With Australia's population ageing, demand for aged care services will increase. This will require not only adequate facilities but a skilled and committed workforce. The aged care workforce is facing significant challenges: the lack of pay parity along with the requirements for paperwork means that nursing staff and personal carers are difficult to recruit and retain; the decrease in the number of nurses employed in the residential aged care sector can lead to inappropriate skills mix, increased stress and potentially a decrease in the quality of care; expansion of the community care sector has lead to increasing demands for skilled workers; and poor pay for personal carers make it difficult to employ staff. There are fewer GPs providing services in residential aged care facilities as well as a lack of specialist geriatricians in residential services. These issues are exacerbated by the current general shortage of nurses and medical practitioners.

The problems within the aged care workforce are not new. While the Commonwealth and States and Territories have instituted a number of initiatives to address the nursing shortage, the Committee considers that more needs to be done, in particular, to increase the number of undergraduate nursing places and to assist additional enrolled nurses to complete medication management training. The scope of the new National Aged Care Workforce Strategy needs to be expanded to address the workforce needs of the whole aged care sector and mechanisms to address wage parity for nurses and personal care workers require further consideration.

The Aged Care Standards and Accreditation Agency plays an important role in assessing and monitoring the care, health and safety of residents in aged care facilities. While the standards of care in aged care facilities are generally adequate, the Agency needs to improve the monitoring of standards in homes especially through increased use of unannounced 'spot checks' of facilities. The Committee considers that the quality of care could be improved through the development of a benchmark of care which ensures that the level and skills mix of staffing in facilities is sufficient to deliver the care required and a review of the Accreditation Standards to define in more precise terms the 'outcomes' in providing care to the elderly. The Committee made recommendations towards improving the Complaints Resolution Scheme so that the Scheme is more accessible and responsive to complainants. The issue of excessive documentation and the need to reduce the administrative and paperwork burden on staff to enable them to concentrate on their primary task of delivering care and meeting residents' needs was also addressed.

There are currently over 6000 people aged under 65 residing in aged care facilities in Australia and many more young people are at risk of being placed in aged care facilities. An aged care facility is an unacceptable accommodation option in most instances for a young person: they do not support the social and emotional needs of young people; there is a lack of privacy and the lifestyle is highly regimented; in some instances staff are not adequately trained to provide the complex care needs of young people; and there is a lack of services including rehabilitation.

The Committee considers that young people should be moved out of aged care facilities and into more appropriate accommodation. Differing models of care were raised with the Committee ranging from small cluster accommodation, to group homes, to support of the individual at home. The Committee had the opportunity to visit supported accommodation homes in Melbourne and Perth. The Committee considers that there is no one model of care suitable for every case but rather endorses an individual approach as each person will have different needs. Indeed, it may be appropriate for some young people to remain in an aged care facility and for access to services to be improved.

The Council of Australian Governments is to address the issue of young people in aged care facilities with Senior Officials to report on this matter by December 2005. The Committee considers that this is an important first step and has recommended that the Senior Officials clarify the roles and responsibilites of all jursidictions in relation to young people in aged care facilities so as to ensure that age-appropriate accommodation options are made available; and funding is available for the provision of adequate services to those transferring out of aged care facilities.

The Committee has also recommended in relation to the Innovative Pool that the Commonwealth and State and Territory Governments work cooperatively to ensure that any barriers to accessing funds available under the Innovative Pool are removed so that the desired objective of moving young people out of residential aged care facilities into more appropriate accommodation is met.

The Committee has also made recommendations for the funding of the care of the frail elderly with special needs such as dementia and mental illness and as a result of long-term disability and homelessness.

Community care programs make a significant contribution in enabling older people to successfully live at home or in the community. While current programs provide valuable services to older people, significant reform is required to achieve a system that better responds to the needs of consumers, care workers and service providers. The current system is not providing adequate levels of service; services are fragmented; and there is a complex mix of services that are often difficult to access.

The Committee has made recommendations for increased funding for community care programs and for improved provision of services for special needs groups. The Committee also called for improved recognition of the role of carers in the informal care system – carers who form the 'backbone' of the community care system.

Care arrangements for the transition of the elderly from acute hospital settings to aged care settings or back to the community should ideally provide for a seamless continuum of care between the health and aged care sectors. The Committee found that while a number of initiatives have been undertaken at the Commonwealth and State levels towards improving current arrangements, there is a need for a more coordinated approach between different levels of government and an urgent need to address a system that remains fragmented and ill-equipped to meet the particular care needs of the elderly. Recommendations are made to improve coordination between governments in the development and implementation of transitional care programs and to improve discharge planning from acute hospital settings and geriatric assessment.

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