Underperforming residential aged care facilities have become such a burden on the sector’s regulator that they are limiting its ability to monitor home care services to older Australians.
The Aged Care Quality and Safety Commission has provided information to the aged care royal commission in which it acknowledges it has fallen short of timelines and budget allocations to ensure standards of home care quality are met.
In addition to the demands from residential homes, the watchdog also cites high turnover of staff that assess home care services and the introduction of more thorough “quality standards” as contributing to progress on home care monitoring moving “more slowly than originally planned”.
This week, the aged care royal commission has been examining the state of home care service in Australia, hearing the majority of older Australians would prefer to remain in their homes for longer and that the form of care – which is cheaper than residential aged care solutions – should be an urgent priority for the government.
Of the $6.59m allocated to the ACQSC in the 2019-20 federal budget to increase visits to home care services and support changes to the framework for home care compliance checks, just $4.372m had been spent by 1 February.
Acknowledging the decline in compliance checks on home care, the watchdog cited soaring rates of non-compliance in residential aged care, up from 10.9% in 2018-19 to 22.8% in 2019-20, as a reason for diverting its resources to the residential facilities that “require more active monitoring”.
ACQSC also cited “a high level of attrition” of “quality assessors”, including the retirement of a number of experienced assessors and others who changed jobs, illustrating the volatile size of its compliance teams.
New standards, which demand assessors spend more time gathering evidence and writing reports of aged care compliance, also contributed to the home care shortfall.
The ACQSC said that, given its limited resources, it had been forced to target its checks to areas it believed were at the highest risk of affecting the safety of home care service recipients.
Ian Yates, the chief executive of the Council on the Ageing, told Guardian Australia the ACQSC is “not anywhere near as resourced or powerful as we would like”.
“Assessing and monitoring quality in-home care is equally important as residential care and needs quite significantly more ongoing resources.
“It’s a challenge because you can go into a residential facility and all the residents are there. But monitoring home care, you have to go through a process to organise visits to each home care recipient.
“The challenge we all have is how do you convince the consumer that it’s safe to tell the regulator that there’s something going wrong with your provider. The fear is real,” Yates said.
Julie Collins, the federal opposition’s aged care spokeswoman, said “the regulator doesn’t have the powers and resources it needs to ensure older Australians are receiving high quality aged care”.
“This is just further evidence of this – it is not good enough that there clearly hasn’t been enough oversight of home care.
“This is despite more and more older Australians wanting to receive aged care at home. It is particularly concerning this has not happened despite the risks of Covid-19,” she said, noting recent “damning revelations” that the regulator stopped visits during the pandemic.
Richard Colbeck, the aged care minister, said “the commission applies a risk-based regulatory approach” and that “risk assessment activities are undertaken continuously to assess the level of risk of home service providers”.
He said the government had allocated “a further $9m to support ongoing regulation of the sector” as part of its Covid-19 response.
Colbeck has weathered calls to resign from his portfolio, after Labor attacked him for failing to know how many deaths had occurred in aged care during the Covid-19 pandemic.
During his opening remarks to the royal commission on Monday, senior counsel assisting, Peter Gray QC, said “there should be far more urgent efforts to prioritise home care over residential care” because “as the research indicates ... [residential care is] not generally the setting a person would choose”.
He said Australia had a “very high” share of aged care recipients in residential aged care compared to most other developed countries, noting 19% of citizens over 80 in Australia lived in residential care – the highest percentage in the OECD.
At the end of March, 103,599 Australians were waiting for a home care package they had been approved for. The waitlist has shrunk by just 838 places since the end of 2019.
