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Standing Committee on Health, Aged Care and Sport
26/04/2018
Quality of care in residential aged-care facilities in Australia

FERGUSON, Ms Helen, Assistant Director-General, Strategic Policy and Legislation, Department of Communities, Disability Services and Seniors

O'CONNOR, Ms Clare, Acting Director-General, Department of Communities, Disability Services and Seniors

Committee met at 8:58

CHAIR ( Mr Zimmerman ): I declare open this hearing of the Standing Committee on Health, Aged Care and Sport in relation to our inquiry into the quality of care in residential aged-care facilities in Australia. Thank you everyone for coming this morning. Before I begin, can I ask a member to move that the media be allowed to record the proceedings today in accordance with the rules set for committees.

Mr ZAPPIA: I move that.

CHAIR: I declare that carried. I welcome representatives from the Queensland Department of Communities, Disability Services and Seniors. Do you have any objection to being recorded by the media today if they happen to be present?

Ms O'Connor : No, we have no objection.

CHAIR: Fantastic. I have some formalities which we are required to go through. I need to remind you that these are formal proceedings of the federal parliament. The giving of false or misleading evidence is a serious matter and may be regarded as a contempt of the parliament. The evidence given today will be recorded by Hansard and attracts parliamentary privilege.

We have a submission from the minister. Tony, can I ask you to move that the submission be admitted as a submission of this inquiry?

Mr ZAPPIA: I move that.

CHAIR: I declare that carried. Would you like to make an opening statement before we move onto questions?

Ms O'Connor : Yes, I would. Good morning, members of the committee. First of all, I acknowledge the traditional owners of the land on which we meet and pay my respects to elders past and present. We also acknowledge that the responsibility for the regulation, monitoring and oversight of residential aged care falls within the portfolio of the Australian government. However, the Queensland government has a strong interest in the experience of older people and the quality of care they receive in residential aged-care facilities. As you are aware, the Hon. Coralee O'Rourke MP, the Minister for Communities and the Minister for Disability Services and Seniors, lodged a submission to the committee's inquiry. I will support the content of that submission by providing some contextual information about Queensland seniors, giving you some information about the work of our department in relation to older people and outlining some of the related findings from a 2015 Queensland parliamentary inquiry into the adequacy of existing financial protections for Queensland seniors.

As you may have heard from other jurisdictions, Queensland's population is also ageing. In 2017, there were approximately 742,000 people of 65 years of age or older, including 87,000 persons aged 85 years or older. Over the next 30 years, we will see the number of older Queenslanders almost double, reaching around 1.7 million people by 2047, with 300,000 of those aged 85 years or older. Older people currently make up 15.1 per cent of our population, and by 2047 they are expected to comprise 21.5 per cent of the population, or one in five people.

Queensland seniors are not a homogenous group; they are very diverse, with a range of different needs and wants. While most live in the south-east corner of the state, Queensland is the second-largest state in area, and a relatively large proportion of its population live in regional centres and some live in remote communities. This presents us with additional challenges in supporting older people in those areas. Minister O'Rourke's submission advises that she regularly hears the concerns of older Queenslanders. Their adult children and members of the community raise matters about the quality of care in aged-care facilities as well as the high cost of entry into these facilities. Our department leads a range of strategic initiatives and provides a range of services and supports for Queensland seniors; some of these we administer directly and others we fund community-based organisations to deliver. I will talk a little bit about those and how they relate to your inquiry.

The Queensland government is committed to creating an age-friendly community in which people of all ages are respected and valued. Age-friendly communities, as advocated by the World Health Organization, can contribute to the overall wellbeing of older people and prevent their mistreatment. We have an age-friendly community strategic direction statement and an action plan, and that outlines how we will promote the value and contribution of older people, support social inclusion and participation and provide appropriate supports and services.

The action plan comprises a number of initiatives relating to elder abuse in particular. The first was that we would commission a review into the prevalence and characteristics of elder abuse to better understand the impacts on older people and to inform the development of integrated service response models. The second is that we would develop education resources and promote awareness, particularly of financial elder abuse, which at the moment is the highest category, including focusing on the roles and responsibilities of people exercising powers of attorney. We would fund programs that provide resources and referrals to address elder-abuse prevention in culturally and linguistically diverse communities and assist older people transitioning into retirement, and we would implement the responses to the parliamentary inquiry into the adequacy of existing financial protections for Queensland seniors. That inquiry found that there are benefits associated with mandatory reporting requirements when abuse of a person with impaired capacity is suspected. The value of the enduring powers of attorney documents to support and protect older people in planning and decision-making was highlighted by the parliamentary inquiry, and there were a number of recommendations also made relating to housing, and we are making very strong headway in addressing the inquiry's findings and recommendations.

There has been an Advisory Taskforce on Residential Transition for Ageing Queenslanders to examine options for enabling older people to continue to be connected to their community and to access suitable housing. That task force had some findings which included that: there were limited affordable and appropriate housing options, it was expensive to right-size or move closer to services, there was a complicated legal and pension maze and the housing market is difficult to navigate for seniors. So a number of initiatives that we are putting in place include: a telephone helpline to provide seniors with information on housing options, ranging from home ownership to retirement villages to aged care; an annual summit with stakeholders to bring together representatives of seniors groups, industry and academia to develop practical solutions to seniors' housing issues; and an awareness campaign to encourage people to plan early for their housing needs.

Importantly, our department funds the Elder Abuse Prevention Unit, which is an information, training and referral service for preventing, responding to and raising awareness of elder abuse. I understand that this committee will hear from the EAPU later on today or during your inquiry. There is a state-wide telephone helpline. In 2016-17, the helpline continued to respond to telephone calls and emails. There were 1,652 reported abuse cases or relationships, with financial abuse being the most common abuse type disclosed, and around nine per cent of the victims of elder abuse reported to the EAPU that they resided in an aged-care facility. So that is something you may wish to explore further with them.

We also fund five Seniors Legal and Support Services, located in Hervey Bay, Cairns, Townsville, Toowoomba and Brisbane, to assist older people at risk of or experiencing elder abuse or financial exploitation. We will also have an additional five services coming on board very shortly in the Sunshine Coast, the Gold Coast, Rockhampton, Mackay and Gladstone. We have the Seniors Enquiry Line, which is a state-wide information and referral service which provides access for seniors, their families, friends and carers to information on topics such as financial and legal matters, as well as social activities, household assistance, retirement accommodation, health, education and transport. We are aware of and welcome the establishment of a new, independent Aged Care Quality and Safety Commission. You would know that a similar commission is being established to enhance quality and safeguards for participants of the NDIS, the National Disability Insurance Scheme, and we are looking forward to getting further details on that. I might pause there, Chair, and participate as you wish.

CHAIR: Firstly, one thing to clarify: you referred to the over-65 population increasing to 21 per cent by 2047. The minister's submission refers to it increasing from 15 per cent to 20 per cent by 2036. That would seem to indicate, unless the years are wrong, that there is a tapering of the proportional growth of over-65s. Am I misreading something?

Ms O'Connor : No, I think that's correct. There is a huge belt of baby boomers coming through at the moment that will obviously, at some point, taper off.

CHAIR: So the peak impact is likely to be in the mid-2030s—is that a fair assumption?

Ms O'Connor : Yes.

CHAIR: You obviously point to the fact that aged care is primarily a federal government responsibility. I'm wondering whether you could outline, apart from the aged-care centres that the Queensland government itself operates, which I'll come to in a tick, what regulatory role—because I think you're the first state department that's appeared before the committee—the states have in relation to aged-care facilities at all. For example, it was put to us at hearings in Sydney that there were decisions of the New South Wales government being considered which would affect the requirements in relation to registered nurses. That obviously implied that there is a state regulatory role as well as the federal one.

Ms O'Connor : The Queensland health department runs a number of aged-care facilities that are state-run facilities.

CHAIR: I want to come to that, but, more broadly in the private sector.

Ms O'Connor : We don't regulate.

Ms Ferguson : We don't have regulation of aged care as such, but we do have a range of program requirements for the aged-care facilities that the Queensland government runs.

Ms O'Connor : We would need to respond to any directions from the national orbit around quality and standards.

CHAIR: Unless I misunderstood—I'm wondering why a witness would've suggested that, state by state, there were different rules about whether RNs had to be present at aged-care facilities.

Ms Ferguson : I'm not sure of the answer to that question more broadly, but, where states and territories are very interested in aged-care arrangements and in residential aged-care arrangements and they provide such arrangements themselves, there's probably not a lot to stop them from going further into some aspects of regulation that have relationship to the state or territory government. There are probably not a lot of things to prevent that, but most jurisdictions would be looking to Commonwealth regulations.

CHAIR: In relation to the design and construction of aged-care facilities—and I know this is probably not within your department's responsibility, but, for example, take child care—you tend to find that local councils, state government and then the federal government have quite detailed rules, not necessarily the same rules, in relation to the design of aged-care facilities arising from the consideration of development applications and the planning process. Would the Queensland government, that you're aware of, effectively have development planning rules that govern the built form of aged-care facilities or do you rely on the Commonwealth for that?

Ms Ferguson : We'd need to refer that to our colleagues.

CHAIR: Would you mind taking that on notice?

Ms Ferguson : Sure, of course.

CHAIR: The 16 aged-care facilities that are run by the Queensland government—they're department of health rather than your department?

Ms O'Connor : That's right.

Ms Ferguson : Correct.

CHAIR: Do you have much involvement in those?

Ms Ferguson : Not from our department, no.

CHAIR: It's entirely the health department that has responsibility for those?

Ms O'Connor : Yes.

CHAIR: Is it a historical legacy that the Queensland government is operating aged-care facilities? Do you know why they are operating them?

Ms Ferguson : There'd certainly be a legacy element to the rationale for that, absolutely.

Mr LAMING: Chair, that would go back to Queensland hospital boards and decisions made independently in regions.

Mr ZAPPIA: In your opening remarks, Ms O'Connor, you talked about elder abuse. Can you advise whether that includes elder abuse within aged-care facilities. If it does, how are your inquiries about that going to take place?

Ms O'Connor : The Elder Abuse Prevention Unit and the numbers that I referred to in my opening address do include some reference to people who are in non-trust positions—that is, they're not family members, where you could assume that automatic relationship of trust. I mentioned that the statistics currently show that some of the people who contact the Elder Abuse Prevention Unit do reside in aged-care facilities. The detail on the people that I made reference to—I would expect the Elder Abuse Prevention Unit will be able to shed some more light on that when the committee gets to see them.

Mr ZAPPIA: The feedback or the information that has been gathered by the department—can you advise whether that is coming directly from the older people who claim to be abused or is it coming from family members?

Ms O'Connor : It can come from both.

Mr ZAPPIA: I know it can, but is it the case that it is coming from both?

Ms O'Connor : Our understanding is that it is coming from both direct complainants and family members.

CHAIR: Do you have a statistical breakdown of this?

Ms O'Connor : We'll check that for you.

CHAIR: You can take that on notice if you'd like.

Ms O'Connor : Thank you.

Mr ZAPPIA: When you get complaints of that nature and, in particular, complaints coming from residents of aged-care facilities themselves, how are they dealt with? What is the response?

Ms O'Connor : I'm looking at the table. In terms of information that we have to hand, we have elder abuse notifications at 1,652; elder abuse victims at 1,520; non-trust abuse victims, which are usually from a service system, at 222; elder abuse perpetrators at 1,615; and non-trust abuse perpetrators at 220. I don't know that that answers your question in full—

CHAIR: Can you explain the difference in those categories? When you say 'elder abuse perpetrator', that obviously has a pretty literal meaning, but are you saying that that's—

Ms O'Connor : If the distinction is between trust and non-trust, non-trust refers to abuse perpetrated within a relationship where there is no intrinsic expectation of trust. They could be neighbours. They could be staff employed by formal organisations reporting the abuse, where in terms of trust arrangements you'd expect that to be in the family context.

CHAIR: Or an aged-care provider if they're in the care of an aged-care centre?

Ms O'Connor : Yes, because they would have some obligations about the care, but our elder abuse prevention unit in the main deals with people who are not in those settings, deals with people who are in the community and having the relationship with their family members.

CHAIR: Can you put those statistics in context? For example, I thought the 1,600 figure you referred to was the number of complaints that you've had to your hotline.

Ms O'Connor : The number of notifications is 1,652.

CHAIR: And what is a notification in your terms?

Ms O'Connor : A notification is where the elder abuse protection unit is made aware of a potential elder abuse situation.

CHAIR: When you refer to 1,500 elder abuse—

Ms O'Connor : Victims? There can be multiple notifications.

CHAIR: No, perpetrators. What is that a reference to? There are 1,500 complaints about individuals? Is that a subset of the 1,600?

Ms O'Connor : The elder abuse notifications are where the EAPU is notified that a situation of elder abuse may be occurring. The elder abuse perpetrators, we believe, are people who are nominated as potential perpetrators of elder abuse to the EAPU.

CHAIR: So that could be a subset of the 1,600.

Ms O'Connor : That's right.

Mr ZAPPIA: Can you tell me how many of those 1,652 originate from aged-care facilities?

Ms O'Connor : The advice that we had that I've indicated could be explored further with the EAPU was nine per cent.

Mr ZAPPIA: Around nine per cent, which in round figures would be about 150 of those.

Ms O'Connor : Yes.

Mr ZAPPIA: Does the department maintain some kind of monitoring system to determine whether that nine per cent comes largely from a particular group of facilities?

Ms O'Connor : I don't have the information to hand, so I'll have to take that on notice and get that from the EAPU for you.

Mr ZAPPIA: Are you aware of any response to those notifications whereby the department has followed up the notifications with a visit to a particular facility?

Ms O'Connor : I will get that information for you. We fund this service; we don't deliver it directly. Certainly, where instances have been drawn to the attention of the department—and I think of a particular case recently where the person had made a report to EAPU and required further follow-up. We undertook to do that ourselves and we worked with the EAPU on that particular piece of advice.

Mr ZAPPIA: Lastly from me for the time being, are you aware of any action ever being taken against an aged-care provider in response to notifications of elder abuse?

Ms O'Connor : I'm going to take that one on notice, if you don't mind, and come back to you on that.

Mr ZAPPIA: Thank you.

CHAIR: I will follow that. We're not actually seeing the OPU today, but it's effectively an independent service funded by your department; is that the best way to describe it?

Ms O'Connor : Yes.

CHAIR: What oversight do you have in relation to the unit? Presumably there is a contractual relationship.

Ms O'Connor : Yes, it's a contract.

CHAIR: Do you know what their protocols or your department's protocols are in relation to complaints being reported through that channel or directly to your department in relation to aged-care providers? Do you have specific written protocols for how those complaints are handled? Does that involve passing those complaints on to Commonwealth authorities?

Ms O'Connor : We will take that one on notice.

CHAIR: What I'm getting at is that I presume these complaints, if they go in relation to aged-care facilities and some serious matters in relation to the accreditation of those facilities, have a mechanism to be forwarded to the Commonwealth.

Ms Ferguson : Again, we'll follow that up.

Ms O'Connor : One of the things I would say is that the mandatory reporting in aged-care facilities where elder abuse is suspected relates to physical and sexual assaults. One of the areas that we are very interested in is other categories of elder abuse and whether there should be reporting from those facilities around those categories.

CHAIR: What I'm getting at is making sure that there's a seamless process—that someone doesn't ring the Queensland government thinking that they are the primary regulator and that disappearing into a black hole rather than ringing the federal complaints authority, which obviously has the primary investigative responsibility.

Ms Ferguson : If I may: I think that's one of the reasons why the director-general was noting before that the establishment of the new commission is very welcomed given that the functions and roles of that commission will be clearly identified. I presume it will be set up similarly to the NDIS quality and safeguards commission and will have statutory responsibilities for complaints, registration of providers and all that that entails. I guess the NDIS Quality and Safeguards Commission also has a senior practitioner to oversee the use of behaviour support arrangements and eliminate or reduce any restrictive practices that are being used. It's a very firm and sound model that is being put in place for the NDIS that could provide a number of additional safeguards in the aged-care system.

CHAIR: But anyway, if you can come back on the existing protocols, that would be great.

Ms Ferguson : Yes.

CHAIR: The other question I wanted to ask is about the minister making a comment in her submission about pressure on the public hospital system because of the unavailability of beds in aged-care facilities—that is, people are staying in the hospital system longer than they might otherwise need. Do you have any statistics in relation to that issue in Queensland?

Ms Ferguson : Not at our fingertips right now, but it is something that we can provide for the committee should you wish.

CHAIR: That would be great.

Ms Ferguson : Our colleagues in the Department of Health do keep that data.

CHAIR: Occasionally you get the assertion going the other way: that people are put prematurely into aged-care facilities when their treatment might be better continued in a hospital environment. It's the reverse of what we've more frequently heard.

Ms Ferguson : Correct. I think it might be useful for us also—not that I want to add another query to you unnecessarily—for arrangements for hospital-in-the-home programs to support residents who are moving to aged-care facilities to continue to have the support of acute medical intervention while there. We could also have a look at that.

CHAIR: My final question comes back to the 16 state-run facilities. Whilst you don't manage those, is there some type of holistic, interdepartmental process? I'm obviously thinking particularly of the issues that arose in South Australia and whether that has triggered any processes in other states, including Queensland, obviously, to review and consider the structures around assessing their own state-run facilities. Have you been party to any of those discussions

Ms Ferguson : Again, that's in the province of the Department of Health rather than our department.

CHAIR: But there's nothing that you're involved with in that regard.

Ms Ferguson : That's right.

Mr LAMING: Could I ask a few questions about the proportion of quality monitoring of aged-care facilities that is spent on unannounced visits as opposed to triannual accreditation? I'm trying to see how much of that money is spent on regular announced accreditations as opposed to unannounced visits. Is there a general ratio of resources in the department?

Ms O'Connor : We don't have oversight of those facilities and we don't oversee a visiting program to those facilities, so I don't have that information for you.

Mr LAMING: What's the closest that you guys would come to quality of services delivered by aged-care facilities?

Ms O'Connor : Queensland Health, another Queensland government department that does have state-run aged-care facilities, would be responding to the federal government frameworks and regulation in that area.

Mr LAMING: Thanks.

CHAIR: I assume, by the way, that you don't have any exposure to the work that's being done on staff ratios in the Queensland government-run facilities.

Ms O'Connor : No, we don't. We do have a lot of interaction in terms of the disability frameworks, which we think have relevance here because the area of vulnerability is in common. We do have our own human services quality framework that we operate in the disability space. In terms of the new commission, we believe that there will be similarities in terms of safeguards between aged care and the disability space.

Mr LAMING: Is there a clear line with the NDIS rolling out in much of the Brisbane area midyear? Is there a fairly clear delineation that can see for those with a disability identified as NDIS-eligible being able to access services whether they're over or under the age of 65, or are there some grey zones around age?

Ms O'Connor : No, I think that has been clarified in terms of eligibility. There is a lot of preparatory work underway to make sure participants are ready, their families are ready and people do get the services required as soon as possible. I don't think there is still a lingering question around age 65. That has been settled now at the national level.

Mr LAMING: And what about mental health in particular? Are those with mental health issues fully able to access federal government funded services through a PHN or other networks? Do they simply have to be an NDIS-accredited provider to have sufficient access to those services?

Ms Ferguson : Where the person is eligible for the NDIS, they're then able to access reasonable and necessary supports in accordance with their plan whether or not they have a mental illness. Mental illness is an eligible disability under the NDIS, and people who are eligible for the NDIS and able to access supports through their plan are also able and encouraged to access mainstream services, so a person with mental illness may well be receiving reasonable and necessary supports and state supports for their recovery.

Mr LAMING: So there's no evidence in the parts of Queensland where it's rolled out that mental health services at federal level—for instance, mental health aftercare in the home—aren't accessible, because they're not registered as an NDIS provider? And is it the same with education? Are we not seeing an example of individuals with a disability not being able to access educational services as part of their NDIS package?

Ms Ferguson : As I was saying, people are encouraged to receive supports both through registered providers as part of their package and through mainstream services that are provided by states and territory governments.

Mr LAMING: So you're not seeing any evidence that federal services, be they either education or health related, aren't accessible to NDIS clients, because they're not registered to be an NDIS provider?

Ms Ferguson : That should not be an impediment to people accessing supports.

Mr LAMING: Great.

CHAIR: Thank you for your evidence today and also thank you for agreeing to take some of those questions on notice. You will be provided with a Hansard transcript of today's proceedings. If there are any factual corrections to that that you think are required, could you come back to the committee secretariat. If at all possible, if you could you provide that additional information by 10 May, that would be very helpful. Thank you for your participation today.