Inquiries and reports into the state of aged care in Australia have often either not been acted on, or not acted on fully or quickly, the Royal Commission into Aged Care Quality and Safety has heard.
The commission heard successive Australian governments have shown a lack of willingness to commit to changes recommended by numerous inquiries
Senior counsel assisting the inquiry Peter Gray QC told the commissioners that implementation of change had been patchy
The commission’s final report is expected in February
Counsel assisting the royal commission on Friday made their final submissions at the end of the two-year inquiry.
The commission has heard successive Australian governments have shown a lack of willingness to commit to changes recommended by numerous inquiries into and reviews of aged care over more than 20 years.
Senior counsel assisting the inquiry Peter Gray QC told the commissioners implementation of change had been patchy.
“And when one reads those responses carefully, one sees that some of them only partially address recommendations, sometimes under the guise of some fanfare that the recommendation will be implemented.
“One needs to look very carefully at the detail, when it comes to government responses to recommendations of inquiries into aged care.”
The counsel assisting team has made 124 recommendations, including for new laws based on human rights principles for older people, mandated staffing ratios, an independent aged care commission and that wider enforcement powers be given to the aged care regulator.
“Our recommendations … call for sweeping reforms to the system in order to address what we have identified as pervasive systemic problems,” Mr Gray said.
Mr Gray said the people at the heart of the system — those receiving care, the aged care workforce and the close supporters of those receiving care — needed to be heard.
More staff needed
Sinikka Heikkila from Tasmania saw her parents’ health decline after they were each diagnosed with dementia.
Her father spent two months in an aged care home in Hobart, and her mother was later cared for in the same home for about 18 months, before she died in August.
Ms Heikkila said she was very happy with the care her parents received, but the former nurse said caring for people with dementia was challenging.
“I just felt that you need more staff in those areas,” she said.
Better standards for dealing with dementia was among the issues raised on Friday.
“Dementia is so important to … almost every aspect of our recommendations,” Mr Gray said.
Among the recommendations are tougher restrictions on the use of anti-psychotic medications.
“In the future, the system should never again be involved in, and the community should never be confronted by, this apparent resort to the use of anti-psychotics in the place of proper care,” Mr Gray said.
Broader powers for the regulator to crack down on non-compliant aged care providers have been recommended, along with pricing reforms and immediate funding for more staff training.
During Thursday’s hearing, it was revealed 50 people in residential aged care in Australia were sexually assaulted each week.
The commission heard that figure was the best estimate because some alleged assaults were not reported, such as those where the alleged perpetrator was a fellow resident and had a diagnosed cognitive or mental impairment and the aged care provider had put in place arrangements to manage the alleged perpetrator’s behaviour.
Dental scheme for seniors recommended
The commission also heard older people were far more likely to have poor oral health which had adverse consequences for their health and social lives.
The counsel assisting team has recommended a seniors’ dental benefits scheme be part of improved access to allied health services for older people.
Mr Gray said the scheme should also provide dental care for older people who are not in aged care but who cannot afford it.
The commissioners thanked all of the people who shared the stories as part of the inquiry.
“In a very real way, we have moved forward together and, counsel, I’m confident that we will change the landscape of aged care in Australia,” Commissioner Lynelle Briggs said.
“After two years of evidence, it’s clear to me that we have an underfunded system that demonstrably fails to meet community standards of health, personal care and sustenance for a generation of people who are used to just making do.
“The system is not good enough for them and it is unimaginable that future generations will stand for it as it is. It is unacceptable to us all.”
Mr Gray said the proposed recommendations would require careful planning and careful implementation over a lengthy period.
“This has to be done deliberately and with relevant safeguards and, we would say, also with reporting of progress,” he said.
The commission’s final report is expected in February.
IN 1943 WINSTON CHURCHILL promised to bring the “magic of averages to the rescue of millions” by creating a national-insurance system to look after Britons from cradle to grave. Some 77 years later, Boris Johnson employed the same phrase at the Conservative Party conference. This time, the “magic of averages” would be used to fix “the injustice of social-care funding”.
Many politicians, including Mr Johnson, have made similar vows, yet failed to act. On October 22nd the House of Commons health and social care committee, led by Jeremy Hunt, Mr Johnson’s erstwhile opponent for Tory leadership, gave the prime minister a prod, with a report urging the government to spend at least £7bn ($9bn) more on social care by 2023-24, thus raising total spending by a third.
Some £3.9bn of the money would cover demographic change—growing numbers of old people and more young people requiring care—and enable providers to pay their staff the rising living wage. The other £3.1bn would be spent on capping the amount people pay for care during their lifetime at £46,000: anything above that would be covered by the state. That idea dates back to a review of social care in 2011 by Andrew Dilnot, an economist.
Unlike health care, social care is both needs-tested and means-tested. At present, only those with assets below £23,250 receive any state support. Since the cost of care is so hard to predict, firms are unwilling to offer protection, making social care the one great risk in life that is in effect uninsurable. A cap on costs would still require fiddly assessments of people’s needs, to keep tabs on how much they have spent from their approved budget. But it would also prevent people’s savings from being wiped out if they get dementia.
It may have other benefits, too. Mr Dilnot argues that people underspend on care because they want to have enough in the bank for the long haul. A cap would remove the fear of running out of money, enabling people to spend more in the short term, including on things (a stairlift, say) that stop them having accidents in the first place. Meanwhile, a more stable financial settlement would help reassure private providers to stay (and invest) in the market. Both would increase the incentive to develop new and better forms of care.
The £7bn price-tag for the committee’s proposal is hefty—but it still leaves plenty out. Social-care workers were more likely to die than even their colleagues in hospitals during the first wave of the covid-19 pandemic, a fact that has drawn attention to their meagre pay. Their wages could be pegged to similar roles in the health service, which would help reduce extremely high levels of turnover, but require additional funding unless the government wanted to bankrupt providers. Labour and some senior Tories support the introduction of free personal care, which covers things like help with bathing and dressing, and would cost another £5bn.
The problem with social care is not a lack of options. The King’s Fund, a think-tank, counts a dozen government papers on reform in the past two decades. The difficulty is summoning the political will to implement any of them, and raising the cash to do so, with opposition parties reliably objecting to plans for change. After the general election last year, Mr Johnson had an 87-seat majority and had declared his intention to fix social care once and for all. He was edging towards a Dilnot-style cap.
The pandemic has shone a light on the problems of social care. But it has also wrecked the public finances. On October 21st the Treasury said that a planned three-year spending review had been ditched in favour of a one-year one, owing to the unusual circumstances. With finances tight and the government reluctant to make long-term decisions, an announcement on social-care reform is likely to be delayed. Mr Hunt, who was health secretary from 2012 to 2018, does not think the pandemic is a good excuse, however. As he puts it: “We were even more bankrupt in 1945 when we decided to sort out the NHS.” ■
This article appeared in the Britain section of the print edition under the headline “Big old problem”
An extraordinary scene played out in the final hearings of the historic Royal Commission into Aged Care Quality and Safety yesterday.
It may have looked like a minor difference of opinion, but the public split between the two key people deciding the future for our elderly shows just how controversial real reform is going to be.
At 9:30am, counsel assisting, QCs Peter Gray and Peter Rozen, began detailing 124 recommendations they had made after spending two years examining more than 10,000 submissions, a comparable amount of government data and hearing some of the most heartbreaking stories of abuse, neglect and failures of regulation and governance.
It was their big day to put their far-reaching recommendations for reform before the royal commissioners, detailing how to transform a system which has been delivering substandard care for decades, but which successive governments have packaged as a privatised system of choice.
Ninety minutes in, counsel assisting Mr Gray had finished with his proposal for a new aged care act and the establishment of an independent aged care authority.
The current regulator — the Aged Care Quality and Safety Commission — and the Department of Health have been roundly criticised at the royal commission for inadequacy and contributing to substandard care.
A new authority removed from the Government and Canberra would put the elderly first rather than worrying about the cost, according to the recommendation.
And that’s when things became interesting.
Independent regulator an ‘extraordinary proposal’, says commissioner
Lynelle Briggs, the first commissioner appointed by Prime Minister Scott Morrison in 2018, spoke up, reading from a prepared statement.
“The independent commission that you describe in your submissions is quite an extraordinary proposal and, indeed, some might even call it courageous,” she said.
“I am yet to hear you present arguments, counsel, as to how the commission model will improve the quality and safety of care for older Australians, or how any such benefits would outweigh the very substantial costs and disruption involved in such a radical transformation of the Government’s administrative machinery.”
Next, it was the turn of the other commissioner, Tony Pagone, who assured those watching that “obviously those remarks are not intended to be a final decision by us” and that conversely he was inclined to support an independent aged care authority, adding that he didn’t agree with Ms Brigg’s description of “courageous” as “quite the right description” for the regulator.
For the two commissioners to disagree so vehemently with each other during the final hearing and for one of them to question counsel assisting is the equivalent of a bar brawl in royal commission terms.
Give Government another chance: Briggs
One of the concerns of Ms Briggs is the cost of setting up an independent authority and its accountability when it has no link to the Minister and the Department of Health.
She says she wants to give the Department of Health and the Government another chance to fix things up.
“I’ve detected over the last year, a growing determination among officials and in the Government to fix the problems of the aged care system and to pursue a genuine reform agenda,” Ms Briggs said.
The commissioner favours what has been done before, reforming the system while keeping the same people.
She described making the regulator more robust so it was really the “tough cop on the beat” and a “one-stop shop” for complaints — the same phrases used by Health Minister Greg Hunt back in 2018 when he established the very regulator that has been found to be so woefully inadequate at this royal commission.
Mr Pagone disagreed.
He referred to evidence earlier in the day to make his point about the Government’s overwhelming concern with the bottom line — a cabinet-in-confidence document from 1997 when the Howard government effectively privatised aged care, noting how the Government lauded its reform because it “has saved billions since its introduction and continues to do so”.
Mr Pagone said that document “did show what some might regard a rather cynical approach — when you have the combination of the people spending money with those guiding the money.”
He supports counsel assisting, who say putting the elderly first has to be done by an authority that is not worried about the cost and that means being independent of the Government.
Staff ratios and register proposed among tough reforms
There’s no doubt the ambitious reforms are a lot to take in.
Almost 25 years after the Howard government handed the aged care system over to market forces, counsel assisting have presented an ambitious blueprint for change which will please neither the Government nor the industry.
The recommendations include:
A new aged care act
Three-and-a-half hours of direct care per resident per day
Stopping GPs prescribing antipsychotics
More Indigenous staff
A public star rating system allowing families to compare nursing homes for quality and safety
An aged care pricing authority to tell the Government how much needs to be spent on aged care rather than the Government deciding what the Budget can afford
Registering all carers
Clearing the home care waiting list by the end of next year.
Normally, the public worries whether the Government will adopt the recommendations of a final report of a royal commission.
In this instance, we’re left wondering what happens next when the Commissioners are clearly in dispute with each other about a major reform. And we won’t find out until February next year.
Queensland Premier Annastacia Palaszczuk says a decision on the NSW border is still coming this month, as she fends off attacks from out of state over the issue as well as a new in-land highway proposal that the Federal Government says has no funding.
Annastacia Palaszczuk has defended plans for an alternative in-land highway between Charters Towers and the NSW border
A decision on whether Queensland will open its border to NSW will be made before the end of October
Opposition Leader Deb Frecklington has announced plans for an $80 million boost to after-school care
Speaking at the Great Barrier Reef on day 17 of the election campaign, Ms Palaszczuk hit back at NSW Premier Gladys Berejiklian after comments that Queensland should pull its weight when it comes to hotel quarantine and returned travellers.
The ongoing tensions between the NSW and Queensland premiers bubbled over again when Ms Palaszczuk was asked if NSW had its coronavirus numbers low enough to allow the border to fully reopen by November 1.
The Queensland Government was expected to make an announcement today on its border status with NSW.
Earlier, Ms Berejiklian accused Queensland of closing its borders “without reason”.
“I’m not going to be lectured by the Premier of New South Wales,” Ms Palaszczuk said in response.
“What happened to all working together? I mean, that’s what we do — we go into that National Cabinet, and we want to work together.”
Ms Palaszczuk said a decision on the borders would be made before the end of October after consultation with the state’s Chief Health Officer.
The stoush comes as Deputy Prime Minister Michael McCormack labelled Labor’s plans to build an alternative in-land highway from Charters Towers to the NSW border as a “thought bubble”, and said federal funds had already been allocated to other projects.
“There’s already some cooperation happening between the State and Federal Government in relation to [the second Bruce Highway].”
“We’ve heard in the past that the Federal Government doesn’t support Queensland,” Ms Palaszczuk said.
“We’ve seen the extra billions of dollars going to Victoria and NSW … I am simply asking for our fair share.”
LNP unveils $80m after-school care plan
As Ms Palaszczuk announced a $40 million environment and tourism boost for the Great Barrier Reef, Opposition Leader Deb Frecklington unveiled an $80 million proposal to expand before-and-after school care in state primary schools.
“High costs of care are a major barrier for any parents re-entering the workforce,” Ms Frecklington said, speaking at Tugun on the Gold Coast.
“With long-day centres you have to pay for seven, eight and nine hours, irrespective of the hours that your kids are in care.
“And that is very expensive … I was going to swear then … it is a very expensive process.”
It’s not easy to define “good medicine.” When I think of “good medicine,” I think of medical care that isn’t reactive, ponderously slow and inefficient. Good medicine is efficient, impactful, proactive, empowering and curative. Much of medicine treats illness, but good medicine heals it. Much of medicine is based on science but good medicine is based on trustworthy science. Good medicine teaches patients to take better care of themselves, and requires time and effort by providers. It is not easy, but it’s worth every penny invested in it.
We in medicine have a wonderful opportunity to provide good medicine to young men who are, by any measure, medically underserved. This is so because much of young men’s medicine is sexual health or fertility-related and therefore couched in silence or shame. Although not always life-threatening or painful, these issues matter a lot because they greatly affect quality of life. On a grander scale, they also provide an opportunity for medicine to get its “foot in the door” in caring for men so much earlier in their lives than we currently are.
Filling a Void
Here’s how the care of young men can be very good medicine:
We can catch things early. Bad habits (drugs) and risky behaviors (STDs, accidents) kill many a young man. Taking a deep interest in the lives of young men encourages responsibility and better behavior.
We can change life trajectories. It’s clear that bad habits when young (food choices) can lead to illness (obesity, diabetes) when older. Encouraging healthy lifestyle choices is key to longevity.
We can cure what bothers them. Sexual health issues are quite curable. And many treatments require attention and effort from patients. That is a healthy model for empowering men in the future.
We can predict future health. Fertility and erection issues are now known to be “biomarkers” of future health. Thus, there is an incredible opportunity for providers to practice the holy grail of care: preventative medicine!
We can get them to trust medicine. Delivering good care to young men leads to trust in the healthcare system later on and to more healthy behaviors.
We can imbibe a sense of mortality. Young men are not immortal, but simply more robust than older men. The sooner they realize this, the longer they’ll live.
Health is their best investment. Young men need to know that keeping a body healthy takes attention and work, but it’s also a priceless investment in their future.
Dr. Paul Turek is an internationally known thought leader in men’s reproductive and sexual health care and research. A fellowship trained, board-certified physician by the American Board of Urology (ABU), he has received numerous honors and awards for his work and is an active member in professional associations worldwide. His recent lectures, publications and book titles can be found in his curriculum vitae.
Building a company, no matter the size is always celebrated as a success. But business owners know only too well that entrepreneurship is tough. They are responsible for themselves, their customers and their employees.
Anxiety steps in mostly because of financial concerns, but mental, emotional, and physical stress can also cause anxiety that may lead to long-term mental health issues. Many small-business owners tend to spend too much time taking care of their business that sometimes they overlook their mental health. For these reasons and more, people who run their own businesses are more likely to experience mental health issues than regular workers.
How do you
ensure that you are on top of not just your own mental health but your
Set and Keep Work-Life Boundaries. When you own the business, it can be difficult to stick to a work schedule. However, as important as it is to have time for business, it is also important to set aside time for self-care, family, social life and other enjoyable things. The same goes for your employees. You are taking care of your mental health when you have balance in your work and personal life. Some of the work can wait so, as much as possible, set reasonable business hours for you and your employees and keep them.
Have a Flexible Work Arrangement. Being holed up in the same environment everyday may cause burnout. Do all tasks they need to be done in the office or can some tasks be done elsewhere like, say, at home, at a park or at a coffee shop? To be able to get out of the office from time to time can positively boost output. A flexible work environment that fits your and your employees’ lifestyle can help maintain your emotional and psychological balance and beat burnout.
Assign and Delegate. Running a business means juggling many duties. Consider delegating some of your tasks to free up time so you can step back, relax and take a break. Observe, too, if and when your employees are overwhelmed with their duties. If so, you may consider reassigning and distributing some of the work to other employees or you may try outsourcing. Know that you can’t possibly do everything yourself so there’s no point in trying to do it all. Similarly, do not assign to an employee more tasks than they can reasonably manage.
Take Your Mind Off Work. Since you own the business, it is understandable that there is a lot on your mind. Set aside some time to take your mind off work from time to time by engaging in other activities like exercise which has proven to be a great stress reliever. You can also start an exercise program for employees. And, after dealing with business for most of the day, try to clear your mind from work matters during the evening.
Socialise. You know what they say about all work and no play? Spend fun time with your employees outside the work setting, minus the business talk. This will foster camaraderie and help strengthen your work relationship. Encourage your employees to also spend time with their friends and families. Socialization helps reduce stress and improve mental health.
Know that your
psychological health is vital to the success of your company. With many
businesses folding because of the pandemic, it is important to keep your and
your employees’ mental health in check to maintain your resilience and keep
your business running as smoothly as possible.
Manna Maniago, Registered Counsellor & Psychotherapist and Founder, Kairos Assist
Wanting something a little exotic, tasty and easy to grow then consider planting a Cape Gooseberry, often referred to as the “Golden Gems” plant.
They are are small fruits, 2.5 to 3 centimetres in size (the size of a cherry tomato), and they grow on a small fast growing bush.
While the plant is considered a perennial it is best treated in Alice as an annual as they do not like frost, and will die once temperatures drop to below minus 2 to 3 degrees.
Having said that if planted in a warm protected location they can survive really cold spells. I’ve seen many plants over the years that have not or only slightly been affected by quite severe frosts.
The Cape Gooseberry is a native plant from South America being introduced to England in 1774 and later to the Cape of Good Hope before 1807 and soon after to Australia.
The Cape Gooseberry is soft-wooded, a somewhat vining plant usually growing to 60 to 100cm high. In good conditions they can grow to over 1.5 metres.
The plant has heart-shaped nearly opposite largish leaves up to 15cm long and has attractive bell shaped, nodding flowers being yellow with dark purple brown spots in the throat.
Once the flowers fall a straw-coloured husk forms and inside can be found the fruit. These fruit take between 70 to 80 days to mature. The fruit is a berry with smooth, waxy, orange-yellow skin, are very aromatic, and the juicy pulp inside contains very small yellowish edible seeds.
As the fruits ripen they can drop to the ground but will continue to mature turning from green to golden-yellow.
Cape Gooseberries are self pollinating.
However pollination can be improved by giving the plant an early morning gentle shake. A light short misting with a fine spray of water will also improve pollination.
The plants like a sunny, frost-free location preferably sheltered from strong winds. It will grow well against a northern facing wall or in the protective confines of a patio garden.
The Cape Gooseberry grows best in well drained sandy or gravelly soils as it hates wet feet and root rot can occur if the soil is over wet. They do however require consistent watering to ensure they crop well.
Cape Gooseberries thrive on near neglect and grow well in under fertilised soils. In fact a well manured soil will promote excessive vegetative growth at the expense of good flowering and fruiting. High yields are best obtained when little of no fertiliser is given.
A small amount of organic fertiliser maybe incorporated into the soil prior to planting and an application of potash at flowering will improve fruit quality and size.
While the plant is young pinch out the new tips to promote a compact bush, otherwise little pruning is required unless an attempt is made to grow the plant on a trellis which isn’t really required.
Cape Gooseberries have few pest and disease problems although in moist or humid conditions powdery mildew can be a problem. Wet feet can result in root rot, and several pests can attack the plant including the cut worm, fleas beetle, aphides and white fly. All these pests are easily manageable.
Fruit is generally harvested when it drops to the ground, although dropping fruit can be at varying stages of maturity and they should be gathered and allowed to fully mature.
Cape Gooseberries are best left in their brown papery protective husk, they will last and store much longer in this state.
The fruits can be eaten straight from the Cape or made into Gooseberry jam. They can be added to salads, desserts and cooked dishes and they are most delicious when stewed with apples or dipped into chocolate. Try an apple and gooseberry pie or tart, you’ll love it.
They can also be dried and become tasty raisins, or can be used in savoury dishes with meats and seafood. Cape gooseberries have a high pectin content thus making it a great fruit to turn into preserves and jam.
Gooseberries grow well in both the ground or in pots. In a pot I plant them into premium potting mix for best results.
Growing in a pot you have the advantage of moving them as the weather conditions change. When its stinking hot move them to a lightly shaded location, when frosts are pending move them to a warm protected frost free spot.
They will grow in full sun, light shade and part sun and part shade. They are really a great small plant that can be accommodated in even the smallest of gardens.
Geelong has stormed into their first Grand Final since 2011, beating Brisbane by 40 points at The Gabba on Saturday night.
In a game that the Cats were able to control throughout, only inaccurate kicking prevented them from holding a greater margin earlier in the match.
Brisbane threatened on multiple occasions to close within striking distance, but their inability to find a clean exit from defensive 50 for most of the night ultimately cost them.
A Lachie Henderson brain fade in the final term handed Ryan Lester a golden opportunity to draw his side within two goals of Geelong with less than 10 minutes on the clock, but he sprayed the set shot and Zach Tuohy went down the other end to kick the game-defining goal.
The Lions will be left wondering what might have been, while the Cats can look forward to playing in the AFL’s biggest game for the first time in nine years.
Here’s everything you need to know!
The star: Gary Ablett winds back the clock
It’s hard to believe that Ablett only has one game of football left before retirement.
When the game was there to be won in the third quarter, the 36-year-old wound back the clock and was one of his side’s most important players, kicking two goals and providing a constant target inside 50 for Geelong to kick to.
As the Cats reasserted their dominance in general play after half time, it was Ablett who was able to make it count on the scoreboard.