The Prime Minister called the Royal Commission into Aged Care Quality and Safety to a number of documented cases of abuse and neglect in Australia’s aged care sector.
The first session, held over eight days in February, was about identifying where failures have occurred and teasing out key issues of concern across the sector.
Among the first witnesses were people receiving aged care and their families, advocacy groups, aged care and health workers and government representatives.
What are the key themes that emerged?
Home care
The inquiry heard many Australians would rather receive help at home than move to an aged care facility, but the waiting time for home care services .
Kaye Warrener told the Commission her husband Les is still waiting for his home care package to be delivered, despite receiving approval back in November 2017.
"It’s very frustrating, and I’ve watched Les get very depressed over things, about not being able to get the package," she said. Home care will be covered in detail when the royal commission .
Surveillance in nursing homes
Some witnesses, particularly those who have seen loved ones injured or neglected in aged care facilities, have suggested CCTV inside nursing homes could protect residents and act as a deterrent against abuse.
Barbara Spriggs, wife of former Oakden resident Bob Spriggs, believes cameras should be installed in all common areas, as well as in patient’s rooms, as long as they consent.
"This would mean that if anything goes wrong, there is a clear record of what’s happened," she said. "CCTV is not just for the safety of patients, it also protects staff."
Department of Health Secretary Glenys Beauchamp said while neither she nor the department had an official position on the issue, it was "probably an area of contention".
"I think there would be a need for a substantial amount of consultation, both with care recipients’ families and certainly service providers in implementing CCTV."
Treatment of dementia patients
The royal commission heard more than 900,000 Australians will be living with dementia by 2050, yet the current treatment of patients leaves a lot to be desired.
In his evidence, Edward Strivens from the Australian and New Zealand Society for Geriatric Medicine said about 80 per cent of dementia patients in nursing homes are given at least one form of psychotropic drug, with only about 10 per cent actually benefitting from the medication.
"It far too often becomes the first step to look at, say, managing someone who is presenting with agitation [or] physical outbursts," he said.
The use of chemical and physical restraints looks set to be a topic to be examined in detail. Dr Harry Nespolon of the Royal Australian College of General Practitioners, gave the inquiry a different perspective. He pointed to data showing about 90 per cent of dementia patients have a behavioural issue, and that can put staff and other patients at risk.
"I would ask you how you would feel if you were in a nursing home and there’s one of your co-residents spends most of the night screaming, or if you’re a staff member and you’ve got a patient that’s hitting you," he said.
Dr Nespolon said the guidelines state non-chemical methods should be used as a first response, but that medication is sometimes needed.
"The point is that it doesn’t work for everyone, and that it’s something that should be monitored, introduced at low levels, and ultimately if it doesn’t work, it should be stopped," he said.
Staff ratios
The commission has so far received more than 800 public submissions. Many of those were from people concerned about staff-to-patient ratios across the aged care sector.
Some worker's unions have been advocating for minimum staff ratios, but there is plenty of opposition to it. Ian Yates, chief executive of a peak body for older Australians, COTA Australia, told the inquiry he doesn't believe it is the answer.
"Many of the horror stories that we hear in aged care are committed by people who have qualifications--nursing and other qualifications. I don’t want high ratios of them, to be kind of blunt."
A national database
Oakden whistleblowers Clive and Barbara Spriggs voiced their support for a national database for aged care workers on day one of public hearings.
Barbara Spriggs said this could prevent workers who have been sacked or sanctioned for wrongdoing from continuing to work in the industry. "Future employers should be able to see that there is a mark against their name in the system," she said.
Department of Health Secretary Glenys Beauchamp said there was "some merit" in the idea.
"It’s something that we’ll be looking at as a government in the context of the workforce strategy and working with the department of education."
Food
Several witnesses spoke about the quality of food in nursing homes, and the fact that many residents require assistance to eat meals.
Paul Versteege of the Combined Pensioners and Superannuants Association of NSW said there is evidence many people who have moved into care are "still malnourished". "This is a very obvious breach of safety," he said.
