The federal government’s aged care regulator conducted just two unannounced or ‘surprise’ quality and safety checks of home care providers in an entire year, according to new data released as the agency comes under fire for suspending visits of nursing homes during Covid-19.
In figures supplied at the request of the aged care royal commission and tendered in evidence this week, the Aged Care Quality and Safety Commission revealed it has only performed 213 quality reviews or on-site ‘assessment contacts’ of home care providers in the year to 31 July. Fewer than 1 per cent of these were gold standard checks where a provider is given no warning that the regulator will be auditing their standards.
Further, these in-person visits represent little more than 5 per cent of its entire regulatory work in the home care sector in the same year. More than 3660 quality checks by Commissioner Janet Anderson and her team were done over the phone.
The ACQSC notes the “number of quality reviews/audits has been reduced in 2019-20 by the Covid-19 pandemic and the associated restrictions on site visits and reallocation of resources.”
A parliamentary hearing last month was told the regulatory body was given only 13 extra staff to deal with the coronavirus outbreak in Australia. At its beginning, the plan from the regulator involved ringing every residential aged care provider in the nation and asking them to ‘self-assess’ their preparedness for an outbreak.
More than 40 per cent rated their service as ‘best practice’. One of those was Newmarch House in Sydney where 19 residents died between April and May as a result of the viral outbreak.
At least part of the funding crisis in Australia’s aged care system can be traced to the relatively recent introduction of Home Care Packages (HCPs) which are also paid for, and rationed by, the federal government.
Despite a multi-billion dollar funding injection to create 50,000 new home care packages in the last few years, some of that has come at the cost of residential aged care quality. While home support is designed to reduce pressure on nursing homes, numbers are still rising and the frailty of new residents has never been greater.
In 2018, the Coalition combined the home care and residential aged care budget line items and confirmed it was reallocating ‘unused’ nursing home places to free up more slack in the home care system. “It appears the increase in HCPs has been offset by a decrease in the more expensive residential places, which may explain the budget neutrality of the overall measure,” parliamentary library researcher Alex Grove wrote of the 2018-19 budget.
Even with these adjustments, the waiting list of older Australians who have been assessed as eligible for aged care funding in their own homes but who have not been given access to a package is more than 100,000 people long. Thousands have either deteriorated so badly that they have been sent to a nursing home before receiving the allocated support in their home or, in many cases, died before it arrived,
In its interim report in October the Royal Commission said these long wait times have “contributed to unnecessary and premature deaths.” The commonwealth provided only an additional 10,000 home care places following the report at a cost of $500 million but this has not changed the number of people waiting in the queue.
This week, the royal commission heard evidence that even if the government funded the entire wait list right now there would not be enough aged care workers to fill it. “When comparing service hours delivered between a Level 1 and Level 4 home care packages, both personal care and nursing service hours generally need to be doubled to meet a consumer’s assessed care needs,” Australian Unity, a large provider, said in its submission.
Macquarie University professor Gabrielle Meagher told the inquiry in her submission that in home care alone there is “evidence that shows between 2012 and 2016 (the last year for which data are available) the equivalent full-time direct care workforce in home and community care for older people actually shrank, despite growth in the number of Home Care Packages and in total Commonwealth Home Support Programme hours.”
There are critical shortages in residential aged care and in the National Disability Insurance Scheme, both of which compete with each other and parts of the acute health system for workers. Aged care workers are the lowest paid.
Rick Morton is the author of the bestselling One Hundred Years of Dirt. He has been a journalist for 15 years with a particular focus on social policy and national affairs. Rick is the senior reporter for The Saturday Paper.
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