Written by Professor Jennifer Tieman, Director, RePaDD
The report of the Royal Commission into Aged Care Quality and Safety was tabled on 1 March 2021. Since then there has been extensive commentary and positioning around futures arising from what may be in the Federal budget and what will be in the formal response of the Federal Government to the report.
The report’s recommendations are many and comprehensive. But at the heart of the report is a call for a new aged care system that is driven by a rights-based Act with a stronger and more transparent regulatory and governance framework. The report is detailed in its assessment of the context for aged care, the processes by which such care is enabled, the requirements and characteristics of a workforce to provide care, and the diversity and individuality of the needs of older Australians requiring care.
Importantly, the report also recognises that ageing inevitably associates with dying. This is not to say that preventative, restorative, and rehabilitative approaches are not essential, but the report acknowledges the reality of end of life and the need to address the care needs of older Australians for whom end of life is a reality.
While the Commissioners recognised that residential aged care is often a person’s final place of residence before they die, they also indicated that care at home until the end of life must be addressed. The tone and intent of the report sees that palliative and end-of-life care, like dementia care, needs to be considered as core business for aged care providers.
High quality palliative care is essential to ensuring that an older person can live their life as fully and as comfortably as possible as they approach death. Compassionate, respectful, and individualised support for older people approaching the end of their lives is a necessary component of aged care services. p94
What does this mean for palliative care as a sector, as a discipline, and for healthcare and aged care professionals providing palliative care?
The report highlights the need for a responsive health system that responds to the healthcare needs of all older Australians and enables access regardless of where they live. Our health system must look at how at these needs are most appropriately and humanely addressed across the diversity inherent in our population.
Specialist palliative care services will need to consider how to manage increasing demand and the interfaces with aged care providers and primary care working into aged care. They will need to ensure that the needs of a complex and vulnerable group of older Australians often presenting with cognitive impairment, multimorbidities, and frailty are accommodated while not neglecting the care needs of patients and families dealing with interrupted life course dying through cancer and other chronic and acute diseases.
Education and workforce development will be critical to an ensure a sufficient and capable workforce in both the health and aged care system. Palliative care needs to be involved in designing, developing, and delivering educational, training, and professional development activities to enhance and sustain a capable workforce in providing palliative care and care at the end of life. Care for families and carers of older Australians across illness, decline, death and bereavement also needs to be considered.
Research was a specific focus within the Royal Commission report. The lack of research funding on aged care and a paucity of data on activity and on quality was identified. The Commissioners have called for data and research that can inform and evaluate new models, that can track how aged care is delivered, and that can identify approaches to support change and adoption within the sector.
Urgent research and development to support the use and application of technology was also noted. These research deficits and opportunities also resonate within the palliative care agenda and highlight the need for palliative care and aged care researchers to address these gaps to improve care.
While the palliative care sector is already active in many of these areas, the report of the Royal Commission reminds us of the scale and impact of needs associated with an ageing population. We are living longer and dying older. This will influence how we provide care and address needs within our community.
Given the universal and unique circumstance of end of life, palliative care will need to be cognizant of responses and initiatives arising from the Royal Commission and the response to it. As health professionals, academics, researchers, and community members we need to make its contribution to improving the quality of life, quality of care, and quality of dying for all of our older Australians.