Released on 31 October 2019 and titled Neglect, the Royal Commission into Aged Care Quality and Safety Interim Report has outlined, with no restraint, the sometimes cruel and unjust realities of aged care in Australia.
Speaking at a LASA-hosted event shortly after the report was released, Leading Aged Services Australia (LASA) CEO, Sean Rooney, called it a “beacon for immediate reform”, urging leaders to “as a sector get our act together”.
The overarching approaches discussed were, primarily, bringing the needs of people with lived experience to the forefront and having the government work closely and in consultation with aged care providers. Sounds sensible. But there are significant structural, financial and cultural impediments in the way.
For a sector that is reform weary, the Royal Commission is still a once-in-a-generation opportunity to move aged care to a position of long-term sustainability.
The Commissioners have identified three priority areas where immediate action needs to be taken: providing more home care packages to reduce waiting lists for higher level care at home; reducing reliance on chemical restraint in aged care; and, reducing the numbers of young people with disability going into aged care.
There will be no argument with providers on any of these counts.
However, digging deeper into the Interim Report and drawing on our experience working closely with clients and partners in the sector – at the corporate and facility or community levels – we can see the underlying issues.
Funding and sustainability
The Interim Report explains that the sector design means it is prone to income volatility and staffing is essentially a tool to manage costs.
Throughout the hearings and in industry commentary, the issue of insufficient staffing is regularly raised.
Staffing levels in aged care are intrinsically related to the government funding. Why? Because staffing is the greatest cost of care delivery and, unlike the funding (which is not controlled by the provider) it can be manipulated. In fact, it must be, as it should reflect the needs of the people in care.
Funding also determines the capacity to attract and retain staff, and the ability to train them in the diverse needs of the role.
So, necessarily, staffing has become an important margin management lever in a sector that operates on very low margins. But staffing is very hard to manage as the short stays in residential care mean a continually evolving resident need profile, and the sector wide workforce churn demands continuous investment in recruitment, induction and training.
And, as funding is currently not set up to correlate with care outcomes, it does not regulate or monitor the quality of care. This is not unique to aged care, however. Hence the value-based health care movement and its tireless mission to move from output to outcome funding.
Data measuring growth in aged care (StewartBrown, September 2018) indicates that, in September 2018, 41.4% of residential facilities were operating at a loss.
Insolvency is the spectre of many (but not all) providers. That’s extremely challenging for the boards and management teams grappling with the impact on people’s lives.
What can be done now? Recruiting and retaining good staff.
- Selling the purpose of aged care and the provider and telling the story of positive social impact.
- Ensuring brand experience and purpose is evident in all recruitment touchpoints – and is distinct from all other providers
- Making induction a peer-learning journey that validates the decision to take the job
- Ensuring that training prepares employees for the challenging reality of end of life discussions.
- Celebrating people.
Leadership and staffing
People can be trained to provide good care but not everyone has the right attitude and commitment to do it – the emotional intelligence. Empathy is a talent of carers and, without it, that important and intimate relationship between elderly person, carer and family cannot properly function.
But investing emotion can be draining if it is not rewarded and acknowledged. Over time, it leads to people finding employment in other industries where, even if the job attracts similar pay, there is not the emotional context.
Organisational leadership and culture are critical to person-centred care; they play a central role in fostering relationships and the attitudes that support effective care delivery.
For providers, long-term retention of staff creates business sustainability and perpetuates the culture of care (and stability of service delivery) that customers seek.
Creating pathways to the aged care workforce, through university engagement, recruitment campaigns and proper training to the existing workforce, can make sure an organisation lives by its purpose, is resilient and also customer centric.
Leadership needs to be authentic. And evidence of organisational purpose being expressed in the actions and investments of the company provides regular reference points for employees: moments that say, ‘it’s sometimes hard but look at the good we are doing’.
Gateway to a complex system
While many people prepare for being healthy in older age, most don’t prepare for aged care.
Research by National Seniors Australia, featured in the Interim Report, indicates a need to increase the aged care knowledge of those who will have contact with the system in the next five to ten years.
Perceptions of MyAgedCare?
Providers have an opportunity to start speaking to this cohort now, as an investment in the future. Regular awareness campaigns are required to increase understanding of aged care: not only for those soon to enter the system, but also their families and community.
Implementing campaigns and tailored communications around place-based care and tailored aged care services will help current and future users to navigate an increasingly complex system.
At the facility level, this builds relationships with communities and leads to consistently higher occupancy, as well as culturally responsive services.
How we can help
Ellis Jones has been working with aged care providers, government departments and agencies, peak industry groups and suppliers for over a decade. We have advised clients through productivity commission, parliamentary and royal commission inquiries; and, we have supported providers in response to major reforms such as Living Longer, Living Better.
The royal commission has made customers and communities anxious; they are wary of provider claims. That’s why we have modelled how providers can respond to the royal commission, in consultation with experts, to create a framework for navigating ‘what comes next’.
With reference to the opportunities listed in this article we can help by:
- Defining future state and the business case for change
- Community and health services professional codesign for service innovation
- Brand purpose definition and employee activation
- Grassroots and digital campaigns to cost-effectively raise awareness and shift consumer mindsets.
Call us to speak to the health and ageing team at Ellis Jones about creating sustainability as aged care providers.
The final report of the Royal Commission into Aged Care Quality and Safety is expected to be released in November 2020. Read the full Interim Report here.
To read more of the Ellis Jones series covering the royal commission, visit the Ellis Jones blog or follow the below links: