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[Editorial] Aged care in Australia falls short

Tags: General

Care for older people in Australia is disgraceful and needs a fundamental overhaul. These are the stark conclusions of an interim report by the Royal Commission into Aged Care Quality and Safety, released on Oct 31. Entitled Neglect, the report describes the failures to meet the needs of older people in a system that ignores the concerns of people receiving care, is rife with substandard care, and relies on an overstrained workforce that is undervalued and often unskilled to provide safe and humane care.

The Commissioners described “a shocking tale of neglect” in an ageist society. Many older people struggle to navigate a complex care-entry process into a depersonalised system that can enable cruelty and abuse. Untreated wounds, poor continence management, malnutrition, assaults, medical sedation without clear consent, and fragmented palliative care for those who are dying characterise a harmful system that is awash with gaps in services and clinical knowledge.

The Commissioners identified three areas for immediate action. First, reduce the waiting time for home care, which can be over a year. During this time people are at risk of declining cognitive and physiological function, preventable hospitalisation, and death. Second, address misconceptions among care staff and doctors regarding the benefit of psychoactive drugs to sedate residents, alongside regular medication reviews. The over-reliance on chemical constraint reduces the responsiveness of residents, isolating them from others. The care workforce needs the skills to appropriately address confrontational or uncooperative behaviour. Third, prevent people younger than 65 years with disabilities entering aged care and expedite helping them to leave.

An inadequate regulatory framework, a lack of transparency, no change despite awareness of the problems for years, and a system not built around the needs of older people, but based on funding mechanisms, have all contributed to the dreadful state described in the report. Australian Prime Minister Scott Morrison's pledge to provide extra aged-care funding is only the first step. Transformation will require a change to a mindset that values older people and gives them a voice to receive the dignity they deserve.

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