” Older Aboriginal and Torres Strait Islander people are being let down by the aged care system.
They are significantly underrepresented in residential aged care services, at under one per cent, and their uptake of dementia services is very poor.
Yet older Aboriginal and Torres Strait Islander peoples experience at least 2.3 times the burden of disease as other Australians and are also 3-5 times more likely to experience dementia.i
It is a sad indictment of the system that the care needs of our ageing First Peoples are not being met.
The needs of older Aboriginal and Torres Strait Islander peoples require urgent attention by the Australian Government and the health and aged care systems.
NACCHO Submission to the Royal Commission into Aged Care Quality and Safety 30 September
Download the full NACCHO Submission HERE
” The Royal Commission, we know, has been extended to 2020, November 2020.
And they’re having to encounter and deal with an enormous number of submissions, of stories that we see making the front pages of our papers and the headlines on our evening news day after day after day.
They’re stories of neglect, they’re stories of lack of care, of stories of lack of access at the appropriate and necessary time of their life.
The Aged Care Commission will deliver its findings in November 2020 and they need that additional time – it’s just been announced that their findings will be delayed another six months, because they’ve got to deal with all the necessary work and all the submissions they’re receiving.
But the message I want to leave with you today is that we can’t wait for the findings of the Royal Commission to start investing in aged care. “
AMA President, Dr Tony Bartone, and ANMF President, Annie Butler, Doorstop, Parliament House, Monday, 30 September 2019 Pictured above :
” Aboriginal and Torres Strait Islander people living in regional, rural and remote Australia experience particular challenges in accessing culturally and linguistically appropriate aged care services and supports.
Ongoing investment into programs such as the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) is essential in supporting the growth and development of aged care services for Indigenous Australians. ”
AMA Recommendation 40 of 42 see in full Part 2 below or Download
As the Commissioners will be aware, the population of First Peoples aged 65 and over is projected to grow by 200 per cent between 2011 -2031.ii
This unprecedented population growth combined with the complex health issues that our people experience as they age presents major challenges for providers of both aged care and primary health care to respond to increased service needs from Aboriginal and Torres Strait Islander elders.
We believe it is imperative that the Australian Government commits to resourcing more innovative, efficient and effective solutions that address the barriers to accessing aged care solutions for older Aboriginal and Torres Strait Islander peoples.
NACCHO welcomes the opportunity to provide this submission to the Royal Commission into Aged Care Quality and Safety.
We wish to acknowledge the comprehensive nature of this inquiry, including the different ways in which members of the public, aged care providers and other interested agencies have been invited to contribute.
The Royal Commission hearings have provided ample evidence of the key components and conditions that make up best practice aged care for older Aboriginal and Torres Strait Islander peoples.
They have also provided evidence of systemic failures to provide culturally safe, accessible care. It is also evident from the hearings, however, that there is a genuine interest among all participants to better understand the needs of older Aboriginal and Torres Strait Islander people in order to inform recommendations on how to improve their health and aged care outcomes.
NACCHO’s vision is that all Aboriginal and Torres Strait Islander peoples be able to enjoy quality of life through whole-of-community self-determination and individual spiritual, cultural, physical, social and emotional well-being.
To enable this vision, our people must be granted agency in the development and implementation of policies and programs that impact on their lives, as enshrined in the Aboriginal and Torres Strait Islander Act 2005 (Cth) and the UN Declaration on the Rights of Indigenous Peoples 2007.iii
We believe the next step forward in addressing the needs of older Aboriginal and Torres Strait Islander peoples as outlined in this submission, is a genuine commitment from the Australian Government to work in partnership with Aboriginal and Torres Strait Islander peoples and their representatives to develop solutions and oversee their implementation in services on the ground.
This submission addresses the Royal Commission’s Terms of Reference in relation to the criteria of:
- Person-centred aged care;
- Challenges and opportunities for delivering accessible, affordable and high quality aged care services; and
- How best to deliver aged care services in a sustainable way, including through innovative models of care and investment in the aged care
NACCHO’s response to the Terms of Reference includes feedback received from our member services, Aboriginal Community Controlled Health Organisations (ACCHOs), who deliver a range of services in urban, rural and remote communities across Australia.
NACCHO Concluding comments and recommendations
It is imperative that, given the population projections of older Aboriginal and Torres Strait Islander peoples, the burden of disease they carry, and their underrepresentation in the aged care system, that their needs and preferences are given urgent priority.
NACCHO believes the next step forward is for the Australian Government and providers to deliver on what works, in genuine consultation with Aboriginal and Torres Strait Islander peoples and their representatives.
Aboriginal and Torres Strait Islander peoples need to be decision makers on what a culturally safe aged care system looks like.
NACCHO is strongly committed to and interested in being part of the solutions to address the care needs of our people and is confident that, with adequate resourcing, the Aboriginal community controlled health sector has the knowledge and experience to make a positive difference to older First Peoples’ health and aged care outcomes.
The following list of recommendations are based on our consultations with Aboriginal and Torres Strait Islander representatives, including our member services.
NACCHO recommends that:
- Cultural safety be embedded across all areas of aged care services, compliant with what is outlined in the Aged Care Diversity Framework and Action xxxvi
- Cultural safety be a mandatory part of accreditation
- As part of their accreditation requirements, mainstream aged care services commit to work collaboratively with local ACCHOs, including seeking their advice on issues relating to cultural safety and trauma-informed
- Aboriginal community controlled organisations be funded to deliver regular cultural competency training, tailored to local protocol, to mainstream aged care
- Regular cultural safety training be mandatory for all aged care assessors and call centre staff.
- There must be a concerted effort to increase the numbers of Aboriginal and Torres Strait Islander peoples who receive higher levels of package care (levels 3 and 4).
- That the Australian Government commit to undertaking feasibility studies on the need for additional residential aged care services in remote and very remote locations in close consultation with Aboriginal local communities, including exploring options for:
- additional National Aboriginal and Torres Strait Islander Flexible Aged Care Services; and
- establishing Aboriginal and Torres Strait Islander specific, community-based, small scale hostels with formal ties to local ACCHOs and/or residential aged care services.
- Funding for interpreters be available for Aboriginal and Torres Strait Islander language speakers as it is for other
- Aboriginal and Torres Strait Islander run aged care services become eligible to access block
- Aboriginal Community Controlled Health Organisations receive an increase in their baseline funding in recognition of:
- the vital roles they play in keeping older Aboriginal and Torres Strait Islander peoples healthy and well in community and residential aged care settings;
- the projected population growth of this age group; and
- the significant burden of disease and complex health conditions experienced by older Aboriginal and Torres Strait Islander
- ACCHOs are designated as preferred providers of aged care navigation services for older Aboriginal and Torres Strait Islander peoples, through the aged care application and assessment
- ACCHOs are designated as preferred providers of primary health care for all Aboriginal and Torres Strait Islander residents of aged care
- The Australian Government increase its investment in integrated primary health and aged care exemplified by
- The Australian Government, at a minimum, reinstate aged care workforce funding to the same level prior to the 2015
- Aged care services are funded to employ Aboriginal liaison
PART 2 The AMA makes the following recommendations to the Royal Commission and looks forward to further working with the Royal Commission and the Australian Government to further improve the aged and health care systems.
Aged care workforce
Recommendation 1: Retaining and increasing the number of doctors interested in working in the aged care space should be the focus of any future reforms in aged care if appropriate clinical care is to be provided. Investing in primary care particularly for patients in aged care settings will save on public hospital expenditures.
Recommendation 2: Further investigation and research is needed into the demographics and movements of GPs in the aged care sector due to the decreasing trend in GP aged care visits and an ageing medical workforce. The research needs to take into consideration the forward-looking trends of expenditures related to Australia’s ageing population and the projected need for the medical workforce.
Recommendation 3: Medicare rebates need to increase in excess of 50 per cent to begin to adequately compensate for the additional time and complexity involved in comparison to a GP attendance in their own consulting rooms.
Recommendation 4: Introduce an MBS telehealth item for phone calls between the GP, RACF staff and relatives. This may reduce some barriers to accessing medical services after hours. The Government should consider introducing telehealth for RACFs for afterhours consultations as a pilot. Outcomes of such a pilot program will help inform government policy and provide an evidence base for informed decision making.
Recommendation 5: The Royal Commission should investigate the absence of routine roles for geriatricians and psychogeriatricians and how this should be addressed to better support GPs.
Recommendation 6: Further research is needed into improved funding and workforce models for medical care of older people.
Recommendation 7: Aged care providers need to provide basic equipment and facilities to support doctors to carry out their services in aged care settings. This includes access to a consulting room, a computer and appropriate clinical software.
Recommendation 8: Education and training for Doctors in Training and medical students on caring for older people should be increased.
Recommendation 9: Registered nurses should be available on site, 24 hours a day in RACFs to ensure older peoples’ medical needs are adequately met, including the appropriate administration of medicines.
Recommendation 10: There should be a mandatory minimum qualification for personal care attendants that includes basic health care.
Recommendation 11: Government should provide additional funding for specialised training of the aged care workforce, primarily personal care attendants. This should include a professional development leave option for those wanting to further develop their skills.
Recommendation 12: Implement a streamlined process to improve access to respite care for people who have not yet been assessed by an ACAT/RAS or who have not yet entered the aged care system.
Recommendation 13: Minimum mandatory staff-resident ratios should be researched and then introduced in RACFs that reflect the level of care need of older people and ensure 24 hour on site registered nurse availability.
Recommendation 14: The Aged Care Safety and Quality Commission should investigate staff turnover when assessing and auditing aged care providers.
Recommendation 15: The effectiveness of the aged care assessment process should be improve by including the patient’s usual doctor in the assessment arrangements.
Fragmentation between health and aged care systems
Recommendation 16: Communication between doctors, hospitals and aged care providers must be improved through minimum standards and guidelines.
Recommendation 17: Government must make more home care packages available to older people to address their care needs and to prevent the need for more complex care in RACFs and hospitals.
Aged care regulation
Recommendation 18: More specific Aged Care Quality Standards, including a Medical Access Standard should be developed for RACFs that helps to facilitate access to doctor services and high-quality clinical care.
Recommendation 19: Quality Indicator data should be made an integral part of the accreditation/audit reports conducted by the Aged Care Quality and Safety Commission.
Quality of care in aged care settings
Recommendation 20: Palliative care must be built into any aged care model, by defining the skills and staff requirements and recognising that palliative management is a basic RACF service. The funding model must be flexible enough to account for increased needs at the end of life and be responsive enough to allow for reassessment when required.
Recommendation 21: AMA members support mandating the requirement that all RACFs residents should have a current up to date ACD. AMA members also contend that there should be an MBS item/fee available for GPs to complete ACDs with their patients living in RACFs or their SDMs.
Recommendation 22: Further work is needed to raise awareness among aged care service providers on advance care planning, the role of aged care providers in ensuring the development and implementation of advance care plans, directives and communication around hospital transfers and the person’s usual GP, the need for caring staff to be aware of existence of ACDs, My Health Record and advance care planning, as well as the role of ACDs in clinical care.
Recommendation 23: Expand the Better Access to Mental Health Initiative to ensure older people living in RACFs receive the same access to mental health services as the rest of the population.
Recommendation 24: Improve dementia management and behavioural training for nursing and personal care staff attendants to reduce prescription of antipsychotic medication.
Recommendation 25: Doctors must be able to maintain clinical independence in order to make the best treatment recommendations for patients, based on current evidence, preserving their own clinical judgments regarding treatment recommendations.
Recommendation 26: Medication reviews should occur annually, and when there is a significant change in an older person’s medication and/or medical condition.
Recommendation 27: A National strategy on polypharmacy should be developed, along with evidence-based guidelines for prescribing to the elderly. Having a strategy and guidelines may reduce adverse events, hospitalisation and PBS costs.
Recommendation 28: Develop and implement national nutrition standards for aged care facilities, ensuring menus are varied and food is appealing and palatable.
Recommendation 29: Continuing education on elder abuse and neglect of the profession, including doctors, nursing aged care staff and personal care staff is essential to evaluate and mitigate medical and psychiatric consequences for the victims.
Recommendation 30: Introduce relevant safeguards for whistle-blowers in aged care, along with regulation for urgent mandatory investigations into their revelations.
Recommendation 31: Older people should maintain the choice of their preferred medical practitioner in residential care.
Recommendation 32: Simplify the aged care navigation process and ensure access to more information on aged care provider performance against the Aged Care Quality Standards.
The use of technology in aged care
Recommendation 33: Greater transparency for GPs and patients to be able view the progress of aged care assessments. This will provide GPs with confidence that their patients are being provided with the necessary care in a reasonable timeframe, as well as enable GPs to take action if this is not occurring.
Recommendation 34: More investment in innovation, digital technologies and telehealth in aged care.
Recommendation 35: Use of digital technologies in aged care in the future should be planned now by the Government and in coordination with relevant stakeholders.
Aged care in regional, rural, and remote Australia
Recommendation 36: Government needs to develop comprehensive plans to better support the provision of health and aged care in regional, rural, and remote Australia, and to commit to significant funding increases to bridge the gap between city and country.
Recommendation 37: Multi-purpose model of services for rural and remote communities should be further supported by the Government, particularly with the implementation of new Aged Care Quality Standards and accreditation under those standards for multi-purpose providers.
Young people living in residential aged care facilities
Recommendation 38: Options other than residential aged care facilities should be explored and implemented by the Government for younger people with disabilities who are currently serviced by residential aged care facilities.
Recommendation 39: Better coordination between disability and aged care systems is required to enable seamless transition between different services for people living with disability. Coordination with primary care in the process is crucial as well as other service sectors including allied health.
Aged care for special needs groups
Recommendation 40: The AMA calls for more research into health and aged care needs of special needs groups, including but not limited to CALD, ATSI and LGBTQI. These groups have particular needs around culturally appropriate and culturally safe services, which should be further documented and enable equity in accessing services and service provision.
The need for research on the care of older people
Recommendation 41: More research into care of older people in the future, including appropriate aged care and health care data collection to inform future policy and regulation.
Recommendation 42: Conduct a scientific evaluation of the impact of government policies on the wellbeing of older Australians. This will lead to proper policy adjustments and revisions as needed.
There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.
The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.
To help you prepare your answers, you can look at a full copy here
The survey is open to everyone and can be accessed here: