The Australian aged care sector has been the subject of numerous major inquiries and reviews over the last two decades since major reforms were introduced to the aged care system through the Aged Care Act 1997 (Cth). The Terms of Reference for this Royal Commission direct the Commissioners to have regard to, amongst other things, ‘the findings and recommendations of previous relevant reports and inquiries’.
This background paper provides an overview of many of the major public reports and inquiries related to publicly-funded aged care in Australia since 1997, with a greater focus on the more recent of them. It deals primarily with official inquiries that generally involved submissions and evidence from the public and generated reports that are publicly available.
These reviews and inquiries address recurring issues within the aged care system, including:
- the difficulty people have in understanding and navigating the aged care system
- the need for improved advocacy services for older people • the lack of coordination across different levels of government and between different types of services in the care and services provided to older people
- poor access to care, especially for people with chronic conditions or complex needs, and long waiting times for access to services for many people, especially those who are still living at home
- the recurrence of instances of poor quality of care across the aged care system, including for dementia and other cognitive disability
- the excessive use of chemical—sedatives, psychotropic medication and other drugs—and physical restraints on people in aged care
- the need for additional support for people with special needs, including those with dementia, those at the end of their life, those with mental illness, people with disability and those experiencing homelessness
- serious current and projected shortages of appropriately skilled and qualified nursing and personal care workers
- ineffective regulatory oversight of aged care providers, and a lack of focus on the quality of care
- the absence of any rating or assessment system for providers that can give older people and their families accurate, or sometimes any, information about the services they are seeking to access
- complaints mechanisms that are difficult to access, a lack of responsiveness by the Australian Government complaints authority and situations where people fear to make a complaint because of the risk of retaliation by the service provider
- weaknesses in the delivery of services aimed at maintaining healthy functioning, such as physiotherapy, nutrition advice, speech pathology, oral health services and podiatry
- inadequate access to, and integration with, the broader health care system, impacting on the health outcomes of older people
- failings in the quality of the care provided for people who are close to death.
Sadly, the Royal Commission has been confronted by many of these issues in its own investigations into the aged care system.
This paper has been prepared to assist in understanding the issues covered, findings and recommendations of previous major public inquiries. Previous inquiry reports have been included in this paper where they are relevant to current concerns with aged care quality and safety, have involved public processes and have been widely received or influential. Because of the limitation of space and time available, not all the reviews and reports that meet these criteria have been included. A non-exhaustive list of previous reviews and inquiries over the last four decades is provided in an appendix.