The Royal Commission will release its final report on 26 February 2021. This year, then, dawns as potentially a watershed year for the aged care sector. The problem is that the release of the report will mark the beginning of the wait for the Government’s response. Until then there will be endless rounds of speculation and conjecture.
Until such time as the Government responds to the report and commits to reforms, it will all just be words on pieces of paper – or screens.
If past performance is any guide, there could be an extended period of waiting and providers must consider what strategies they should adopt during this hiatus. Where should they direct their resources and what should Boards prioritise?
Here are three focus points to consider:
1. Strengthen Governance Frameworks
There is no speculation required in making a decision to focus on ensuring corporate and clinical governance is based on strong and effective frameworks. Since the introduction of Standard 8 – Organisational Governance as part of the changes to the Aged Care Standards, providers have known that it will be a focus for accreditation reviews. It is a fundamental part of ensuring safe and high quality care is delivered.
Providers wanting to consider what further changes might be necessary can take a look at Recommendations 52 and 53 from Counsel Assisting the Royal Commission. The introduction of the recommended requirements would be relatively low cost for Government and the purely governance elements of those are uncontroversial. Even if they aren’t adopted, there would be no harm in using them as a guide to improving governance.
The increasing community and regulatory focus on director accountability mean that engaging in such a focus would be beneficial regardless of any future legislative reforms in this area.
2. Think Small
There are some issues that have been a constant over recent years and one of those is the debate about what size residential care facility provides the best care. Is the care better in small facilities than it is in big and which of them is more financially sustainable?
The debate was reignited in August 2020 when the Royal Commission released two research papers that essentially concluded that better quality care is delivered in smaller homes but at an increased cost. The lead researcher was reported as saying that “If Australia wants to shift to smaller models because they are preferred, then it will require quite a large investment in both running costs and new infrastructure to shift to those smaller models”
There is also international research that supports the view that the quality of care is higher in smaller homes.
Regional providers have been grappling with this reality for a long time. They are necessarily on the small side and many have decreased their capacity in recent years with declining populations and increased availability of home care. The challenge they have had to confront is how to be small and profitable. These forces are also beginning to have an impact in urban centres.
Both the Government and the community want more home care. If we are to be pragmatic, it is the financial implications of this fact that will provide the greatest impetus toward smaller residential facilities rather than considerations of culture and quality. There is no point expending large amounts of capital on buildings no one wants to live in.
So, regardless of what recommendations the Royal Commission makes about design, providers should be considering how they can remain viable and sustainable with a smaller footprint.
3. Prepare for the Certainties
In speculating about what might be or should be, it is easy to lose sight of the changes that we know are certainties. Such changes include the Serious Incident Response Scheme which will commence in April 2021 and the likelihood that accumulated unspent funds will have to be returned to the Commonwealth when phase 2 of the Improved Payment Arrangements for Home Care is implemented. The introduction of the SIRS can be seen as part of the initial response to the Royal Commission’s findings of neglect and substandard care. It is a good reminder that not all of the changes to be wrought by the Royal Commission will come as part of a reform package. They might be implemented in dribs and drabs as part of piecemeal changes to the system.
Providers will need to ensure they allocate adequate resourcing to the implementation of these changes as they become known.
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