Royal Commission into Aged Care Quality and Safety Final Report: Care, Dignity and Respect Volume 3A The new system Royal Commission into Aged Care Quality and Safety Final Report: Care, Dignity and Respect Volume 3A The new system © Commonwealth of Australia 2021 ISBN: 978-1-921091-69-8 (print) ISBN: 978-1-921091-70-4 (online) With the exception of the Coat of Arms and where otherwise stated, all material presented in this publication is provided under a Creative Commons Attribution 4.0 International licence. For the avoidance of doubt, this means this licence only applies to material as set out in this document. The details of the relevant licence conditions are available on the Creative Commons website as is the full legal code for the CC BY 4.0 licence <www.creativecommons.org/licenses>. The terms under which the Coat of Arms can be used are detailed on the Department of the Prime Minister and Cabinet website <www.pmc.gov.au/government/commonwealth-coat-arms>. Table of Contents Introduction to Volume 3 1 1. Foundations of the New Aged Care System 5 1.1 Introduction 5 1.2 Common themes and desired outcomes 6 1.2.1 Dignity and respect 7 1.2.2 Self-determination 8 1.2.3 Quality of life 10 1.2.4 Relationships 11 1.2.5 Care at home 12 1.2.6 Connection to the community 13 1.3 A new Act and purpose 13 1.3.1 A rights foundation for high quality aged care 16 1.3.2 Rights 17 1.3.3 Principles for the aged care system 20 1.4 Supporting people to age well 23 1.4.1 Integrated long-term support and care 24 1.5 Conclusion 28 1.6 Annexure: Policy principles 28 2. Governance of the New Aged Care System 37 2.1 Introduction 37 2.2 Nature of governance required 39 2.3 Independent Commission model | Commissioner Pagone 41 2.3.1 Overview of model 41 2.3.2 The Australian Aged Care Commission 45 2.3.3 The Australian Aged Care Pricing Authority 54 2.3.4 Responsible Minister, Department, and new National Cabinet 56 Health Reform Committee 2.3.5 Aged Care Advisory Council 57 2.3.6 Conclusion on Independent Commission model 58 2.4 Government Leadership model | Commissioner Briggs 60 2.4.1 Overview of model 60 2.4.2 Minister for Health and Aged Care 64 2.4.3 Department of Health and Aged Care 64 2.4.4 The Council of Elders 71 2.4.5 Aged Care Safety and Quality Authority 72 2.4.6 Conclusion on Government Leadership model 79 2.5 Inspector-General of Aged Care 79 2.5.1 Inspector-General of Aged Care 80 2.6 Conclusion 83 iii Royal Commission into Aged Care Quality and Safety Final Report Volume 3A 3. Quality and Safety 87 3.1 Introduction 87 3.2 Quality levels in the current system 88 3.3 High quality aged care 89 3.3.1 Quality of life 92 3.3.2 The personal touch 96 3.4 Approved providers must have a statutory duty of care 97 to people receiving care 3.5 Areas for immediate improvement 100 3.5.1 Food and nutrition 100 3.5.2 Caring for people living with dementia 104 3.5.3 Eliminating or reducing restrictive practices 108 3.5.4 Palliative care 117 3.6 Aged Care Quality Standards 119 3.6.1 Setting aged care Standards 119 3.6.2 What should happen to the existing Standards? 122 3.7 Measuring aged care quality 125 3.7.1 Quality indicators 126 3.7.2 Star ratings 131 3.8 Conclusion 134 4. Program Design 143 4.1 Introduction 143 4.2 A new aged care program 143 4.2.1 Accessible information 145 4.2.2 A single avenue of assessment 149 4.2.3 Local assistance to gain access to services 152 4.2.4 Recognising diversity and individuality 155 4.2.5 Care management 159 4.3 Aged care service categories 163 4.3.1 Respite supports 165 4.3.2 Social supports 167 4.3.3 Assistive technology and home modifcations 169 4.3.4 Care at home 172 4.3.5 Residential care 176 4.4 Challenges of transition and implementation 183 4.4.1 Interim measures to clear the home care waiting list 183 4.4.2 Transition to care at home 185 4.5 Removal of population-based restrictions on subsidies 187 4.5.1 New planning measures 188 4.6 Existing service arrangements to remain 192 4.7 Conclusion 193 iv Table of Contents 5. Informal Carers and Volunteers 201 5.1 Informal carers 201 5.1.1 Informal carers do not feel supported 204 5.1.2 My Aged Care and Carer Gateway 205 5.1.3 How can support for informal carers be improved? 208 5.2 Volunteers 212 5.2.1 Community Visitors Scheme 213 5.3 Conclusion 216 6. Aged Care Accommodation 221 6.1 Introduction 221 6.2 Residential aged care accommodation for the future 222 6.2.1 Appropriate design 222 6.2.2 National Aged Care Design Principles and Guidelines 225 6.2.3 Small household design 226 6.3 Secure accommodation for changing needs 231 7. Aged Care for Aboriginal and Torres Strait Islander People 237 7.1 Introduction 237 7.2 Population trends 239 7.3 Access to services 241 7.3.1 NATSIFACP 244 7.4 Aboriginal and Torres Strait Islander aged care pathway 245 7.4.1 Embedding cultural safety 248 7.5 Aboriginal and Torres Strait Islander Aged Care Commissioner 251 7.5.1 Interpreters 254 7.5.2 Interface with the National Disability Insurance Scheme 254 7.6 Closing the Gap 255 7.6.1 The Stolen Generations 256 7.7 Priority for Aboriginal and Torres Strait Islander aged care providers 257 7.8 Employment and training 258 7.9 Funding 262 7.10 Conclusion 266 8. Aged Care in Regional, Rural and Remote Areas 271 8.1 Introduction 271 8.2 Planning in regional, rural and remote Australia 272 8.3 Expansion and augmentation of the Multi-Purpose Services Program 275 8.4 Conclusion 280 v Royal Commission into Aged Care Quality and Safety Final Report Volume 3A 9. Better Access to Health Care 283 9.1 Introduction 283 9.2 A new primary health care model 284 9.3 Accreditation of general practices providing primary care 293 to people receiving aged care 9.4 Multidisciplinary outreach services for access to specialists 294 and other health practitioners 9.5 Improved access to Older Persons Mental Health Services 298 9.6 A Senior Dental Benefts Scheme 300 9.7 Medicare Benefts Schedule changes 303 9.7.1 Comprehensive health assessments 304 9.7.2 Better access to Medicare-subsidised mental health services 305 9.7.3 Changes to the General Practitioner Aged Care Access Incentive Payment 309 9.8 Enhanced access to specialists 311 9.8.1 Access in regional, rural and remote areas 311 9.8.2 Access to specialist telehealth services 312 9.9 Better medication management 313 9.9.1 Access to medication management reviews 313 9.9.2 Greater safeguards against inappropriate prescription of antipsychotics 316 9.10 Improving transition between hospital and residential aged care 317 9.10.1 Transfer from hospital to residential aged care 318 9.10.2 Transfer from residential aged care to hospital 319 9.11 Better collection, sharing and analysis of health data for people 319 receiving aged care 9.11.1 Aged care identifer 321 9.11.2 Minimum health dataset 322 9.11.3 Approved providers’ adoption of digital technology interoperable 323 with My Health Record 9.12 Understanding who should deliver health care to people receiving aged care 325 9.12.1 Clarifcation of respective roles and responsibilities 325 9.12.2 Improved access to State and Territory health services by people 327 receiving aged care 9.12.3 Ongoing intergovernmental consideration of health care for people 329 receiving aged care 9.13 Conclusion 330 10. Aged Care for Older People with Disability 341 10.1 Equitable access to support 342 10.2 Reporting on outcomes 347 vi Table of Contents 11. Younger People in Residential Aged Care 351 11.1 Information and accountability 355 11.2 Appropriate assessment to prevent entry into residential aged care 356 11.3 Access to advocacy and improved pathways 358 11.4 Limited exceptions 360 11.5 Transitional accommodation and care 362 11.6 Long-term accommodation and care 364 11.7 Conclusion 367 12. The Aged Care Workforce 371 12.1 Introduction 371 12.2 Strategic leadership and workforce planning 372 12.2.1 Aged care workforce planning 373 12.2.2 Regional, rural and remote 380 12.2.3 Immigration 381 12.2.4 Aged Care Workforce Industry Council Limited 382 12.3 Building an aged care profession 385 12.3.1 Designing the future aged care workforce 385 12.3.2 Turning jobs into careers | Commissioner Briggs 388 12.3.3 Attracting people to aged care | Commissioner Briggs 389 12.3.4 Registration for personal care workers 391 12.3.5 Mandatory minimum qualifcations for personal care workers 398 12.3.6 Profciency in English 401 12.4 Educating and training 402 12.4.1 Review of certifcate-based courses 402 12.4.2 Dementia and palliative care training for workers 405 12.4.3 Improving the skills of the existing workforce 406 12.4.4 Review of health professions’ undergraduate curricula 409 12.4.5 Teaching aged care services 410 12.5 Improving pay for the aged care workforce 414 12.5.1 Applications to the Fair Work Commission 415 12.5.2 Improved remuneration a policy goal for price setter 418 12.6 Getting stafng right—residential care 418 12.6.1 Why stafng levels matter 420 12.6.2 Skills mix 421 12.6.3 The value of a continuous nurse presence 421 12.6.4 International and national benchmarks 422 12.6.5 Exemptions 424 12.7 Getting stafng right—home and community care 424 12.7.1 Supervision and support for home care workers 426 12.7.2 Modes of engagement 427 12.7.3 Implications for quality of care 428 12.7.4 Requirement to employ care workers 430 12.8 Leadership and culture 432 12.8.1 The Government Workforce | Commissioner Pagone 434 12.8.2 The Government Workforce | Commissioner Briggs 434 12.9 Conclusion 437 vii Introduction to Volume 3 In this volume, we set out our vision for the future of aged care in Australia.