It was billed as the “opportunity of a lifetime”.And as senior counsel assisting said in the final hearings of the Aged Care Quality and Safety Royal Commission last week, it is “the most in-depth and thorough examination of Australia’s aged care systems that has ever been undertaken”.The QCs have presented more than 120 recommendations detailing massive reform, including a new Aged Care Act; a star rating system allowing families to compare nursing homes for quality and safety that would also show any reports of abuse and neglect; and new staffing requirements with more nurses and specialist care for dementia and palliative patients.Of course, none of these recommendations are guaranteed to be taken up by commissioners Tony Pagone and Lynelle Briggs for their final report.But the reforms include many of the issues the ABC has also investigated over the past two-and-a-half years, from the time we launched our crowdsourced investigation in April 2018 asking families, staff and insiders to share their experiences with us.The surprise announcement of the aged care royal commission was made by Prime Minister Scott Morrison the day before Four Corners aired the first of our two-part series using the collected stories.Today, we take a look back at some of those disturbing stories and consider what could change if the reforms being proposed go aheadNeglect: Hidden camera showed what it really looked likeSpace to play or pause, M to mute, left and right arrows to seek, up and down arrows for volume.Luigi Cantali’s daughter hid a camera in his Sydney nursing home”Neglect” is the title of the royal commission’s interim report released late last year because the inquiry found it was the common factor in the majority of its 10,000 submissions to the inquiry.It is difficult to see neglect in action, but that’s exactly what happened when one family gave us two weeks of hidden camera footage showing life at Sydney nursing home Carino Care for 80-year-old Luigi Cantali — a blind Italian man with mild dementia.We watched three days in his life, revealing how he was left in his chair or bed all day wearing soiled incontinence pads and clothes; how he went hungry when his meal was left out of reach and the hours left alone because staff members rarely came to assist him.The day after our story aired, the regulator, the Aged Care Quality and Safety Commission, found the home failed more than half the required standards, saying there were not enough skilled staff and recording that residents had “died in pain and distress”.A lack of staffing ratios and not enough trained staff are two of the consistent themes running through all the royal commission hearings.That is because there are no staff-to-resident ratios, no requirement for a registered nurse to be on duty, and no standard minimum training for carers who are unregulated.But that could all change if counsel assisting’s recommendations are accepted by the commissioners.Staff-to-resident ratios haven’t been proposed, however, the suggested solution is a mix of more qualified staff including registered nurses, enrolled nurse and personal care workers with proper qualifications working a mandated number of hours.The hidden camera showed blind man Luigi Cantali’s dinner was left out of reach.(Supplied)They suggested a registered nurse on duty 24/7 with residents receiving more than three hours direct care per day from a mix of staff, better pay for workers, and more accountability from providers who would have to provide quarterly reports on staffing. This recommendation along with a system rating nursing homes on the My Aged Care website would allow families to make better decisions when choosing care.Regarding our story on Luigi — he died six days after the family moved him out of Carino Care.The Quality and Safety Commission hasn’t done a full audit of Carino Care for over a year because of COVID-19.In its last full audit in October 2019, the regulator found it posed a “serious risk” to residents, failing over 40 per cent of standards, with subsequent inspections finding it is still non compliant, yet the nursing home remains fully accredited until the end of this year.Carino Care is owned by parent company Tierra Health, a consultancy firm advising other aged care homes on how to meet quality and safety standards.Sexual assault: 50 assaults per weekDorothy Major was sexually assaulted by a nurse in her room at an aged care facility.(ABC News: Brendan Esposito)Sexual assault in aged care is more common than anyone wants to believe.In April last year, we spoke to brave families who detailed shocking attacks like the resident with a history of sexually abusing residents who was caught on CCTV assaulting a woman with dementia.And the worker who sexually abused an elderly woman but escaped any action because she wasn’t believed.In the final hearings, the royal commission revealed a government-commissioned report that estimated there are 50 sexual assaults per week — the vast majority perpetrated by other residents with dementia and cognitive disabilities.Under current regulations, there is no requirement to report or register those attacks by impaired residents.”This is a national shame,” Mr Rozen told the inquiry.”As disturbing as these figures are, the evidence of the lack of follow-up by the Australian Government department that receives the reports is, if anything, worse.”However, the issue of sexual abuse was a glaring omission at the hearings.No victims or families of victims gave evidence, and the issue was not examined in any detail — something that has angered grassroots aged care advocates and support groups who have been dealing with the fallout for years.However, the counsel assisting has recommended a new “serious incident reporting scheme” that would require nursing homes and home care providers to report all physical and sexual abuse perpetrated by staff as well as residents — including when the allegations involve a perpetrator with dementia.And there could be more transparency, with a proposed new regulator required to publish a record of the assaults every quarter, showing which providers and individual nursing homes have had assaults on their properties.Aged care providers would also have to prove what action they had taken and have those measures approved by the regulator.Dementia care: The hidden camera tells a troubling storySpace to play or pause, M to mute, left and right arrows to seek, up and down arrows for volume.Ernie’s family put a secret camera in his room to find out why his pyjamas were regularly torn.(Supplied)Over half the residents in aged care have dementia — and that’s a conservative estimate.Yet, personal care workers — who do the crucial work of showering, feeding and mobilising the elderly — don’t require any training in the often complex task of helping people who suffer from cognitive decline.For one of our investigations, we were given hidden camera video showing how Ernie Poloni, who suffered with dementia, was treated at Bupa Templestowe in Melbourne.Unable to speak, the 85-year-old couldn’t explain why his pyjamas were ripped and in need of replacing so his family installed a camera in his clock radio and discovered it was due to “rough handling” by carers — a term used to describe rough treatment and incorrect techniques.The camera showed much more than that — carers who looked after the man every day but didn’t speak to him, didn’t warn him when they were moving him, who watched TV and talked to each other as if he wasn’t there.This lack of knowledge in dealing with people with dementia is the reason counsel assisting has proposed compulsory training in dementia care (and palliative care) for every single aged care worker; reviewing training courses to ensure appropriate education on dementia training; and a register for personal care workers (who are currently unregulated), which would mean mistreatment could see them struck off rather than allowed to move between nursing homes.Following our story, lawyers for Bupa viewed all the hidden camera footage and said it “seemed likely” that other residents with dementia were treated in the same way as Mr Poloni and undertook to retrain staff in “person centred care”.Ultimately, Bupa concluded that the care was adequate “but could have been undertaken in a better fashion” and did not see any need to report staff to the regulator.The Quality and Safety Commission has not done a full audit at Templestowe since August 2019.Chemical and physical restraint: Dad ‘never came back 100 per cent’Terry Reeves on his first day in the home and seven weeks later.(Supplied)The overuse of physical and chemical restraints has been described as a human rights abuse with the Australian Law Reform Commission making recommendations to stop it six years ago — reforms that were ignored by Government.In January 2019, the issue came up again after we broadcast video footage of Terry Reeves, a man with dementia who was regularly tied to his chair with a lap belt — sometimes for a total of 14 hours a day — and heavily sedated with the anti-psychotic Risperidone.His daughter Michelle McCulla gave evidence at the royal commission of other residents with dementia who were kept in a small room, strapped to their chairs like her father.At the time, Garden View nursing home had a 100 per cent score from the regulator, the Quality and Safety Commission, but when it visited after our story, the nursing home failed over 75 per cent of standards.The story was so shocking, then-aged care minister Ken Wyatt announced the Government would introduce new regulations on restraint.The royal commission has already found elderly people are subjected to “unjustified clinical and physical restraints”.In its final hearings last week, counsel assisting recommended new, stricter regulations and proposes that GPs no longer prescribe powerful antipsychotics unless a geriatrician or psychiatrist has consulted the resident and approved a prescription.That’s likely because evidence shows GPs are often pressured by staff to prescribe such medication due to low staffing levels and a lack of dementia training.Counsel assisting says civil suits could be laid against providers who breach these rules, which has angered advocates who say criminal charges should be laid instead due to the obstacles and cost of taking civil legal action against big providers.As for our story on Mr Reeves — he died in August with his family saying: “He never came back 100 per cent.”The Quality and Safety Commission found Garden View nursing home met all standards in October last year but has not conducted a full audit since then, with the home accredited until May next year due to the “exceptional circumstances” of COVID-19.Garden View management tells the ABC it currently has no restraints in use.Home care: Endless waiting lists and high feesEvelyn Micallef’s daughter and son-in-law care for her at home.(ABC News)The home care waiting list has more than 100,000 people on it, with people waiting a year or more.With COVID-19 causing indefinite restrictions on visits to nursing homes, home care is the preference for many elderly Australians and their families.For that reason, counsel assisting proposes clearing the waiting list by the end of next year — a reform that will cost many billions of dollars.And they suggest the disparity in funding of home care and residential care should end, with those staying at home given the same maximum amount of funding as if they were in a nursing home, which equates to about $60,000 a year.However, counsel assisting shied away from the thorny issue of uncapped administration fees charged by home care providers, something we investigated last month.Our story showed that the elderly had a large proportion of their home care subsidy taken in fees by home care providers.Instead, counsel assisting is proposing standardised statements showing the monthly amount of money paid out and including fees and charges with consultants to assist in guiding aged Australians.The final report to come in FebruaryMany of the proposed reforms hinge on a new Aged Care Act to replace the one created by John Howard’s government in 1997, which opened aged care up to private enterprise and led to less staff, a deskilled workforce and a regulator that has been more about cutting red tape than investigating mistreatment and protecting the elderly.Crucially, counsel assisting wants a new independent commission as the regulator, removed from any Federal Government influence.It’s this reform that led to the highly unusual and public disagreement between the two commissioners last week, with Lynelle Briggs, a former Public Services Commissioner, labelling the proposal “extraordinary” and arguing in favour of maintaining the current regulator, the Aged Care Quality and Safety Commission, despite overwhelming evidence of its failures especially during the COVID outbreaks.She says the commission could be bolstered to become the “tough cop on the beat” and a “one stop shop” — phrases used by Health Minister Greg Hunt when he announced the establishment of the Quality and Safety Commissioner in 2018.Commissioner Tony Pagone, a former Federal Court judge, directly opposed her, lending support to the new proposal.With no tie breaker on this one, we now have to wait until the final report in February next year to see which of the commissioners wins out and whether the aged care system really will be rebuilt again from the ground up.
The aged care royal commission was billed as the “opportunity of a lifetime”. But, Anne Connolly asks, will it change the outcomes on all the shocking issues we’ve uncovered?