Newsletter - Issue 3 - October 2019
New Commissioner appointed as the Royal Commission is extended
The Honourable Tony Pagone QC, was appointed in September as the third commissioner to the Royal Commission into Aged Care Quality and Safety. The former Federal Court Judge joins the Honourable Richard Tracey AM RFD QC and Ms Lynelle Briggs AO as they continue to hear evidence.
The announcement was made by the Minister for Aged Care and Senior Australians, Senator Richard Colbeck who also announced the Royal Commission would be granted a six month extension. This extension will not affect the interim report, which is still due by 31 October 2019. The final report will now be due by 12 November 2020.
Commissioner Pagone served as a judge of the Federal Court of Australia from 2013 to 2018 and previously held the role of national coordinating judge of the Federal Court’s Taxation National Practice Area. Prior to this, he was a judge of the trial division of the Supreme Court of Victoria and the judge in charge of its Commercial Court.
Commissioner Pagone is the president of the International Association of Judges, a member of the Governing Council of the Judicial Conference of Australia and a professorial fellow at the University of Melbourne’s Law School.
Known for his expertise in the human rights field, and for being the youngest judge to be appointed to the Victorian Supreme Court in 2001, Commissioner Pagone is motivated by a sense of duty to serve the community and an interest in improving society for all Australians.
Nutrition in Aged Care
The previous edition of the newsletter highlighted the Royal Commission’s focus on food and nutrition at the Cairns hearing in July. Maggie Beer, AM gave evidence about her foundation’s vision ‘to ensure that all residents in aged care have access to fresh, wholesome, seasonal food, abundant with flavour’. We wanted to share more about what the Royal Commission heard, given that food occupies much of our day and is central to our enjoyment of life and physical health.
Robert Hunt and Sharon Lawrence from the Dietitians Association of Australia and Dr Sandy Iuliano, a nutritionist, explained how older people need more protein and some additional micronutrients than younger people. One challenge, they noted, is that older people have smaller appetites and therefore nutrition needs to be concentrated in every meal. Dr Iuliano stated that because of this reduced appetite ‘every mouthful needs to have some kind of benefit’ to the older person.
Maggie Beer, AM who gave evidence at the Cairns hearing in July.
Ms Lawrence told us that approximately 1.14 million older Australians are at risk of malnutrition and 300,000 are malnourished. Mr Hunt, Ms Lawrence and Dr Iuliano noted that malnutrition can have dire consequences for an older person’s health. Such consequences include: increased risk of falls, osteoporosis and fractures, slowed wound healing, extended hospital stays, cognitive impairment, increased risk of infection and increased morbidity and mortality. Mr Hunt described malnutrition as the ‘silent faceless abuser’ in aged care.
Food preparation is also important. The Commission heard that often food prepared and delivered within many aged care facilities does not adequately meet the nutrition and protein needs of older people, even if they ate everything served to them. Some ways to increase the levels of protein include providing extra cream, butter, margarine, milk, cheese, yoghurt, eggs, legumes and meat. One example Ms Lawrence shared was adding milk powder to milk so that ‘every little mouthful is worth more’. Many of the witnesses talked about a food first approach to meeting a person’s nutritional needs, noting that supplements may only have a temporary impact on improved nutritional status.
Ms Beer talked about the need for food to be prepared in ways that seduce a resident to eat. This can be achieved through aromas and presentation, which can increase saliva production and, in turn, increase a person’s desire to eat.
Assisting and encouraging people to eat is also very important. The witnesses told the Royal Commission how important it is for care workers to spend time with residents when they eat. Dr Iuliano said that simply sitting with a resident can improve their experience and hence increase their desire to eat. Older people who are unable to consume foods independently are at a higher risk of becoming malnourished. Dr Iuliano referred to a study which found that increasing the time spent assisting a resident at meal times could improve oral and fluid intake.
Adrienne Lewis, from the South Australian Dental Service, explained how good oral hygiene is fundamental to being able to eat properly. Poor oral health can affect an older person's ability to eat and enjoy meals due to the impact on chewing capacity, food choices and sense of taste.
The Royal Commission heard that reducing malnutrition involves a multi-pronged approach, starting with planning and preparation to deliver and present nutritious, appetising meals. This involved everyone from dietitians, who assess and advise on the nutrient value of food and specific dietary needs, to cooks and chefs, responsible for sourcing, planning and preparing food, and to service providers who manage and prioritise food and drink, to care workers who can help people eat and drink and are ideally positioned to notice and address signs of dehydration or malnourishment. Nurses, doctors, dentists, oral hygienists and speech pathologists, can also play a positive role, identifying and addressing relevant problems that would otherwise result in malnutrition.
A reporter's view of the Royal Commission
Lauren Broomham is a journalist and editor for DCM Media (Do Come Monday) – an aged care industry website. She also works across a range of media including ‘The Weekly Source’, ‘The Donaldson Sisters’ and ‘Villages.com.au’. As an aged care industry journalist, she has a special interest in this Royal Commission and has been with us every step of the way. We asked her a few questions about what it’s like to be the only journalist covering every hearing and community forum of the Aged Care Royal Commission in person.
Q. As the only journalist covering the entirety of the Royal Commission in person – what’s it been like from your unique view?
I have found the whole process fascinating. Most of us would be unaware of the logistics that go into staging a Royal Commission, but being on the ground, I see everything from the witness support officers and tech team to the security arrangements and the day-to-day business of keeping the hearings and community forums on track. It’s a big job and while the Commissioners are the face, there’s a lot of going on behind the scenes.
Q. What’s been the most interesting or surprising thing you have heard so far?
I have worked in the aged care sector for over three years now so I have a good grasp of the issues but even I was surprised by some of the information that has emerged during the hearings, in particular the Darwin and Cairns hearings on quality of life and clinical care. Take pressure injuries for example – there was one expert wound care consultant Catherine Sharp who gave evidence that tissue death can occur within half an hour, yet repositioning guidelines are that immobile residents must be moved every two hours. It gave me a new understanding of the challenges in providing care – and the difficulties staff must face daily.
Q. Has the Royal Commission lived up to your expectations?
The Commission has surpassed my expectations. I anticipated many sad stories would come out of the evidence, but what has emerged alongside these are some innovative ideas and models to improve the system and some good experiences. At the recent hearings in Melbourne, there was a witness Robyn Spicer whose daughter Jessie has a disability and is thriving in residential care. It was amazing how her story buoyed the mood in the hearing room.
Q. What feedback have you got from your readers about your Royal Commission coverage?
I receive very positive feedback on my coverage – the main comment people often make is that I provide a real picture of what being at the hearings is like, rather than just a simple summary of the issues. I am presenting the Commission from my perspective and analysing the ideas that are raised and that is very different from the other sources of information available.
Q. Is there a town or city you have been to covering the Royal Commission that stands out as significant? Why?
This will probably surprise some people, but Mildura stands out for me. The town reminded me of the country towns where I grew up, and those hearings really gave a voice to carers of older Australians who often don’t get much media attention.
Q. What do you hope this Royal Commission will achieve?
To quote Commissioner Lynelle Briggs from the first community forum held in Bankstown in Sydney’s west, I would like to see the system turned ‘upside down’. The Commissioner noted this is a ‘once in a lifetime’ opportunity and I would agree with her assessment. As an observer, I see the issues that affect the sector, but I also see the solutions being put forward and I think there is scope for a significant re-think of how we provide aged care in this country.
Q. Anything else you would like to add about this experience?
Travelling to every capital city – and being a fan of dining out – my colleagues also joke that I could now write a restaurant guide to Australia. Perhaps when the Commission wraps up…
The first of three hearings in Melbourne took place in early September 2019. The hearing theme was young people in aged care and featured direct experience evidence from a number of witnesses.
Lisa Corcoran, Kirby Littley, and James Nutt, were some of the witnesses who gave evidence about the personal challenges they faced moving from hospital and rehabilitation following a catastrophic incident to find that the only accommodation available was in residential aged care living with people 40 to 50 years their senior.
They described their loneliness, isolation and a sense of despair at the lack of activities of interest to them and of people their own age. Each of them told of their battle to eventually get settled into appropriate accommodation.
A number of the witnesses explained that when they left hospital and went into aged care there was no further rehabilitation for them to improve their ability to live independently. Once they had resettled into age-appropriate accommodation, rehabilitation resumed.
In his closing remarks, Counsel Assisting, Richard Knowles, said the week’s evidence left no doubt about the question of the nearly 6000 younger people under the age of 65 living in residential aged care being fundamentally one of human rights.
He said that residential aged care had become the solution for gaps in other parts of the system leaving people placed in inappropriate care, deskilled and disempowered.
At the Brisbane Hearing in August, the Royal Commission heard evidence about the regulation of aged care including the dramatic closure of the Earle Haven residential aged care home on the Gold Coast only two weeks earlier and the slowness in implementing changes recommended by previous reviews.
Senior Counsel Assisting, Peter Gray QC, said the week’s evidence had exposed serious defects in the regulation of quality and safety in aged care at both operational and design levels.
In July the Royal Commission undertook its third regional hearing in Mildura in Victoria where it heard evidence about the role of carers and access to services such as respite care.
There was direct evidence from a number of individuals in relation to their experiences as carers for aged relatives or friends and the difficulties in getting respite from providing 24-hour a day care.
Rosemary Cameron told how she was unable to find suitable care for her husband who has Lewy body Dementia and is prone to challenging behaviours. She told how she was left with no alternative but to try to continue caring for him in their home despite his often aggressive behaviour towards her. She eventually found a place for him in a home where staff were trained to deal with residents with his type of dementia.
Elaine Gregory told the Royal Commission of her struggle to care full time for her mother and how she felt frustrated and overwhelmed by the lack of available assistance which she described as leaving her emotionally drained.
Melbourne hearing 2 will begin on Monday 7 October. You can find more details about future hearings on our website.
Community forum round up
There have been a number of community forums in cities and towns around Australia since the Royal Commission began. At community forums, members of the public can find out more about the work of the Royal Commission. People are also invited to register to speak and to offer their ideas on the challenges and strengths of aged care.
The seventh community forum was held on 12 August in the city where the Royal Commission into aged care held its first hearing. This was the largest forum to date with close to 400 people attending. There were 20 speakers and Commissioner Tracey was in attendance.
Many of the speakers referred to harrowing care causing distress to their families, and the need for more empathetic, better qualified or trained carers.
Commissioner Tracey summarised the statements at the end of the forum and thanked the speakers. He stated ‘there is not much point in having higher qualifications if there is no empathy’.
On 19 August, Commissioner Briggs attended the Brisbane community forum at the Brisbane Convention and Exhibition Centre. Speakers focussed on a range of topics including challenges with My Aged Care, the use and misuse of enduring power of attorney, dementia care, concerns with the Aged Care Complaints systems (both current and past), and concerns over the cost of care.
Other topics covered by speakers included challenges faced by people from culturally and linguistically diverse backgrounds, people with a vision impairment or blindness, and the importance of family advocacy.
There was a more intimate gathering at the Rockhampton community forum which took place the day after the forum in Brisbane. Commissioner Briggs described community forums as being at ‘the heart of the Royal Commission’.
Many speakers raised concerns about residential care facilities. One speaker talked about poor facilities, lack of choice, lack of care and the lack of activities for residents. There were stories of sub-standard medical care and neglect. Another detailed the importance of good dental health.
The next community forum will be in Launceston, Tasmania on Thursday 3 October.
Counselling and support
Please go to our support page to see a full list of support services that are available to you.
The Royal Commission website has a number of elements designed to make it easier to use:
- You can read about the Royal Commission in plain English
- There is information in other languages
- We offer guidance on making a submission and details of further assistance on the submissions page of the website
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