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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