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Honourable Tony Pagone QC
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.
Maggie Beer, AM who gave evidence at the Cairns hearing in July.
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
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
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.
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
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.
Examples given in the hearing of how to make
food more appealing and nutritious.
Lauren Broomham at the Melbourne Hearing in September
A reporter's view of the Royal Commission
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.
As the only journalist covering the
entirety of the Royal Commission in person – what’s it been like from your
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.
Has the Royal Commission lived up to
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.
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.
Is there a town or city you have been to
covering the Royal Commission that stands out as significant? Why?
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.
What do you hope this Royal Commission
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.
Anything else you would like to add
about this experience?
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…
James Nutt gives evidence at Melbourne Hearing 1
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.
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.
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,
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.
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
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
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.
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.
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.
hearing 2 will begin on Monday 7 October. You can find more details about
future hearings on our website.
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.
Commissioner Tracey addresses a packed Adelaide Town Hall.
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.
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’.
Brisbane Community Forum
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
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.
community forum will be in Launceston,
Tasmania on Thursday 3 October.
Accessibility and support
To date, the Royal Commission has received 6281 submissions.
We have received 3988 telephone calls to our 1800 960 711 information line.
Individuals who are visually impaired can call our inquiry line on 1800 960 711 for assistance with a question or to make a submission.
For people who are hearing-impaired or have complex communication needs, we are using a phone service provided by the National Relay Service.
The Royal Commission can provide an Auslan interpreter at hearings and community forums upon request.
We can also accept submissions in other languages over the phone or via hard copy. We are using the Translating and Interpreting Service to help support this.
Counselling and support
Trained operators are available through the Royal Commission information line to offer information and support for callers who are distressed. Phone 1800 960 711 8am-6.30pm ACST, Monday-Friday except on public holidays. An interpreter service is also available.
Please go to our support page to see a full list of support services that are available to you.
Royal Commission is still accepting submissions. You can get more information
on the submissions
page on this website.’
The Royal Commission website has a number of elements designed to make it easier to use:
You can contact the Royal Commission in a number of ways:
- By email at ACRCenquiries@royalcommission.gov.au
- By telephone on 1800 960 711 (between 8.00am-6.30pm ACST,
Monday-Friday except on public holidays; interpreter service available)
- By post at GPO Box 1151, ADELAIDE, SA 5001
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