drugged to keep them placid and easier to manage, and in 2017-18, there were more than 4,000 notifications of alleged or suspected physical and sexual assaults. Those are just three of many terrible pieces of evidence the Royal Commission had heard.

Commissioners also found that the aged care system isn’t successfully dealing with those issues and that residents and their families often feel frustrated and hopeless by the system. That’s if a complaint is made at all with some saying they were fearful of speaking up because they were worried their care will become worse. That speaks to a big observation of the system in those hearings – and that is the aged care system lacks transparency.

Witnesses from the Federal Department of Health told the Royal Commission that there is very little information available to the public about the performance of service providers. And that lack of reporting and transparency has been shown to be a major issue during this coronavirus crisis.

How has COVID-19 affected people living in aged care facilities?

Nursing home outbreaks and deaths have been a feature of the COVID-19 pandemic in many countries. There have been large numbers of deaths of care home residents in countries such as Belgium, Canada, France, Germany, Spain, the United Kingdom and the United States.

Australia hasn’t seen anywhere near the same number of cases or deaths as in many of those nations. But when you get into the number of what we have seen, about 7.5% of the cases have been from people living in residential aged care facilities, and they account for 65% of people who have died in Australia from coronavirus since the start of the pandemic.

Where were these cases?

Most of those cases and deaths have occurred in Victoria during the second wave. But the first big outbreak in aged care happened in Sydney at Newmarch House in Kingswood and Dorothy Henderson Lodge in Macquarie Park. Newmarch House was particularly bad – there were 71 cases leading to 17 deaths. The Federal Government established a review to look into what went wrong, it said to learn the lessons for future outbreaks. What the review found was there was conflict over the management of the outbreak and confusion over the policy – and that increased the dangers for aged care residents and staff.

Why is coronavirus spreading in nursing homes?

There’s a lot of confusion over who is responsible for responding to the COVID-19 crisis. While the federal government is responsible for funding and regulating aged care. But the states are responsible for operational public health responses. And it’s those roles and the lack of definition about what the means that saw things fall through the cracks – not just at Newmarch House, but in many nursing homes in Victoria.

There have also been problems with staffing. Many aged care worked became sick or had to isolate after COVID-19 outbreaks, and that had a big impact on residents. There are many examples of a nursing home’s staff being out of action for weeks. That’s let to problems with residents getting food, having showers, receiving medical care. The federal government has had to source rapid response teams to go into those homes. And in Victoria, it cancelled elective surgery in hospitals to redeploy staff to homes.

Infection control and homes’ access to personal protective equipment have been identified as big problems. And the biggest point that continues to come up is whether the Federal Government had a plan to deal with COVID-19 in aged care.

That came up when the Royal Commission had a week of hearings probing the handling of the coronavirus in nursing homes. Counsel assisting the commission, Peter Rozen QC, said “neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector.” That’s a claim denied by the Morrison Government, but it certainly has been ceased on by Labor and aged care advocates.

Another report generated by the Royal Commission says a lot of the problems in the system come down a lack of funding. The system needs a $621 million/year boost to get all Australian aged care homes to meet basic standards. And for $3.2 billion a year, the sector could be brought up to a high-quality standard, the report says. The Royal Commission’s final report is due to be handed down by 26 February next year.

Squiz Recommends:

Aged Care Royal Commission Interim Report

‘Pearls of Wisdom’