Submissions to the Royal Commission into Aged Care Quality and Safety

NARI and the Melbourne Ageing Research Collaboration (MARC) have made two new submissions into the Royal Commission into Aged Care Quality and Safety. The comprehensive proposals cover a range of issues including workforce, quality, models of care and funding. The proposals are based on the knowledge, expertise and findings from previous research and practice of MARC and NARI partners.

The submission focusing on CALD Australians – from the perspective of older people and the workforce – highlights the importance of leveraging an increasingly multicultural aged care workforce, exposes the challenges the workforce faces, and suggests that Australia is missing a major opportunity to engage with migrant workers and CALD communities about what good quality care entails.

Currently Indian and Filipino communities are already strongly represented in the aged care workforce but there is increasing representation from those from Iraq and Sudan. Nevertheless, to work in aged care, the minimum qualification is a Certificate III in Individual Support.

“Several education initiatives target migrants to complete the Certificate but often charge high fees, and do not provide adequate training for working with people with dementia in residential and community aged care environments. These oversights matter because more than 50% of people in residential aged care have dementia and migrant care workers have limited experiences of dementia care. Moreover, migrant workers face many challenges in aged care around communication difficulties and prejudicial treatment,” the submission states.

“If we limited our views to this deficit model – which recognises only problems and deficiencies arising from having a CALD aged care workforce and the need for further training to plug these knowledge gaps – then we miss a unique opportunity in Australia to engage with migrant workers and CALD communities about what good quality care entails,” it says.

The submission highlights that many CALD communities have a language of hope and community when it comes to describing care. Words in Hindi such as seva (service); zimmedaaree  (responsibility); vernaculars in Chinese such as Zhào Gù (to shine and watch over someone); and in Arabic, ḥanān (kindness, compassion, and love) are radically different to Western notions of individually-oriented care.

The submission emphasises that migrant care workers are likely to grow as a proportion of the aged care workforce; therefore, harnessing the benefits of a multilingual, multicultural aged care workforce to cater to the needs of older people, including CALD people, starts from a position of strength and builds connections between these vulnerable populations.

Other pointers from a CALD perspective raised in the NARI submission include:

  • the need to overcome language barriers which may lead to delayed diagnoses of conditions and delayed uptake of services;
  • delivering sustainable, culturally appropriate models of care;
  • lower uptake of residential care among CALD groups potentially reflects barriers to access such as lower levels of literacy about health and aged care services, lower English proficiency, a lack of trust in those services, community stigma associated with formal care, and lack of culturally appropriate options;
  • an urgent need for evidence on what kinds of home-based or institution-based models of care can best support the needs of older CALD people and their carers and how knowledge and access to these models can be improved.

The submission concludes that the Royal Commission provides an opportunity to reflect and act on how Australia has cared for its diverse older populations and how it will do so into the future.

“To best deliver aged care services to older Australians (of whom CALD people make up a third), robust research into the diverse care needs of CALD Australians is needed. NARI’s experience in such research indicates that for interventions and delivery to be successful, programs must be co-designed with communities and service providers.”

Melbourne Ageing Research Collaboration submission

MARC’s submission was based on findings from its one day symposium “Redefining Quality in Ageing and Aged Care: Multidisciplinary perspectives.”

The ten findings include a discussion on quality measurement which the submission emphasises is not the same as benchmarking. However, the submission points out that current quality measures have “snuffed out” points of difference and do not encourage innovation as they only allow minor variances. This results in a tendency to congregate around the conservative middle ground.

“Quality measurement should be about fewer surveys and more conversations. Quality measures also need to address diversity and inequalities in income and access. Improving quality outcomes needs ongoing community and generational exchange and debate,” the submission states.

The MARC submission underscores the importance of the need to have more fully scoped economic evaluations which adopt a broad societal perspective to collect costs, including inter-sectoral costs and benefits. 

It also emphasises the need to disentangle quality and risk, and quality and safety. Restrictive practices and heightened risk management concerns can limit quality, and need to be mediated by balancing personal choice and autonomy needs. Freeing up of funding silos to enable innovation and creativity in health care particularly primary care can also foster creativity and new approaches.

Other findings include:

  • quality indicators need to consider diversity, inequities, identity, community and citizenship;
  • the need to challenge and confront ageism which is at the heart of poor quality aged care and is an enemy of quality; and
  • ensuring that in the future, there is more realistic funding for residential and community aged care services allocated to increase the basis capacity of provide good services.