In the two years since the announcement of the Royal Commission into Aged Care, a lot has changed. The events of 2020 have overwhelmed health care systems around the world. One of the most significant issues to emerge is the serious systemic failings of Australia’s aged care system. With three-quarters of COVID-19 deaths in Australia accounted for in aged care homes, the system seems not only broken, but in some cases, it has proved to be actively harmful for the very people it intends to care for.
Last week, in the final hearing, Senior Counsel Assisting Peter Gray QC and Peter Rozen QC presented submissions on behalf of the Counsel Assisting team, once again calling for public submissions on the 124 recommendations they made to the Royal Commission.
A third of people over the age of 65 live with chronic pain, a figure that rises to up to 80 per cent for residents of aged care. As noted in our submission to the Royal Commission, the data suggests a high proportion of people with chronic pain also have cognitive or communication impairment and inability to report pain. These recommendations, if and when implemented, will see a tectonic shift in the way aged care is structured, funded and delivered in Australia.
One of the most significant recommendations is the creation of a new Act based on human rights principles for older people. This will be a welcome first step, and will align with our call to ensure access to pain management, which is acknowledged globally as a fundamental human right.
Counsel Assisting have recommended a new and independent process for setting aged care quality standards, which we strongly support. The submission notes that the current Aged Care Quality Standards use subjective language and, in some respects, provide less detail than the standards they replaced. The current standards also lack any specific reference to effective pain management.
As I noted in an earlier blog, without any measurement or monitoring, we may as well be perpetuating failure. The provision of quality pain management is not measured, not rewarded, not even acknowledged. With this kind of system is it any wonder that so many residents are in pain?
We welcome the endorsement for mandatory dementia and palliative care training and recommend that this be expanded to include training in pain management. Inadequate education and training of residential and community aged care staff is largely responsible for the under-reporting of pain in cognitively impaired residents. The Australian Pain Society guidelines, Pain in Residential Aged Care Facilities – Management Strategies, indicates that staff workloads may also be to blame, with a lack of time for adequate pain assessment on a regular basis. These Guidelines should be promoted across aged care as a useful resource that aids best practice pain management.
We particularly support the recommendation that residential aged care should include access to allied health care, which will require approved providers to engage at least one of each of the following:
oral health practitioner
mental health practitioner
music or art therapist.
Recommendations also include providing funding to approved providers for the engagement of allied health professionals through a blended funding model including:
a capped base payment per resident designed to cover about half of the costs of establishing ongoing engagement of allied health professionals
an activity-based payment for each item of direct care provided.
Other significant recommendations include a new enforceable general duty of care on approved providers and a new planning regime for aged care which provides demand-driven access rather than the current rationed approach.
As the Royal Commission Inquiry nears its end, with a final report due early next year, we may finally begin to see resolutions to this most persistent of issues. With over 10,000 public submissions and over 600 witnesses, the task of the Commissioners is certainly not easy.
What is certain is that it will be difficult, if not impossible, to provide quality aged care without addressing the need for systemic change and an increased capacity to respond to the much-ignored issue of pain management.