The Royal Commission’s final report into aged care was tabled in March 2021 and laid out an extensive plan to overhaul Australia’s troubled aged-care system.

Among the 148 recommendations, the report called for a new system underpinned by a rights-based Act, funding based on need, and much stronger regulation and transparency to transform the industry over five years.

Halfway to the deadline, there is still a broad range of views and priorities among providers and stakeholders in the aged-care sector.

The long-term workforce shortages forecast by CEDA, and the challenges of attraction and retention, however, remain unchanged. A range of initiatives will be necessary to continue to address these challenges.

At a recent CEDA roundtable discussion at BDO in Adelaide, several key players in the sector discussed the state of the industry and the opportunities and challenges that lay ahead.

These are the 10 key insights of the discussion from Fahim Khondaker, BDO Partner in Data Analytics & Insights and Professor of Practice at UNSW.

1. Recent changes are having some positive impact on the ground

Staff turnover has decreased and staff engagement has increased relative to recent years. The recent increase in wages and changes to the funding model are showing signs of having a positive impact.

2. Raising the profile of aged-care workers requires a concerted effort

Aged-care workers are one of the most purpose-driven and caring groups of people in our society. More can be done to raise the level of respect and gratitude shown to them across all channels and forums. Sharing and promoting positive stories from the sector is likely to have an impact as well.

3. Further investment in leadership development will be beneficial

Leadership has proven to be a key factor that impacts both the retention of staff and the quality of care provided in an aged-care service. Further research and investment into the training and development of leaders is required.

4. There is a need to investigate ways to lighten workload and increase productivity

Advancements in digital technologies, data and artificial intelligence can offer a wide range of potential opportunities to assist workers in reducing their workload and increase both the productivity and quality of their work. Potential areas for consideration include the balance between automated vs human-driven services; rostering; and operational performance monitoring to drive key decisions and ensure compliance. However, this does not come without risk, and requires significant focus on the impact it could have on both workers and care recipients. Codesign approaches and sharing stories of success are likely to help gain the social licence to implement digital- and technology-driven changes.

5. Navigating complex reforms will remain challenging in the short term

Providers may be feeling overwhelmed with the complexity and volume of reform. Two key areas to focus on include:

• Funding – to ensure that providers are receiving all funds to which they are entitled i.e., providers must ensure that ‘no money is left on the table’; and
• Compliance – to ensure that providers are not in breach of any regulatory or legal requirements. Information management and data governance are essential to ensure compliance, and it will be important for providers to ensure that the lifecycle of information within their service (from creation to updating to reporting to deletion) matches their compliance requirements.

6. Social isolation at home is a key challenge

Consumer preferences are trending towards ‘ageing at home’, however this is posing a significant challenge in the form of social isolation and loneliness for many older Australians. It will be important to also consider the diverse needs and preferences of care recipients in addressing this challenge, as there is unlikely to be a ‘one-size-fits-all’ solution.

7. New investment in residential care is very low and this will have long-term implications

Most older Australians who receive home-care services eventually move to residential care at the latter stages of their lives. With Australia’s ageing population there is likely to be significant demand for residential care in the future. The current level of investment in the development of new residential aged-care places is unlikely to meet this demand.

8. Solutions should not be considered in isolation and require system-wide collaboration

Aged care does not operate in a vacuum and the possible solutions to the challenges faced by the sector should not be explored in isolation. Changes made in the sector have flow-on implications for the broader care sector, including the disability and healthcare sectors.

For example, unmet demand by the aged-care sector typically has significant downstream implications for health and public hospitals in particular. Similarly, resolving workforce challenges in aged care may have negative implications in other sectors. Any new rules and regulations issued relating to quality and safety also must be evidence-based and assessed for the impact they have on quality. These are all very complex issues and require significant system-wide collaboration to investigate and action.

9.There is very little safety net for older Australians who are homeless or at risk of homelessness

The housing crisis and increases in cost of living are having a significant impact on older Australians. More work needs to be done to address this issue to ensure that older Australians are not disproportionately disadvantaged.

10. Australia should learn from other countries about the impact of moving to a ‘user pays’ model

Australia may move further down the track of the ‘user pays’ model in aged care. Other comparable countries, including New Zealand and the Netherlands, have adopted such models previously. It will be important for Australia to learn any lessons from those jurisdictions to better understand the overall impact of such changes on the quality of care provided.