Royal commission: All workers should pay to fix crisis-hit system

Income of every working ­Australian should be levied to ­fix ‘neglected’ aged-care system, royal ­commission recommends.

Tony Pagone and Lynelle Briggs concluded the royal commission with two sets of recommendations on key issues. Picture: Arsineh Houspian

The income of every working ­Australian should be levied to ­repair an aged-care system ­“besieged by neglect”, a royal ­commission into the sector has recommended.

The commission called for the system to be overhauled, and two decades of legislation underpinning its operation to be torn up, but was split about how to ensure a universal entitlement to quality and safe care.

A deep split between the ­commissioners — revealed by The Australian on Monday — meant the royal commission established in the wake of shocking allegations of neglect in the sector ­concluded with two sets of recommendations on key issues such as whether the government should continue to fund and run aged care and how it should be paid for.

But the commissioners, Tony Pagone QC and Lynelle Briggs QC, were clear that the current state of aged care could not be ­tolerated.

“The extent of substandard care in the current aged-care system is unacceptable, deeply concerning, and has been known for many years,” Mr Pagone said in his introduction to the report.

 

Ms Briggs agreed, noting that at least one in three people who used either nursing home or in-home care services had experienced substandard care, and up to 18 per cent of aged-care residents had been physically or sexually assaulted.

“People in aged care cannot be confident that they will receive the care that they need, whether it be in relation to their health, social, cultural or emotional needs, or that they will avoid experiencing restrictive practices or abuse,” the final report reads.

“The extent of substandard care in Australia’s aged-care system is inexcusable.”

Scott Morrison said the government would start work immediately on new aged-care legislation and allocate an ­additional $452m to support ­improvements in the sector.

A comprehensive response to the royal commission’s recommendations is expected to be released in the May federal budget.

“The findings of this commission’s work is as shocking as I feared it would be and, frankly, ­expected it to be,” the Prime Minister said. “In this country, we have a needs-based system of healthcare … we don’t have a needs-based system of aged care.

“ No government has done that ever and the result of that is what we read in this report today. That’s why I say that generational change is now required.”

While the commission has proposed a five-year timeframe to ­implement a transformation of how aged care is delivered, government sources indicated concerns that that schedule may be too ambitious. Some interim targets such as clearing the waiting list for home care by the end of the year were deemed too tight given the lack of suitably qualified staff.

Many of the report’s 148 recommendations were common ground between the two commissioners, including on such matters as the increased amount of care to which nursing home residents should be legally entitled.

One recommendation proposes that, from July next year, each resident should have access to at least 200 minutes with a personal care worker — and at least 40 minutes should be with a registered nurse. But on a significant range of matters — including whether the government or an independent commission should regulate and fund the sector, doling out $20bn a year — the pair were at odds.

Mr Pagone favoured the establishment of an aged care commission along similar lines to the agency that runs the National Disability Insurance Scheme.

“The independence of the commission will mean that it can give undivided attention and focus to its task of being an effective system governor of aged care,” Mr Pagone wrote. “The same cannot be said of a department of state subject to ministerial direction … such a body will always face conflicting or competing demands.”

Ms Briggs opted to stick with existing government institutions, including the much criticised Aged Care Quality and Safety Commission, albeit with a commitment to improve them.

Another point of contention was the financing of aged care.

Mr Pagone wants the Productivity Commission to be tasked with developing a “hypothecated levy” for each person to fund their aged care under a user-pays ­approach. He floated various levels for the levy, including a scenario that ran up to 5 per cent for high-income earners.

Ms Briggs proposed a 1 per cent levy on income tax to be pooled into an aged-care improvement fund to support the delivery of safe and quality care.

These differences will make it more difficult for the government to proceed, forcing it to choose ­between the commissioners and their various recommendations.

Aged-care providers have backed the immediate injection of money into the sector and supported many recommendations.

Leading Age Services chief executive Sean Rooney, who represents many providers, said: “We look forward to the new Aged Care Act, based on respect for people’s requirements and a needs-based aged-care system centring on ­individuals. We also welcome higher levels of staffing for older Australians in home and residential care, to provide the care that our elders need.”

The report noted a number of areas requiring urgent attention including food, nutrition and the use of restrictive practices.

The commission said the current legislation, the Aged Care Act put in place under the Howard government in 1997, had been ­motivated by a desire for budget savings rather than service delivery. Decades of cuts had left ­expenditure 22.4 per cent lower than the level it would otherwise have been, Mr Pagone concluded.

Of the government’s commitment of $452m, $92m is allocated to increasing the number of aged-care workers and $32m is earmarked for additional regulatory audits of nursing homes.

Labor leader Anthony Albanese said the government had overseen a system that was “chaotic (and) unsafe” while unions representing care workers said they were sceptical the government would proceed with major reforms. “We have no confidence older Australians and frontline aged-care workers will ever see the benefits of the vaunted reforms and promised funding,” said ­United Workers Union aged-care ­director Carolyn Smith.