Access to telehealth services needs to be expanded across Australia to support the increasing number of elderly people choosing to age in their own home, the Royal Commission into Aged Care Quality and Safety is recommending.
The Commission’s Final Report, which was released publicly last week, has highlighted the importance of telehealth as a “means of avoiding the potential harm and distress for frail older people caused by travel to receive medical care”.
It is recommending changes to improve accessibility to telehealth be introduced by as early as 1 November 2021.
The report outlines how the telehealth rebates that were introduced as a temporary measure by the Federal Government at the start of the COVID-19 pandemic in 2020, are currently only available to people living in residential aged care. The telehealth rebates are not available to older people who access aged care from their homes, unless they live in remote Australia or access an Aboriginal Medical Service.
The report recommends:
- the Australian government expands access to Medicare Benefits Schedule-funded specialist telehealth services to older people receiving personal care at home, and
- there should be a requirement that aged care providers delivering residential care or personal care at home, have the necessary equipment and clinically and culturally capable staff to support telehealth services.
The report also recommends that aged care providers be required to use a digital care management system, and the My Health Record System by July next year.
Greater support for care at home
The Final Report, titled Care, Dignity and Respect, has revealed a systemically flawed aged care sector that provides poor quality and substandard care.
Since October 2018, the Royal Commissioners, Tony Pagone QC and Lynelle Briggs AO, have considered more than 10,500 public submissions.
They have made 148 wide-ranging recommendations including a new Aged Care Act that puts older people first, enshrining their rights and providing universal entitlement for high quality and safe care based on assessed need.
Care at home has also emerged as an important focus, as has increased support for the development of ‘small household’ models of accommodation.
“A constant theme we have heard throughout our inquiry is that people want to remain at home. For older people to remain safely in their homes, they must have access to aged care that meets their assessed needs. We recommend a category of care at home.
“The care at home category should support older people living at home to preserve and restore capacity for independent and dignified living and prevent inappropriate admission to long-term residential care. Based on assessed need, it should provide an entitlement to care at home with a personalised budget which allows for a coordinated and integrated range of care and supports.
“These could include: care management; living supports (for example, cleaning, preparation of meals, shopping, gardening, and home maintenance); personal, clinical, enabling and therapeutic care; and palliative and end-of-life care.
“There should be a lead provider, chosen by the older person, who would be responsible for ensuring that services are delivered and for adjusting the care to meet the older person’s changing needs.”
The report also says care at home needs to include access to allied health care; while unacceptable wait times for Home Care Packages – which can take up to 34 months for a Level 4 high-care package – need to be cleared immediately by increasing the number of packages available.
Extent of substandard care
According to the report, “those who run the aged care system do not seem to know about the nature and extent of substandard care and have made limited attempts to find out. There has been a reluctance to measure quality”.
- On average, government-run residential aged care providers perform better than both not-for-profit care providers and in particular, for-profit care providers.
- Small residential care services (less than 30 beds) also tend to outperform larger services in terms of quality.
- Studies have revealed that as many as 68% of people receiving residential aged care are malnourished or at risk of malnutrition.
- The incidence of assaults may be as high as 13-18% in residential aged care.
- There is clear overuse of physical and chemical restraint in residential aged care.
- In residential aged care, some 47% of people have concerns about staff, including understaffing, unanswered call bells, high rates of staff turnover, and agency staff not knowing the residents and their needs.
- In home care, one-third of people have concerns about staff, including continuity of staff and staff not being adequately trained.
- In respite care in residential facilities and in the Commonwealth Home Support Programme, about 30% of people have concerns about staff, including understaffing, continuity, training, and communication.
- Substandard care has become normalised in some parts of the aged care system, such that people have low expectations of the quality of their care.
- The extent of substandard care in Australia’s aged care system reflects both poor quality on the part of some aged care providers and fundamental systemic flaws with the way the Australian aged care system is designed and governed. People receiving aged care deserve better. The Australian community is entitled to expect better.