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Aged Care Quality and Safety—Royal Commission—Final report: Care, dignity and respect—Volume 5: Appendices


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Royal Commission into Aged Care Quality and Safety

Final Report: Care, Dignity and Respect

Volume 5 Appendices

Royal Commission into Aged Care Quality and Safety

Final Report: Care, Dignity and Respect

Volume 5 Appendices

© Commonwealth of Australia 2021

ISBN: 978-1-921091-79-7 (print)

ISBN: 978-1-921091-80-3 (online)

With the exception of the Coat of Arms and where otherwise stated, all material presented in this publication is provided under a Creative Commons Attribution 4.0 International licence. For the avoidance of doubt, this means this licence only applies to material as set out in this document.

The details of the relevant licence conditions are available on the Creative Commons website as is the full legal code for the CC BY 4.0 licence .

The terms under which the Coat of Arms can be used are detailed on the Department of the Prime Minister and Cabinet website .

Table of Contents

Appendix 1: Witnesses 3

Appendix 2: Roundtable Discussions and Participants, and Other Key Consultations

33

Appendix 3: Service Provider Visits 45

Appendix 4: Community Forums 49

4.1 Introduction 49

4.2 Bankstown community forum 50

4.3 Bendigo community forum 53

4.4 Wollongong community forum 56

4.5 Maidstone community forum 58

4.6 Broome community forum 60

4.7 Townsville community forum 62

4.8 Adelaide community forum 66

4.9 Brisbane community forum 68

4.10 Rockhampton community forum 70

4.11 Launceston community forum 72

4.12 Canberra community forum 74

4.13 Newcastle community forum 78

4.14 Community forum questionnaire summary 80

iii iii

iv

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Appendix 5: Summary of Background Papers 87

Appendix 6: Commissioned Reports 93

Appendix 7: Summary of Commissioners’ International Research, January 2020

99

Appendix 8: Aged care and COVID-19: a special report (reproduction) 109

Appendix 9: The Royal Commission’s Finances 145

Appendix 10: The Team of the Royal Commission into Aged Care Quality and Safety 151

Appendix 1: Witnesses

Appendix 1: Witnesses Adelaide Hearing 1

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

1. Barbara Spriggs 1-1 11-Feb-19 Statement of Barbara Spriggs 11-Feb-19

2. Clive Spriggs 1-2 11-Feb-19 Statement of Clive Spriggs 11-Feb-19

3. Ian Yates AM 1-3 11-Feb-19 Statement of Ian Yates 11-Feb-19

4. Prof John

McCallum

1-4 11-Feb-19 Statement of John McCallum 11-Feb-19

5. Justine Boland 1-6 12-Feb-19 Statement of Justine Boland 12-Feb-19

6. Louise York 1-7 12-Feb-19 Statement of Louise York 12-Feb-19

7. Mark Cooper-Stanbury n/a n/a n/a 12-Feb-19

8. Craig Gear 1-8 12-Feb-19 Statement of Craig Gear 12-Feb-19

9. Paul Versteege 1-9 12-Feb-19 Statement of Paul Versteege 12-Feb-19

10. Susan Elderton 1-11 12-Feb-19 Statement of Susan Elderton 12-Feb-19

11. Assoc Prof Edward Strivens 1-14 13-Feb-19 Statement of Edward Strivens 13-Feb-19

12. Prof Deborah Parker 1-15 13-Feb-19 Statement of Deborah Parker 13-Feb-19

13. Annie Butler 1-16 13-Feb-19 Statement of Annie Butler 13-Feb-19

14. Glenys Beauchamp PSM 1-23 18-Feb-19 Statement of Glenys Beauchamp 18-Feb-19

15. Commissioner Janet Anderson PSM

1-38 18-Feb-19 Statement of Janet Anderson 18-Feb-19

1-39 18-Feb-19 Corrigendum to the statement of Janet Anderson

16. Dr Harry Nespolon

1-40 18-Feb-19 Statement of Harry Nespolon 18-Feb-19

17. Maree McCabe 1-44 19-Feb-19 Statement of Maree McCabe 19-Feb-19

18. Patricia Sparrow 1-45 19-Feb-19 Statement of Patricia Sparrow 19-Feb-19

19. Sean Rooney 1-46 19-Feb-19 Statement of Sean Rooney 19-Feb-19

1-47 Second statement of Sean Rooney

20. Nicolas Mersiades

1-50 19-Feb-19 Statement of Nicolas George Mersiades 19-Feb-19

21. Claerwen Little 1-51 20-Feb-19 Statement of Claerwen Little 20-Feb-19

22. Melissa Coad 1-52 20-Feb-19 Statement of Melissa Coad 20-Feb-19

23. Matthew Richter 1-54 20-Feb-19 Statement of Matthew Richter 20 Feb 19

1-55 20-Feb-19 Supplementary statement of Matthew Richter

3

4

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

24. Dr Anthony Bartone

1-56 20-Feb-19 Statement of Anthony Bartone 20-Feb-19

1-57 20-Feb-19 Additional statement of Anthony Bartone

25. Gerard Hayes 1-60 21-Feb-19 Statement of Gerard Hayes 21-Feb-19

26. Kaye Warrener 1-61 21-Feb-19 Statement of Kaye Warrener 21-Feb-19

27. Margaret Harker 1-62 21-Feb-19 Statement of Margaret Harker 21-Feb-19

28. Barrie Anderson 1-63 21-Feb-19

Statement of Barrie Anderson 21-Feb-19

Adelaide Hearing 2

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

29. Lynda Henderson 2-1 18-Mar-19 Statement of Lynda Henderson 18-Mar-19

2-3 18-Mar-19 Video of Lynda Henderson and Veda Meneghetti

30. Raelene Ellis 2-4 18-Mar-19 Statement of Raelene Ellis 18-Mar-19

31. BE 2-9 18-Mar-19 Statement of BE 18-Mar-19

32. Paul Sadler 2-12 18-Mar-19 Statement of Paul Sadler 18-Mar-19

33. Josef Rack 2-15 19-Mar-19 Statement of Josef Rack 19-Mar-19

34. Caroline Ford 2-23 19-Mar-19 Statement signed by David Moran and Caroline Ford on behalf of Southern Cross Care

19-Mar-19

35. David Moran 2-23 19-Mar-19 Statement signed by David Moran and Caroline Ford on behalf of Southern Cross Care

19-Mar-19

36. Clare Hargreaves 2-25 19-Mar-19 Statement of Clare Hargreaves 19-Mar-19

37. Sally Warren 2-26 19-Mar-19 Statement of Sally Warren 19-Mar-19

38. Heather Jackson 2-27 19-Mar-19 Statement of Heather Jackson 19-Mar-19

39. Anna Hansen 2-28 19-Mar-19 Statement of Anna Hansen 19-Mar-19

40. Rosemary Dale 2-29 19-Mar-19 Statement of Rosemary Dale 19-Mar-19

41. Gregory Holmes n/a 19-Mar-19 n/a 19-Mar-19

42. BC 2-33 20-Mar-19 Statement of BC 20-Mar-19

43. Marie Dowling 2-34 20-Mar-19 Statement of Marie Dowling 20-Mar-19

44. BA 2-36 20-Mar-19 Statement of BA 20-Mar-19

45. Mary Patetsos 2-37 20-Mar-19 Statement of Mary Patetsos 20-Mar-19

46. Ruth Harris 2-76 21-Mar-19 Statement of Ruth Harris 21-Mar-19

47. Graeme Barden 2-78 21-Mar-19 Statement of Graeme Barden 21-Mar-19

48. Rita Kersnovske 2-80 21-Mar-19 Statement of Rita Kersnovske 21-Mar -19

49. Dr Lisa Studdert n/a 21-Mar-19 n/a 21-Mar-19

50. Anthony Speed n/a 21-Mar-19 n/a 21-Mar

-19

5

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

51. Prof Hjalmar Swerissen 2-86 21-Mar-19 Statement of Hjalmar Swerissen 21-Mar-19

52. Fiona Buffinton 2-89 22-Mar-19 Statement of Fiona Buffinton 22-Mar-19

Sydney Hearing 1

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

53. Merle Mitchell AM 3-1 6-May-19 Statement of Merle Mitchell 6-May-19

54. Darryl Melchhart 3-3 6-May-19 Statement of Darryl Melchhart 6-May-19

55. George Akl 3-4 6-May-19 Statement of George Akl 6-May-19

56. Eresha Dassanayake 3-6 6-May-19 Statement of Eresha Dassanayake

6-May-19

57. Lillian Reeves 3-8 6-May-19 Statement of Lillian Reeves 6-May-19

58. Michelle McCulla 3-9 7-May-19 Statement of Michelle McCulla 7-May-19

59. Natalie Smith 3-10 7-May-19 Statement of Natalie Smith 7-May-19

3-11 7-May-19 Supplementary statement of Natalie Smith

60. Jayanthi Kannan 3-12 7-May-19 Statement of Jayanthi Kannan 7-May-19

61. Dr Miles Burkitt 3-13 7-May-19 Statement of Miles Burkitt 7-May-19

62. Dr Kenneth Wong 3-14 7-May-19 Statement of Kenneth Wong 7-May-19

63. Kee Lau 3-15 7-May-19 Statement of Kee Lau 7-May-19

64. DM 3-20 8-May-19 Statement of DM 8-May-19

65. DL 3-21 8-May-19 Statement of DL 8-May-19

66. Richard Farmilo 3-22 8-May-19 Statement of Richard Farmilo 8-May-19

3-23 8-May-19 Supplementary statement of Richard Farmilo

3-83 17-May-19 Second supplementary statement of Richard Farmilo

67. Cheryl Lee 3-26 8-May-19 Statement of Cheryl Lee 8-May-19

68. Dr Margaret Ginger 3-27 8-May-19 Statement of Margaret Ginger 8-May-19

69. Kathryn Nobes 3-28 8-May-19 Statement of Kathryn Nobes 8-May-19

70. DF 3-32 8-May-19 Statement of DF 8-May-19

71. Marian Anderson 3-33 8-May-19 Statement of Marian Anderson 8-May-19

72. DI 3-35 13-May-19 Statement of DI 13-May-19

73. DJ 3-36 13-May-19 Statement of DJ 13-May-19

74. Maureen Berry 3-38 13-May-19 Statement of Maur

een Berry 13-May-19

75. Glenn Rees 3-40 13-May-19 Statement of Glenn Rees 13-May-19

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

Amy Tinley 76. 3-44 13-May-19 Statement of Amy Tinley 13-May-19

77. Tamar Krebs 3-45 14-May-19 Statement of Tamar Krebs 14-May-19

78.

Jonathan Gavshon

n/a n/a n/a 14-May-19

79. Jennifer Lawrence

3-46 14-May-19 Statement of Jennifer Lawrence 14-May-19

80. Lucille O'Flaherty 3-47 14-May-19 Statement of Lucille O'Flaherty 14-May-19

81. Prof Constance Pond 3-48 14-May-19 Statement of Constance Pond 14-May-19

82. Prof Elizabeth Beattie 3-49 3-50

14-May-19 Statement of Elizabeth Beattie

Supplementary statement of Elizabeth Beattie

14-May-19

14-May-19

83. Dr Peter Foltyn 3-51 14-May-19 Statement of Peter Foltyn 14-May-19

84. Assoc Prof Lynette Goldberg 3-52 14-May-19 Statement of Lynette Goldberg 14-May-19

85. Prof Brendan Murphy 3-55 14-May-19 Statement of Brendan Murphy 14-May-19

86. Elizabeth 3-57 15-May-19 Statement of Elizabeth 15-May-19

87. Margaret Bain 3-58 15-May-19 Statement of Margaret Bain 15-May-19

88. Susan Walton 3-59 15-May-19 Statement of Susan Walton 15-May-19

89. Suzanne Wilson 3-60 15-May-19 Statement of Suzanne Wilson 15-May-19

90. Dr Juanita Breen (formerly Westbury)

3-61 15-May-19 Statement of Juanita Westbury 15-May-19

91. Assoc Prof Stephen Macfarlane

3-68 15-May-19 Statement of Stephen Macfarlane 15-May-19

92. Prof Joseph Ibrahim 3-70 16-May-19 Statement of Joseph Ibrahim 16-May-19

93. Christina Bolger 3-75 16-May-19 Statement of Christina Bolger 16-May-19

94. Amy Laffan 3-78 16-May-19 Statement of Amy Laffan 16-May-19

95. Josephine Mond 3-79 16-May-19 Statement of Josephine Mond 16-May-19

96. Prof Henry Brodaty AO 3-80 17-May-19 Statement of Henry Brodaty 17-May-19

97. Trevor Crosby 3-82 17-May-19 Statement of Trevor Crosby 17-May-19

98. Kate Swaf

fer 3-84 17-May-19 Statement of Kate Swaffer 17-May-19

7

Witnesses Appendix 1

Broome Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

99. Madeleine Jadai n/a n/a n/a 17-Jun-19

100. Faye Dean 4-2 17-Jun-19 Statement of Faye Dean 17-Jun-19

101. Ryan Hammond n/a n/a n/a 17-Jun-19

102. Yvonne Grosser 4-3 17-Jun-19 Statement of Yvonne Grosser 17-Jun-19

103. Craig Barke 4-4 17-Jun-19 Statement of Craig Barke 17-Jun-19

104. Tamra Bridges 4-5 17-Jun-19 Statement of Tamra Bridges 17-Jun-19

105. Prof Leon Flicker AO 4-6 17-Jun-19 Statement of Leon Flicker 17-Jun-19

106. Dr Martin Laverty 4-7 18-Jun-19 Statement of Martin Laverty 18-Jun-19

107. Graham Aitken 4-8 18-Jun-19 Statement of Graham Aitken 18-Jun-19

108. Ruth Crawford 4-9 18-Jun-19 Statement of Ruth Crawford 18-Jun-19

109. Belinda Robinson 4-10 18-Jun-19 Statement of Belinda Robinson 18-Jun-19

110. Rejane Le Grange

4-11 18-Jun-19 Statement of Rejane Le Grange 18-Jun-19

111. Dr Michael Preece 4-12 18-Jun-19 Statement of Michael Preece 18-Jun-19

112. Dr Kate Fox 4-13 19-Jun-19 Statement of Kate Fox 19-Jun-19

4-14 Second statement of Kate Fox

113. Roslyn Malay 4-15 19-Jun-19 Statement of Roslyn Malay 19-Jun-19

114. Venessa Curnow 4-16 19-Jun-19 Statement of Venessa Curnow 19-Jun-19

Perth Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

115. Noleen Hausler 5-9 24-Jun-19 Statement of Noleen Hausler 24-Jun-19

116. Rachel Musico 5-10 24-Jun-19 Statement of Rachel Musico 24-Jun-19

117. Diane Jones 5-11 24-Jun-19 Statement of Diane Jones 24-Jun-19

118. Julie Reed 5-12 24-Jun-19 Statement of Julie Reed 24-Jun-19

25-Jun-19

119. Mark Sudholz 5-13 25-Jun-19 Statement of Mark Sudholz 25-Jun-19

120. Jason Burton 5-14 25-Jun-19 Statement of Jason Burton 25-Jun-19

121. EA 5-15 25-Jun-19 Statement of EA 25-Jun-19

122. Chris Mamarelis n/a n/a n/a 25-Jun-19

123. Carolyn Jubb 5-16 25-Jun-19 Statement of Carolyn Jubb 25-Jun-19

124. Kevin Chester 5-17 25-Jun-19 Statement of Kevin Chester 25-Jun-19

125. Kate Rice 5-18 25-Jun-19 Statement of Kate Rice 25-Jun-19

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

126. Bryan Lipmann AM 5-19 25-Jun-19 Statement of Bryan Lipmann 25-Jun-19

127. Anthony O’Donnell

5-1 30-May-19 Statement of Anthony O’Donnell 25-Jun-19

5-20 Video: Examination

of Anthony O’Donnell

25-Jun-19

128. Stuart Woodley 5-21 26-Jun-19 Statement of Stuart Woodley 26-Jun-19

129. Gaye Whitford 5-22 26-Jun-19 Statement of Gaye Whitford 26-Jun-19

130. Emma-Kaitlin Murphy 5-23 26-Jun-19 Statement of Emma-Kaitlin Murphy

26-Jun-19

131. Anna Urwin 5-24 26-Jun-19 Statement of Anna Urwin 26-Jun-19

132. Patti Houston 5-25 26-Jun-19 Statement of Patti Houston 26-Jun-19

133. Hon Dr Kay Patterson AO 5-26 26-Jun-19 Statement of Kay Patterson 26-Jun-19

134. Dale Fisher 5-27 26-Jun-19 Statement of Dale Fisher 26-Jun-19

135. Matthew Moore 5-28 26-Jun-19 Statement of Matthew Moore 26-Jun-19

136. Dr John Rungie 5-29 26-Jun-19 Statement of John Rungie 26-Jun-19

137. Dr Craig Sinclair 5-30 26-Jun-19 Statement of Craig Sinclair 26-Jun-19

138. Shannon Ruddock

5-32 27-Jun-19 Statement of Shannon Ruddock 27-Jun-19

139. Joshua Cohen 5-33 27-Jun-19 Statement of Joshua Cohen 27-Jun-19

5-34 27-Jun-19 Statement of Joshua Cohen

140. John Leong 5-35 27-Jun-19 Second statement of John Leong 27-Jun-19

5-36 27-Jun-19 Statement of John Leong

141. Prof Jennifer Tieman 5-37 27-Jun-19 Statement of Jennifer Tieman 27-Jun-19

142. Dr Jane Fischer 5-38 27-Jun-19 Statement of Jane Fischer 27-Jun-19

143. Dr Elizabeth Reymond 5-39 27-Jun-19 Statement of Elizabeth Reymond 27-Jun-19

144. Dr Lisa Trigg 5-40 28-Jun-19 Statement of Lisa Trigg 28-Jun-19

Darwin and Cairns Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

145. Dr Meredith Hansen-Knarhoi 6-2 8-Jul-19 Statement of Meredith Hansen-Knarhoi

8-Jul-19

146. [redacted] n/a n/a n/a 8-Jul-19

147. Sarah Brown 6-3 8-Jul-19 Statement of Sarah Brown 8-Jul-19

148. Kim McRae 6-4 8-Jul-19 Statement of Kim McRae 8-Jul-19

149.

Donna Ah Chee 6-5 8-Jul-19 Statement of Donna Ah Chee concurred in by Dr Boffa 8-Jul-19

9

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

150. Dr John Boffa 6-5 8-Jul-19 Statement of Donna Ah Chee concurred in by Dr Boffa 8-Jul-19

151. Olga Havnen 6-6 8-Jul-19 Statement of Olga Havnen

concurred in by Dr Giles 8-Jul-19

152. Dr Sarah Giles 6-6 8-Jul-19 Statement of Olga Havnen concurred in by Dr Giles 8-Jul-19

153. Michelle McKay 6-7 8-Jul-19 Statement of Michelle McKay 8-Jul-19

154. Lyndall Fowler 6-9 9-Jul-19 Statement of Lyndall Fowler as amended 9-Jul-19

6-10 9-Jul-19 Statement of Lyndall Fowler

155. Kristy Taylor 6-11 9-Jul-19 Statement of Kristy Taylor as amended 9-Jul-19

156. Sophoronia (Nia) Briguglio 6-12 9-Jul-19 Statement of Sophoronia Briguglio

9-Jul-19

157. Anamaria (Anna) Ng 6-15 10-Jul-19 Statement of Anamaria Ng 10-Jul-19

158. Dr Eric Tay 6-16 10-Jul-19 Statement of Eric Tay 10-Jul-19

159. Paul Cohen 6-17 10-Jul-19 Statement of Paul Cohen as amended 10-Jul-19

6-18 10-Jul-19 Supplementary statement of Paul Cohen 10-Jul-19

160. Donato (Don) Smarrelli 6-19 10-Jul-19 Statement of Donato Smarrelli 10-Jul-19

161. Lisa Backhouse 6-20 11-Jul-19 Statement of Lisa Backhouse 11-Jul-19

162. Assoc Prof Peter Gonski 6-21 11-Jul-19 Statement of Peter Gonski 11-Jul-19

163. Prof Johanna Westbrook 6-22 6-23

11-Jul-19

11-Jul-19

Statement of Johanna Westbrook

Supplementary statement of Johanna Westbrook

11-Jul-19

11-Jul-19

164.

Prof Michael Murray AM

6-24 11-Jul-19 Statement of Michael Murray as amended 11-Jul-19

165. Dr Joan Ostanszkiewicz 6-25 11-Jul-19 First statement of Joan Ostaszkiewicz

11-Jul-19

6-26 11-Jul-19 Second statement of Joan Ostaszkiewicz 11-Jul-19

6-27 11-Jul-19 Corrigendum of Joan Ostaszkiewicz 11-Jul-19

166. Catherine Sharp 6-28 11-Jul-19 Statement of Catherine Sharp 11-Jul-19

167. Sally Hopkins 6-29 11-Jul-19 Statement of Sally Hopkins 11-Jul-19

168. Prof Geoffr

ey

Sussman

6-30 11-Jul-19 Statement of Geoffrey Sussman and Hayley Ryan 11-Jul-19

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

169. Hayley Ryan 6-30 11-Jul-19 Statement of Geoffrey Sussman and Hayley Ryan 11-Jul-19

170. Jo-Ann Lovegrove

6-31 12-Jul-19 Statement of Jo-Ann Lovegrove 12-Jul-19

171. Dr Janet Sluggett 6-32 12-Jul-19 Statement of Janet Sluggett 12-Jul-19

172. Catherine Maloney

6-33 12-Jul-19 Statement of Catherine Maloney 12-Jul-19

173. Sharai Johnson 6-34 12-Jul-19 Statement of Larrakia Nation Aboriginal Corporation 12-Jul-19

174. Michelle McCall 6-34 12-Jul-19 Statement of Larrakia Nation Aboriginal Corporation 12-Jul-19

175. Anna Morgan 6-34 12-Jul-19 Statement of Larrakia Nation Aboriginal Corporation 12-Jul-19

176. Johanna Aalberts-Henderson

6-36 15-Jul-19 Statement of Johanna Aalberts-Henderson 15-Jul-19

177. Robert Van Duuren 6-37 6-38

15-Jul-19

15-Jul-19

Statement of Robert Van Duuren

Supplementary statement of Robert Van Duuren

15-Jul-19

178. Jan Rice 6-39 15-Jul-19 Statement of Jan Rice 15-Jul-19

6-40 15-Jul-19 Additional statement of Jan Rice

179.

Petronella Neeleman

6-41 15-Jul-19 Statement of Petronella Neeleman 15-Jul-19

6-42 15-Jul-19 Supplementary statement of Petronella Neeleman 15-Jul-19

180. Nicholas Hall 6-43 16-Jul-19 Statement of Nicholas Hall 16-Jul-19

181.

Timothy Deverell 6-44 16-Jul-19 Statement of Timothy Deverell 16-Jul-19

182. Lindy Twyford 6-45 16-Jul-19 Statement of Lindy Twyford 16-Jul-19

183. Maggie Beer AM 6-46 16-Jul-19 Statement of Maggie Beer 16-Jul-19

184. Dr Sandra Iuliano 6-47 16-Jul-19 Statement of Sandra Iuliano 16-Jul-19

16-Jul-19 Corrigendum to statement of Sandra Iuliano

185. Robert Hunt 6-48 16-Jul-19 Statement of Robert Hunt and Sharon Lawrence on behalf of the Dietitians Association of Australia

16-Jul-19

186. Sharon Lawrence 6-48 16-Jul-19 Statement of Robert Hunt and Sharon Lawrence on behalf of the Dietitians Association of Australia

16-Jul-19

187. Adrienne Lewis 6-49 16-Jul-19 Statement of Adrienne Lewis 16-Jul-19

188. Dr Frances Batchelor 6-50 16-Jul-19 Statement of Frances Batchelor 16-Jul-19

189. Elsie Scott 6-51 17-Jul-19 Statement of Elsie Scott 17-Jul-19

11

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

190. Lisa Jones 6-52 17-Jul-19 Statement of Lisa Jones 17-Jul-19

191. Natasha Chadwick

6-53 17-Jul-19 Statement of Natasha Chadwick 17-Jul-19

192. FA 6-54 17-Jul-19 Statement of FA 17-Jul-19

193. Sandy Green 6-55 17-Jul-19 Statement of Sandy Green 17-Jul-19

194. Angela Raguz 6-56 17-Jul-19 Statement of Angela Raguz 17-Jul-19

195. Dr Drew Dwyer 6-57 17-Jul-19 Statement of Drew Dwyer 17-Jul-19

196. Dr Jennifer Abbey 6-58 17-Jul-19 Statement of Jennifer Abbey 17-Jul-19

Mildura Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

197. Elaine Gregory 7-2 29-Jul-19 Statement of Elaine Gregory 29-Jul-19

198. Dorothy Holt 7-3 29-Jul-19 Statement of Dorothy Holt 29-Jul-19

199. Rosemary Cameron

7-4 29-Jul-19 Statement of Rosemary Cameron 29-Jul-19

200. Joan Rosenthal 7-5 29-Jul-19 Statement of Joan Rosenthal 29-Jul-19

201. Barbara McPhee 7-6 29-Jul-19 Statement of Barbara McPhee 29-Jul-19

202. Shontia Saluja-Honeysett 7-7 29-Jul-19 Statement of Shontia Saluja-Honeysett

29-Jul-19

203. Lynette Bishop 7-8 29-Jul-19 Statement of Lynette Bishop 29-Jul-19

204. Donald Laity 7-9 30-Jul-19 Statement of Donald Laity 30-Jul-19

205. Bonney Dietrich 7-10 30-Jul-19 Statement of Bonney Dietrich and its identified annexures 30-Jul-19

206. Nicole Dunn 7-11 30-Jul-19 Amended statement of Nicole Dunn 30-Jul-19

207. Dr Catherine Thomson 7-12 30-Jul-19 Joint paper of Catherine Thomson, Trish Hill and

Myra Hamilton

30-Jul-19

208. Meredith Gresham

7-13 30-Jul-19 Statement of Meredith Gresham 30-Jul-19

209. Dr Lyn Phillipson 7-14 30-Jul-19 Statement of Lyn Phillipson 30-Jul-19

210. Assoc Prof Suzanne Hodgkin 7-15 30-Jul-19 Statement of Suzanne Hodgkin 30-Jul-19

211.

Kay Gray 7-16 31-Jul-19 Statement of Kay Gray 31-Jul-19

212. Danijela Hlis 7-17 31-Jul-19 Statement of Danijela Hlis 31-Jul-19

213. Darren Midgley 7-18 31-Jul-19 Statement of Darren Midgley 31-Jul-19

214. Maree Woodhouse

7-19 31-Jul-19 Statement of Maree Woodhouse 31-Jul-19

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

215. Xenofon Voukelatos

7-20 31-Jul-19 Statement of Xenofon Voukelatos 31-Jul-19

216. Jennifer Garonne 7-21 31-Jul-19 Statement of Jennifer Garonne 31-Jul-19

217. Fiona Buffinton 7-22 31-Jul-19 Statement of Fiona Buffinton 31-Jul-19

218. Nigel Murray 7-23 31-Jul-19 Statement of Nigel Murray 31-Jul-19

219. George Sotiropoulos (appeared in place of Emma McGuirk)

7-24

7-25

31-Jul-20 Statement of Emma McGuirk

Supplementary statement of Emma McGuirk

31-Jul-20

31-Jul-20

Brisbane Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

220. Cary Strong 8-2 5-Aug-19 Statement of Cary Strong 5-Aug-19

221. Karen Parsons 8-3 5-Aug-19 Statement of Karen Parsons 5-Aug-19

222. Telecia Tuccori 8-4 5-Aug-19 Statement of Telecia Tuccori 5-Aug-19

223. Karen Heard 8-5 5-Aug-19 Statement of Karen Heard 5-Aug-19

8-6 Supplementary statement

of Karen Heard

224. Bruce Lang 8-9 5-Aug-19 Statement of Bruce Lang 5-Aug-19

225. Arthur Miller 8-10 5-Aug-19 Statement of Arthur Miller 5-Aug-19

226. Kristofer Bunker 8-11 5-Aug-19 Statement of Kristofer Bunker 5-Aug-19

227. Tracey Rees n/a n/a n/a 5-Aug-19

228. Petronella Neeleman

8-15 6-Jul-19 Statement of Petronella Neeleman 6-Aug-19

229. Judith Coombe 8-16 6-Jul-19 Statement of Judith Coombe 6-Aug-19

230. Catherine Rosenbrock 8-17 6-Jul-19 Statement of Catherine Rosenbrock

6-Aug-19

8-18 6-Jul-19 Supplementary statement of Catherine Rosenbrock

231. Gilda D'Rozario 8-19 6-Jul-19 Statement of Gilda D'Rozario 6-Augl-19

232. Susan Waters 8-20 6-Jul-19 Statement of Susan Waters 6-Aug-19

233. Colette Marshall 8-21 6-Jul-19 Statement of Colette Marshall 6-Aug-19

8-21 Corrigendum to statement

of Colette Marshall

234. Elsy Brammesan 8-22 6-Jul-19 Statement of Elsy Brammesan 6-Aug-19

235. Peter O'Brien n/a n/a n/a 6-Aug-19

7-Aug-19

236. Gwenda Darling 8-24 7-Aug-19 Statement of Gwenda Darling 7-Aug-19

13

Witnesses Appendix 1

Exhibit Number Date Tendered

Oral Evidence Given

Witness Title

237. Anthony Speed 8-25 7-Aug-19 Statement of Anthony Speed 5-Aug-19

8-26 Second statement

of Anthony Speed

7-Aug-19

238. Sarah Holland-Batt 8-28 7-Aug-19 Statement of Sarah Holland-Batt 7-Aug-19

239. Prof Ron Paterson

8-29 7-Aug-19 Precis of the evidence of Ron Paterson 7-Aug-19

240. Ann Wunsch 8-30 8-Aug-19 Statement of Ann Wunsch 8-Aug-19

241. Amy Laffan 8-31 8-Aug-19 Statement of Amy Laffan 8-Aug-19

8-32 Statement of Amy Laffan

242. Commissioner Graeme Head 8-34 8-Aug-19 Statement of Graeme Head 8-Aug-19

243. Beverley Johnson 8-36 8-Aug-19 Statement of Beverley Johnson 8-Aug-19

244. Geoffrey Rowe 8-37 8-Aug-19 Statement of Geoffrey Rowe 8-Aug-19

245. Natalie Siegel-Brown 8-38 8-Aug-19 Statement of Public Guardian 8-Aug-19

246. Debra Barnes 8-39 9-Aug-19 Statement of Debra Barnes 9-Aug-19

247. Shona Reid 8-40 9-Aug-19 Statement of Shona Reid 9-Aug-19

248. Prof Deborah Picone 8-41 9-Aug-19 Statement of Deborah Picone 9-Aug-19

249. Prof John Braithwaite 8-44 9-Aug-19 Answers to questions posed by the Commission to John

Braithwaite, Valerie Braithwaite and Toni Makkai

9-Aug-19

250. Prof Valerie Braithwaite 8-44 9-Aug-19 Answers to questions posed by the Commission to John

Braithwaite, Valerie Braithwaite and Toni Makkai

9-Aug-19

Melbourne 1 Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

251. Jodie Chard 9-2 9-Sep-19 Statement of Jodie Chard 9-Sep-19

252. Lisa Corcoran 9-3 9-Sep-19 Statement of Lisa Corcoran 9-Sep-19

253. Catherine Roche 9-4 9-Sep-19 Statement of Catherine Roche 9-Sep-19

254. Jessica Dodds 9-5 9-Sep-19 Statement of Jessica Dodds 9-Sep-19

255. Dr Nicholas Hartland PSM 9-6 9-Sep-19 Statement of Nicholas Hartland 9-Sep-19 10-Sep-19

256. Michael Lye 9-1,

tab 2

9-Sep-19 Department of Social Services Response to NTG356 10-Sep-19

257. Neale Radley 9-8 10-Sep-19 Statement of Neale Radley 10-Sep-19

14

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tender ed Given

258. Robyn Spicer 9-9 10-Sep-19 Statement of Robyn Spicer 10-Sep-19

259. Chris Carlile n/a n/a n/a 10-Sep-19

260. Scott McNaughton n/a n/a n/a 10-Sep-19

261. Peter Broadhead n/a n/a n/a 10-Sep-19

262. Vicki Rundle 9-10 11-Sep-19 Statement of Vicki Rundle 11-Sep-19

263. Kirby Littley 9-11 11-Sep-19 Statement of Kirby Littley 11-Sep-19

264. Carol Littley 9-12 11-Sep-19 Statement of Carol Littley and Kevin Littley 11-Sep-19

265. Kevin Littley 9-12 11-Sep-19 Statement of Carol Littley and Kevin Littley 11-Sep-19

266. Mario Amato 9-13 11-Sep-19 Statement of Mario Amato 11-Sep-19

267. Suzanne Lulham 9-14 11-Sep-19 Statement of Suzanne Lulham 11-Sep-19

268. Deborah Hoffman 9-15 11-Sep-19 Statement of Deborah Hoffman 11-Sep-19

269. Liz Cairns 9-16 11-Sep-19 Statement of Liz Cairns 11-Sep-19

270. Tamara T

omic 9-17 11-Sep-19 Statement of Tamara Tomic 11-Sep-19

271. Dr Ben Gauntlett n/a n/a n/a 11-Sep-19

272. James Nutt 9-18 11-Sep-19 Statement of James Nutt 11-Sep-19

273. Dr Bronwyn Morkham 9-19 13-Sep-19 Statement of Bronwyn Morkham 13-Sep-19

274. Luke Bo'sher 9-20 13-Sep-19 Statement of Luke Bo'sher 13-Sep-19

275. Shane Jamieson 9-21 13-Sep-19 Statement of Shane Jamieson 13-Sep-19

276. Kym Peake 9-22 13-Sep-19 Statement of Kym Peake 13-Sep-19

Melbourne 2 Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

277. Angelos Angeli 10-2 7-Oct-19 Statement of Angelos Angeli 7-Oct-19

278. Samantha Edmonds

10-3 7-Oct-19 Statement of Samantha Edmonds 7-Oct-19

279. Mary Patetsos 10-4 7-Oct-19 Statement of Mary Patetsos 7-Oct-19

280. Noeleen Tunny 10-5 7-Oct-19 Statement of Noeleen T

unny 7-Oct-19

281. Samantha Jewell 10-6 7-Oct-19 Statement of Samantha Jewell 7-Oct-19

282. Fiona York 10-7 7-Oct-19 Statement of Fiona York 7-Oct-19

283. Brian Lynch 10-8 8-Oct-19 Statement of Brian Lynch 8-Oct-19

284. Nathan Klinge 10-9 8-Oct-19 Statement of Nathan Klinge 8-Oct-19

285. Helen Radoslovich

10-10 8-Oct-19 Statement of Helen Radoslovich 8-Oct-19

15

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

286. Anne Tudor 10-11 8-Oct-19 Statement of Anne Tudor 8-Oct-19

10-12 Supplementary statement

of Anne Tudor

287. Elizabeth Cosson AM CSG 10-13 8-Oct-19 Statement of Elizabeth Cosson 8-Oct-19

288. Janette McGuire 10-14 8-Oct-19 Statement of Janette McGuire 8-Oct-19

289. Dr Duncan McKellar 10-15 8-Oct-19 Statement of Duncan McKellar 8-Oct-19

290. Jaye Smith 10-17 9-Oct-19 Statement of Jaye Smith 9-Oct-19

291. Heather Brown 10-18 9-Oct-19 Statement of Heather Brown 9-Oct-19

292. Dr Nicholas Hartland PSM 10-19 9-Oct-19 Statement of Nicholas Hartland 9-Oct-19

293. Malloy 10-20 10-Oct-19 Statement of Malloy 10-Oct-19

294. Ann Wunsch 10-21 10-Oct-19 Statement of Ann Wunsch 10-Oct-19

295. Dr Philip O'Meara 10-22 10-Oct-19 Statement of Philip O'Meara 10-Oct-19

296. Elizabeth Drozd 10-23 10-Oct-19 Statement of Elizabeth Drozd 10-Oct-19

297. Dr David Panter 10-24 10-Oct-19 Statement of David Panter 10-Oct-19

298. Catharina Nieuwenhoven 10-25 11-Oct-09 Statement of Catharina Nieuwenhoven

11-Oct-19

299. Moreen Lyons 10-26 11-Oct-19 Statement of Moreen Lyons 11-Oct-19

300. Uncle Brian Campbell n/a n/a n/a 11-Oct-19

301. Uncle Brian Birch n/a n/a n/a 11-Oct-19

302. Jaklina Michael 10-27 11-Oct-19 Statement of Jaklina Michael 11-Oct-19

303. Elizabeth Karn 10-28 11-Oct-19 Statement of Elizabeth Karn 11-Oct-19

Melbourne 3 Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

304. Prof Kathleen Eagar 11-2 14-Oct-19 Statement of Kathleen Eagar 14-Oct-19

305. Prof John Pollaers OAM 11-3 14-Oct-19 Statement of John Pollaers 14-Oct-19

306. Kevin McCoy 11-4 14-Oct-19 Statement of Kevin McCoy 14-Oct-19

307. Jane Trewin 11-5 14-Oct-19 Statement of Jane Trewin 14-Oct-19

308. Robert Bonner 11-6 14-Oct-19 Statement of Robert Bonner 14-Oct-19

309. Michelle Eastman 11-7 14-Oct-19 Statement of Michelle Eastman 14-Oct-19

310.

Christine Lynch n/a n/a n/a 15-Oct-19

311. Sandra Nisi 11-10 15-Oct-19 Statement of Sandra Nisi 15-Oct-19

16

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

312. Yvonne Henderson

11-11 15-Oct-19 Statement of Yvonne Henderson 15-Oct-19

313. Bridget Scarff 11-12 15-Oct-19 Statement of Bridget Scarff 15-Oct-19

314. Fiona van den Berg 11-13 15-Oct-19 Statement of Fiona van den Berg 15-Oct-19

315. Brendan Coulton 11-14 15-Oct-19 Statements of Brendan Coulton 15-Oct-19

316. Craig Holland 11-15 15-Oct-19 Statement of Craig Holland 15-Oct-19

317. Ann Wunsch 11-16 15-Oct-19 Statement of Ann Wunsch 15-Oct-19

318. Darren Mathewson

11-19 16-Oct-19 Statement of Darren Mathewson 16-Oct-19

319. Lisa Alcock 11-20 16-Oct-19 Statement of Lisa Alcock 16-Oct-19

320. Paul Gilbert 11-21 16-Oct-19 Statement of Paul Gilbert 16-Oct-19

321. Clare Tunney 11-22 16-Oct-19 Statement of Clare Tunney 16-Oct-19

322. Jenna Field 11-23 16-Oct-19 Statement of Jenna Field 16-Oct-19

323. Prof Eileen Willis 11-26 16-Oct-19 Statement of Eileen Willis, Julie Henderson and Ian Blackman 16-Oct-19

324. Robert Bonner 11-27 16-Oct-19 Statement of Robert Bonner 16-Oct-19

325. Kym Peake 11-29 16-Oct-19 Statement of Kym Peake 16-Oct-19

11-29b Supplementary statement

of Kym Peake

326. Amy Lazzaro 11-51 16-Oct-19 Statement of Amy Lazzaro 16-Oct-19

327. Prof Sara Charlesworth 11-52 16-Oct-19 Statement of Sara Charlesworth 16-Oct-19 Supplementary statement

of Sara Charlesworth

328. Dianne Mnich 11-54 17-Oct-19 Statement of Dianne Mnich 17-Oct-19

329. Nicole Farrell 11-55 17-Oct-19 Statement of Nicole Farrell 17-Oct-19

11-56 Statement of Nicole Farrell

330. Janice Hilton 11-58 17-Oct-19 Statement of Janice Hilton 17-Oct-19

331. Sandra Hills OAM 11-59 17-Oct-19 Statement of Sandra Hills 17-Oct-19

332. Jason Howie 11-60 17-Oct-19 Statement of Jason Howie 17-Oct-19

333. Kerri Rivett 11-61 17-Oct-19 Statement of Kerri Rivett 17-Oct-19

334. Richard Hearn 11-62 17-Oct-19 Statement of Richard Hearn 17-Oct-19

335. Prof James Vickers 11-63 17-Oct-19 Statement of James Vickers 17-Oct-19

336. Rachel Yates 11-64 17-Oct-19 Statement of Rachel Yates 17-Oct-19

337. Adj Pr

of

Kylie Ward

11-65 17-Oct-19 Statement of Kylie Ward 17-Oct-19

338. Dr John Maddison

11-66 17-Oct-19 Statement of John Maddison 17-Oct-19

17

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

339. Lavina Luboya 11-67 18-Oct-19 Statement of Lavina Luboya 18-Oct-19

340. Karen Cusack 11-68 18-Oct-19 Statements of Karen Cusack 18-Oct-19

341. Andrew Brown 11-69 18-Oct-19 Statement of Andrew Brown 18-Oct-19

342. Shona Reid 11-70 18-Oct-19 Statement of Shona Reid 18-Oct-19

343. Glenys Beauchamp PSM 11-71 18-Oct-19 Statement of Glenys Beauchamp 18-Oct-19

344. Charles Wann 11-72 18-Oct-19 Statement of Charles Wann 18-Oct-19

Mudgee Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

345. Ruth Hamilton 12-2 4-Nov-19 Statement of Ruth Hamilton 4-Nov-19

346. Allan Codrington 12-7 4-Nov-19 Statement of Allan Codrington 4-Nov-19

347. Tania Sargent 12-8 4-Nov-19 Statement of Tania Sargent 4-Nov-19

348. Prudence Dear 12-9 4-Nov-19 Statement of Prudence Dear 4-Nov-19

349. Phillip Dunlop 12-10 5-Nov-19 Statement of Phillip Dunlop 5-Nov-19

350. Suzanne Dunlop 12-11 5-Nov-19 Statement of Suzanne Dunlop 5-Nov-19

351. Dean Chesterman

12-12 5-Nov-19 Statement of Dean Chesterman 5-Nov-19

352. Jaclyn Attridge 12-14 5-Nov-19 Statement of Jaclyn Attridge 5-Nov-19

353. Helen Miller 12-13 5-Nov-19 Statement of Helen Miller 5-Nov-19

354. Dr Rachel Winterton

12-15 5-Nov-19 Statement of Rachel Winterton 5-Nov-19

355. Lyndon Seys 12-16 5-Nov-19 Statement of Lyndon Seys 5-Nov-19

356. Sally Goode 12-17 5-Nov-19 Statement of Sally Goode 5-Nov-19

357. Susan Hood 12-18 5-Nov-19 Statement of Susan Hood 5-Nov-19

358. Julian Krieg 12-19 6-Nov-19 Statement of Julian Krieg 6-Nov-19

359. Dr Nigel Lyons 12-20 6-Nov-19 Statement of Nigel Lyons 6-Nov-19

360. Sharon-Lee McKay 12-21 6-Nov-19 First statement of Sharon-Lee McKay

6-Nov-19

12-22 6-Nov-19 Second statement of Sharon-Lee McKay

361. Margaret Denton 12-23 6-Nov-19 First statement of Margaret Denton 6-Nov-19

12-24 6-Nov-19 Second statement of Mar

garet Denton

6-Nov-19

362. Graeme Barden 12-25 6-Nov-19 Statement of Graeme Barden 6-Nov-19

363. David Hallinan n/a n/a n/a 6-Nov-19

364. Peter Harris 12-26 6-Nov-19 Statement of Peter Harris 6-Nov-19

18

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Hobart Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

365. Helen (Ellie) Valier 13-3 11-Nov-19 Statement of Helen Valier 11-Nov-19

366. Tammy Marshall 13-4 11-Nov-19 Statement of Tammy Marshall 11-Nov-19

367. Jo-Anne Hardy 13-5 11-Nov-19 Statement of Jo-Anne Hardy 11-Nov-19

368. Kylie Bennett 13-6 11-Nov-19 Statement of Kylie Bennett 11-Nov-19

369. Patrick Anderson 13-7 11-Nov-19 Statement of Patrick Anderson 11-Nov-19

370. Mary Sexton 13-8 11-Nov-19 Statement of Mary Sexton 11-Nov-19

371. Ann McDevitt 13-9 11-Nov-19 Statement of Ann McDevitt 11-Nov-19

372. Judith King 13-10 12-Nov-19 Statement of Judith King 12-Nov-19

373. Peter Williams 13-11 12-Nov-19 Statement of Peter Williams 12-Nov-19

374. Helen Marshall 13-12 12-Nov-19 Statement of Helen Marshall 12-Nov-19

375. Andrew George-Gamlyn 13-13 12-Nov-19 Statement of Andrew George-Gamlyn

12-Nov-19

376. Andrew Crane 13-14 12-Nov-19 Statement of Andrew Crane 12-Nov-19

377. Pauline Robson 13-15 12-Nov-19 Statement of Pauline Robson 12-Nov-19

378. Richard Sadek 13-16 12-Nov-19 Statement of Richard Sadek 12-Nov-19

379. Stephen Shirley 13-17 13-Nov-19 Statement of Stephen Shirley 13-Nov-19

380. Raymond Groom 13-18 13-Nov-19 Statement of Raymond Groom 13-Nov-19

381. Patricia Job 13-19 13-Nov-19 Statement of Patricia Job 13-Nov-19

382. Diane Daniels 13-21 13-Nov-19 Statement of Diane Daniels 13-Nov-19

383. Dr Elizabeth Monks 13-22 13-Nov-19 First Statement of Elizabeth Monks

13-Nov-19

13-23 13-Nov-19 Supplementary statement of Elizabeth Monks

384. Merridy Eastman 13-24 14-Nov-19 Statement of Merridy Eastman 14-Nov-19

385. Elizabeth Wesols 13-25 14-Nov-19 Statement of Elizabeth Wesols 14-Nov-19

386. Stephanie Hechenberger 13-26 14-Nov-19 Statement of Stephanie Hechenberger

14-Nov-19

13-27 14-Nov-19 Supplementary statement of Stephanie Hechenberger

387. Davida Webb 13-28 14-Nov-19 Statement of Davida Webb 14-Nov-19

13-29 Supplementary statement

of Davida Webb

14-Nov-19

388. Linda Hudec 13-30 14-Nov-19 Statement of Linda Hudec 14-Nov-19

389. Tiffany Wiles 13-31 14-Nov-19 Statement of Tif

fany Wiles 14-Nov-19

390. Cynthia Payne 13-32 14-Nov-19 Statement of Cynthia Payne 14-Nov-19

391. John Engeler 13-33 14-Nov-19 Statement of John Engeler 14-Nov-19

19

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

392. Dr Marguerite (Maggie) Haertsch

13-34 14-Nov-19 Statement of Marguerite Haertsch 14-Nov-19

393. UQ 13-35 15-Nov-19 Statement of UQ 15-Nov-19

394. US 13-36 15-Nov-19 Statement of US 15-Nov-19

395. Bethia Wilson AM 13-37 15-Nov-19 Statement of Bethia Wilson 15-Nov-19

396. Dr Penelope Webster 13-37 15-Nov-19 Statement of Bethia Wilson 15-Nov-19

397. Carolyn Cooper 13-38 15-Nov-19 First statement of Carolyn Cooper 15-Nov-19

13-39 Supplementary Statement

of Carolyn Cooper

398. Catherine Maxwell

13-40 15-Nov-19 Statement of Catherine Maxwell 15-Nov-19

Canberra Hearing

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

399. Rhonda McIntosh 14-3 9-Dec-19 Statement of Rhonda Mclntosh 9-Dec-19

400. Kristine Stevens 14-4 9-Dec-19 Statement of Kristine Stevens 9-Dec-19

401. Dr Paresh Dawda 14-5 9-Dec-19 Statement of Paresh Dawda 9-Dec-19

402. Dr Troye Wallett 14-6 9-Dec-19 Statement of Troye Wallett 9-Dec-19

14-7 Supplementary statement

of Troye Wallett

403. Susan Irvine 14-8 9-Dec-19 Statement of Susan Irvine 9-Dec-19

404. Dr Anthony Bartone 14-9 9-Dec-19 Supplementary statement of Anthony Bartone

9-Dec-19

405. Assoc Prof Mark Morgan 14-10 9-Dec-19 Statement of Mark Morgan 9-Dec-19

406. Jennifer Walton 14-11 10-Dec-19 Statement of Jennifer Walton 10-Dec-19

407. Dr Carolyn Hullick 14-12 10-Dec-19 Statement of Carolyn Hullick and Ellen Burkett 10-Dec-19

408. Dr Ellen Burkett 14-12 10-Dec-19 Statement of Carolyn Hullick and Ellen Burkett 10-Dec-19

409. Dr Terry Nash 14-13 10-Dec-19 Statement of Terry Nash 10-Dec-19

410. Meegan Beecroft 14-14 10-Dec-19 Statement of Meegan Beecroft 10-Dec-19

411. Dr Michael Montalto 14-15 10-Dec-19 Statement of Michael Montalto 10-Dec-19

412. Tess Oxley 14-16 10-Dec-19 Statement of Tess Oxley 10-Dec-19

413. Hamish Macleod 14-17 11-Dec-19 Statement of Hamish Macleod 11-Dec-19

414. Catherine Davis 14-18 11-Dec-19 Statement of Catherine Davis 11-Dec-19

20

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tender ed Given

415. Thomas Woodage

14-19 11-Dec-19 Statement of Thomas Woodage 11-Dec-19

416. Judith Gardner 14-20 11-Dec-19 Statement of Judith Gardner 11-Dec-19

417. Fiona Lysaught 14-21 11-Dec-19 Statement of Fiona Lysaught 11-Dec-19

418. Nikki (Nicole) Johnston OAM 14-22 11-Dec-19 Statement of Nicole Johnston 11-Dec-19

419. Peter Jenkin 14-23 11-Dec-19 Statement of Peter Jenkin 11-Dec-19

420. Prof Christopher Poulos 14-24 11-Dec-19 Statement of Christopher Poulos 11-Dec-19

421. Prof Leon Flicker 14-25 12-Dec-19 Statement of Leon Flicker 12-Dec-19

422. Prof Leonard Gray 14-26 12-Dec-19 Statement of Leonard Gray 12-Dec-19

423. Dr Nigel Lyons 14-27 12-Dec-19 Statement of Nigel Lyons 12-Dec-19

424. Dr John Wakefield PSM 14-28 12-Dec-19 Statement of John Wakefield 12-Dec-19

425. Dr Andrew Robertson CSC PSM

14-29 12-Dec-19 Response from Western Australia Department of Health 12-Dec-19

426. Christopher McGowan 14-30 12-Dec-19 Statement of Christopher McGowan

12-Dec-19

427. Glenys Beauchamp PSM 14-31 12-Dec-19 Statement of Glenys Beauchamp 12-Dec-19

428. Penny Shakespeare n/a n/a n/a 12-Dec-19

429. Prof Brendan Murphy n/a n/a n/a 12-Dec-19

430. Rhonda Payget 14-32 13-Dec-19 Statement of Rhonda Payget 13-Dec-19

431. Clare Skinner 14-33 13-Dec-19 Statement of Clare Skinner 13-Dec-19

432. Dr Maggie Jamieson

14-35 13-Dec-19 Statement of Maggie Jamieson 13-Dec-19

433. Terry Symonds 14-36 13-Dec-19 Statement of Terry Symonds 13-Dec-19

434. Michael De'Ath 14-37 13-Dec-19 Statement of Michael De'Ath 13-Dec-19

435. Ross Smith (appeared in place of Katherine Morgan-Wicks)

14-34 13 Dec-19 Statement of Katherine Morgan-Wicks 13-Dec-19

21

Witnesses Appendix 1

Adelaide Workshop 1

Witness

Exhibit Number

Date Tendered Title

Oral Evidence Given

436. David Tune AO PSM n/a n/a n/a 10-Feb-20

437. Glenn Rees n/a n/a n/a 10-Feb-20

438. Dr Kirsty Nowlan n/a n/a n/a 10-Feb-20

439. Robert Bonner n/a n/a n/a 10-Feb-20

11-Feb-20

440. Patricia Sparrow n/a n/a n/a 10-Feb-20

11-Feb-20

441. Michael Lye n/a n/a n/a 10-Feb-20

442. Prof Michael Woods n/a n/a n/a 10-Feb-20

443. Ian Yates AM n/a n/a n/a 10-Feb-20

444. Prof Mark Morgan n/a n/a n/a 10-Feb-20

11-Feb-20

445. Dr Ricki Smith n/a n/a n/a 10-Feb-20

446. Prof John McCallum n/a n/a n/a 10-Feb-20

447. Prof Michael Fine n/a n/a n/a 10-Feb-20

448. Samantha Edmonds n/a n/a n/a 10-Feb-20

449. Dr Nicholas Hartland PSM n/a n/a n/a 10-Feb-20

11-Feb-20

450. Sean Rooney n/a n/a n/a 10-Feb-20

11-Feb-20

451. Bryan Lipmann AM n/a n/a n/a 10-Feb-20

452. Graham Aitken n/a n/a n/a 10-Feb-20

453. Jane Mussared n/a n/a n/a 10-Feb-20

454. Dr David Panter n/a n/a n/a 10-Feb-20

11-Feb-20

455. Paul Sadler n/a n/a n/a 10-Feb-20

456. Prof Julie Ratcliffe n/a n/a n/a 11-Feb-20

457. Dr Gill Lewin n/a n/a n/a 11-Feb-20

458. Jaye Smith n/a n/a n/a 11-Feb-20

459. Sue Elderton n/a n/a n/a 11-Feb-20

460. Dr Henry Cutler n/a n/a n/a 11-Feb-20

461. Prof Deborah Parker n/a n/a n/a 11-Feb-20

462. Maree McCabe n/a n/a n/a 11-Feb-20

463. Nicholas Mersiades n/a n/a n/a 11-Feb-20

464. Melissa Coad n/a n/a n/a 11-Feb-20

22

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

465. Annie Butler n/a n/a n/a 11-Feb-20

466. Matthew Richter n/a n/a n/a 11-Feb-20

467. Sandra Hills OAM n/a n/a n/a 11-Feb-20

Adelaide Hearing 3

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

468. Prof Charlene Harrington 15-1 21-Feb-20 Statement of Charlene Harrington 21-Feb-20

469. Dr Katherine Ravenswood 15-2 21-Feb-20 Statement of Katherine Ravenswood

21-Feb-20

Adelaide Hearing 4

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

No witnesses called n/a n/a n/a n/a

Adelaide Workshop 2

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

470. Denise Griggs n/a n/a n/a 16-Mar-20

471. Damien Harker n/a n/a n/a 16-Mar-20

472. Prof Sue Gordon n/a n/a n/a 16-Mar-20

473. Jennene Buckley n/a n/a n/a 16-Mar-20

474. Dr Tanya Petrovich

n/a n/a n/a 16-Mar-20

475. Daniella Greenwood

n/a n/a n/a 16-Mar-20

476. Barbara Hamilton Ramsay n/a n/a n/a 16-Mar-20

477. Dr Rob Grenfell n/a n/a n/a 16-Mar-20

478. Louise York n/a n/a n/a 16-Mar-20

479. Assoc Prof Maria Inacio n/a n/a n/a 16-Mar-20

480. Ben Lancken n/a n/a n/a 16-Mar-20

481. Dr Veronique Boscart n/a n/a n/a 17-Mar-20

482. Dr Kate Barnett n/a n/a n/a 17-Mar-20

483. Helen Loffler n/a n/a n/a 17-Mar-20

484. Megan Corlis n/a n/a n/a 17-Mar-20

23

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tender ed Given

485. Prof James Vickers n/a n/a n/a 17-Mar-20

486. Prof Andrew Robinson n/a n/a n/a 17-Mar-20

487. Prof Steven Wesselingh n/a n/a n/a 17-Mar-20

488. Julianne Parkinson

n/a n/a n/a 17-Mar-20

489. Prof Alison Kitson n/a n/a n/a 17-Mar-20

490. Briony Dow n/a n/a n/a 17-Mar-20

491. Adj Prof Judy Lowthian n/a n/a n/a 17-Mar-20

Melbourne Hearing 4

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

492. UX 17-2 15-Jul-20 Statement of UX 15-Jul-20

493. Dr Alison Argo 17-3 15-Jul-20 Statement of Alison Argo 15-Jul-20

494. Dr Diane Corser 17-4 15-Jul-20 Statement of Diane Corser 15-Jul-20

495. Assoc Prof Stephen Macfarlane

17-5 15-Jul-20 Statement of Stephen Macfarlane 15-Jul-20

496. Prof Sunil Bhar 17-6 15-Jul-20 Statement and response to draft propositions of Sunil Bhar 15-Jul-20

497. Mark Silver 17-7 15-Jul-20 Statement and response to draft propositions of Mark Silver 15-Jul-20

498. Dr Leanne Beagley

17-8 15-Jul-20 Statement by Leanne Beagley 15-Jul-20

499. Dr Janet Wallace 17-9 15-Jul-20 Statement of Janet Wallace and response to draft propositions 15-Jul-20

500. Dr Kathleen Matthews 17-11 16-Jul-20 Statement of Kathleen Matthews and response to propositions

16-Jul-20

501. Nicole Stormon 17-10 16-Jul-20 Statement of Nicole Stormon and response to propositions 16-Jul-20

502. Beryl Hawkins 17-12 16-Jul-20 Statement of Beryl Hawkins 16-Jul-20

503. Prof Fredrick Wright 17-13 16-Jul-20 Statement of Fredrick Wright and response to draft propositions

16-Jul-20

504. Dr Martin Dooland

17-14 16-Jul-20 Statement of Martin Dooland and response to draft propositions 16-Jul-20

505. Dr Stephanie Ward 17-15 16-Jul-20 Statement of Stephanie Ward 16-Jul-20

24

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

506. Dr Jennifer Hewitt 17-16 16-Jul-20 Statement of Jennifer Hewitt and response to propositions 16-Jul-20

507. Angeline Violi 17-18 16-Jul-20 Statement of Angeline Violi 16-Jul-20

508. Nicholas Young n/a n/a n/a 16-Jul-20

509. Lidia Conci 17-17 16-Jul-20 Statement and supplementary statement of Lidia Conci 16-Jul-20

510. Claire Hewat 17-19 16-Jul-20 Responses of Allied Health Professionals Australia 17-Jul-20

511. Prof Esther May 17-20 17-Jul-20 Statement of Esther May 17-Jul-20

512. Allen Candy 17-21 17-Jul-20 Statement of Allen Candy and Life Care response to propositions

17-Jul-20

513. Josephine Boyland-Marsland

17-22 17-Jul-20 Statement of Josephine Boyland-Marsland 17-Jul-20

514. Timothy Henwood

n/a n/a n/a 17-Jul-20

515. Dr Nigel Lyons 17-23 17-Jul-20 Response of NSW Ministry of Health 17-Jul-20

516. Dr Christopher McGowan n/a n/a n/a 17-Jul-20

517. Penny Shakespeare n/a n/a n/a 17-Jul-20

518. Tania Rishniw n/a n/a n/a 17-Jul-20

Sydney Hearing 2

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

519. Prof Marie-Louise McLaws 18-4 10-Aug-20 Precis of evidence of Marie-Louise McLaws

10-Aug-20

520. Prof Nicola Spurrier 18-1, tab 69

10-Aug-20 CV of Nicola Spurrier 10-Aug-20

521. Merle Mitchell AM 18-5 10-Aug-20 Statement of Merle Mitchell 10-Aug-20

522. Ross Low n/a n/a n/a 10-Aug-20

523.

Melanie Dicks n/a n/a n/a 10-Aug-20

524. Pr

of Gwendolyn Gilbert 18-6 10-Aug-20 CV of Gwendolyn Gilbert 10-Aug-20

525. UY 18-7 10-Aug-20 Statement of witness identified

as UY

10-Aug-20

526. Virginia Clarke 18-8 11-Aug-20 Statement of Virginia Clarke 11-Aug-20

527. Erica Roy 18-12 11-Aug-20 Statement of Erica Roy 11-Aug-20

25

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

528. Grant Millard 18-10 11-Aug-20 Statement of Grant Millard 11-Aug-20

18-11 Supplementary statement

of Grant Millard

529. Dr James Branley 18-14 11-Aug-20 Statement of James Branley 11-Aug-20

530. Kathleen Dempsey

18-13 11-Aug-20 CV of Kathy Dempsey 11-Aug-20

531. Jonathan Anderson

18-16, tab 15 11-Aug-20 Learnings from a COVID-19 Outbreak

11-Aug-20

532. Lucy Thompson 18-16, tab 15 11-Aug-20 Learnings from a COVID-19 Outbreak

11-Aug-20

533. Dr Stephen Judd 18-15 11-Aug-20 Statement of Stephen Judd 11-Aug-20

534. Angela Raguz n/a n/a n/a 11-Aug-20

535. Rik Dawson 18-1,

tabs 17, 17A

10-Aug-20 Submission by the Australian Physiotherapy Association on the impact of COVID-19 on aged care

11-Aug-20

Supplementary submission by the Australian Physiotherapy Association on the impact of COVID-19 on aged care

536. Julie Kelly n/a n/a n/a 11-Aug-20

537. Prof Joseph Ibrahim 18-17 12-Aug-20 Precis of evidence of Joseph Ibrahim

12-Aug-20

538. Dr Nigel Lyons 18-18 12-Aug-20 Statement of Nigel Lyons 12-Aug-20

539. Annie Butler 18-1,

tab 18 10-Aug-20 Submission of the Australian Nursing and Midwifery Federation in relation to the Impact of

COVID-19 in Aged Care

12-Aug-20

540. Diana Asmar 18-19 12-Aug-20 Statement of Diana Asmar 12-Aug-20

541. Carolyn Smith 18-1, tab 37 10-Aug-20 United Workers Union - Submission on the impact

of the Coronavirus (COVID-19) on the aged care sector

12-Aug-20

542. Michael Lye 18-20 12-Aug-20 Statement of Michael Lye 12-Aug-20

543. Commissioner Janet Anderson PSM

18-21 12-Aug-20 Statement of Janet Anderson 12-Aug-20

544. Dr Brendan Murphy 18-23 12-Aug-20 CV of Brendan Murphy 12-Aug-20

545. Dr Melanie Wroth 81-24 n/a Statement of Melanie Wroth 12-Aug-20

26

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Sydney Hearing 3

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

546. Maria Brenton 19-2 13-Aug-20 Statement of Maria Brenton 13-Aug-20

547. Hedi Argent n/a n/a n/a 13-Aug-20

548. Dr Brendon Radford n/a n/a n/a 14-Aug-20

549. Simon Schrapel AM 19-3 14-Aug-20 Statement of Simon Schrapel 14-Aug-20

550. Peta Harwood n/a n/a n/a 14-Aug-20

551. David Larmour 19-5 14-Aug-20 Statement of David Larmour 14-Aug-20

552. Catherine Humphrey

19-6 14-Aug-20 Statement of Catherine Humphrey 14-Aug-20

553. Michael Lynch 19-7 14-Aug-20 Statement of Michael Lynch 14-Aug-20

554. Robert Pahor n/a n/a n/a 14-Aug-20

555. Adj Prof Stephen Cornelissen 19-8 14-Aug-20 Statement of Stephen Cornelissen

14-Aug-20

556. Frank Weits 19-9 14-Aug-20 Statement of Frank Weits 14-Aug-20

Sydney Hearing 4

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

557. Rodney Foreman 20-2 31-Aug-20 Statement of Rodney and Rosalie Foreman, video and transcript of video recording

31-Aug-20

558. Rosalie Foreman 20-2 31-Aug-20 Statement of Rodney and Rosalie Foreman, video and transcript of video recording

31-Aug-20

559. Brian Corley 20-1,

tab 72 31-Aug-20 Statement of Brian Corley 31-Aug-20

560. Ahilan St George 20-1, tab 93 31-Aug-20 Submission of Ahilan St George 31-Aug-20

561. Sharyn Broer 20-1, tab 70 31-Aug-20 Meals on Wheels response to draft home care propositions

31-Aug-20

562. Jaclyn Attridge 20-1, tab 71 31-Aug-20 Uniting Care response to draft home care propositions

31-Aug-20

563. Fonda Voukelatos 20-1, tab 71 31-Aug-20 Uniting Car

e response to draft

home care propositions 31-Aug-20

564. Jessica Timmins n/a n/a n/a 31-Aug-20

565.

Peter Scutt 20-1,

tab 47 31-Aug-20 Mable reponse to home care propositions 31-Aug-20

566. Prof Jos Schols n/a n/a n/a 31-Aug-20

27

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

567. Rosemary Milkins PSM 20-3 31-Aug-20 Statement of Rosemary Milkins, video recording and transcript

of video recording

1-Sep-20

568. Assoc Prof Gillian Caughey n/a n/a n/a 1-Sep-20

569. Commissioner Robert Fitzgerald AM

20-1, tab 73 31-Aug-20 Statement of Robert Fitzgerald and Kathryn McKenzie, NSW

Ageing and Disability Commission

1-Sep-20

570. Kathryn Mckenzie 20-1, tab 73 31-Aug-20 Statement of Robert Fitzgerald and Kathryn McKenzie,

NSW Ageing and Disability Commission

1-Sep-20

571. Dr Fiona Macdonald

20-1, tab 48 31-Aug-20 Response to draft home care propositions

1-Sep-20

572. Prof Andrew Stewart 20-1, tab 36

31-Aug-20 Statement of Andrew Stewart 1-Sep-20

573. Dr Jim Stanford n/a n/a 1-Sep-20

574. Eileen Kramer 20-1, tabs 89, 91, 92

31-Aug-20 Statement of Eileen Kramer

Video interview of Eileen Kramer and Maggie Haertsch

1-Sep-20

Transcript of video interview Eileen Kramer and Maggie Haertsch

575. Dr Marguerite (Maggie) Haertsch

20-1, tabs 90, 91, 92

31-Aug-20 Statement of Maggie Haertsch

Video interview of Eileen Kramer and Maggie Haertsch

1-Sep-20

Transcript of video interview Eileen Kramer and Maggie Haertsch

576. Assoc Prof Lee-Fay Low 20-1, tab 44

31-Aug-20 Professor Lee-Fay Low response to draft Home Care propositions 2-Sep-20

577. Dr Carmel Laragy 20-1, tabs 28, 40

31-Aug-20 Submission of Carmel Laragy

Carmel Laragy response to draft Home Care propositions

2-Sep-20

578.

Susan Emerson n/a n/a n/a 2-Sep-20

579. Commissioner Janet Anderson PSM

n/a n/a n/a 2-Sep-20

580. Sarah Kelly n/a n/a n/a 2-Sep-20

581. Mark Rummans n/a n/a n/a 2-Sep-20

582. Ms Amy Laffan n/a n/a n/a 2-Sep-20

583. Michael Lye n/a n/a n/a 2-Sep-20

584. Dr Nicholas Hartland PSM n/a n/a 2-Sep-20

28

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Sydney Hearing 5

Witness

Exhibit Number Date Tendered

Title

Oral Evidence Given

585. Hon Paul Keating n/a n/a n/a 14-Sep-20

586. Prof John McCallum

n/a n/a n/a 14-Sep-20

587. Paul Versteege n/a n/a n/a 14-Sep-20

588. Ian Yates AM n/a n/a n/a 14-Sep-20

589. Grant Corderoy 21-2 14-Sep-30 Statement of Grant Corderoy 14-Sep-20

590. Andrew Fielding n/a n/a n/a 14-Sep-20

591. Fahim Khondaker n/a n/a n/a 14-Sep-20

592. Prof Michael Woods 21-3 15-Sep-20 Statement of Michael Woods 15-Sep-20

593. Prof Naoki Ikegami

21-4

21-5

15-Sep-20 Statement of Naoki Ikegami

Presentation slides by Naoki Ikegami

15-Sep-20

594. Prof Michael Sherris n/a n/a n/a 15-Sep-20

595. Prof John Piggott 21-6 15-Sep-20 Submission of the ARC Centre of Excellence in Population Ageing Research

15-Sep-20

596. Hon Peter Costello AC n/a n/a n/a 16-Sep-20

597. Dr Kenneth Henry 21-7 16-Sep-20 Precis of evidence - Kenneth Henry 16-Sep-20

598. Prof Flavio Menezes

n/a n/a n/a 16-Sep-20

599. Jason Ward 21-9 16-Sep-20 Submission on prudential propositions 16-Sep-20

600. Mike Callaghan AM PSM 21-10 16-Sep-20 Statement of Mike Callaghan 17-Sep-20

601. Prof Kathleen Eagar 21-11 16-Sep-20 Statement of Kathleen Eagar 17-Sep-20

602. Prof Stephen Gray n/a n/a n/a 17-Sep-20

603. Dinesh Kumareswaran n/a n/a n/a 17-Sep-20

604. James Downie 21-12 16-Sep-20 Statement of James Downie 17-Sep-20

605. Dr Steven Kennedy

n/a n/a n/a 18-Sep-20

606. Jenny Wilkinson n/a n/a n/a 18-Sep-20

607. Dr Brendan Murphy n/a n/a n/a 18-Sep-20

29

Witnesses Appendix 1

Exhibit Date Oral Evidence

Witness Title

Number Tendered Given

608. Dr Nicholas Hartland PSM n/a n/a n/a 18-Sep-20

609. Nigel Murray n/a n/a n/a 18-Sep-20

610. Jaye Smith n/a n/a n/a 18-Sep-20

611. Commissioner Janet Anderson PSM

21-28, tab 5 18-Sep-20 Statement of Janet Anderson 18-Sep-20

612. Campbell Ansell 21-13 18-Sep-20 Statement of Campbell Ansell 18-Sep-20

613. Thea Hordern 21-16 21-Sep-20 Statement of Westpac Banking Corporation 21-Sep-20

614. Chris Williams 21-14 21-Sep-20 Statement of Commonwealth Bank of Australia 21-Sep-20

615. Sam Morris 21-15 21-Sep-20 Statement of Australian and New Zealand Banking Group 21-Sep-20

616.

John McCarthy 21-17 21-Sep-20 Voluntary statement of National Australia Bank 21-Sep-20

617. Dr Linda Mellors 21-19 21-Sep-20 Statement of Linda Mellors 21-Sep-20

618. Ian Thorley 21-20 21-Sep-20 Statement of Ian Thorley 21-Sep-20

619. Nicolas Mersiades

21-18 21-Sep-20 Statement of Nicolas Mersiades 21-Sep-20

620. Jonathan Gavshon

21-21 21-Sep-20 Statement of Jonathan Gavshon 21-Sep-20

621. Natasha Chadwick

21-22 21-Sep-20 Statement of Natasha Chadwick 21-Sep-20

622. Chris Mamarelis 21-23 21-Sep-20 Statement of Chris Mamarelis 21-Sep-20

623. Cheyne Chalmers n/a n/a n/a 21-Sep-20

624. David Bennett n/a n/a n/a 21-Sep-20

625. Dr David Panter n/a n/a n/a 22-Sep-20

626. Martin Warner n/a n/a n/a 22-Sep-20

627. Prof Henry Cutler 21-25 22-Sep-20 Statement of Henry Cutler 22-Sep-20

628. Dr Pieter Bakx n/a n/a n/a 22-Sep-20

Appendix 2: Roundtable Discussions and Participants, and Other Key Consultations

Appendix 2: Roundtable Discussions and Participants, and Other Key Consultations Younger people in residential aged care

22 November 2018 Quay West Suites 26 Southgate Ave Southbank VIC 3006

Commissioner Attending Ms Lynelle Briggs AO

Attendee Attendee’s Role

Mr Alan Blackwood Policy and Innovation Manager, Young People in Nursing Homes - National Alliance

Mr Luke Bo’sher Chief Executive Officer, Summer Foundation

Ms Sarah Krause Connect Coordinator, Youngcare

Dr Bronwyn Morkham National Director, Young People in Nursing Homes - National Alliance

Dr George Taleporos Policy Manager, Summer Foundation

Commonwealth agencies

27 November 2018 International Visualisation Centre 19 Young Street Adelaide SA 5000

Commissioner Attending Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Gayle Anderson First Assistant Secretary, Client Engagement and Support Services Division, Department of Veterans’ Affairs

Ms Christina Bolger Executive Director, Regulatory Policy and Performance, Australian Aged Care Quality Agency

Ms Pam Christie Executive Director, Industry Engagement and Communication, Australian Aged Care Quality Agency

Ms Helen Grinbergs Acting First Assistant Secretary, Aged Care Royal Commission Taskforce, Department of Health

Ms Sarah Kelly Office of the Aged Care Complaints Commissioner

Ms Rae Lamb Aged Care Complaints Commissioner

Dr Margot McCarthy Deputy Secretary, Population Health, Sport and Aged Care Quality, Department of Health

33

34

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Mr Nick Ryan Chief Executive Officer, Australian Aged Care Quality Agency

Ms Samantha Taylor PSM Registrar, National Disability Insurance Scheme Quality and Safeguards Commission

Ms Catherine Walsh Executive Director, Client Programs, Client Engagement and Support Services Division, Department of Veterans’ Affairs

Mr Andrew Whitecross Group Manager, National Disability Insurance Scheme Market Reform, Department of Social Services

Aged care statisticians

27 November 2018 International Visualisation Centre 19 Young Street Adelaide SA 5000

Commissioner Attending Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Justine Boland Program Manager, Health and Disability Branch, Australian Bureau of Statistics

Mr Mark Cooper-Stanbury Head, Disability and Ageing Unit, Australian Institute of Health and Welfare

Ms Louise York Senior Executive, Community Services Group, Australian Institute of Health and Welfare

Consumer representatives

27 November 2018 International Visualisation Centre 19 Young Street Adelaide SA 5000

Commissioner Attending Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Linda Bateman Manager, Aged and Health Support, Returned and Services League Victoria

Ms Sue Elderton National Policy Manager, Carers Australia

Mr Bob Ellis National Vice President, Vietnam Veterans’ Federation of Australia

Mr Ian Henschke Chief Advocate, National Seniors Australia

Mr Tony Lawson Chair, Consumers Health Forum of Australia

Ms Maree McCabe Chief Executive Officer, Dementia Australia

Mr David Panter Board Member, Australian Council of Social Services

Mr Mal Thiele National Vice President, Vietnam Veterans’ Federation of Australia

Mr Ian Yates AM Chief Executive Officer, COTA Australia

35

Roundtable Discussions and Participants, and Other Key Consultations Appendix 2

Home care

27 February 2019 Adina Apartment Hotel Sydney Town Hall 511 Kent Street Sydney NSW 2000

Commissioners Attending Hon Richard Tracey AM RFD QC, Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Fiona Duncan National Operations Manager, Aged Care Management Australia

Prof Michael Fine Honorary Professor, Department of Sociology, Macquarie University, New South Wales

Ms Claire Hargreaves Manager, Social Policy, Municipal Association of Victoria

Ms Ronda Held Chief Executive Officer, COTA Victoria

Dr Anna Howe Consultant Gerontologist (retired)

Ms Mary Karras Chief Executive Officer, Ethnic Communities Council of New South Wales

Ms Esther Kerr-Smith Group Executive of Finance Australia, Australian Unity

Mr Paul Sadler Chief Executive Officer, Presbyterian Aged Care New South Wales and Australian Capital Territory

Mr David Salisbury General Manager, Consumer and Small Business Strategies, Australian Competition and Consumer Commission

Ms Pat Sparrow Chief Executive Officer, Aged and Community Services Australia

Prof Hal Swerissen Visiting Fellow, Grattan Institute, Victoria

Ms Sue Thompson Chief Executive Officer, McLean Care, New South Wales

Dementia

4 March 2019 Collins Street Tower

Level 3 480 Collins Street Melbourne VIC 3000

Commissioners Attending Hon Richard Tracey AM RFD QC, Ms Lynelle Briggs AO

Attendee Attendee’s Role

Prof Henry Brodaty Head, Memory Disorders Clinic, Prince of Wales Hospital, Sydney; Co-Director of Centre for Healthy Brain Ageing, New South Wales

Prof Joseph Ibrahim Head, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Victoria

Dr Stephen Judd Chief Executive Officer, HammondCare, New South Wales

Ms Jennifer Lawrence Chief Executive Officer, Brightwater Care Group, Western Australia

36

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Ms Maree McCabe Chief Executive Officer, Dementia Australia

Mr James Nelson Carer and dementia advocate

Ms Lucy O’Flaherty Chief Executive Officer, Glenview Community Services, Tasmania

Ms Kate Swaffer Chair and Chief Executive Officer, Dementia Alliance International

Prof James Vickers Director, Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania

Commonwealth agencies 29 April 2019 Realm Hotel

18 National Circuit Barton ACT 2600

Commissioners Attending Hon Richard Tracey AM RFD QC, Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Janet Anderson PSM Commissioner, Aged Care Quality and Safety Commission

Ms Glenys Beauchamp PSM Secretary, Department of Health

Ms Pam Christie Executive Director, Industry Engagement and Communication, Aged Care Quality and Safety Commission

Dr Margot McCarthy Deputy Secretary, Ageing and Aged Care, Department of Health

Mr Nigel Murray Assistant Secretary, Funding Policy and Prudential Branch, Residential and Flexible Aged Care Division, Department of Health

Dr Lisa Studdert Deputy Secretary, Population, Health, Sport and Aged Care Royal Commission Task Force, Department of Health

Ms Ann Wunsch Executive Director, Quality Assessment and Monitoring Operations, Aged Care Quality and Safety Commission

Culturally and Linguistically Diverse Communities

30 April 2019 Sir Stamford at Circular Quay

93 Macquarie Street Sydney NSW 3000

Commissioner Attending Ms Lynelle Briggs AO

Attendee Attendee’s Role

Dr Bianca Brijnath Adjunct Associate Professor, National Ageing Research Institute, Victoria

Ms Ada Cheng Chief Executive Officer, Australian Nursing Home Foundation, New South Wales

Dr Jonathan Crichton Senior Lecturer in Applied Linguistics, University of South Australia, South Australia

37

Roundtable Discussions and Participants, and Other Key Consultations Appendix 2

Ms Anna Maria Harrison Chief Executive Officer, Umbrella Multicultural Community Care Services, Western Australia

Ms Danijela Hlis Dementia and Cultural and Linguistically Diverse Advocate, Tasmania

Ms Penni Michael General Manager Business Development, MiCare, Victoria

Dr Lillian Mwanri Public Health Physician; Associate Professor, Discipline of Public Health, Flinders University, South Australia

Ms Mary Patetsos Chairperson, Federation of Ethnic Communities’ Council of Australia

Ms Assunta Polito Home Care Coordinator, CORE Community Services, New South Wales

Ms Leyda Suttor Village Manager, Scalabrini Village, Drummoyne, New South Wales

LGBTI Communities

30 April 2019 Sir Stamford at Circular Quay

93 Macquarie Street Sydney NSW 3000

Commissioner Attending Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Brenda Appleton Chair, Transgender Victoria and Co-Chair, Lesbian, Gay, Bisexual, Transgender and Intersex Taskforce, Victoria

Dr Catherine Barrett Director, Celebrate Ageing, Victoria

Ms Samantha Edmonds National Project Manager, Silver Rainbow, National LGBTI Health Alliance

Mr Corey Irlam Director, Advocacy and Government Relations, COTA Australia

Ms Samantha Jewell Executive Manager, Lifeview Residential Care, Victoria

Ms Robyn Lierton Diversity Manager, ECH Inc, South Australia

Dr Anthony Lyons Associate Professor, Australian Research Centre on Sex, Health and Society, La Trobe University, Victoria

Ms Karen Price Deputy Chief Executive Officer, ACON, New South Wales

38

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Workforce

2 May 2019 Sir Stamford at Circular Quay

93 Macquarie Street Sydney NSW 3000

Commissioner Attending Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Annie Butler Federal Secretary, Australian Nursing and Midwifery Federation

Ms Carolyn Cooper Interim Chief Operating Officer, BUP

A Aged Care Pty Limited

Ms Leanne Cover Chief Executive Officer, Canberra Institute of Technology, Australian Capital Territory

Ms Judy Gregurke National Manager, Aged Care Reform Council, COTA Australia

Mr Gerard Hayes National Secretary and Branch Secretary, Health Services Union, New South Wales, Australian Capital Territory and Queensland

Ms Natalie James Workplace Relations Advisor, Deloitte Australia

Mr Darren Mathewson Executive Director, Services, Support and Engagement, Aged and Community Services Australia

Prof Kostas Mavromaras Professor of Economics, University of Adelaide, South Australia

Ms Maureen McCarty Director, Workforce Data and Analysis and Planning, Health Workforce Division, Department of Health, Australian Capital Territory

Ms Helen Miller Senior Manager, Aged and Community Services, LiveBetter, New South Wales

Mr Stephen Muggleton Group Chief Executive Officer, Bolton Clarke; Board Director, Leading Age Services Australia

Prof John Pollaers OAM Chancellor, Swinburne University, Victoria

Ms Carolyn Smith Secretary, United Voice, Western Australian Branch

39

Roundtable Discussions and Participants, and Other Key Consultations Appendix 2

Aboriginal and Torres Strait Islander people

28 May 2019 Hilton Adelaide

233 Victoria Square Adelaide SA 5000

Commissioners Attending Hon Richard Tracey AM RFD QC, Ms Lynelle Briggs AO

Attendee Attendee’s Role

Mr Graham Aitken Chief Executive Officer, Aboriginal Community Care, South Australia

Ms Wendy Ashwin Aboriginal Health Co-ordinator, Windsor Park Aged Care Home, Hall and Prior, Western Australia

Ms Venessa Curnow Executive Director, Aboriginal and Torres Strait Islander Health, Torres and Cape Hospital Health Service, Queensland

Ms Rachel Dunn Chief Executive Officer, Karadi Aboriginal Corporation, Tasmania

Dr Emma Fitzsimmons General Practitioner, Danila Dilba Medical Service, Darwin, Northern Territory

Mr Matthew Moore General Manager, Aged and Disability Services, Institute for Urban Indigenous Health, Queensland.

Mr Gary Morris OAM Chief Executive Officer and Co-Founder, Booroongen Djugun, New South Wales

Ms Noeleen Tunny Acting Director Policy and Advocacy, Victorian Aboriginal Community Controlled Health Organisations

Ms Patricia Turner AM Chief Executive Officer, National Aboriginal Community Controlled Health Organisation

Commonwealth agencies: younger people in residential aged care and carers 1 July 2019 Rydges Capital Hill Hotel

17 Canberra Ave Forrest ACT 2603

Commissioners Attending Hon Richard Tracey AM RFD QC, Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Gayle Anderson First Assistant Secretary, Client Engagement and Support Services, Department of Veterans’ Affairs

Ms Glenys Beauchamp PSM Secretary, Department of Health

Mr Peter Broadhead Acting Group Manager, National Disability Insurance Scheme, Transition Oversight, Department of Social Services

Ms Fiona Buffinton First Assistant Secretary, In Home Aged Care Division, Department of Health

Ms Kathryn Campbell AO CSC Secretary, Department of Social Services

40

Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Mr Mark Cormack Deputy Secretary, Policy and Programs, Department of Veterans’ Affairs

Ms Elizabeth Cosson AM CSC Secretary, Department of Veterans’ Affairs

Mr Michael Francis Deputy Chief Executive Officer, Participants and Planning Experience, National Disability Insurance Agency

Ms Trish Garrett Acting First Assistant Secretary, Cancer, Hearing and Support Division, Department of Health

Ms Helen Grinbergs Acting First Assistant Secretary, Aged Care Royal Commission Taskforce, Department of Health

Mr David Hallinan Deputy Secretary, Ageing and Aged Care, Department of Health

Ms Sarah Johnson Scheme Actuary, National Disability Insurance Agency

Mr Michael Lye Deputy Secretary, Disability and Carers, Department of Social Services

Ms Emma-Kate McGuirk Branch Manager, Carer and Disability Payments Branch, Department of Social Services

Mr Scott McNaughton Deputy Chief Executive Officer, Government Communications and Stakeholder Engagement Group, National Disability Insurance Agency

Mr Nigel Murray Assistant Secretary, Funding Policy and Prudential Branch, Department of Health

Ms Vicki Rundle Acting Chief Executive Officer, National Disability Insurance Agency

Mr George Sotiropoulos Group Manager, Disability, Employment and Carers, Department of Social Services

Dr Lisa Studdert Deputy Secretary, Population, Health, Sport and Aged Care Royal Commission Taskforce, Department of Health

Mr Andrew Whitecross Group Manager, National Disability Insurance Scheme, Market Reform Group, Department of Social Services

41

Roundtable Discussions and Participants, and Other Key Consultations Appendix 2

Briefing on the Interim Report: Aged Care Sector Committee 31 October 2019 Hotel Realm

18 National Circuit Barton ACT 2600

Commissioners Attending The Honourable Tony Pagone QC, Ms Lynelle Briggs AO

Attendee Attendee’s Role

Ms Andrea Coote Chair, Aged Care Quality and Safety Advisory Council

Ms Ara Cresswell Chief Executive Officer, Carers Australia

Mr Richard de Hasst Executive Manager Care Services of Aged Care Plus, The Salvation Army

Mr David Hallinan Acting Deputy Secretary, Department of Health

Dr Stephen Judd Chief Executive, HammondCare

Ms Claerwen Little National Director, UnitingCare Australia

Ms Maree McCabe Chief Executive Officer, Dementia Australia

Mr Nick Mersiades Director, Aged Care, Catholic Health Australia

Ms Sophia Petrov Director, National Aged Care Alliance, Aged Care Reform Secretariat

Mr Graeme Prior Chief Executive Officer, Hall and Prior Health and Aged Care Group

Ms Julie Reeves Federal Professional Officer, Australian Nursing and Midwifery Federation

Mr Matthew Richter Chief Executive Officer, The Aged Care Guild

Mr Sean Rooney Chief Executive Officer, Leading Age Services Australia

Ms Patricia Sparrow Chief Executive Officer, Aged and Community Services Australia

Mr David Tune AO PSM Independent Chair, Aged Care Sector Committee

Mr Ian Yates AM Chief Executive, COTA Australia

Other key consultations

Date Attendee Location

13 February 2020 Hon Paul Keating Sydney

13 May 2020 Hon Peter Costello AC Teleconference

26 May 2020 Hon John Howard OM AC Teleconference

17 June 2020 Senior officials from the Australian Department of Health and the Aged Care Quality and Safety Commission Teleconference

Appendix 3: Service Provider Visits

Appendix 3: Service Provider Visits The Royal Commissioners visited a number of service providers around Australia to gain an understanding of a range of services available to older people.

The visits enabled the Royal Commissioners to see different care settings and services. The range of services visited include large and small providers; mainstream, specialist and innovative services; and residential, home care and respite services.

The selection of a service for a visit does not reflect any judgement, positive or negative, about the safety and quality of a service.

Aged care service visits

Date Service Provider Location

26-Feb-19 Dudley Foord House Anglicare The Ponds, Sydney, NSW

Woodbury Village Winston Hills, Sydney, NSW

26-Feb-19 Residential Cottage Group Homes Australia St Ives, NSW

28-Feb-19 Our Lady of Consolation Home

Our Lady of Consolation Day Respite and Wellness Service

Our Lady of Consolation Aged Care & Services Ltd

Rooty Hill, NSW

28-Feb-19 Kincare Home Car

e Services Kincare Bella V

ista, NSW

1-Mar-19 HammondCare Hammondville HammondCare Hammondville, NSW

5-Mar-19 Strathdon Community Nursing Home Uniting Agewell Forest Hill, VIC

Strathdon Community Aged Care Services

5-Mar-19 Port Melbourne Hostel Wintringham Specialist Aged Care Port Melbourne, VIC

8-Mar-19 Smorgon Nursing Home Jewish Care Victoria South Melbourne, VIC

Montifiore Nursing Home Senior Living Precinct

28-May-19 Aboriginal Elders Village Aboriginal Community Care Davoren Park, SA

20-Jun-19 Bidyadanga Health Clinic Kimberley Aboriginal Medical service Bidyadanga, WA

20-Jun-19 Kimberley Aged and Community Services, including Home and Community Care (HACC) Centre

Western Australian Country Health Service Bidyadanga, WA

45

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Aged care service visits

Date Service Provider Location

20-Jun-19 Kimberly Aged and Community Services (KACS) Western Australian Country Health Service

Bidyadanga, WA

Kimberly Indigenous Cognitive Assessment (KICA)

21-Jun-19 Germanus Kent House

Bran Nue Day Respite and Breakfast Club

Southern Cross Care WA Broome, WA

10-Jul-19 Juninga Nursing Home

Juninga Independent Living Units (home care)

Australian Regional and Remote Community Services

Coconut Grove, NT

16-Jul-19 Mercy Place Retirement Village Home Mercy Health Cairns, QLD

Mercy Place Westcourt Home Care

18-Jul-19 Regis Kirwan Regis Aged Care Townsville, QLD

19-Jul-19 Carinity Fairfield Grange Aged Care Carinity Townsville, QLD

23-Jul-19 Elizabeth Lodge Anglicare Rushcutter’s Bay, NSW

30-Jul-19 Regis Ontario Regis Aged Care Mildura, VIC

13-Aug-19 Balaklava Mill Court Homes Balaklava Mill Court Homes Balaklava, SA

13-Aug-19 Kiandra Residential Aged Care Rosha Group Prospect, SA

21-Aug-19 Bupa Modbury Bupa Aged Care Modbury, SA

21-Aug-19 Northgate House SA Department for

Health and Wellbeing Northgate, SA

3-Oct-19 Community Care Tasmania Community Care NESB Inc. Launceston, TAS

21-Oct-19 Mercy Place Melbourne Mercy Health Montrose, VIC

23-Oct-19 Eldercare Acacia Court Eldercare Hendon, SA

7-Nov-19 Rylstone Multi-Purpose Service Western NSW Local Health District Rylstone, NSW

7-Nov-19 Ada Cottage RSL LifeCare Kandos, NSW

11-Nov-19 Glenview Community Services and Korongee Dementia Village Glenview Community Services Inc

Glenorchy, TAS

13-Nov-19 BUPA South Hobart BUPA Aged Care Hobart, TAS

28-Nov-19 Bernard Chan Nursing Home Australian Nursing Home Foundation (ANHF)

Burwood, NSW

28-Nov-19 Opal Annandale Opal Aged Care Sydney, NSW

28-Nov-19 Group Homes Australia (GHA) Vaucluse Group Homes Australia

Waverley, NSW

Appendix 4: Community Forums

Appendix 4: Community Forums

4.1 Introduction Engaging with the community was integral to our work. We did this in multiple ways, including by holding 12 community forums in different locations around Australia. More than 2400 people attended the community forums, and 228 people had the opportunity to describe their personal experiences in a setting less formal than those of hearings. Some of these people later gave evidence at hearings. One or both of Commissioners Tracey and Briggs attended each community forum.

We thank all speakers for their time and the courage they showed to share their personal experiences. Participants at community forums provided valuable information to support our inquiry. They offered their ideas about current aged care services and what they saw as important to consider for the future. The importance of community forums is described in ‘Approach to the inquiry’, in Volume 1 of this report.

This appendix contains overviews of the 12 community forums, held in the following locations:

• Bankstown (NSW): 1 March 2019

• Bendigo (Vic): 5 March 2019

• Wollongong (NSW): 13 March 2019

• Maidstone (Vic): 3 May 2019

• Broome (WA): 19 June 2019

• Townsville (Qld): 18 July 2019

• Adelaide (SA): 12 August 2019

• Brisbane (Qld): 19 August 2019

• Rockhampton (Qld): 20 August 2019

• Launceston (Tas): 3 October 2019

• Canberra (ACT): 25 November 2019

• Newcastle (NSW): 27 November 2019.

A questionnaire, distributed at community forums, provided a further opportunity for people to share their opinions and experiences. Just over 10% of the people who attended the community forums responded to this. A summary of these written responses appears below.

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4.2 Bankstown community forum The first community forum was held on 1 March 2019 in Bankstown Sports Club at Bankstown in Western Sydney in New South Wales, with Commissioner Briggs attending. There were 22 speakers and about 270 people attended. While two of the speakers described positive experiences with aged care services, the majority raised concerns about the quality and safety of aged care.

Speakers provided examples of poor medication management, serious pressure injuries, falls and inadequate hydration and nutrition. A speaker described finding her mother-in-law with extensive bruising:

we saw heavy bruising on her face. When we got her home I undressed her and saw…she was black from one end of her to the other…My mother-in-law said that she had been left alone in the bathroom in the shower chair and had fallen onto the floor…I wrote a detailed letter to the Director of Nursing and was told that ‘old people bruise easily’. I suppose they do if you drop them onto concrete.

Another speaker talked about finding her mother dehydrated in a residential care facility:

I was told that they have not been able to get [her] to take in any fluids…Nor had they called a GP [general practitioner] to examine her. She was barely speaking by then and prior to that week she had been walking by herself, assisted by a walker…She was in hospital for…nearly five weeks—being treated for severe dehydration as well as several infections and pressure sores…The hospital found out that my mother had not toileted for up to five days, hence her stomach pains. There were limited or no records kept of [her] fluid intake…the facility was not even aware that she had developed pressure sores.

A personal care worker employed in home care explained that she is often the only person who goes into the house. She commented that she was trained to note changes in people’s mental and physical health, but that she could not do this properly during 15-minute visits.

One speaker described the risk to the mental health of nurses and her own depression after being bullied when unable to meet unrealistic work expectations. Several speakers raised concerns about the adequacy of training of aged care staff members, particularly in caring for people with dementia.

Recurring concerns about the quality of care included:

• overuse of antipsychotic medication for dementia patients to ‘keep them controlled, quiet, managed and, in some instances, tolerated’

• relying on a limited number of continence pads rather than providing assistance with using the toilet.

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Several speakers described poor reactions by aged care providers when responding to concerns and complaints. One speaker described being informed by the Chief Executive Officer of the facility that his mother had been abused, and then told, ‘to move on and get over it’. Another speaker reflected on cultural differences:

It’s an all-Chinese nursing home, containing staff and residents who are culturally reluctant or scared to complain…[the air conditioning] was not fixed for years— senior management told us no-one had complained and they did not know, which we find hard to believe…residents were at times left sweltering in 30-plus degree heat…one resident’s bathroom measured 40 degrees on a heatwave day.

Several speakers mentioned that residents and family members are fearful of making complaints due to possible repercussions.

Two speakers from the deaf community raised concerns about the availability of appropriate assistance to navigate the aged care system. In particular, they spoke about the importance of access to Auslan interpreters, particularly when making important decisions about their care, as well as when dealing with wills and bequests.

A number of speakers had experience as nurses or personal care workers, including in aged care. They raised particular concerns about nursing staff members being diverted from care to administration. One speaker said:

A registered nurse’s job is to monitor change in patients but there is constant pressure to do paperwork and get funding.

Another said:

Managers are too busy doing paperwork and they’re not on the floor. Get rid of paperwork and prove what you can do. It’s not about sitting at a computer while somebody needs to go to the toilet.

There was cynicism expressed about behaviour of some aged care providers. For example, one family member heard from an aged care worker that they were to ‘make up and exaggerate’ the behaviour and needs of residents to get more funding subsidies, and another described the ‘fudging’ of numbers of staff recorded on duty. One speaker saw changes in staffing before a visit from the regulator:

employees would come out of the woodwork to make it look better, right before a visit.

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Several spoke of their difficulties in accessing services, including through My Aged Care, and of the long waiting lists for home care services and inadequate support for family carers.

My financial paperwork was lost four times. January 2018 My Aged Car e cancelled mum’s home care package [and] did not advise why, after many phone calls [I] was advised [they] did not have my financial paperwork. I then personally handed it in, they lost it, then I had faxed it and it was lost yet again and then I faxed it a second time…Finally it was in the system April 2018.

A personal care worker employed in home care explained that she is often the only person who goes into the house. She commented that she was trained to note changes in people’s mental and physical health, but that she could not do this properly during 15-minute visits.

Two speakers from the deaf community raised concerns about the availability of appropriate assistance to navigate the aged care system. In particular, they spoke about the importance of having access to Auslan interpreters, particularly when making important decisions about their care, as well as when dealing with wills and bequests.

Several also spoke of financial stress around aged care, including a speaker who reflected on the particular experience of older women facing homelessness. One family member gave up her employment to care for her mother, and was experiencing severe financial hardship:

when we have given up our careers, spent our super, when we are close to 60 and cannot return to our former careers, we have nowhere to turn to for help. Carers are the silent sufferers of the global dementia pandemic.

A number of speakers emphasised the importance of respect and dignity for older people as a foundation for aged care:

Elderly people were once part of the fabric of society and just because they have become ill and frail and no longer independent, does not mean they deserve less care of respect. It should be the opposite.

The final speaker spoke about the importance of person-centred care, and encouraged a conversation about love in aged care:

Residents want someone to listen to them, for someone to sit on their bed and have someone hold their hand.

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4.3 Bendigo community forum The second community forum was held on 5 March 2019 in Bendigo Town Hall at Bendigo in Victoria, with Commissioner Briggs attending. There were 20 speakers and about 250 people attended.

Several speakers suggested that people in the community lack knowledge about aged care services and about how to navigate the very complex system. One speaker, a volunteer who supports families, explained that an applicant may have to speak to nine different services to access care:

I trust this complicated process will be simplified.

One speaker described her struggle to obtain community services to help her keep her father, who had dementia and feared residential care, at home. She was unable to access residential respite for a break. She was also unable to access home-based palliative services at the end of her father’s life, when he was admitted to a palliative care unit:

As carers, we carry the burden of the system and funding failures…in the absence of system reform, these failures will continue.

Another speaker described a broken resource system. He said that he found it necessary to accept residential care for his father while waiting for home care services, but his father subsequently became despondent and died. Another speaker expressed concerns about the significant gap in respite care services in the community, where lack of relief from caring can lead to ill health for the family carer. One speaker suggested that concern in the community about entering residential care can lead to a reluctance to plan for care needs and services in later life.

The quality of residential aged care services received particular focus. One speaker considered the physical care in his mother’s facility as adequate, but described the transition to care with loss of connection to friends and community as ‘like stepping off a cliff’. The speaker said that there was a total absence of assistance to help his mother adapt. He observed that staff members are stretched thinly and unable to respond to the loneliness that residents experience, or to give a personalised response to their care needs:

Aged care facilities should be homes first, workplaces second, and institutions third.

One speaker spoke about both his parents, who live in the same facility. The speaker described how his father, affected by a stroke, would hear his wife, who has dementia, wailing down the hallway. His father would ring the bell for help:

No-one would come…he felt useless.

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As a result, the speaker explained, the family organised for private care to be provided for 11 hours a day, six days a week. Over a two-year period, they advocated to the facility for their mother to be weaned off her medication. This eventually occurred, resulting in her laughing and smiling, and generally being happier. The speaker described person-centred care as more than physical care, with a need to focus on a person’s wellbeing:

We took matters into our own hands. Their home is where they should feel safe and loved.

Other speakers also provided examples of inadequate care of people with dementia. One speaker described how the manager of an aged care home insisted that her mother be lifted with a lifting machine due to mobility issues, which caused her mother to become withdrawn. Physiotherapy at the facility only provided for pain relief and not, despite requests, reablement. The family invested in private physiotherapy and equipment for 18 months. Their mother was able to walk again and her cognition improved:

We were able to do this for mum because we never gave up. It should be about living, not waiting to die.

Two separate speakers stated that injuries to family members were not detected in a timely fashion, resulting in undetected pain and increased infection. Several described significant mistakes being made in the medication provided to people. In one instance, the medication was meant for a resident in the adjoining room. In another, medication mismanagement resulted in the person not eating. This led to significant weight loss.

One speaker advocated for changes in legislation to protect vulnerable people in aged care services who receive injuries as a result of poor care. Another speaker described the everyday neglect of her mother with respect to hygiene and nutrition. The speaker’s mother subsequently died of sepsis. The speaker said she felt the facility treated her like a troublemaker when she raised care issues:

I was bullied and intimidated by management…before my mother passed away I was told that she was taking up too much of the staff’s time.

A number of speakers raised the issue of adequate staffing. One speaker, calling for mandatory staff levels, said that staff are constantly rushed off their feet. Another believed that poor staffing levels place residents at risk because staff struggle to carry through basic care tasks and are stressed:

Very hard working, well-intentioned staff doing the best they can in challenging circumstances.

Several spoke about the need for more staff skills and knowledge, with different speakers making the following suggestions:

• capability improvements through more training

• the screening of staff for qualifications and personality suited to caring

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• closer monitoring of staff who carried out their care tasks poorly

• staff training in dementia care, such as understanding that pain may be a cause of distress

• greater emphasis on staff giving attention to the information provided by family members, who know the person and their needs.

Another concern was that of reduced care options for younger people. One younger person with a disability described her struggle to stay at home, which required her periodic admittance to a residential aged residential care facility. She described this experience as confronting and humiliating, with her dignity and privacy not respected, and implied that she would end her life if that became the only option ahead:

If my funding and supports do not…enable me to stay at home, I’ve made a decision not to go to aged care. I’m not going there again.

One person spoke of the incompetent management of diabetes and a lack of assistance with meals for their sister, who had Down syndrome. The speaker’s sister died of pneumonia. Earlier, the family had been so distressed that they considered kidnapping her from the facility but believed that they would be in trouble with the law.

Other speakers described their distress at the type and limited amount of care for their family member and in particular the lack of personalised holistic care:

To watch what she’s going through is life-destroying.

Several speakers described the need to become advocates on behalf of a family member to ensure that basic care needs and rights were met. One speaker explained that they felt they had no voice in representing the needs of their family member. To be able to speak up on behalf of their family member receiving residential care, they had needed to educate themselves about the Aged Care Act 1997 (Cth) and about rights:

We fought for our dad, because he mattered, because people matter, because human rights matter.

Many speakers acknowledged the grief, anxiety and emotional trauma experienced by families:

Our story is filled with heartache, like many of you here.

Several speakers spoke of priorities in aged care being out of balance. One suggested that the facility providing care to their family member focused on meeting organisational needs rather than patient needs, while another speaker expressed concern about the financial motivations of aged care organisations:

The thing is, there should be care before profit.

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4.4 Wollongong community forum The third community forum was held on 13 March 2019 in WIN Stadium at Wollongong in New South Wales, with Commissioner Briggs attending. There were 20 speakers and about 187 people attended.

Speakers discussed person-centred care, care of residents with dementia and palliative care. A particular theme was the need for a skilled and kind workforce as a pathway to quality and safe care for older people in aged care facilities. This included calls for improvements in the training of registered nurses, enrolled nurses and personal care workers. Some speakers referred to the need for improvements in provider leadership.

The main workforce issues that speakers identified related to training needs, a requirement for increased numbers of staff for residents, and better pay rates. A general practitioner who had worked in aged care for 22 years raised workforce as a ‘crucial issue’:

We need more registered nurses, better trained aged care registered nurses, and better paid aged care registered nurses. We also need better trained enrolled nurses and better trained carers.

Another speaker made several points about improving the status, training and salaries of all workers in aged care, including:

• requiring registered nurses to have postgraduate qualifications in gerontology and reward them accordingly

• recommending senior classifications for registered nurses with specialist qualifications in wound care, continence, palliative care and so on

• providing incentives for care workers to increase basic qualifications to Certificate 4 level and remunerate accordingly

• considering Certificate 4 as entry level qualification in the future.

A number of speakers emphasised the importance of better training, with particular focus on dementia, trauma, and behavioural management:

Beyond the RNs, the enrolled nurses and carer staff are usually poorly skilled in aged care specific challenges such as dealing with challenging behaviours in dementia, such as agitation or aggression. Because of this, there is often a push from both RN and other staff to use strong pain medications or sedation or even antibiotics when they are not necessary in order to do ‘something’ about behaviours.

Speakers provided examples of poor person-centred care, ranging from waiting lengthy periods for care packages, lack of focus on prevention of harm from falls, problems with ulcers or oral health issues, dependence on staff, and random care episodes that did not meet their relative’s needs of timely assisted meals and help with hygiene, going to the toilet and hydration. One speaker stated that each aged care facility needed to have, or

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have access to, at least one specialist in palliative care. Another speaker described a need for leadership in practice with end-of-life care, which should extend beyond the last few days and hours. Two speakers referred to the need for gender-specific personal care.

Several speakers raised the issue of carer stress associated with lack of communication from staff. These speakers worried about possible adverse consequences if they spoke to the facility on behalf of their relative, including the possibility of them being isolated or banned from visiting the facility:

There must be a recognition that the services provided by carers such as myself, are saving the country a fortune, but often at great personal cost…The knowledge that we could access a home where we would be expertly, gently and lovingly cared for in our community, would relieve so much stress and greatly enrich the remaining years of our lives.

Another theme for many speakers related to improved service integration, including better processes for communicating and resolving issues. One speaker suggested better service integration and coordination between governments, as operators can be very cautious due to over-regulation. Similarly, one speaker reported that the National Disability Insurance Scheme had suggested going to My Aged Care, but My Aged Care then said that they couldn’t help. Another speaker suggested that negotiating the network of government and provider red tape was more stressful than her husband’s dementia. Another speaker stated that the system assumed, incorrectly, that people had family support. What the community needs, one speaker suggested, is a transparent, dependable and affordable system, with personalised support to navigate the bureaucracy.

One speaker described how a family member was neglected, abused and forgotten when the family expected that she would be comfortable and safe. She died within six weeks of entering the aged care facility. A different speaker cited an example of unprofessional behaviour where confidentiality and privacy were ignored at a service provider meeting. Another speaker referred to the ‘forgotten Australians’, people who as children were placed into institutional or other out-of-home care. The speaker recognised that these people would face particular challenges if they returned to residential care as an older person. A different speaker suggested the need for video cameras in common areas and residents’ bedrooms, or for families to have cameras to monitor activities of daily living.

Several speakers who had worked, or continue to work, in aged care reflected on their experiences. This included being told not to get attached to the residents. They described the increasing complexity of caring for residents, including the need to provide higher levels of care, to deal with complex medications, and to work with limited preparation or training. A health professional observed that there is no standardised information technology system in residential aged care facilities. A different speaker commented that some things had not changed: the high workloads, the shortage of staff, and the pay. Another speaker stated that they had serious concerns for their safety and that of their fellow workers, compounded by management’s attitude.

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4.5 Maidstone community forum The fourth community forum was held on 3 May 2019 in White Knight Receptions Maidstone, at Maidstone in Victoria, with Commissioner Briggs and Commissioner Tracey attending. There were 18 speakers and about 260 people attended. Three younger people with disabilities, together with their family members or carers, spoke about the experience of living in residential aged care. Other speakers focused on inadequate care, staffing ratios, complaints processes, and the rights of residents and carers. Several people spoke about the experiences of younger people in residential aged care:

My daughter spent 12 months in aged care at age 18 after a craniotomy for to a brain tumour and strokes. At 28 [years] she was unable to speak or move… Our observations and reading notes accessed through Freedom of Information convince us that aged care is no alternative for young people...She often waited half an hour for a worker to arrive when she buzzed…Her room was next to the pan room and the smell was sickening at times. Friends stopped visiting. It was a depressing place. A staff member pulled us aside one morning and told us that some of the staff were not treating her well. We already knew that but any concerns fell on deaf ears. Residents were not being treated equally. We observed bullying and neglect of ‘difficult’ residents who weren’t silent and compliant.

One young person, assisted in her verbal communication by a support worker, described living in a nursing home for six years. She explained that people are constantly screaming and that there is no stimulation. She finds it hard to come up with ideas of what to do, and just sits quietly on her own. She explained that life has changed so much for her. She used to like to paint and to be outside: ‘now all that is unreachable’. As a vegetarian, she finds there is lack of food choices, and that the food is the same every day. With the National Disability Insurance Scheme plan, she used to have up to 500 hours of therapy, but now only has 60 hours:

They said no one would be worse off under the NDIS [National Disability Insurance Scheme] but that is not my experience.

This speaker spoke of a desire to end her life, saying she would do so if her arms would allow it.

A speaker in her thirties spoke with the assistance of a communication device. Following a stroke after an operation, this speaker’s only option, because of a lack of disability funding, was an aged care facility. From her 18 months in the facility, the speaker described having little autonomy about decisions such as her daily routine, activities and food. She found some staff patronising, and said they treated her as being unable to make her own decisions. According to this speaker, the most important thing was for staff ‘to truly listen and support us to drive the process of our lives’. She believed that better trained and better educated care support workers were required to meet complex needs.

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One speaker spoke of her experiences with home care services:

I have travelled from rural New South Wales to speak today because I am disgusted by the corrupt, inconsistent behaviour of providers and their care staff…

This speaker explained that she had changed providers because workers lied about hours worked and because transport was not provided. However, the situation did not improve:

the next provider I went to was unreliable. Staff did not turn up for necessary showers…sometimes no staff for a couple of days and that meant no personal care on those days…so I changed providers again…every statement with that provider was incorrect…

The speaker expressed concern that she would be forced into residential care, defeating the whole purpose of home care allowing her to remain in her own home: ’I am blessed I have a family who care but many don’t.’

One speaker noted what they regarded as inadequate or poor residential care, with insufficient focus on the quality of life of residents:

I have observed my mum sitting in her seat for her meal and have it put in front of her without any acknowledgement or even a smile…my impression and feeling of this facility is one of a business on a budget waiting for turnover with little thought to promote the quality of care for these aged people in their final years.

The speaker said that aged care should not just be ‘a place to die’.

Another speaker raised concerns about his wife’s care in a residential facility, including dirty toilets and the misuse of medication. He stated that the User Rights Principles should offer protection from all types of abuse. However, the Principles were ineffective in supporting rights of care recipients because the facility treated them ‘flippantly’:

the ‘Charter’ is in reality a toothless tiger. It is not in its current form affording protection to the people it purports to defend…In the absence of a ‘charter’, what does the resident have in their corner? Who speaks for these poor souls, some with dementia, when their basic rights are denied them? The government complaints department just took the word of the facility as fact and were unhelpful.

Another speaker found the local advocacy service to be very supportive but observed that the service had little power to make changes.

A representative of Carers Victoria, a state-wide advocacy group for carers, spoke about the need to acknowledge relationships between family carers and people for whom they care. This speaker stated that care provided by family and friends is the backbone of the Australian aged care system, and noted that carers need acknowledgement as people with their own needs. The speaker said that the obligations on providers is not consistent

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with the Carers Recognition Act 2012 (Vic). In addition, car

ers, family and friends are

notably absent from the new Charter of Aged Care Rights. The speaker concluded that improved recognition of carers would promote safer and better quality care for people using the aged care sector.

Some speakers connected better care with higher levels or ratios of staff to residents, and with improved training. One speaker said that lack of staff led to neglect. This speaker considered the Australian Government’s complaint, accreditation and advocacy systems to be ineffectual. She described starting a petition to mandate skilled staff to resident ratios, which had to that point attracted 312,000 signatures. Another speaker advocated for better training, including specific care for lesbians and other minorities because aged care staff members do not know how discrimination works. One more speaker commented that staff ratios need to be informed by complexity of the needs of the residents. She had observed staff members who wanted to help but did not have the necessary skills. Another speaker suggested that the aged care system of safety is ‘impotent’ and would benefit from a focus on the sort of safety models that exist in health care systems.

Several speakers suggested empowering families to assist with care, along with the need for the community to engage more with older people living in aged care. Some speakers suggested ways to bring younger people into aged care roles through credits towards Higher Education Contribution Scheme (HECS) debt and for universities to look beyond Australian Tertiary Admission Rank (ATAR) scores for community involvement. According to one speaker, all personal care workers should be registered with the Australian Health Practitioner Regulation Agency. Another speaker thought staff should have a university qualification to provide dementia care and that salaries should reflect that. Another speaker commented on the need for appropriate rewards and a clear long-term career path for staff.

Finally, a speaker commented that the ‘government needs to stop giving aged care licences to unsuitable people who lack empathy, compassion, experience and the values needed to be entrusted with the care of our elderly’.

4.6 Broome community forum The fifth community forum was held on 19 June 2019 in the Broome Civic Centre at Broome in Western Australia, with Commissioner Briggs attending. The Broome community forum commenced with a Welcome to Country provided by Jimmy Edgar, a Karajarri man and descendent of a Yawuru Elder. There were 13 speakers, predominantly Aboriginal and Torres Strait Islander people. About 50 people attended. Two speakers had an additional person stand up with them to make their statement. A number of the speakers travelled long distances across the Kimberley region to share their experiences about aged care in remote areas of Western Australia.

Speakers told about the need for cultural safety, enabling people to fulfil their cultural responsibilities to their families and communities and to have the choice to remain on Country. They emphasised the importance of treating Elders with respect. Speakers referred to Elders as ‘knowledge holders’ and ‘living treasures’.

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One speaker commented that the Stolen Generations Elders did not want to go back to institutionalised care:

They were removed from everything from a very early age and re-programmed; let us not put them through this trauma again toward the end stage of their lives.

Another drew on his history as an Aboriginal Elder and Japanese descendant to tell the story of multi-racial Australia and shed light on the fear that older people with such experiences have about further institutionalisation.

Speakers provided examples of substandard care and neglect, financial abuse of elders, and a sexual assault.

Several people commented on issues and challenges facing Aboriginal people due to low income, the high costs of food and services in regional areas, living below the poverty line, and the need for safe houses. One speaker said that the economic status of Aboriginal people needed to be looked into when considering how to deliver aged care services in remote areas.

According to one speaker, many Aboriginal people have a fear of moving out of their homes and going out of their Country to a strange place, particularly because residential aged care services are not culturally well informed.

Several speakers commented on the need for providing services for Aboriginal people by Aboriginal people. As one person put it:

There could be more done around training and/or upskilling more Indigenous people in Palliative Care so that when and if our Stolen Generation Elders do need to go to these Aged Care Facilities, the least we can assure them is that there will be familiar faces for them.

If we have more local people trained and employed across all levels, not just in junior roles, we may start to see a difference. We still need these facilities in our communities but we also need them to be run better so our Elders see it as an option and not a sentence.

One speaker suggested implementing measureable outcomes into service agreements that reflected the cultural requirement and the complexities of living remotely. Another speaker suggested the implementation of a cultural audit.

Speakers commented on aged care issues, including access and equity, the complexity of systems, assessment barriers, and the need for face-to-face services with local providers. One speaker explained that they were unable to navigate myGov, even though they have a Masters and a Bachelor of Applied Science. This speaker questioned how an Aboriginal person who has English as a third language would navigate this sort of online system:

ACAT is not an easy process and is used more as a barrier than a pathway to accessing care. Language is exclusive and not easily understood.

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One speaker advised that some people choose to not access care because they do not understand the packages or because of the high costs.

One speaker, whose mother is happy with the care received from her home car

e

package, commented that the communication from the centralised service was confusing and lacked empathy. She considered that there needed to be more focus on ensuring that people understood the system, not helped by the use of acronyms in monthly statements. Another speaker said that fees for a person in residential care were raised without informing Centrelink to increase deductions, causing additional difficulty to a grieving daughter:

After losing her mother and going through ‘sorry time’, the carer (daughter) was advised that there was an outstanding invoice. There are always many other service providers that are involved in the overall care of our Elders but communication between these services and the relevant family member is not always as good as it could be. We also need to ensure that families are not further traumatised when their loved ones pass away with issues that should be dealt with as they arise.

Other people made the point that many people are not eligible for services and may fall through the cracks, and noted limited services for young people with disabilities. One speaker said the Aged Care Funding Instrument does not take into account the complex needs of Aboriginal people in regional, rural and remote areas. Another speaker said support is inadequate and that some services written into agreements and contracts do not happen.

Several speakers talked about challenges with respite, and one speaker explained that the delivery of dementia services to Aboriginal and Torres Strait Islander populations faced serious challenges.

One speaker commented on the complaints process:

maybe have a more open process where complaints can be made to an independent party so they are addressed.

Several speakers praised the work of many professionals who work in aged care in remote and regional services in the community.

4.7 Townsville community forum The sixth community forum was held on 18 July 2019 in Rydges Hotel South Bank at Townsville in Queensland, with Commissioner Briggs attending. There were 20 speakers, with about 180 people attending. Speakers provided examples of inadequate care, poor medication management, and inadequate care coordination. Some people talked about the gaps in care for Aboriginal and Torres Strait Islander people, the Forgotten Australians, people from culturally and linguistically diverse backgrounds, and people with a disability.

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One speaker talked of the inadequate care her father received prior to his death in a residential facility:

My family considers his death was premature as a result of the aged care facility not providing adequate care for him. My father was found on the floor on a number of occasions when he had fallen, sometimes only wearing an adult nappy and shirt, and was eventually found with a broken ankle. We will never know how many times he fell nor how long he was left on the floor each time as the r ecord keeping at the facility was not accurate.

This speaker described how the family lodged a complaint just before her father’s death, but was advised after his death that no further action would be taken by the Complaints Commissioner. Family members found this extremely upsetting. A new process was initiated following a request for a review and the report identified significant concerns impacting all residents:

The audit indicates that there are insufficient staff, staff do not have time to attend to residents’ needs, and processes are not effective to ensure that staffing is maintained to meet residents’ needs...how many times can a facility not meet Standards before there are serious consequences?

One speaker described the lack of emotional care for her mother ‘in terms of her loneliness and social engagement. Frequently, she was left isolated and ignored in her room’. The speaker’s mother also received poor personal care:

Mum endured the most distressing lack of, and inconsistencies with, toileting support. I had growing concerns when Mum’s pullup was frequently soaked with urine when I would change her for bed. The nursing home then committed to a toileting schedule. However, toileting support never lasted for more than two consecutive days before it petered out. During this supposed toileting support, a diary entry for June 2015 says ‘Mum had long pants on inside out and back to front, no pull-up on, was smeared with faeces on her hands and needed a shower’ and in July says ‘Arrived at 2pm—toilet filthy, faeces on toilet seat (cased on the rim of the seat), faeces on all towel in the room and wearing a filthy pull-up.’

This speaker also described visiting her mother on a weekend when being informed that she had been prescribed morphine for back pain:

On arrival at Mum’s room, she was lying across the middle of the bed with her legs hanging over, crying out in pain and repeatedly saying that she ‘wanted to die’. She could not move from that position. After 10 minutes, I asked for the doctor to attend earlier and when he didn’t arrive I asked a care worker to call an ambulance. She said she wasn’t allowed to, so, at 9:28am, I called an ambulance myself and mum was taken to hospital. She had a broken back.

This speaker considered that a camera should be in every room ‘when a family requests it, or mandated for residents’ rooms where there are no family who visit’. She considers there needs to be the establishment of ‘an authority, with real power, for families to report concerns, and not condone and ignore them’.

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Three speakers regarded getting an Aged Care Assessment Team visit, a Home Care Package, accessing Residential Aged Care facilities, and using the My Aged Care Portal as complicated:

My mum is elderly and has health issues, there is no way that she would have been able to do all of the work involved with getting Dad a Nursing Home place within the 35 days outlined by the hospital staff as well as deal with the reality that she has ‘separated’ medically from her husband of 54 years, the grief and emotions that she is experiencing every day is mentally and physically exhausting.

From memory, approximately four years ago my husband was approved for a level 4 care package. I received notification about six months after his death last year that a package was available. How does that happen in a system which has sifted through everything about us? I felt guilt, frustration and sadness as he diminished despite our best efforts.

How our aged persons are best served by the online ‘My Aged Care’ and a telephone helpline baffles me. Great people when you can get in touch with them but an awful system! The shortcomings were a constant source of angst for me. I can imagine how older, more technically challenged people must struggle.

On the question of care for Aboriginal and Torres Strait Islander people, speakers referred to specific needs and the gaps they have encountered in aged care services. One speaker stated that although cultural values from some places do not fit with Aboriginal and Torres Strait Islander people, they have to ‘just put up with it’ because there are not many affordable options available to them in their own parts of the country. These situations, the speaker suggested, would not be tolerated in mainstream nursing health care.

Another speaker noted that English is not a first language for some Aboriginal people, and may be a third or fourth language. These people may have a cohort of identified health and ageing conditions, including hearing issues, dementia, confusion, communication issues, assertiveness issues, grieving for their family and Country, and so on. They may find themselves ‘in a foreign routine where enclosure inside a building, noise and rush, rush, rush is the norm’:

Too often there is not enough resources to take them outside to even connect with Country, sunshine, fresh air, nature, sounds of birds etc. I have found far too often, their culinary preferences are unavailable on the menu and many residents of Indigenous heritage are too often, not made a priority and are left in a soiled bed (their budget didn’t allow for more incontinent aids etc.), to wait, last to receive care or left for the next shift—there is not enough assertive presence in the facility to assert for them.

Australia’s care and standards for Indigenous peoples in aged care facilities are, in general, a disgrace to our nation and need monumental review in the near future not the ‘who knows when’ future… they are human beings who deserve the same rights and entitlements as any other Australian.

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A number of speakers considered that the needs of culturally and linguistically diverse residents in residential aged care was neglected. Some people raised communication as a major issue for culturally and linguistically diverse people: ‘care ultimately rests a lot on communication’. One speaker noted that some people with dementia may revert to using their mother tongue, leaving them unable to voice their needs.

Other issues raised included the need for understanding of cultural perspectives and a requirement for service providers to receive cross cultural training and cultural awareness training. One speaker talked about isolation and loneliness and cultural inhibitions, while another suggested that, ‘Nursing homes could be marked as suitable for people from a particular ethnicity or culture.’ Another speaker saw the culturally and linguistically diverse background of care staff as adding to the challenges in the care environment:

Too often care delivery is delivered by ‘caring’ carers with a limited command of English. There is a high proportion of non-English speaking background staff in Aged Care and whilst their intentions are usually honourable, there are issues with their standard of knowledge and skills to enable them to deliver the standards of care expected in Australia.

One speaker highlighted issues facing Forgotten Australians, who had an ‘entrenched mistrust of systems’ due to their previous experience in institutions. A return to institutionalised living could trigger ‘loss of power and independence again’ and memories of past trauma. The speaker stated that such people needed extra support following their entry into residential aged care facilities, not just ‘a tick and flick type form about their wellbeing treatment’.

A disability advocate made the following comment:

I have witnessed in my eight years attending residential aged care facilities in Townsville and surrounding areas, insufficient staff levels to adequately care for the residents both aged and young, and more so for those with disabilities. There is also a gap in the skills of the staff and there are some staff who should not be working in the sector, sadly.

Several speakers advocated for closed-circuit television cameras in aged care facilities, indicating this would assist with the quality and safety of care. However, one speaker acknowledged this would not be an easy road, while another speaker suggested it should be on family request. Another speaker thought closed circuit television cameras could perhaps be considered for residents who did not have any family visits.

Some speakers raised instances of medication mismanagement, such as mistakes that caused falls or drowsiness or where residents had to wait over an hour for pain relief.

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One speaker commented that the facility where his mother lives is driven by an economic imperative, despite being not-for-profit. The economic objective is met, the speaker said, through cutbacks to staffing and to the quality of staff because of the shift from a regular to a casual workforce. This same speaker spoke of medication mismanagement, missed meals and the facility’s inability to know the special needs of his mother or even respond to her call bell. He reported that his mother had said she wanted to die and had looked with interest at euthanasia laws.

4.8 Adelaide community forum The seventh community forum was held on 12 August 2019 in the Adelaide Town Hall at Adelaide in South Australia, with Commissioner Tracey attending. There were 20 speakers and about 400 people attended. Many of the speakers referred to instances of harrowing care that caused distress to both residents and their families, and the need for more empathetic, better qualified or better trained carers.

Five speakers talked about their experience at the Oakden Older Persons Mental Health Service. One speaker, who had a family member at the previous Oakden facility, stated:

The impact of reality that this could be or could have and probably will happen to a loved one or you at some stage is felt by everyone.

Another speaker strongly advocated for preventing what they had experienced ever happening again:

Since the horrors of Oakden have aired, I have worked closely with the current SA Government on various projects to ensure that what Dad went through was not in vain. I would prefer that he not be remembered as a victim of abuse, but rather be instrumental in the catalyst for change.

Many speakers questioned the empathy, qualifications, training and pay levels of the carers and staff they encountered in aged care. One speaker stated:

It seems that for many of the staff, it is just a job with no responsibility or care. There are some that are very capable, sympathetic, fun loving and caring; however, and unfortunately, these seem to be the silent minority. If only they could have more influence on their colleagues, this might improve but it seems they are so busy doing the right thing for the residents they just don’t have the time.

We can plead for higher staff numbers. We can call for a higher nurse to carer ratio, but I don’t believe this will in itself change much. I believe if everyone performed their duties competently and diligently then even with the existing staffing there would be a large improvement in performance. One of the critical elements currently missing is accountability. Too many of those involved in providing care for the aged are not held accountable for their areas of responsibility. This must change and that change must come from the top down to those providing first level care. The top being Facility Managers, CEOs and even the Federal Minister.

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Another speaker said:

It’s getting harder and harder for everyone to care for our elderly in the way they deserve when you don’t have time to care for residents properly. We used to have time to talk with residents, sit down and do their nails, not just clean them, and take them for walks. But now, we don’t have the time. The carers are run off their feet and don’t have the few extra minutes to get to know their residents.

One speaker was disturbed by the way the Aged Care Funding Instrument is calculated, suggesting that because providers do a self-assessment, there is self-interest.

Individual speakers made reference to power of attorney, the Office of the Public Advocate and the South Australian Civil and Administrative Tribunal. One speaker stated that after the family had repeatedly asked the facility questions about their mother’s medication, the speaker lost guardianship to the Office of the Public Advocate. Another speaker stated that their parent was vulnerable and that there were family abuse issues, but that the South Australian Civil and Administrative Tribunal had refused to appoint an independent guardian. A different speaker said that a social worker had made a submission for the public trustee to look after the affairs of the speaker’s parent, even though the family had a valid power of attorney. One woman stated that her husband had frontal lobe dementia and that facility staff had blocked the family from visiting him. The family reported this situation to the South Australian Civil Administration Tribunal.

Other speakers raised issues with complaints processes. One speaker stated that deaths had occurred which should have been avoided through proper care and the facility did not have a complaints system, which led to anger among family members. Another speaker said they had complained to all staff at a particular facility, all the way up the chain, as well as to the Australian Competition and Consumer Commission, the Australian Health Practitioner Regulation Agency, the police, and elsewhere. One person said that they complained to the Aged Care Quality and Safety Commission about a particular medication being given to a family member, and that after 48 hours the drug was ceased. Another person stated that the Commission was not working effectively following its last restructure.

One speaker believed his parents, who were both in a high care facility, chose to end their own lives by not eating, drinking or taking medications. He stated that they had died alone in their room. The facility did not inform the family what was happening and told the family they had 24 hours to clear the room.

Another speaker said there was a need for regulation in balanced with compliance, the need for profit and the need for individual human dignity.

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An Aboriginal woman described herself as ‘so angry’, but said ‘anger won’t fix this’:

Our elderly come to you to live safe, comfortable, happy lives ‘til they die. Let’s make these places somewhere we would all be happy to let our mums die irrespective of race or what they did in their younger years. Every elderly person in Australia has the right to die with dignity, grace and respect.

Two of the speakers had nothing but praise for the facility where their family member resided.

4.9 Brisbane community forum The eighth community forum was held on 19 August 2019 at the Brisbane Convention and Entertainment Centre in South Bank at Brisbane in Queensland, with Commissioner Briggs attending. There were 20 speakers and about 260 people attended.

Speakers focused on a range of topics, such as the following: challenges with My Aged Care (including the complaints systems, both current and past); guardianship aspects and the use and misuse of enduring power of attorney; dementia care; the cost of care; challenges for people with a disability; people from culturally and linguistically diverse backgrounds; people with a vision impairment or blindness; and the importance of family advocacy.

One speaker commented on what he called ‘the entire debacle’ of his experience with My Aged Care and the Aged Care Assessment Team:

It is a very complicated system and difficult to understand even for a university educated person—I despair for the elderly with no one to help or advocate for them.

The bureaucracy around aged care services is beyond comprehension; and the waste of money and resources filling in paperwork aggravating. My Aged Care does not focus on the person needing the care, but on their systems. Once, the wait time for an assessment to get someone to assist him to put a plastic bag on his arm prior to a shower, when his arm was in a cast, was 6 weeks, by which point the cast would be off.

From a ‘consumer’ perspective, My Aged Care is simply woeful. Not one of the many people to whom I have spoken has ever said ‘let me have a look into this and try and find a solution’. They tick a box, and hang up.

One speaker, who had experienced challenges with enduring power of attorney, the aged care complaints system and the Queensland Civil and Administrative Tribunal, said:

My mother suffered for eight years, and died in the most horrific and painful way. This could have been prevented if she was cared for properly. My life will never be the same again.

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Another speaker said they had lost confidence in the Complaints Commission because they received an acknowledgment of the complaint but with another person’s complaint information. According to the speaker, the complaint assessor was difficult to contact and unresponsive, requiring the speaker to follow up and undertake significant research to prove staff were lying.

One speaker highlighted poor responses from the aged car

e complaints system,

along with insensitivity to the needs of Forgotten Australians:

My understanding of the role of an Aged Care Commission is to uphold high standards for all residents in care, however my experience was that they did not want to know about any troubles experienced by my mother, a ‘Forgotten Australian’. I was passed from person to person and the process was made exceedingly difficult and traumatic for me.

One speaker identified access barriers for deaf older people:

Most Deaf Australian Elders are able to access free medical interpreters for their limited health, allied health and GP appointments through National Auslan Booking Services known as ‘NABS’. However, the Deaf Australian Elders are having greater difficulties and uncertainty over their futures for receiving support services and facilities for the Deaf needs…due to gaps and breakdowns of government funding systems in different areas, such as Health, Medicare, NDIS/ NDIA [National Disability Insurance Scheme / National Disability Insurance Agency], My Aged Care, Seniors support, Hospital (Public and Private Hospitals) and Education (for further study if the Deaf Australian person age 65+ wishes to study at TAFEs/colleges or universities)…These Deaf people from the Australian Deaf Elders group have to be fully reliant on their hearing adult children or relatives or senior hearing signing family members to provide free basic sign language interpretation for their simple appointments/errands even (though) they are entitled to free qualified Auslan interpreters with NAATI [National Accreditation Authority for Translators and Interpreters] licences.

Several speakers described the failures in care experienced by vulnerable family members in care. One speaker said that her mother’s needs were not understood and there were constant instances of inadequate care, such as unsafe positioning, becoming chilled when in front of an air conditioner, hygiene issues such as soiled clothes, and rough handling resulting in bruising.

Another speaker believed there was a lack of humanity in the institutional delivery of aged care, and emphasised the importance of family advocacy to ensure that the needs of the older person were met:

The ‘aged care’ we have experienced could be characterised as often lacking in ‘care’. These shortfalls place a heavy burden on us to always be ‘on guard’— to always double-check, to play detective, to second-guess. They are thieves stealing away our time with our dad, forcing us to spend it scrutinising the very institutions entrusted with his care.

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4.10 Rockhampton community forum The ninth Royal Commission into Aged Care Quality and Safety community forum was held on 20 August 2019 in Callaghan Park Functions and Events Centre at Rockhampton in Queensland, with Commissioner Briggs attending. There were 12 speakers, with approximately 60 people in attendance.

Many speakers told of their concerns about residential care facilities, including the lack of activities and the lack of choice for residents. They also provided examples of sub-standard medical care and neglect. One speaker noted the lack of activities, apart from ‘TV all day’. Another speaker explained how her mother had to shower at 6am in winter: ‘She was told that she didn’t have a choice in the matter that was when the personal care was done.’ Another speaker said that their mother had lost 24 kilograms while in recovery at a residential aged care facility, noting that the family supplemented meals almost daily. Another speaker said that:

The residential aged care facility withheld all recovery treatment to my friend and there was no consequence for this.

One family member said that their loved one had a pressure sore in their sacrum area. The wound deteriorated ‘and smelt bad’. The wound was subsequently identified as a severe septic infection that required strong intravenous antibiotics and a 10-day hospital visit.

Another speaker stated that her friend’s death was referred to the Coroner as a reportable death:

But where is protection for elderly if there are no real consequences for residential aged care facilities when treatment is withheld? My friend experienced multiple care failures and there was total neglect.

Speakers commented on the Aged Care Quality and Safety Commission, including the complaints process:

We made a complaint to the Complaints Commissioner. It was an intimidating process and the family felt let down. We were told the Complaints Commission could not help with the problems. Why would they say this? The Complaints Commission did not check back with the aged care facility and there was no follow-up to see if matters were addressed. The family needed to monitor care and if they didn’t, our father would not be alive.

Another speaker suggested that:

ACQSC [Aged Care Quality and Safety Commission] should be able to identify criminal behaviours and have people responsible prosecuted. This will go a long way to building a culture of respect for the elderly.

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Speakers also questioned the rights charter and legal system. One speaker suggested that the Charter of Aged Care Rights should mean that ‘older people are pr

otected

and we don’t have to be here’. Another person stated that the legal system ‘doesn’t respect and protect elders’.

One speaker discussed the affordability of care and related financial issues:

More communication is needed between facilities, residents and families. Forums are needed for families to advise them about choices when a resident’s savings have run out.

According to some speakers, older people want to stay living at home, with concerns raised about transition care and home care packages:

Home Care Packages don’t cut the mustard. Level 4 HCP doesn’t provide anywhere near the 24 hour a day support need for people living with dementia.

There is an inability to get home care packages and palliative care packages in a timely way.

Speakers commented on staffing issues in aged care, including the lack of staff, staff being underpaid, staff not having a career path and staff receiving inadequate training.

A dentist highlighted how poor dental health had an impact on overall health, noting the need for oral care plans. The speaker stated that university trials had shown that dental treatment in residential aged care facilities and in home care reduced costs.

Another speaker discussed food safety for ‘robust food safety programs, as safe and nutritious food is an important aspect of aged care’.

Several speakers commented upon the need for inclusive access to services, including the need for aged care facilities to focus on the whole person. Another speaker emphasises the importance of respect:

Mum is not the same person as she was 50 or 60 years ago—or even 2 years ago—but she is still an amazing woman with a lot to contribute. All older people deserve respect.

The question of respect also arose in the context of end-of life-care:

We need quality end-of-life care. We need medication available in RACF [Residential Aged Care Facility] to provide pain relief and help families to understand loved ones’ needs.

One speaker said that Aged and Disability Advocacy was very helpful. Another speaker noted examples of good care abroad, such as Green House homes in the US and dementia villages in the Netherlands.

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4.11 Launceston community forum The 10th community forum was held on 3 October 2019 at the Grand Chancellor Hotel, Launceston, in Tasmania, with Commissioner Briggs attending. There were 19 speakers and about 210 people attended.

Speakers referred to challenges in accessing timely, supportive and appropriate medical care. Issues raised included: poor medication management, the use of physical and chemical restraints, unrealistic pressures on staff members, and low levels of skills among staff members. Further concerns were raised about the need for skilled staffing and adequate numbers to care for residents living with dementia, the importance of family members and friends operating as carers and advocates, the challenges of caring for a loved one when living interstate, and the intimidation of residents and their family members.

One speaker described a lack of respect for older people and instances of unsafe care delivered by general practitioners, emergency departments and the aged care workforce. Another spoke of her family’s challenges with a lack of empathy shown by a general practitioner towards her father as his health deteriorated:

After trying medications without success, there appeared to be an ‘attitude of dismissal’ towards dad, as if he was ‘past the point of no return’ and he should resign himself to an aged care home.

Dad entered what was to be the first of three residential facilities and it quickly became apparent that we were negotiating a system that was ‘broken’. I kept moving him, hoping in vain to find the best possible care.

The partner of an aged care resident with Huntington’s disease spoke of their partner’s transfer into residential aged care and the gap between his health care needs and the ability of the aged care system to meet them:

Due to overload in the acute care health system, people with co-morbidities are being transferred early into the aged care sector, making the nursing homes medical wards with higher acuity patients, but without proper staffing.

A daughter spoke of the experience of her mother, living with Lewy Body dementia. Her experiences included mistreatment and poor medical care, admission and re-admissions to respite care, emergency departments, assessment centres, and a ‘high care facility’— in the case of the latter, only to be returned to the emergency department as the ‘high care facility’ had just one staff member on duty overnight.

This daughter described her mother experiencing ‘multiple injuries’ and ultimately being diagnosed with a broken hip—undetected for 10 days. Her surgery was subsequently delayed due to an infected catheter. Following the surgery, family members were told, ‘she can never be rehabilitated’ and they were asked to consider palliative care. The daughter said:

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Her life had become a nightmare of fear, injury, pain, loss, grief, displacement, confusion and rejection.

Surely, she should have been given immediate palliative care and never have had that hip operated on, saving her so much pain and agony.

The same woman said when her father was told later that his own illness of prostate cancer had progressed to his bones, he made his own decision about his future:

He had seen the nursing homes, seen what happened to his wife, so he would never consider one for himself! He refused my entreaties to come and live with us in Launceston.

…aged 91, he climbed a tree in the back yard of his beloved home and hung himself. The letter he left us confirmed that he had chosen to end his life, hanging from a tree, rather than go through the five months of sheer hell that he had seen my mother suffer.

A number of speakers raised concerns about a workforce under immense pressure and the impact this has on those receiving care. One daughter highlighted the impact of inadequate staffing on her mother’s care, resulting in a loss of dignity, increased vulnerability and distress:

I would like to clarify from the outset that we have the utmost respect for aged care workers. It is obvious to anyone that spends time within the aged care system that they are under-resourced, overworked and underpaid. It is the system at fault here, not the staff.

To this end, we have witnessed a massive turnover in staff, impacting upon mum’s ability to form trusting and meaningful long-term personal relationships with the staff. This adds to her sense of vulnerability, distrust and sense of worth.

A daughter of another woman spoke of the neglect and loneliness that many aged care residents experience, exacerbated by low levels of staffing:

It is a sobering thought that 40% of residents in aged care have no visitors, none at all. Our mum receives daily visits, sometimes twice daily. We observe and we witness—staff under increasing pressure, residents with way too much time in-between personal care, residents who need assistance with meals not receiving the care they need, and deep, deep loneliness.

Aged care should not be a money-making exercise. It should not be for-profit and this culture needs to change.

A speaker representing a State-wide advocacy group for carers stated that families and carers are doing the heavy lifting in caring for older Tasmanians:

Our family carers watch as the person they are caring for deteriorates while they literally wait for someone to die to be able to get their own package funded. And by the time it is, it often isn’t at the right level to address their worsening needs.

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Concerns about speaking up were highlighted by a number of speakers. One said:

Ageism is a very real issue that ageing residents are likely to find themselves in, especially when vulnerable; fearful to speak out in case nothing changes or when they have been told that if they complain, good staff they like will get into trouble and they would not want that.

Several speakers made suggestions and observations focused on the potential for improvements to aged care services and the system. One speaker proposed there be:

a set of core key values at all residential care facilities observed by staff and residents i.e. dignity, integrity, diversity, collaboration, trustworthiness, compassion, and respect …

Another speaker promoted the concept of:

a system that promotes the health, happiness and engagement of older Australians;

• to maintain and support family and community in their non-commercial support for the aged

• to help older people support themselves and maintain their contribution to the wider community

• to help the aged to retain maximum independence

• to listen and respond to their preferences.

This will maximise human happiness and minimise societal costs.

The partner of a person living in residential aged care proposed that a new system should respect older people and be accountable, concluding:

Can I just say the new model of aged care needs to respect and value the dignity of older Australians. They are not an epidemic or problem to be sorted. The properly funded model needs to embrace human health needs and contain clear accountabilities and responsibilities, with well-educated staff caring for us in this last stage of our lives.

4.12 Canberra community forum Commissioner Briggs attended the 11th community forum, held at the QT Hotel, Canberra, in the Australian Capital Territory, on 25 November 2019. There were 20 speakers and approximately 150 members of the public attended.

Speakers referred to the ‘interface’ between health and aged care systems and services and failures between them, sometimes leading to dire consequences because of a lack of continuity in treatment and care. Other issues raised included a need for allied health services in aged care, inappropriate placement of young people with disabilities in

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residential aged care facilities, complexities ar

ound the cost of living in an aged care facility,

and problems with the My Aged Care portal. There was representation from the LGBTI community, veterans and a peak multicultural body. These speakers raised a multitude of issues, including: the lack of advocacy, the lack of training and understanding of the needs of people from diverse groups, the lack of recognition of veterans in the aged care system, and problems of access to appropriate aged care for diverse groups in the community.

Some speakers highlighted difficulties in accessing appropriate therapies for family members and said this contributed to their family member’s decline in health. The wife of a man who had frontal lobe dementia spoke of her husband’s rapid deterioration on entering an aged care facility, where he died six months later. She spoke of staff not assisting with feeding him, so food was left untouched, and nurses being too busy to engage properly with residents. She added:

Physios didn’t have the time to spend on my husband who never walked again once in permanent care.

A daughter spoke about her late mother’s experience, recovering from a fractured ankle, in an aged care facility. She said the facility could not provide any rehabilitation:

I was advised that my mother could not access rehabilitation as she was in a facility.

This daughter described the lack of empathy or care for individual needs that her mother experienced:

I asked the care manager if mum could be given some lunch and mentioned that she was a vegetarian…He then gestured towards her and said ‘look at her… she’s not going to know the difference between vegetables and pork’.

A physiotherapist spoke about the current aged care funding model and said it denies people access to restorative therapies that they could avail themselves of outside an aged care facility:

The Aged Care Funding Instrument should allow consumers to choose the therapies that are effective in meeting their functional goals—in line with contemporary models of consumer directed care. There should be equity for ageing Australians in accessing quality treatment, not a two-tiered system with denial of effective therapy based on age.

The physiotherapist also referred to research that showed that falls were reduced by 55% when aged care residents had two physiotherapy sessions a week.

One speaker described her 58-year-old family member’s inappropriate placement in residential aged care. She said the woman was placed in a dementia unit and denied essential schizophrenic medication and treatment. She described physical and sexual abuse, years of neglect, and a lack of proper up-to-date medication for the woman’s condition. She said that carers did not attend to her needs and she was left alone and in pain with a mental health disorder.

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She said:

younger people with disabilities definitely need a place to call their own, to feel that they belong within society and above all to be treated with dignity and respect.

A woman who was receiving both aged care and disability services found the interface between them confusing. She asked that the Royal Commission consider the interaction between the two systems:

The MAC [My Aged Care] scheme needs to allow for NDIS [National Disability Insurance Scheme] participants seeking supports not available to them in the NDIS or indeed all supports if they are removed with little warning. There should be a possibility for NDIS participants to apply for packages under MAC in case they lose NDIS.

Several speakers highlighted the complexity of the aged care system and difficulty they had accessing the right information. One man spoke about how he had to enter an aged care facility without government assistance which he said has put him into financial hardship. He said there should be better information available to users in relation to fees for residential aged care:

Not only is it expensive, in my view, to be in a nursing home, it is also very difficult to find out how and what you need to understand about funding a nursing home bed.

The importance of increasing and improving Home Care Packages was addressed by a number of speakers. One raised the balance of funding between the Commonwealth Home Support Programme and Home Care Packages. She suggested that the Royal Commission give more attention to the former, rather than increasing the latter.

A former registered nurse said there needs to be a reduction of administration charges by providers of Home Care Packages and random audits of home care providers. They added that providers’ profits should be capped.

A speaker from a consumer organisation suggested there should be a star rating system in aged care facilities similar to that used in the United Kingdom. She said there was a need for face-to-face information about navigating the system and a focus on reporting about quality of care in residential aged care facilities:

there needs to be more focus on reporting on the quality of care in RACFs [residential aged care facilities], and making this information publicly available in ways that are easily understood by aged care consumers and the public.

A representative from a veterans’ organisation spoke about the restrictions Ex-Service Organisations face in getting information through My Aged Care, restricting their ability to assist veterans. She also said that veterans living at home have access to full Australian Department of Veterans’ Affairs psychological services, but once inside an aged care facility, there are restrictions on accessing services and in most cases the facilities do not include the provision of a psychologist:

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DVA’s [Australian Department of Veterans’ Affairs] motto used to be that they cared for veterans ‘from enlistment to death’. They can no longer say that.

It is now that they care for veterans from ‘enlistment to My Aged Care’.

A hospital emergency department nurse described the Geriatric Rapid Acute Care Evaluation program, piloted at the hospital he works in. The program is aimed at decreasing transfers from aged care facilities to the Emergency Department. He suggested that the program be rolled out in every State and Territory.

A speaker who delivers ‘Silver Rainbow’ LGBTI awareness training to the aged care sector said the current system needs to be more accessible and inclusive for LGBTI older people. He said there should be more accessible training for aged care staff on the unique needs of LGBTI older people as many have a fear of entering residential facilities:

It is important that aged care providers educate themselves and design and deliver culturally safe, inclusive services.

A representative from the culturally and linguistically diverse community said that outcomes for older Australians in this group have not improved and the Government should provide funding to monitor and evaluate the Aged Care Diversity Framework action plan. She said there is a lack of appropriate interpreters when using My Aged Care and that people from a culturally and linguistically diverse background are often misinterpreted or misunderstood. She proposed that advocacy services and bilingual officers be provided to this community and that there be mandatory cultural awareness training for the aged care workforce.

A former registered nurse who made numerous complaints to her employer regarding substandard care, said her concerns were ignored. She reported experiencing bullying and harassment over a prolonged period of time and said she ultimately left her job with mental health issues. She said she was punished for what she did and the system did not protect her when she was trying to protect residents and their families:

It is clear from my experience that we cannot rely on an organisation to implement their own policies and follow best practice guidelines. The standards do not have any way of demonstrating that correct procedures are or have been followed.

The woman’s husband, who worked in the aviation industry, said some of the problems in aged care are caused by the fact that there is no Mandatory Accident and Incident Reporting System, unlike in the aviation industry, and there is no voluntary confidential reporting system:

In aviation there are strict time limits and heavy fines for failure to report accidents and incidents, but as far as I can tell, nothing like that in aged care.

One speaker, who had been supporting an older man, was concerned his friend had experienced abuse by an estranged family member who had used their Enduring Powers of Attorney to remove the man from his family. He advocated for the need to strengthen law enforcement powers across the States and to increase the authority of hospital staff to identify and report suspected elder abuse. He also suggested there should be a central database for Enduring Powers of Attorney which includes up-to-date, certified documentation to reduce abuse or contention.

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There were other stories of people losing their right to personal choice and respect, and speakers questioned how aged care facilities were managed. A husband questioned the ethics and moral compass of some of the operators of aged care services and the ramifications on the quality of life of older people in care:

One’s life story can be usurped, engulfed and even trampled on by an outsourced, unregulated, under-staffed and dysfunctional aged care system…

4.13 Newcastle community forum The 12th community forum was held on 27 November 2019 at NEX Wests City (Newcastle Exhibition Centre) in Newcastle, New South Wales, with Commissioner Briggs attending. There were 21 speakers and about 170 people attended.

Many spoke about staffing issues, including: insufficient staff numbers, a shortage of allied health services, high staff turnover, a lack of training, poor clinical knowledge and skills, a lack of professionalism, inappropriate use of language / terminology, and a requirement for the registration of people in the system. One speaker stated:

The abilities, experience and attitudes of persons at all levels of care needs to be reviewed. It must become a privilege not a last port of call to be involved. Some just do not have the patience, skill or empathy and should not be involved.

One speaker suggested a top down approach to drive cultural change and said ideas should be obtained from staff members, volunteers, families and residents, stating:

Some residents used to be captains of their industries and have great ideas to contribute.

Another speaker proposed the introduction of basic medical care in residential aged care facilities and said this should be in the hands of appropriately trained nurses, such as nurse practitioners. They said the assessment and management of dementia, including challenging behaviours, should be the responsibility of specialist dementia nurses.

Speakers provided examples of inadequate clinical care, neglect and failures of management. They described serious issues such as residents acquiring bone breakages and wounds, leading to sepsis.

One speaker raised concerns about the use of incorrect dressings, due to budget constraints. This led to a netted dressing being placed on the donor site of a skin graft so the new skin was growing into the net.

Speakers also described poor quality meals and insufficient support being made available to residents to enable them to maintain their personal hygiene:

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We regularly visit with dinners and keep a stash of snack food for him to eat, otherwise he starves. He is not being fed accor

ding to his needs, even after

the new standards have been rolled out.

Another speaker said:

My wife refuses to be showered by a male nurse and where there isn’t a second female nurse in attendance she isn’t showered.

One speaker commented that a residential care facility did not inform them of the need for an insurance policy to cover the loss / theft of personal items.

Other concerns raised included the mismanagement of medication, and pain being under-recognised and under-treated, saying that people:

with inadequate pain management are at increased risk of falls, have higher rates of depression, anxiety, confusion and agitation, reduced quality of life and poor physical function...We have an ethical and moral obligation to ensure that our elders have access to the most contemporary, timely and effective management of their pain from now and into the future.

A speaker expressed the view that there needs to be more public education about positive aspects of ageing. Several speakers raised concerns about loss of social contact, including one who said:

One of our biggest problems is social isolation. Some days, the only person outside the three of us that we see, is the personal care assistant for the shower/ dressing in the morning.

Another stated:

Isolated older people living in the community are at risk of loneliness, depression and suicide but are also vulnerable in extreme weather events, which will become more common with each passing year. We need a national plan to safely identify these people and strategies to minimise isolation and vulnerability.

Although examples were provided of lengthy waiting times for Home Care Packages, insufficient home care assistance, inflexibility of Home Care Packages, and a shortage of respite services, speakers also said they want to live in their own homes and receive home care where possible. One stated:

The length of time involved in getting in-home care packages is far too long and needs reassessing and should reflect the different needs instead of being set at varying levels.

In regard to home modification, one speaker said:

Requirements for provision of in-home modifications needs consultation with the customer to consider their wishes and finances, rather than a set agenda.

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One speaker referred to the challenge of getting respite as ‘a chaotic and humiliating experience’.

Speakers made a range of suggestions to improve the aged care sector, including suggestions of:

• more stringent laws on employee / officer behaviour

• a new Aged Care Act, an enforceable code of operating standards and an independent complaints tribunal

• compulsory cameras

• a buddy program to help people adjust with their transition into care and programs to help alleviate depression and loneliness

• alternative housing to institutional settings.

4.14 Community forum questionnaire summary A questionnaire was distributed at each of the Royal Commission’s 12 community forums to give the 2400-plus people who attended a further opportunity to tell their stories and express views about aged care. It provided an additional, informal way for people to ‘put pen to paper’ rather than speaking at the forum or making a submission. The questionnaire also enabled those attending to comment about matters raised by speakers.

The questionnaire included the following three questions:

• What are the problems or challenges in aged care?

• What can be done to achieve high quality, safe, person-centred care into the future?

• How can we build a culture of dignity and respect for older people?

A summary of the responses to these questions is below. A fourth ‘open’ question provided an opportunity to make any further comments.

Respondents wrote about many issues, including home care, experiences in the community, dementia, person-centred care, choice and control, and residential care. There were also stories and views about transitioning into aged care, navigating the system, access and inclusion, rural and remote considerations, and younger people with a disability in residential aged care.

An overall total of 251 questionnaires were completed, equating to approximately 10% of people who attended the 12 community forums.

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4.14.1 Question 1: Issues: what are the pr oblems or challenges in aged care? Many people identified inadequacies in staffing numbers and the mix of skills as a significant problem in aged care, with some viewing workforce numbers as insufficient to meet individual, basic daily needs. Some people empathised with aged care workers and cited a need for better regulation and training of the workforce. One person suggested that training should include interaction with people receiving care and that training should not be rushed.

The difficulties in securing Home Care Packages, in particular the length of time it takes to get them, was another common concern. Some suggested this is putting extreme stress on older people who need these packages, and also on providers. Many were concerned about what they see as an absence of oversight in the delivery, implementation and evaluation of packages.

Other challenges identified were the delivery of services in remote and rural areas. In particular, the lack of available, qualified workers, staff retention problems, high costs of travel and access to appropriate food. One person wrote:

choice and control in these areas can be a bit of a joke.

People also expressed a reluctance for ‘remote oversight’, where operations such as the rostering of staff at remote aged care homes are done in a capital city. Others wrote that the Aged Care Quality and Safety Commission accreditation system needs to better match remote and rural needs.

Another significant area of concern centred on navigating ‘the system’, with the My Aged Care website a particular concern. Some people also raised overlaps between the aged care system and primary care networks, as well as ‘constant changes’ in policy, as adding to the confusion.

A lack of contemporary dementia care was a further area of concern. Respondents suggested that all aged care staff members should hold a minimum dementia qualification. The funding model, locked units and loneliness were all identified as issues that need to be reviewed and improved.

Others wrote that person-centred care is poorly understood and inconsistently implemented. Some believed that there is a lack of energy or enthusiasm about this and different new models of care. Others suggested that families are afraid to speak out. Language barriers were cited as a very common barrier to residents receiving person-centred care.

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4.14.2 Question 2: Opportunities: what can be done to achieve high quality, safe, person-centred care into the future?

Family members of older people wrote about wanting to be included in the planning and delivery of care. They saw this as integral to incr

easing the safety and comfort of older

people in aged care. One proposed that this be included in the accreditation process. Many suggested the development of a personal care plan, visible in each person’s room.

The quality of meals in aged care, including doubts about the nutritional value and temperatures of meals served, as well as the timing of meals and the adequacy of variation, were raised. One person simply wrote:

make sure someone in the kitchen can cook!

People raised a number of issues associated with leadership and governance. These ranged from concerns about vetting processes for prospective staff members to the licensing and monitoring of providers, as well as the knowledge providers have about aged care and standards. Some said that the Aged Care Quality Standards are ambiguous.

The funding methodology in aged care was also raised, with some doubting the model is adequate in addressing the increasing complexity of care as older people live longer, and with more than one chronic condition. The level of fees applied to the administration of Home Care Packages providers caused concern and some respondents said current dementia care and palliative care funding models need to improve.

Finally, several people observed the inability to interpret current data and some said there was a lack of motivation by aged care providers to embrace change. One wrote:

the sector lacks innovation. It largely continues to operate as it did 20 years ago.

Respondents identified a wide range of potential improvements for the future. A recurring theme was that the delivery of high quality, safe and person-centred care can be improved by addressing the remuneration of the aged care workforce. People referred to media attention about this issue and the length of time this has been on the aged care agenda without progress. Others identified improving collaborations with universities in the training of aged care staff members and focusing on fine-tuning the nursing degree in aged care competencies as other areas of opportunity to address concerns about workforce issues.

Particular comment was made about services provided to Aboriginal and Torres Strait Islander people, with people suggesting that shortfalls in this area can be addressed by encouraging and supporting Aboriginal and Torres Strait Islander people to select careers in aged care, particularly related to medical and allied health professions.

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Some respondents also said it is important to ensure general practitioners can be available 24 hours a day, that incentives are offered to geriatricians to work in remote and rural areas, and that more ‘local people’ become involved in delivering care. The provision of more on-the-job practical training—as opposed to online certificate programs—and collaborations between ambulance services and the aged care sector were among other innovative suggestions.

The Home Care Package program was another area which people suggested required overhauling due to issues with timeliness and efficiency. Some felt that changing policies, to focus on care needs rather than consumer wants, would help address this, and that improvements would reduce the need for older people to go into residential care. One respondent suggested a diabetes focus be embedded in the home care workforce.

Drawing on experiences of neglectful care and elder abuse, some respondents said the values and principles of some aged care providers need to change. One person wrote:

aged care needs to be social work value led rather than business led.

Pockets of excellence were also highlighted, but respondents advocated for consistency through stronger oversight and supportive leadership in the areas of technology, governance, policy and methodologies in aged care.

Some people called for better models for dementia care and innovations like integrating kindergarten children in residential aged care facilities. People identified a need to increase the knowledge of aged care workers in the area of dementia, and to develop a care model to address the care needs of older people living with Lewy Body Dementia. They also suggested attaching primary care dementia nurses to aged care homes.

Some respondents also wrote that there were opportunities for improvements in safe and high quality care by making navigation and care between the health system and aged care seamless. One person wrote that older people often feel like they are ‘entering a lottery’ in this area.

Some people also acknowledged the costs associated with caring for an ageing population and suggested that changes to funding approaches can drive improvements. Others advocated for research to bring new investment. Some proposed the removal of privatisation in aged care. The asset test and accommodation deposits also drew criticism as unfair. However, others indicated that they believed a community expectation that one should not have to fund one’s own aged care needs to shift.

The Aged Care Act 1997 (Cth) also attracted comments, with some calling for legislative reform based on human rights and the removal of boards that have no knowledge of aged care governance. Some suggested that the Act may no longer be working for older people and should be reviewed.

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New technologies were seen as an area for significant opportunity

, providing mechanisms

for improved transparency, greater efficiency, and providing answers to many care problems. Telehealth was seen as opportunity to improve access of older people to specialised health services. One person suggested the introduction of robotic pets and virtual reality for older people.

The involvement of diverse groups in the community in guiding access and inclusion policies in the aged care sector was another strategy that people suggested as an opportunity for improvement.

4.14.3 Question 3: Dignity and respect: how can we build a culture of dignity and respect for older people?

Many people considered that good culture develops from leadership and governance— but they found these lacking in their experience of the aged care sector. Some suggested removing the word ‘consumer’ from aged care because they believed this would help personalise care and promote dignity and respect. Annual training in dignity and respect was also suggested.

Some wrote that a media focus on the benefits of ageing and interaction with children would build positive cultural change, along with encouraging closer family ties and carer involvement. Countering ageism and discrimination more generally in the community was seen as another way to promote dignity and respect in aged care services.

Many respondents saw a need to monitor for elder abuse. Some respondents suggested that video cameras may be the only solution to ensure that people living in residential aged care are assisted to eat and treated well. Others saw a need to challenge assumptions that everyone is heterosexual or from the same cultural background. Several people raised education and training in diversity and person-centred care as key to improving respect and dignity. One person considered that diversity consultation is integral to understanding and responding to cultural needs, and to promote inclusiveness, dignity and respect. Others said aged care legislation should place human rights at its core.

Some respondents also wrote that older people should be given adequate information and time to make choices and be listened to. They said that this was not currently the case, with older people sometimes being treated like children and given no privacy. Some also felt there was a need for fairer complaint and grievance processes.

There was also a call for greater emphasis on supporting staff members who work in aged care, with the focus shifting from bad things that occur in aged care to encouragement and support. High values-based recruitment and training of all staff was often emphasised.

Appendix 5: Summary of Background Papers

Appendix 5: Summary of Background Papers The Royal Commission publicly released eight background papers between February and October 2019. The papers were designed to inform the Royal Commissioners and orientate members of the public about issues of relevance to aged care in Australia. In some cases, they were released prior to hearings that explored topics addressed in the papers.

The papers were made available to members of the public on the Royal Commission’s website.

Views expressed within the papers are not necessarily those of the Commissioners.

Background Paper 1: Navigating the maze: an overview of Australia’s current aged care system

This paper outlines different aspects of the Australian aged care system, the services currently being delivered in Australia and the areas in need of substantial reform. The paper provides a general overview and some background information relevant to key issues for the Royal Commission.

Prepared by a Royal Commission Senior Adviser, Ms Carolyn Smith, and the Office of the Royal Commission.

Published: 25 February 2019.

Background Paper 2: Medium-and long-term pressures on the system: the changing demographics and dynamics of aged care

This paper outlines how demographic, social and economic pressures will impact on aged care in Australia. It explores complex issues associated with the country’s changing demographic profile, including changes in patterns of disease and dependency, the rising incidence of dementia, changing expectations and the changing cultural profile of the Australian community. It also explores current arrangements, future pressures and a greater need for preventative and restorative health.

Prepared by a Royal Commission Senior Adviser, Dr David Cullen, and the Office of the Royal Commission.

Published: 1 May 2019.

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Background Paper 3: Dementia in Australia: nature, prevalence and care

This paper provides a high-level introduction to dementia, including its nature, its prevalence in Australia, and information research about how best to care for people living with dementia. Dementia is a complex and broad set of conditions which can have a devastating impact on people’s lives—those living with dementia and their families, close friends and carers.

Prepared by the Office of the Royal Commission.

Published: 3 May 2019.

Background Paper 4: Restrictive practices in residential aged care in Australia

This paper provides a high-level introduction to restrictive practices in residential aged care in Australia, as they were at the time of publication.

Prepared by the Office of the Royal Commission.

Published: 3 May 2019.

Background Paper 5: Advance care planning in Australia

This paper summarises research on the uptake, benefits, issues and practices associated with advance care planning. It also outlines the various arrangements for advance care planning in place in each State and Territory at the time of publication.

Prepared by the Office of the Royal Commission.

Published: 20 June 2019.

Background Paper 6: Carers of older Australians

This paper provides a high-level introduction to the role of family members and friends who provide what is often called informal and unpaid care to older people. It provides an overview of the role of carers, the impact of caring and carer needs, and available support and services at the time of publication.

Prepared by the Office of the Royal Commission.

Published: 26 July 2019.

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Summary of Background Papers Appendix 5

Background Paper 7: Legislative framework for Aged Care Quality and Safety regulation

This paper summarises the key aspects of quality and safety regulation provided for in the Aged Care Act 1997 (Cth), the Aged Care Quality and Safety Commission Act 2018 (Cth) and supporting legislative instruments, at the time of publication. There have been significant legislative amendments since the publication of this background paper— notably, on 1 January 2020, legislation commenced that shifted a range of functions from the Australian Department of Health to the Aged Care Quality and Safety Commission.

Prepared by the Office of the Royal Commission.

Published: 2 August 2019.

Background Paper 8: A History of Aged Care Reviews

This background paper provides an overview of 18 major public reports and inquiries related to publicly-funded aged care in Australia since 1997, and looks at government responses to each of these. It includes reports by Parliamentary committees, the Productivity Commission, the Australian Law Reform Commission and other independent reviews commissioned by the Australian Government. The reviews and inquiries examined in the paper have addressed multiple aspects of the aged care system, including funding, workforce, the regulatory system, young people in residential aged care, palliative care, dementia care, and quality and safety.

Prepared by the Office of the Royal Commission.

Published: 28 October 2019.

Appendix 6: Commissioned Reports

Appendix 6: Commissioned Reports The Royal Commission completed a wide range of innovative research that answered policy questions and informed the recommendations in this report. This internal and commissioned research included economic modelling, surveys, focus groups, analysis of industry finances, calculation of quality indicators, and research into international practice and benchmarks. As part of the research, 100 gigabytes of data were acquired from different parts of the aged care system that had previously been inaccessible to researchers. Key commissioned research projects are listed here.

Commissioned reports published as research papers

Report Title

Research Paper 1—How Australian residential aged care staffing levels compare with international and national benchmarks

Date Published 11 October 2019

Commissioned Organisation Australian Health Services Research Institute, University of Wollongong

Authors K Eagar, A Westera, M Snoek, C Kobel, C Loggie and R Gordon

Report Title

Research Paper 2—Review of international systems

for long-term care of older people

Date Published 24 January 2020

Commissioned Organisation Rehabilitation, Aged and Extended Care Group, Flinders University and THEMA Consulting

Authors SM Dyer, M Valeri, N Arora, T Ross, M Winsall, D Tilden and M Crotty

Report Title Research Paper 3—Review of innovative models of aged care

Date Published 24 January 2020

Commissioned Organisation Flinders University, Bolton Clarke Research Institute, SAHMRI and Stand Out Report

Authors

SM Dyer, MEL van den Berg, K Barnett, A Brown, G Johnstone, K Laver, J Lowthian, AJ Maeder, C Meyer, C Moores, R Ogrin, A Parrella, T Ross, W Shulver, M Winsall and M Crotty

Report Title Research Paper 4—What Australians think of ageing and aged care

Date Published 13 July 2020

Commissioned Organisation Roy Morgan

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Report Title

Research Paper 5—They look after you, you look after them: Community attitudes to ageing and aged care

Date Published 13 July 2020

Commissioned Organisation Ispos

Report Title

Research Paper 6—Australia’s aged care system: assessing the views and preferences of the general public for quality of care and future funding

Date Published 23 July 2020

Commissioned Organisation Caring Futures Institute, Flinders University

Authors

J Ratcliffe, G Chen, J Cleland, B Kaambwa, J Khadka, C Hutchinson and R Milte

Report Title Research Paper 7—Models of integrated care, health and housing

Date Published 13 August 2020

Commissioned Organisation National Ageing Research Institute

Authors AS Gilbert, E Owusu-Addo, P Feldman, P Mackell, SM Garratt and B Brijnath

Report Title

Research Paper 8—International and national quality and safety indicators for aged care

Date Published 24 August 2020

Commissioned Organisation SAHMRI

Authors

GE Caughey, CE Lang, SC Bray, M Moldovan, RN Jorissen, S Wesselingh and MC Inacio

Report Title Research Paper 9—The cost of residential aged care

Date Published 27 August 2020

Commissioned Organisation University of Queensland

Report Title Research Paper 10—Technical mapping between ACFI and AN-ACC

Date Published 27 August 2020

Commissioned Organisation University of Wollongong

Authors C Kobel and K Eagar

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Commissioned Reports Appendix 6

Report Title

Date Published

Research Paper 11—Aged care reform: projecting future impacts

7 September 2020

Commissioned Organisation Deloitte Access Economics

Report Title

Date Published

Research Paper 12—Report on the profitability and viability of the Australian aged care industry

9 September 2020

Commissioned Organisation BDO

Report Title

Date Published

Research Paper 13—Inside the system: aged care residents’ perspectives care

21 October 2020

Commissioned Organisation National Ageing Research Institute

Authors

F Batchelor, S Savvas, C Dang, AMY Goh, P Levinger, A Peck, I Katz and B Dow

Report Title

Date Published

Research Paper 14—Inside the system: home and respite care clients’ perspectives

21 October 2020

Commissioned Organisation National Ageing Research Institute

Authors F Batchelor, S Savvas, A Peck, C Dang, C Wade, AMY Goh and B Dow

Report Title

Date Published

Research Paper 20—Australia’s aged care system: the quality of care experience and community expectations

16 February 2021

Commissioned Organisation Caring Futures Institute, Flinders University

Authors

J Ratcliffe, G Chen, J Khadka, S Kumaran, C Hutchinson, R Milte, S Savvas and F Batchelor

Appendix 7: Summary of Commissioners’ International Research, January 2020

Appendix 7: Summary of Commissioners’ International Research, January 2020 We undertook international research, in January 2020, to:

• examine approaches to aged care design and funding in different countries, and consider whether and how they could apply to Australia

• meet with experts on ageing, aged care design and delivery, quality and measurement of quality, governance, system design, funding models and implementation of transformational change

• view practical examples of innovative aged care services which might be relevant to, or applied, in some way in Australia.

The table provides an outline of meetings and site visits, listed in chronological order. These meetings and site visits helped us form views about the aged care system in Australia—and to understand high quality and safe care for older people internationally.

International research Meeting Date Content of meetings

United States of America

Commissioner Briggs met with Mr Matthew D’Uva, then Chief Executive Officer of the International Association for the Study of Pain, to discuss best practice studies in pain management for older people.

International Association for the Study of Pain

13 January 2020

Commissioner Briggs met with Mr Lance Robertson, Administrator & Assistant Secretary for Aging, Administration for Community Living, an operating division of the United States Department of Health & Human Services, and other officers from the Department of Health and Human Services including the Centers for Medicare and Medicaid Services. The discussion explored the approach of the United States to aged care policy and programs, including the Nursing Home Compare system, a web-based tool that provides detailed information about every Medicare and Medicaid-certified nursing facility in the United States.

United States of America, Department of

Health and Human Services

13 January 2020

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International research Meeting Date Content of meetings

Dr Jerry Avorn MD, Pr

ofessor of

Medicine, Harvard Medical School

Professor Malcolm K Sparrow, John F. Kennedy School of Government

Dr David Grabowski PhD, Professor of Health Care Policy, Harvard Medical School

Beacon Hill Village

Leonard Florence Center For Living

14 January 2020

14 January 2020

14 January 2020

14 January 2020

15 January 2020

Commissioner Briggs met with Dr Jerry Avorn, who has published extensively on the use of antipsychotic medicines in older people. Matters discussed included: the extent of antipsychotic prescribing in the United States; causes of inappropriate prescribing; efficacy of different policy responses; quality use of medicines generally for older people; and the ‘academic detailing’ approach to continuing medical education for doctors.

Commissioner Briggs met with Professor Malcolm Sparrow, a leading international expert in regulatory and enforcement strategy, security and risk control. Matters discussed included: risk-control functions of government; the challenges of social regulation; discovery mechanisms; compliance management and consequences for non-compliance; and the skills required of the regulator.

Commissioner Briggs met with Dr David Grabowski, an internationally recognised health economist and health services researcher. Matters discussed included: Professor Grabowski’s research into the economics of ageing and health care regulation; the market for long-term care services; improving quality of care, including through increased staffing; and rebalancing long-term care to increase care in the home.

Commissioner Briggs met with representatives from Beacon Hill Village, a non-profit community group in the Boston central business district, which coordinates a range of support services, social and wellbeing programs, cultural and educational activities, and excursions for its members such as transportation, gardening and social activities. The concept is a peer-led approach of ‘neighbours helping neighbours’. She met with Ms Susan McWhinney-Morse, co-Founder and Board Member, Mr Doug Fitzsimmons, Board President, and others. They discussed: the founding of Beacon Hill Village; approaches to building social capital, community engagement and community development; funding arrangements; and replicating the approach in other settings.

Commissioner Briggs visited the Leonard Florence Center For Living site in Chelsea, Massachusetts, which was the first to adopt the Green House Model of care in an urban setting. She met with: Ms Betsy Mullins, the Chief Operating Officer; Ms Susan Ryan, Senior Director of the Green House Project; staff members; and residents. The visit included discussion of the Green House Model and philosophy, and a discussion about the innovative cognitive impairment / dementia model and its benefits to residents. Steve Saling, co-founder and now resident living with ALS, provided a tour of his home within the Leonard Florence Center and demonstrated the PEAC automation solution.

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International research Meeting Date Content of meetings

Japan

Professor Naoki Ikegami, St Luke’s International University Graduate School of Public Health, Tokyo

Canada

15 January 2020

Commissioner Pagone and Senior Counsel Assisting, Mr Peter Gray QC, met with Pr

ofessor Naoki Ikegami at

St Luke’s International University. The meeting covered: Professor Ikegami’s research into long-term care insurance, the history of Japan’s long-term care reforms, and certain economic and policy issues arising from analysis of the health and long-term care systems in Japan. This led to further telephone and email contact with Professor Ikegami later in the year, and to Professor Ikegami giving evidence by videolink at a hearing in September 2020.

Commissioner Briggs met with Josie D’Avernas, Executive Director of the Research Institute for Aging; a number of researchers from the Institute; and staff from the Schlegel Village at University Gates and other on-site programs. The visit included: a tour of the research institute site and the Conestoga College Living Classroom; a visit with the GeriMedRisk interdisciplinary telemedicine services; and observing a Project Echo online peer-based learning meeting involving several Green House pilot communities. The meeting also included a visit to Schlegel Village, at University Gates in Ontario, a long-term care facility that is co-located and integrated with the research institute and the living classroom. The visit was facilitated by Dr Allen Power MD, Schlegel Chair in Aging and Dementia Innovation.

Commissioner Briggs met with Dr Jane Barrett, Secretary General, and Mr Greg Shaw, Director International and Corporate Relations, at the International Federation on Ageing. Matters discussed included: the rights of older people and how to protect them; international research, including trends in ageing and aged care; and the World Health Organization Decade of Healthy Ageing.

Commissioner Briggs met with Ms Marie-Lison Fougère, Deputy Minister of Long-Term Care, and other representatives from the Ontario Ministry of Long-Term Care. Matters discussed included: the policy settings for long-term care in Ontario; the implementation and impact of the change to limit residential care to people with very high needs; and approaches to staff ratios, training and regulation and accreditation of long-term care.

Commissioner Briggs visited the Baycrest Health Sciences complex, which is affiliated with the University of Toronto. She toured the site, including visiting the Centre for Aging + Brain Health Innovation (CABHI), and the independent living, independent assisted living and residential care sites located within the complex. During the visit, information about systems interfaces between health and aged care, as well as research and aged care, was explored. The visit was facilitated by Ms Jacqueline Baptist, Marketing and Business Development Lead, CABHI.

Research Institute for Aging and Schlegel Village at University Gates

International Federation on Ageing

Ontario Ministry of Long-Term Care

Centre for Aging + Brain Health Innovation (CABHI) and Baycrest

16 January 2020

17 January 2020

17 January 2020

17 January 2020

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International research Meeting Date Content of meetings

The Netherlands

De Hogeweyk

Topaz Revitel

Buurtzorg

The Hague University of Applied Sciences

The Ministry of Health, Welfar

e

and Sport, the Netherlands

20 January 2020

20 January 2020

20 January 2020

21 January 2020

22 January 2020

Commissioners Pagone and Briggs visited De Hogeweyk, in Weesp, which delivers residential aged care for people with dementia, using a ‘neighbourhood’ model. They visited the site of service, including one of the homes. They met with Ms Jannette Spiering and Mr Eloy Van Hal, who are among the founders of The Hogeweyk Care Concept. They discussed the Hogeweyk Care Concept and their staff and volunteer workforces, and provided a tour of the facilities and a home on the site.

Commissioners Pagone and Briggs visited the Topaz Revitel site in Leiden, a specialty rehabilitation hotel. They met with: Mr Edwin Kalbfleisch, Chief Executive Officer; Ms Nancy Beukers, Domain Manager Specialist Short-term Care and Treatment; and several members of the care team. They discussed the innovative model of geriatric rehabilitation at Topaz Revitel.

Commissioners Pagone and Briggs met with Mr Ard Leferink, co-founder of Buurtzorg, which delivers aged care services in the home using a ‘neighbourhood care’ model based on nurses working in self-managed teams. The discussion covered the care model and the information technology system that supports it. Ms Corinne Tutein from VGZ, an insurer, also attended this meeting and provided broader context for aged care and insurance in the Netherlands.

Commissioners Pagone and Briggs met with Professor Joost van Hoof, Chair, and other members of the Urban Ageing research group at the Centre of Expertise Health Innovation, Hague University of Applied Sciences. The Commissioners heard about the group’s research into ageing issues, including the quality of daily living of older adults in the city of Hague. Themes explored included dementia, participation, vitality, ageing-in-place, and diversity of the urban population.

Commissioners Pagone and Briggs met with Ms Jacqueline Hoogendam and Mr Martin Holling from the Directorate for Long-Term Care at the Ministry of Health, Welfare and Sport, responsible for aged care policy and implementing a decentralised aged care system. The discussion covered: the decentralised aged care system in the Netherlands from the perspective of those administering the system and how it works; and initiatives to achieve a dementia-friendly society.

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International research Meeting Date Content of meetings

Germany

Federal Ministry of Health, Germany

Centre for Quality in Care

The National Association of Statutory Health Insurance Funds

V

illa Albrecht

Freunde alter Menschen

22 January 2020

22 January 2020

22 January 2020

22 January 2020

22 January 2020

Commissioners Pagone and Briggs met with Dr Martin Scholkopf, Head of Long-Term Care Insurance Directorate at the Ministry of Health. Matters discussed included: the structure of long-term care in Germany; the long-term care workforce; funding of care through the insurance system; strengths and weaknesses of the model; the intersection between the health and long-term care systems; and measuring quality.

Commissioners Pagone and Briggs met with Dr Ralf Suhr, Chairman, and other representatives from the Centre for Quality in Care—a non-profit, non-governmental foundation with the goal to improve health care, especially the quality of long-term care for older people in Germany. Matters discussed included: how best to support aged care research; the translation of research into practice to prevent harm and improve the quality of care for older people; management of chemical and physical restraint in Germany; and quality and safety in home care.

Commissioners Pagone and Briggs met with Dr Eckart Schnabel, Head of the Nursing Insurance Research Division at the National Association of Statutory Health Insurance Funds, the central association of German health insurance funds. Matters discussed included: the role of the association in the German long-term care model and its governance structure; the association’s role in establishing regulations on contributions and statistical data; and the operation of the German model in practice.

Commissioners Pagone and Briggs visited the Villa Albrecht site in Berlin, an integrative outpatient senior centre run by the German Red Cross. They met with staff members at the centre and explored the different accommodation models and services offered, including: senior-friendly rental apartments; shared apartments for people with dementia; and a geriatric day care for older people living with physical conditions, dementia and/or mental illness.

Commissioners Pagone and Briggs visited a dementia flatshare, which operates as part of a model of housing for people living with dementia and which is supported by Freunde alter Menschen, a not-for-profit federation of volunteers working to fighting loneliness and poverty in old age. They met with Mr Klaus Pawletko, Managing Director, and discussed: the housing model, support and activities provided for residents; and the federation’s advocacy role.

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International research Meeting Date Content of meetings

Health Insurance Medical Service 23 January 2020

Federal Ministry for Family Affairs, Senior Citizens,

Women and Y

outh,

Germany

23 January 2020

Sweden

Commissioners Pagone and Briggs met with Mr Hendrik Haselmann, Head of Communications, and Ms Janet Metz, Specialist in Quality Assurance in Nursing, from the Health Insurance Medical Service, jointly run by the statutory health insurance and long-term insurance funds. It is designed to ensure funds can provide medical and long-term care services adequately, expediently and economically. Matters discussed included: the role of the service in the German long-term care model; their advisory and assessment role; and the quality assessment process and grading structure.

Commissioners Pagone and Briggs met with representatives from the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, responsible for a variety of policy areas including older people and promoting solidarity between generations. The discussion explored German approaches to ageing, including policies and programs to support older people and carers.

Neptuna and Malmö City Council 24 January 2020

Commissioners Pagone and Briggs visited the Neptuna site, a seafront housing development for people aged 55 years and over in Malmo, Sweden. Neptuna places older people at the heart of a community development plan which is part of a ‘lifetime neighbourhood’ wher

e people do not need to leave their

neighbourhood as they age and require care. They met with Mr Sven Yngvesson, Chief Executive Officer, Södertorpsgården, and discussed the care structures, funding and rental arrangements at Neptuna. Mr Anders Rubin, City Councillor, and Mr Mathias Johansson, Development Secretary from the Malmö City Council, also attended the meeting and provided an overview of the role and responsibilities of local municipalities in delivering social services and medical care, and how they deliver aged care services in the City of Malmö.

Denmark

Ministry of Health, Denmark 24 January 2020

Municipality of Copenhagen 24 January 2020

Commissioners Pagone and Briggs met with Ms Anne Bækgaard fr om the Ministry of Health and Ms Anne Henriksen

from Healthcare Denmark. Matters discussed included: the localised model for providing long-term care; compulsory rehabilitative measures; principles for reablement; the National dementia action plan support for informal carers; and workforce recruitment and retention.

Commissioners Pagone and Briggs met Mr Jakob Krogh, Director of Health and Social Services at the Municipality of Copenhagen. Matters discussed included: the types of car

e

provided by the municipality; moving towards a reablement approach; replacing traditional nursing homes with care homes where older residents have a more home like environment; and the funding of aged care in Denmark.

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International research Meeting Date Content of meetings

Professor Tine Rostgaard, Vive— Danish Centre of

Applied Social Science

24 January 2020

France

Commissioners Pagone and Briggs met with Professor Tine Rostgaard, a social policy studies academic who specialises in comparative policy analysis and evaluating welfare and social care of children and older people. Matters discussed included: the Danish approach to reablement in aged care; quality of life; and Professor Rostgaard’s research into social formal / informal care-giving and care-work.

Organisation for Economic Co-operation and Development

27 January 2020

United Kingdom

Commissioner Briggs met with: Mr Mark Pearson, Deputy Dir

ector; Dr Monika Queisser, Senior Counsellor and Head of the Social Policy Division; Ms Francesca Colombo, Head of the Health Division; and other representatives from the Directorate for Employment, Labour and Social Affairs. Matters discussed included: comparative data on workforce issues across the member countries; comparative work on quality of care and measuring quality; the integration of aged care and health care; multidisciplinary teams; and the financing of aged care.

Commissioner Briggs met with Mr Paul Burstow, Chair, and Mr Ewan King, Chief Operating Officer, of the Social Care Institute for Excellence. Matters discussed included: the reform of the Care Act 2014 (UK) and its implementation; the United

Kingdom’s challenges in delivering social care; strategies to change practice within the sector and to shape the market; and supporting innovation.

Commissioner Briggs met with Dr Jose-Luiz Fernandez, the Director and Associate Professorial Research Fellow at the Care Policy and Evaluation Centre, London School of Economics and Political Science. Matters discussed included: Dr Fernandez’s extensive research in community care; consumer-directed care; older people; health economics; and social care economics.

Commissioner Briggs met with Mr Peter Wyman CBE, Chair, and other representatives from the Care Quality Commission, the regulator of health and social care in England. Matters discussed included: how the United Kingdom’s quality and safety regulator sets consistent standards for outstanding care; monitors, inspects and regulates care services; engages people receiving care in making a determination of quality; and addresses structural and independence issues for quality regulators.

Commissioner Briggs met with Baroness Sally Greengross, OBE, of the House of Lords. The discussion covered the Baroness’s extensive expertise in ageing including the areas of dementia, end-of-life, and ageing policy.

Social Care Institute for Excellence

Dr Jose-Luis Fernandez

Care Quality Commission

Baroness Sally Greengross

28 January 2020

28 January 2020

28 January 2020

28 January 2020

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David Albury

Professor Nicholas Barr

, Professor of Public Economics European Institute, The London School of Economics and Political Science

Innovation Unit

National Health Service

Glen Garrod, Executive Director of Adult Care and Community Wellbeing, Lincolnshire County Council

Think Local Act Personal

29 January 2020

29 January 2020

29 January 2020

29 January 2020

30 January 2020

30 January 2020

Commissioner Briggs met with Mr David Albury, who advises on forming and implementing strategies and policies for transforming and innovating in education, early learning, health care, and other public services. Matters discussed included: the importance of providing a case for change and a vision for the future; sectoral regulation; incentives for improvement; and how to facilitate innovation in aged care.

Commissioner Briggs met with Professor Nicholas Barr, Professor of Public Economics, European Institute, London School of Economics and Political Science. They discussed models for financing social services, including insurance, levies and other models.

Commissioner Briggs met with Mr William Roberts, Head of Health and Social Care at the Innovation Unit, a social enterprise based in the United Kingdom, Australia and New Zealand. Matters discussed included: drivers of the care market; quality of life, including connection, community and activity; elements of quality care; and how commissioning frameworks can encourage sector transformation.

Commissioner Briggs met with Mr James Sanderson, Director of Personalised Care, and Ms Nicola Kay, Deputy Director for Personalised Care Policy and Strategy at the National Health Service. Matters discussed included: elements of personalised care; how a ‘choice and control model’ works in the United Kingdom; the programs within the system; and the new ‘link worker’ program, including profile of the workforce.

Commissioner Briggs met with Mr Glen Garrod, Executive Director of Adult Care and Community Wellbeing at the Lincolnshire County Council. Matters discussed included: the Scottish model for regulation; the role of technology, and how regulators deal with creative disruption; the role of County councils in delivering services and monitoring quality; the Lincolnshire County Council approach to commissioning and safeguarding; supporting people living with dementia, including digital supports; and reshaping the role of nurses.

Commissioner Briggs met with: Mr Clenton Farquharson MBE, Chair of the Think Local Act Personal Programme Board (TLAP); Ms Sally Percival, Co-Chair of the TLAP Partnership; and other representatives of organisations that are part of the TLAP partnership. Matters discussed included: the ‘citizenship model’ of service delivery; modelling co-production approaches to engage with lived experience of caring, disability, aged care users; and the ‘mature conversations’, rights-based approach.

Appendix 8: Aged care and COVID-19: a special report (reproduction)

Appendix 8: Aged care and COVID-19: a special report (reproduction) On 30 September 2020, we handed Aged care and COVID-19: a special report to the Governor-General, His Excellency, the Honourable David Hurley AC DSC (Retd).

The special report resulted from our Sydney Hearing 2, held between 10 and 13 August 2020. This considered the impact of COVID-19 on aged care. Volume 4 of this Final Report includes an overview of Sydney Hearing 2.

Aged care and COVID-19: a special report is reproduced in the following pages, with the original pagination retained.

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30 September 2020

His Excellency General the Honourable David Hurley AC DSC (Retd) Governor-General of the Commonwealth of Australia Government House CANBERRA ACT 2600

Y

our Excellency

In accordance with the Letters Patent issued on 6 December 2018, as amended on 13 September 2019 and 25 June 2020, we are making inquiries, and preparing the Final Report of the Royal Commission into Aged Care Quality and Safety.

From 10 to 13 August 2020, we held a hearing as part of our investigation of the response to COVID-19 in aged care. We now submit to you a special report on that response.

Yours sincerely

The Honourable Gaetano (Tony) Pagone QC Ms Lynelle Briggs AO

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Table of Contents

1. Introduction and overview 1

2. Visitors and quality of life 6

3. Allied health 10

4. National advisory body and plan 11

4.1 An aged care advisory body and a COVID-19 plan 11

4.2 Protocols between the Australian Government and the States and Territories 13

4.3 The Victorian experience 15

4.4 Hospital transfers and Hospital in the Home 16

5. Infection control expertise and personal protective equipment 22

5.1 Infection control 22

5.2 Personal protective equipment 24

6. Conclusion 25

7. Endnotes 26

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Aged care and COVID-19: a special report From 10 to 13 August 2020 we held a hearing as part of our investigation into the response to COVID-19 in aged care. We are greatly indebted to the many people—including people receiving aged care services and their loved ones, some of whom were recently bereaved—who shared with us their stories and experiences, both at the hearing and by making written submissions.

We heard evidence of the effect of the pandemic on those working in aged care. The Interim Report noted that the aged care workforce is under -resourced and

overworked. It is now also traumatised. Care workers develop close relationships with residents. Many are grieving for residents who have died after contracting COVID-19. Others are anxious about bringing the virus into their work place or home to their loved ones. We pay tribute to aged care workers and to the vital work they do. 3

2 1

In addition, many people and organisations assisted in and cooperated with our investigation. The Australian Department of Health and its officials; the Aged Care Quality and Safety Commission and its officials; State health departments, including New South Wales (NSW), Victoria and South Australia, and their officials; and aged care providers all engaged in our processes in good faith. They provided access to documents, information and witnesses at a time when they were under considerable strain and public pressure. For this we are grateful.

1. Introduction and overview Coronavirus disease is caused by the severe acute respiratory syndrome coronavirus 2. It was first identified in December 2019 and is a novel virus about which understanding is evolving. The World Health Organization (WHO) declared the novel coronavirus a ‘public health emergency of international concern’ on 30 January 2020. In February 2020, it named the disease caused by the virus ‘COVID-19’. On 11 March 2020, COVID-19 was declared a pandemic by the WHO.

4

COVID-19 presents particular risks to older people, who are particularly vulnerable to respiratory diseases. In May 2020, the United Nations reported on the ‘devastating toll’ that the spread of COVID-19 in care homes was having on older people’s lives.

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Never before has the aged care sector in Australia faced a challenge like COVID-19. As at 19 September 2020, 844 people have died in Australia as a result of the virus. Of these, 629 were living in aged care homes at the time of their deaths, although many died in hospital.7

As at 2 September 2020, the overall Australian mortality rate from COVID-19 was 2.6%.8 This case fatality rate, as it is known, is low by international standards.9 For example, the equivalent rate in France is 13.6%; in the United Kingdom it is 12.8%; and in the United States it is 3.1%. However, as at 19 September 2020, the proportion of those Australians who have died and who were living in residential aged care facilities at the time of their deaths is approximately 74%, a high figure by international standards. 10

Caution must be exercised when comparing care home-related death rates in different countries. This is because of the way data is collected and recorded and because the definition of what is a care home varies between countries. 11 One international study suggests that due to these factors:

to look at the relative impact of COVID-19 on care home residents in different countries, it is more useful to focus on the share of care home residents whose deaths have been linked to COVID-19.12

On this measure, Australia has performed relatively well, with a mortality rate of 0.25%. This is considerably lower than the rates in other comparable countries such as Canada (1.5%) and the United Kingdom (5.3%).13

The tragic impacts of the virus have been felt across the nation. An event such as this pandemic, and the consequential social, economic, and day-to-day life impacts, are beyond anything in the living memory of most in this country, with the exception of those people who were born before or during the Second World War.

The Australian Government is responsible for ‘aged care services’, as defined in our Letters Patent.14 The development and implementation of aged care policy, including advising the Australian Government, funding and administration are the domain of the Australian Department of Health. The Aged Care Quality and Safety Commission is responsible for aged care regulation. State and Territory Governments, together with the private sector, are largely responsible for the delivery of health care, including to those living in residential aged care. They also have overall responsibility for managing public health emergencies. Under the Aged Care Act 1997 (Cth), aged care providers are responsible and accountable for providing quality care in a manner that complies with the Aged Care Quality Standards set out in the Quality of Care Principles 2014 (Cth) made under the Act.15

When the Prime Minister announced this Royal Commission in 2018, nobody could have foreseen that the aged care sector would find itself in the grips of a pandemic as we approach the end of our work. Like others, we have had to respond to the changes brought about by the pandemic. This includes releasing this brief report in advance of our Final Report, which will be delivered on 26 February 2021. We do this now because we do not know how long the pandemic will last. Its end is impossible to predict. However, aged care residents continue to suffer and, tragically, some more may die as a result of COVID-19.

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It is clear to us that people receiving aged care services, their loved ones, those providing care and the aged care sector itself need immediate support and action. Governments need guidance based on the evidence we have heard and are able to summarise in this report.

At the time we announced our inquiry on 17 May 2020 into the response to COVID-19 in aged care, outbreaks had struck thr ee homes in suburbs of Sydney, NSW: Dorothy

Henderson Lodge, a home run by BaptistCare NSW & ACT (BaptistCare) in Macquarie Park; Opal Bankstown; and Newmarch House, a home run by Aglican Community Services (Anglicare Sydney) in Kingswood. By the time our hearing commenced on 10 August 2020, a major outbreak of the virus had taken hold in Victoria, with dozens of facilities experiencing outbreaks, 1221 infections among residents of aged care facilities, and, tragically, 189 deaths of residents. Even while the hearing unfolded, further deaths and infections associated with residential aged care were announced daily.

Now is not the time for blame. There is too much at stake. We are left in no doubt that people, gover

nments and government departments have worked tirelessly to avert, contain and respond to this human tragedy.16 However, the nation needs to know what lessons have been and can still be learnt. The nation needs to know what is being done, and what will be done, to protect those people receiving aged care services—those who this virus has affected disproportionately and whose entitlement to high quality care in safe environments that protect their wellbeing and dignity falls within the scope of our commission.17

In the weeks leading up to our hearing there were calls for us to conduct a full inquiry into the impact of COVID-19 on aged care, including into the situation that was unfolding in Victoria. We explained at that time that we did not have the resources or time to conduct such an inquiry. We remain of that view. Whether there is to be a full inquiry into these matters is for governments to decide. It is not for us as serving Commissioners with a broader task to be completed by a fixed date to do so.

In the confines of the inquiry we were able to conduct, we have concluded that there are four areas where immediate action can and should be taken to support the aged care sector:

• First, the Australian Government should fund providers to ensure there are adequate staff available to deal with external visitors so that the Industry Code for Visiting Residential Aged Care Homes during COVID-19 (Visitation Code) can be modified to enable a greater number of more meaningful visits between people receiving care and their loved ones.

• Second, the Australian Government should create Medicare Benefits Schedule items to increase the provision of allied health and mental health services to people living in residential aged care during the pandemic to prevent deterioration in their physical and mental health. Any barriers, whether real or perceived, to allied health and mental health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds.

• Third, the Australian Government should publish a national aged care plan for COVID-19 and establish a national aged care advisory body.

• Finally, the Australian Government should arrange for the deployment of accredited infection prevention and control experts into residential aged care homes.

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COVID-19 is a public health crisis that has disproportionately affected aged care in Australia. Much was made during the hearing of whether there was an aged care-specific plan for COVID-19. There was not a COVID-19 plan devoted solely to aged care. But there was a national COVID-19 plan that the Australian Government sought to adapt and apply to the aged care sector. That plan, the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) (Health Sector Plan), was developed in January 2020 and published on 18 February 2020. On 27 February 2020 it was activated by the Prime Minister in anticipation of a pandemic.18 The Health Sector Plan was developed against the background of the National Health Emergency Response Arrangements which had been in place since 2011 and provided a ‘whole-of-government response to significant national health emergencies, including pandemics’. 19

The Health Sector Plan was drawn to the attention of aged care providers in a letter from Professor Brendan Murphy, then the Australian Chief Medical Officer, that was published on the Australian Department of Health’s website on 27 February 2020. In the letter, Professor Murphy told providers the Health Sector Plan was a ‘useful reference tool for preparing your emergency plan, particularly with respect to pandemic infections’.20

The Health Sector Plan was augmented by a range of guidelines and material that was disseminated to aged care providers in the period from March to August 2020.21 During this period, the Australian Department of Health and the Aged Care Quality and Safety Commission were active in assisting the aged care sector to prepare for and respond to the pandemic.22 The Australian Government has ‘committed over $1.5 billion of additional funding measures to support aged care preparedness and response’ in 2020.23 The Government is to be commended for these initiatives.

Early in 2020, both the Australian Department of Health and the Aged Care Quality and Safety Commission established taskforces dedicated to COVID-19. The role of the Commission’s taskforce was to manage strategic and operational issues in relation to COVID-19, responding ‘as required to issues or needs which arise, quickly and flexibly’. 24 The Australian Department of Health’s taskforce was established to lead ‘the aged care response to the pandemic’.25

On 2 March 2020, the Aged Care Quality and Safety Commissioner, Ms Janet Anderson PSM, wrote to aged care service providers to give them ‘updated advice’ on COVID-19. Ms Anderson told providers they should pay close attention to the Aged Care Quality Standards and urged them to undertake self-assessment. An attachment to the letter contained a list of ‘links to useful resources’ on the Australian Department of Health’s website. Ms Anderson warned, in her letter, that while COVID-19 cases were then low in Australia, the ‘situation could change at any time, and providers of all services need to give a high priority to planning’ for such a scenario.26

Ms Anderson’s advice was portentous. Unbeknownst to her or any others, the very next day the first COVID-19 outbreak in residential aged care in Australia would begin. On 3 March 2020, a personal care worker at Dorothy Henderson Lodge in Sydney was diagnosed with COVID-19. By 6 March 2020, four residents and two more staff members tested positive. On 7 May 2020, the outbreak was declared to be over.

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By this time, 16 of the 80 residents (20%) and five staff members had tested positive. Six of the 16 residents diagnosed with COVID-19 died during the outbreak, a mortality rate of 37.5%. The staff members have since recovered. 27

On 13 March 2020, two days after the WHO had declared the pandemic, the Communicable Diseases Network Australia (CDNA) released its National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia (CDNA Guidelines).28 The CDNA Guidelines were updated on 30 April 2020 and on 14 July 2020.29 Professor Murphy described these guidelines as ‘the fundamental foundational plan’.30 We discuss the CDNA and the CDNA Guidelines below.

Between 17 and 26 March 2020, the Aged Care Quality and Safety Commission conducted ‘assessment contacts by telephone’ with residential care providers to ‘monitor and support their preparation for a COVID-19 outbreak’.31 In a letter dated 4 May 2020 to our staff, Ms Anderson explained that during these contact calls, providers were reminded of their responsibilities under the Standards in relation to infection control, and providers’ attention was drawn to the CDNA Guidelines.32

The Aged Care Quality and Safety Commission also developed an online self-assessment survey to ‘support approved providers’ to review their infection control systems and to evaluate their preparedness for a COVID-19 outbreak.33 Virtually all (99.5%) of providers claimed that their infection control / respiratory outbreak management plan covered all areas identified in the survey. The same proportion assessed their service’s readiness in the event of a COVID-19 outbreak as either satisfactory (56.8%) or best practice (42.7%).34

On 23 March 2020, a resident at Opal Aged Care’s Bankstown residential facility who was already a hospital inpatient was diagnosed with COVID-19. Two further residents who tested positive were transferred to hospital. There were no further cases of COVID-19 at Opal Bankstown. Jonathan Anderson, Opal Aged Care’s NSW South Regional General Manager, considered that this successful response to the outbreak was due to the preparation work that Opal had done including ‘command and control structures’ which had been implemented during the response to the NSW bushfires in December 2019 and January 2020.35

On 11 April 2020, a staff member at Anglicare Sydney’s Newmarch House was diagnosed with COVID-19. By the time the outbreak was declared over on 15 June 2020, 37 of the 97 residents (38%) and 34 staff members had tested positive. Seventeen deaths ‘were directly attributed to COVID-19’, a mortality rate of 46% of the COVID-19 positive residents at Newmarch House.36 The staff members have since recovered. 37

Anglicare Sydney had used the CDNA Guidelines as a model for its COVID-19 preparation at Newmarch House and its 21 other homes.38 On 24 March 2020, Newmarch House completed the Aged Care Quality and Safety Commission’s online self-assessment survey and assessed its readiness for a COVID-19 outbreak as ‘best practice’.39 Ms Erica Roy, Anglicare Sydney’s Manager of Service Development and Practical Governance, oversaw the self-assessment and told us that, with the benefit of hindsight, the assessment was not accurate.40 In part, this was because Newmarch House’s preparedness self-assessment was based on the CDNA Guidelines.

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These, Ms Roy said, caused Newmarch to treat COVID-19 ‘as a flu-like illness’ when in reality it had ‘a lot more of an impact’.41 Further, Ms Roy explained that having ‘the use of an infection prevention specialist on the ground would be something that would be best practice in my eyes now’.42

On 22 August 2020, the Australian Health Protection Principal Committee (AHPPC) released a statement that listed ‘key national statements and guidelines’ relevant to aged care that it had reviewed and authorised. It went on to provide links to eight ‘key national statements and guidelines’.43 This is a positive development that brings together the disparate guidelines and recommendations and draws them to the attention of the aged care sector. It is a useful framework for the national aged care plan for COVID-19 that we recommend be developed.

Our recommendations and reasons for them are set out in detail below. Our first recommendation is that the Australian Government report to Parliament on the implementation of the remaining five recommendations. The recommendations we make are important and the public has a right to know how the Government has responded to them.

Recommendation 1

The Australian Government should report to Parliament by no later than 1 December 2020 on the implementation of these recommendations.

2. Visitors and quality of life

Recommendation 2

The Australian Government should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in residential aged care by their families and friends.

We begin with the measures necessary to restore physical connection between older people in aged care homes and their families and friends. We do so because older people must always be at the heart of the aged care sector and of any response to any event affecting their physical and mental wellbeing. Systems and plans are, of course, important, but they should always be linked to the object of protection. The aim of providing real, tangible and meaningful assistance to people must be our primary, overriding and constant focus. The understandable restriction of visits between older people and their friends and families has had tragic, irreparable and lasting effects which must immediately be addressed as much as possible.

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Visits from family and friends are critical to the physical, mental and emotional health and wellbeing of people living in residential aged care and also their friends and families. The benefit of such visits cannot be wholly replaced by technology.

UY

UY’s father was an Italian man with motor neurone disease who had been living in residential aged care since June 2019. He was non-verbal and relied on physical touch to communicate. His facility went into lockdown in March 2020 due to COVID-19. This meant that UY could no longer hug or touch her father, or hold his hand for walks around the grounds of the facility. UY said that her father could not understand why he could no longer touch and hug his family, and deteriorated rapidly. She said:

I believe that during this time, love was not the biggest priority, but enforcing the system was. I felt that all that had been promised when Dad entered the nursing home had changed.44

On 6 June 2020, UY’s father went to sleep and did not wake up again. He died on 13 June. Of his death, UY said:

I believe Dad gave up wanting to live because his family support and connection was disconnected. As an Italian man, he had lost what he called his ‘blood support’. Without this, he did not have meaning.45

UY told us that she believed her dad needed connection, and that he deteriorated because it was denied to him:

A nursing home can never be what a family is to someone. It will never fill the gap, but it is a tool to help families with their loved ones. It will never replace the love and connection a family can give to loved ones, and it should not assume that it has the right and authority to do that.46

The States and Territories have issued public health directions which have impacted on visitors to aged care homes. Generally speaking, these have limited ‘care and support’ visits to one per day.47 Sometimes, these directions have restricted visits altogether. For example, in late August 2020, NSW Health requested residents of the Sydney Metropolitan and Central Coast areas refrain from visiting residential aged care homes during a period of increased community transmission; and on 18 September 2020, the Victorian Premier foreshadowed that visiting aged care homes in Victoria would not return to normal until well into 2021, while recognising that there is a balance to be struck. Aged care providers have imposed restrictions in line with State and Territory directions. Some providers have elected to impose stricter restrictions on visitation rights in an attempt to halt the spread of COVID-19.

While many residents of aged care homes have not experienced a COVID-19 outbreak at their facility, they have endured r estrictions for most of this year that go beyond those

endured by the general community.

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As a consequence, many have not been able to spend time with their loved ones in a meaningful and fulfilling way. Although there have been attempts by both the aged care sector and the Australian Department of Health to improve this situation, those attempts have been inadequate partly because of a lack of funding for additional staff to facilitate visits by conducting screening, assisting with personal protective equipment (PPE) and, where necessary, accompanying visitors.

The reduction in visitors means that staff time is stretched just trying to meet the day-to-day care needs of residents.48 Some providers have increased staff numbers to meet these additional needs. But many providers, according to the evidence of union surveys, have reduced staff numbers. 49 This deficiency must be addressed urgently.

Maintaining the quality of life of those people living in residential aged care throughout the pandemic is just as important as preparing for and responding to outbreaks. Residents’ entitlement to quality of life does not change in an emergency, although how this can be achieved does. If anything, quality of life becomes more important. For many residents of aged care homes, the restrictions on visits have had, and will continue to have, serious consequences. Ms Merle Mitchell AM acknowledged the success of her facility in keeping the virus out, but asked ‘at what cost?’.50

Visits from family and friends are not just matters of lifestyle. Visits are also an integral part of health, enablement and happiness. Visitors often provide part of the care and support which is needed by older people in aged care homes.51 The time spent with them by their friends and relatives inevitably includes time spent in conversation, exercise, and assisting them to eat and drink, as well as maintaining continuing connection with life and the community. Informal carers, often family members who supplement the care provided in aged care homes, also play a critical role as the ‘eyes and ears’—monitoring the quality of care their loved ones receive.52

Whether family and friends can visit aged care homes has been a contested issue since the first cases of COVID-19 in Australia. On 11 May 2020, the issue was addressed through the Visitation Code, which was developed and endorsed by several peak organisations representing aged care providers, older people and carers.53 That code has been the subject of three reviews. It is not binding. The third version of the CDNA Guidelines acknowledges the likelihood that protracted restrictions on visitation will have ‘detrimental impacts’ on the wellbeing of residents. It notes the ‘vital importance’ of residents’ personal welfare and mental health, in which visitors play an important role.54

COVID-19 has seen a large increase in depression, anxiety and confusion in residents. The risk of suicide in residential aged care has increased.55 Ms Julie Kelly, a psychologist, said that ‘for a lot of the residents, there’s a real, real strong sense of hopelessness, of not knowing when this is going to end or being able to see any changes for them’.56

There is a balance to be struck between limiting the likelihood of an outbreak of COVID-19 and ensuring residents can receive visitors.57 The evidence we have heard makes clear that more can be done to enable older people in aged care homes to have greater access to their friends and families where this can occur without appreciable risk.

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Providers described a number of the measures which they have implemented to strike a better balance than that in the Visitation Code between taking precautions against COVID-19 while maintaining other parts of life that contribute to the health and happiness of residents. Initiatives included:

• a concierge service to coordinate and screen visitors58

• walking programs and active and passive in-room exercise programs59

• dedicated communications teams within facilities to improve coordination between residents and their families60

• training programs for family members in infection control and the use of PPE to continue to ensure safety of visits.61

Such initiatives are dependent upon adequate staffing and therefore require additional resources. Ms Annie Butler of the Australian Nursing and Midwifery Federation and Ms Carolyn Smith of the United Workers Union pointed to a lack of acknowledgement of the increased staffing numbers required to support the measures in the Visitation Code. 62 They complained that they and their members had not been consulted in the development of the Code.63 In submissions filed after the hearing, COTA Australia, the national consumer peak body for older Australians, pointed out that, while it was correct that the unions had not been involved in the preparation of the initial draft, the Australian Nursing and Midwifery Federation was given one week to comment on the draft.64 The aged care workforce and its representatives should not be excluded from any future refinement of the Visitation Code.

Funding to support increased visits is needed immediately. Providers should not be left to divert staff to facilitate such measures from the care and other activities that residents require and which staff must perform. 65 During the pandemic, additional funding is needed for staff dedicated to those activities in order to facilitate access of visitors to the homes in which older people are living. Any provider that commits to employing additional staff for this purpose should receive reasonable funds from the Australian Department of Health to assist it to do so. There should be a simple application process.

Providers must continually review and revise their position on visitation, recognising the particular circumstances of their facility and the level of community transmission in their location. The sector must be encouraged to share and celebrate innovative solutions. Aged care providers, the Australian Department of Health, and the States and Territories must make every effort to encourage and facilitate safe visitation that complies with State and Territory public health restrictions. These visitations should be humane and proportionate to risk, even during periods of community transmission. In all but extreme cases, blanket bans on visitation are unacceptable and should be both explained and justified.

We note that Mr Michael Lye, Deputy Secretary for Ageing and Aged Care in the Australian Department of Health, specifically said, when giving evidence, that he was not aware of any cases where visitation has resulted in a case of COVID-19 within a facility.66

The description of the places in which older people live as ‘their homes’ must be the reality and not just a description. To be a home, those living there should be able to enjoy all of the ordinary incidents of home living, including sharing their home with friends and relatives. They should certainly not find themselves in their more vulnerable days facing their fears of the pandemic without the comfort and support of their friends and families.

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3. Allied health

Recommendation 3

The Australian Government should urgently create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic. Any barriers, whether real or perceived, to allied health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds.

COVID-19 restrictions have a negative impact on the health and wellbeing of residents living in aged care homes. To manage this impact, the Australian Government and pr

oviders should ensure residents have access to the additional services that they need.

Levels of depression, anxiety, confusion, loneliness and suicide risk among aged care residents have increased since March 2020.67 Some of this can be attributed to missing family, changed routines, concern about catching the virus or fear of being isolated in their rooms.68 In some cases, people living in aged care homes are no longer doing the incidental exercise they were previously doing.69 Gerontological physiotherapist Mr Rik Dawson explained that reduced activity and mobility causes older frail people to ‘deteriorate very quickly’, losing their muscle strength which will rapidly lead to a loss of balance and increased falls.70 We are well aware that falls can be the beginning of decline and death for people in aged care.

Allied health professionals told us that COVID-19-related restrictions have had an impact on their ability to provide services. Despite allied health professionals being exempt from those who are excluded from aged care homes, some residents of residential aged care have had their access to allied health professionals reduced at a time when there is an increased need for such services.71

There was variability in the way residential aged care facilities responded to the COVID-19 lockdowns imposed in March 2020, with some seeing allied health professionals as essential workers and others requesting that they return once the restrictions were lifted.72 The Visitation Code and State directives now make clear that allied health professionals are not to be considered visitors. While this has helped, there are still a number of residents who are not getting access to services because of the perceived risk of infection.73 Any real or perceived barriers to allied health professionals accessing aged care homes to provide services must be removed unless they can be justified on genuine public health grounds due to the risks of infection in the community in which a home is located.

The Australian Government responded quickly to create Medicare Benefits Schedule items to increase mental health service access for people, including older people, living in the community.74 Similar measures should be taken to increase the provision of allied health services, including mental health services, to aged care residents during the pandemic to prevent deterioration in physical and mental health. Providers should ensure they provide the fullest range of allied health services they can.

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4. National advisory body and plan The AHPPC is the key decision-making committee for health emergencies. The AHPPC is comprised of the Chief Health Officers of the States and Territories and is chaired by the Australian Chief Medical Officer. 75 Although the AHPPC draws on the expertise of other disciplines, such as emergency management and the Australian Defence Force, none of its members is an aged care specialist.76

On 17 March 2020, the AHPPC released a statement on COVID-19, which directed the following comment to the aged care sector:

While all respiratory viruses can cause outbreaks and significant morbidity and mortality, COVID-19 is acknowledged as a significant health risk particularly for the elderly and individuals with co-morbidities or low immunity.77

While the AHPPC acknowledged this significant issue, it is now clear that the measures implemented by the Australian Government on advice from the AHPPC were in some respects insufficient to ensure preparedness of the aged care sector.

Confused and inconsistent messaging from providers, the Australian Government, and State and Territory Governments emerged as themes in the submissions we have received on COVID-19. All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge? At a time of crisis, such as this pandemic, clear leadership, direction and lines of communication are essential.

4.1 An aged care advisory body and a COVID-19 plan While the Health Sector Plan and CDNA Guidelines discussed above are important documents, there is a clear need for a defined, consolidated, national aged care COVID-19 plan. That plan should be created by the national aged care advisory body which we propose below, having regard to the particular needs of the aged care sector.

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Recommendation 4

The Australian Government should establish a national aged care plan for COVID-19 through the National Cabinet in consultation with the aged care sector. This plan should:

• establish a national aged care advisory body

• establish protocols between the Australian Government and the States and

Territories based on the NSW Protocol but having regard to jurisdictional differences

• maximise the ability for people living in aged care homes to have visitors and to maintain their links with family, friends and the community

• establish a mechanism for consultation with the aged care sector about use of Hospital in the Home programs in residential aged care

• establish protocols on who will decide about transfers to hospital of COVID-19 positive residents, having regard to the protocol proposed by Aged and Community Services Australia

• ensure that significant outbreaks in facilities are investigated by an independent expert to identify lessons that can be learnt. The results of any such investigations should be promptly disseminated to the sector.

Under the Health Sector Plan, the AHPPC is responsible, ‘in consultation with relevant parties and on advice from expert bodies’, for selecting which activities in that plan should be implemented.78

There are five ‘standing committees’ overseen by the AHPPC, of which the Communicable Diseases Network Australia is one. The role of the Network is to provide ‘national public health co-ordination and leadership, and support best practice for the prevention and control of communicable diseases’.79 Most of its 24 members have public health and infectious diseases expertise, but none of them is an aged care specialist.80

Each version of the CDNA Guidelines places primary responsibility for managing COVID-19 outbreaks in residential aged care on the aged care provider. They describe the advisory roles to be performed by the relevant State or Territory departments, and they describe the function of the Aged Care Quality and Safety Commission. The third version of the CDNA Guidelines dealt with the role of the Australian Department of Health in aged care.81 The Australian Government’s role was described as being to ‘work collaboratively with the overall management of the response to support the viability and capacity’ of the provider ‘to access services’.82

The Australian Government commissioned an independent review of the Newmarch House outbreak. The reviewers, Professor Lyn Gilbert AO and Adjunct Professor Alan Lilly, said that at the outset of an outbreak, ‘there must be a clear operating protocol in place, outlining the relevant stakeholders, their respective roles and the hierarchy of decision making’.83 We agree. A national aged care COVID-19 plan developed and supported by the national aged care advisory body we propose would achieve this end.

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This issue featured prominently in the evidence of Professor Joseph Ibrahim, specialist practitioner in geriatric medicine, who has been advocating for the creation of a national coordinating body specifically for residential aged care. 84 We have benefitted from Professor Ibrahim’s analysis of the situation. However, the approach we recommend differs from his.

The existing standing committees of the AHPPC have played, and continue to play, a vital role in Australia’s response to the pandemic. However, in our view, advice for government about the response to the pandemic in the aged care sector must be given by a dedicated national aged care advisory body. Such a body must have members with expertise in the following: aged care; health care, including clinical geriatric care; infection control as it applies in a ‘home-like setting’; the operational requirements of a range of aged care settings; and the particular characteristics of the aged care workforce. Advice from such a body will enable the Australian Government to play the vital leadership role it must play as the Government with responsibility for the sector. The body must consider the needs and rights of those living in aged care and their families and friends. This dedicated body for aged care should fit within the existing AHPPC framework.

We note that the Australian Government recognised the need for such a body with expertise in aged care when on 21 August 2020 it announced the establishment of a ‘time-limited AHPPC Aged Care Advisory Group’.85 This time-limited group is chaired by Professor Michael Kidd, Deputy Chief Medical Officer, Australian Department of Health. Its membership includes people with expertise in geriatric care, primary care and infection control in aged care settings.86

The establishment of this group is positive but does not go far enough and should not be time-limited. It is critical that there is a body responsible for monitoring and planning for health emergencies as they apply to the aged care sector. There is a need for a body with a particular focus on the group of people most vulnerable to this and other infectious diseases to provide regular and timely practical information to the aged care sector. The body we have in mind will have a role beyond the current pandemic. For example, it will assist the sector to prepare for future influenza outbreaks which lead to many deaths in homes each winter.

The Australian Government should establish a dedicated and ongoing aged care standing committee within the AHPPC structure.

4.2 Protocols between the Australian Government and the States and Territories On 23 June 2020, the Australian Government, through the Australian Department of Health and the Aged Care Quality and Safety Commission, and the NSW Government, through the NSW Ministry of Health (NSW Health), formalised, through a protocol, the coordination of support to an aged care provider in its management of a COVID-19 outbreak in NSW (the NSW Protocol).87 We note Counsel Assisting’s submission that a document of this kind could have been prepared in February 2020 before any outbreak of COVID-19 in residential aged care but that it was only formalised after two such outbreaks had been declared to be over in NSW.

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A lack of clarity of roles during the Newmarch House outbreak added to the complexity of the response. The independent reviewers of Newmarch House refer to the ‘dilemma’ faced by senior management at Newmarch House because of the dispute that had arisen between Australian Government officials and NSW Health officials about the transfer of residents to hospital. Dr Melanie Wroth, the Chief Medical Advisor of the Aged Care Quality and Safety Commission, recommended residents with COVID-19 be transferred to hospital. This proposal was ‘vehemently opposed’ by Dr James Branley, Director of Infectious Diseases at Nepean Hospital, who had been providing onsite clinical support at Newmarch House from the outset of the outbreak.88

Dr Branley ended his involvement on 16 April 2020 because of the lack of clarity about:

• the respective roles of the Australian Government, the NSW Government and the provider

• who was making decisions regarding Newmarch House

• his own role.89

Mr Grant Millard, Anglicare Sydney’s Chief Executive Officer, said that the inability to resolve the issue led to a ‘high degree of frustration’. He said that the impasse between the officials was only ‘in part resolved’ after he personally contacted and sought guidance from the Minister for Aged Care and Senior Australians, Senator Richard Colbeck, on 16 April 2020. Senator Colbeck told Mr Millard that he ‘understood the concern for role clarity’.90 Ultimately, the NSW Health position prevailed when Mr Lye, the Deputy Secretary in Senator Colbeck’s department, ‘determined that Dr Branley would be responsible for clinical matters in Newmarch House’.91 Dr Branley was re-engaged as an advisor on 17 April 2020.92

Ultimately, it was NSW Health’s responsibility to make the decision about whether residents would be transferred to hospital.93 As we discuss below, NSW Health implemented its Hospital in the Home program at Newmarch House.

A protocol of the kind entered into between the Australian Government and NSW Health some two and a half months later would have avoided the confusion altogether and would have avoided unnecessary frustration to a provider that was already under considerable strain. A provider should not have to contact the Aged Care Minister to have an operational question answered.

The NSW Protocol sets out the roles and responsibilities of:

• the Australian Government

• aged care providers

• various NSW Government agencies.

The primary objectives of the NSW Protocol ‘are to optimise care for all residents’ of a residential aged care facility affected by COVID-19 ‘irrespective of their COVID-19 status’ and to ‘contain and control the outbreak to bring it to an end as quickly and as safely as possible’.94 Dr Nigel Lyons, Deputy Secretary Health System Strategy and Planning in NSW Health, described the protocol as ‘good practice in how to facilitate fast mobilisation of required government support’ to an aged care facility experiencing a COVID-19 outbreak.95 We agree.

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When asked by Senior Counsel Assisting if it would be beneficial to implement protocols similar to the NSW Protocol between the Australian Government and other State or Territory Governments, Mr Lye explained that the CDNA Guidelines were the guiding principles and they set out the roles and responsibilities.96

The NSW Protocol was shared by the Australian and NSW Governments with the Australian Health Ministers Advisory Council.97 At the time of the hearing, comparable protocols, having regard to jurisdictional differences, had not been entered into between the Australian Government and other States and Territories. They should be.

Establishing protocols between the Australian Government and individual States and Territories is beneficial. Such protocols would leave no doubt about coordination arrangements. They would be valuable State or Territory-specific supplements to the aged care COVID-19 plan that we contemplate above.

4.3 The Victorian experience By the time daily infection rates began to rise in the community in Victoria in mid-June 2020, Australia had experienced two significant COVID-19 outbreaks in residential aged care homes. It is unclear whether the lessons learnt from those outbreaks were shared widely before community transmission put people living and working in aged care in Victoria at risk.

From mid-June 2020, daily infection rates in Victoria began to rise from 20 cases on 16 June 2020 to 76 on 30 June 2020. It is unclear whether there was consideration of what these figures might mean for the aged care sector. Professor Mary-Louise McLaws, Professor of Epidemiology, Health Care, Infection and Infectious Diseases Control, University of New South Wales and a Consultant to the WHO, explained that ‘One or two cases as they started to increase in June should have been an alert that this is potentially a problem.’ 98

The AHPPC released four statements directed to, or relevant to, the aged care sector between 12 March 2020 and 19 June 2020 but it provided no written guidance to the aged care sector in the period between 20 June 2020 and 3 August 2020.99 During that time, the number of new daily infections in Victoria grew from 25 to 413 and the number of active cases in residential aged care facilities grew from zero to over 500.100 It is of the utmost importance that governments and their advisers have the aged care sector uppermost in their considerations during periods of increasing community transmission of the virus or any other contagion due to the vulnerability of the residents. The dedicated advisory body we propose increases the likelihood of this occurring in future.

There were no active cases of COVID-19 in residential aged care before 7 July 2020 but by 13 July 2020 there were 28 cases. By 9 August 2020, the day before our hearing commenced, this figure exceeded 1000. The first recorded death of an aged care resident from COVID-19 in Victoria was on 11 July 2020. As at 13 September 2020, there have been 563 deaths.101

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During this period, both the Australian Department of Health and the Aged Care Quality and Safety Commission were active in providing advice. However, this did not extend to mandating, or recommending, the use of face masks in aged care facilities. This is despite the fact that, according to Professor McLaws, masks are ‘a very cheap and effective method’ of slowing the spread of COVID-19. 102

On 29 June 2020, the Australian Department of Health released a document entitled First 24 Hours - Managing COVID-19 in a residential aged care facility (First 24 Hours Guideline).103 This document provides critical guidance to facilities in the event they experience an outbreak. On 30 June 2020, the Aged Care Quality and Safety Commission issued a document directed to Victorian residential aged care services entitled Covid-19: Are you alert and ready? This document contained advice from the Commission’s Chief Clinical Advisor, Dr Melanie Wroth. It referred providers to the recently updated CDNA Guidelines.104

On 7 July 2020, the Australian Government Minister for Aged Care and Senior Australians wrote to aged care providers urging them to ensure that their outbreak management plans were ‘up to date and ready to be activated’ but did not suggest that they should consider asking their employees to wear masks.105

Two days after the first Victorian COVID-19-related death connected with aged care, on 13 July 2020, on advice from the AHPPC, the Australian Government Minister for Health announced that aged care staff working in Victoria’s lockdown zones (then Greater Melbourne and the Mitchell Shire) ‘will be required to wear surgical masks’.106 This announcement came five weeks after the WHO advised that health workers should wear masks and four weeks after community transmission numbers in Victoria had started to increase in mid-June.107

4.4 Hospital transfers and Hospital in the Home Whether and in what circumstances a resident of an aged care facility who tests positive should be transferred to hospital is a matter that has received much attention both at the hearing and in public discourse. There are various factors that must be balanced in determining the best approach:

• the needs and preferences of residents diagnosed with COVID-19

• the needs of residents who have not contracted COVID-19 and their right not to be exposed to it

• the health and safety of those charged with caring for both sets of residents

• the risk of spread of the infection in all settings including in residential aged care and hospitals

• the impact on the broader health system.

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Reflecting on the experience of the Hospital in the Home program at Newmarch House, Mr Millard told the Anglicare Sydney Board on 27 May 2020 that:

In the event of infection at another [Anglicare Sydney] home, Anglicare would be far more assertive regarding the most appropriate management of COVID-19 positive residents and would strongly push for these residents to be immediately transferred to hospital.108

In evidence at the hearing, Mr Millard explained that the concern he expressed to the Board related to three matters that arose from Hospital in the Home. First, managing the risk of infection to other residents in the home. Second, the challenges of managing the infection to staff and others working with the residents. 109 Third, he said:

I believe that if we would have been able to transfer out COVID-positive residents earlier, we might have had an earlier liberalisation of what was, really, extremely difficult for our residents to go through being isolated in their rooms with the doors closed.110

As Ms Roy of Anglicare Sydney put it, ‘They’re a whole family in there and we need to treat each of them as important.’ 111

A submission we received from BaptistCare Australia, in which the lessons of the Dorothy Henderson Lodge outbreak were discussed in very helpful detail, addressed this issue clearly:

Residential aged care homes are places where people live, assisted by staff to manage their chronic health conditions. They are designed to be as domestic and home-like as possible and they are not suitable places for treating serious cases of COVID-19. Suitable places are those capable of an extremely high level of clinical infection control which even hospitals are struggling with. Further, residential aged care providers have a duty of care to all residents…in the home.112

Views among experts and State health departments varied on the question of whether to hospitalise residents who test positive. Professor McLaws drew on WHO principles to explain that for aged care residents who are COVID-19 positive, ‘Transfer to hospital is the only appropriate solution that may improve their survival rate and reduce the risk of infection in the remainder of residents.’ 113

South Australia has an automatic transfer policy under which a resident who tests positive to COVID-19 ‘will be transferred immediately to hospital by ambulance’.114 It also has a dedicated COVID-19 hospital.115 The policy was informed by the WHO’s investigation of how China has managed the pandemic.116 Professor Spurrier explained that the policy requires the resident who has tested positive to ‘go to the safest place in terms of not spreading the disease any further to other vulnerable residents in that home’.117

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The policy is an application of the ‘population focused principle’ which requires public health decisions to be made to protect and improve the health of the community as a whole while considering the health of individuals.118 Professor Spurrier also explained the importance to public health decision-making of the ‘precautionary principle’, under which, as the Public Health and Wellbeing Act 2018 (Vic) puts it, ‘if a public health risk poses a serious threat, lack of full scientific certainty should not be used as a reason for postponing measures to prevent or control the public health risk’.119

Dr Lyons of NSW Health explained that in NSW, ‘decisions in relation to the location of care and the separation of residents must be made on a case-by-case basis depending on the circumstances of the residents’ and the residential aged care facility.120

The current version of the CDNA Guidelines are silent on the question. This is in contrast to the first two versions of the guidelines which advised that residents should be transferred ‘only if their condition warrants’.121 The Australian Government submitted that the omission of this advice in the current version of the CDNA Guidelines ‘does not reflect a particular policy of the Commonwealth that approved providers should cohort residents within a facility in a COVID-19 outbreak or that all COVID-19 affected residents should automatically be transferred to hospital’.122 ‘Cohort’ and ‘cohorting’ were terms used by a number of the witnesses to refer to separating residents who are COVID-19 positive from those who are COVID-19 negative.

Dorothy Henderson Lodge followed a policy in the early stages of the outbreak of transferring residents who tested positive to COVID-19 to hospital. However, later in the response ‘admission to hospital was not guaranteed with the decision made by MoH [NSW Health] on a case by case basis’.123

Newmarch House residents, on the other hand, were generally treated at the facility under the Hospital in the Home program.124 The prevailing view among the medical staff and government officials at that time was that ‘cohorting’ at the home would be preferred to hospital transfer unless such transfer was clinically necessary. Mr Millard told us that two residents were transferred to hospital. However, the NSW Health response to the independent report into Newmarch House states that seven residents were transferred to hospital.125 NSW Health’s Hospital in the Home program is a substitute for in-hospital care. Under the program, instead of being admitted to hospital, a person who satisfies the criteria for hospital admission is ‘admitted’ to receive hospital-level care in their home.126

NSW Health’s guideline, entitled Adult and Paediatric Hospital in the Home Guideline, details various requirements that need to be in place for Hospital in the Home to be implemented in aged care settings. These include a written agreement setting out the roles and responsibilities as well as the training and support for aged care home staff. 127 Both Mr Millard and Ms Roy spoke of their experience of Hospital in the Home at Newmarch House. While Dr Branley provided an overview of Hospital in the Home at a meeting with representatives of Anglicare Sydney and the Australian and NSW Governments on 16 April 2020, no written agreement of the kind contemplated in the policy was put in place before Hospital in the Home arrangements were implemented the following day. Ms Roy said such an agreement, together with training for staff, would have been useful. 128

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On 4 August 2020, NSW Health’s Agency for Clinical Innovation released a guideline entitled Caring for adults with COVID-19 in the home.129 This document was prepared without consultation with those who had recent experience of Hospital in the Home and without consultation with the aged care sector more generally. NSW Health has since advised that consultations on amendments and future versions will involve the aged care sector.130 We commend this.

Virginia Clarke

Virginia Clarke’s father had been a resident at Newmarch House since 2013. Ms Clarke was generally happy with the communication from Newmarch House until March 2020 when the facility went into lockdown due to COVID-19. After an outbreak on Easter Sunday, Ms Clarke received a phone call to say all residents, including her father, would be tested for COVID-19. Despite calling multiple times the following week, Ms Clarke only found out by accident that her father had tested positive on Friday 17 April 2020. On Sunday 19 April, he died in the facility. Of this experience, Ms Clarke said:

I think he should have been told, and had staff talk to him about it and about his treatment. I don’t know whether he should or should not have gone to hospital, but I just don’t know whether he got the best care that he should have, because none of us were informed.131

Ms Clarke was unaware that her father was being treated under the Hospital in the Home program.132 She told us that if the NSW Government ‘insists on having hospital in place for the aged care facilities, then it needs to be as a hospital in place. So he needs to be able to access doctors all the time, nurses, and…all the equipment that is required that they would have access to if they were in a hospital’.133

Ms Clarke did not think her father knew or had been told that he tested positive for COVID-19. Following his death, the appropriate records had not been kept by the facility and Ms Clarke struggled to obtain the death certificate necessary to hold her father’s memorial service.

She said:

There needs to be more support for family members, more support for residents, and more communication.134

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Representatives from Dorothy Henderson Lodge were clear that the transfer to hospital of residents with COVID-19 in the early stages of the outbreak assisted in controlling the outbreak. Ms Melanie Dicks, Residential Operations Manager, Southern region, BaptistCare, explained that it helped the provider to ‘stabilise our outbreak plan and ensure that our resources were working’.135 In particular, it enabled BaptistCare to ‘say that the service had no active cases at that point, and it certainly supported encouraging staff to come as well because at that time staff were fearful to come on site so we had to work strongly and support our staff to ensure their safety’. 136 The submissions from Anglicare responding to those of Counsel Assisting made similar observations based on the experience at Newmarch House, including the experience of residents and their families.137

The independent review of Newmarch House revealed that there were ‘impediments’ to the ‘successful implementation’ of Hospital in the Home at Newmarch House, ‘the most significant of which was a shortfall in staff familiar with the regular care needs of residents’. In addition, the number of residents with COVID-19 was increasing, which was a ‘continued source of infection to other residents and staff because of imperfect’ infection prevention and control practices. The independent review also identified a ‘lack of adequate provision for medical care of the majority of residents who remained COVID-19 free’ which led to ‘shortfalls in hospital-standard care for some residents with COVID-19 and neglect of or delays in, routine care of many others’.138

These concerns led the independent review to conclude that the ‘successful adoption of Hospital in the Home as a model-of-care, for a large number of residents with COVID-19 in an aged care facility, is very challenging’ and to identify the following ‘key learning’ in the report:

HITH [Hospital in the Home] is an attractive model of care for management of a COVID-19 outbreak in an aged care facility but the precondition of resident safety is only likely to be met if the outbreak is limited to a small number of cases in residents and staff. 139

The evidence before us, limited as it is, supports this view. However, we note that NSW Health maintains that the experience at Newmarch House ‘does not lead to the conclusion that a HITH [Hospital in the Home] model is unsuitable for a large outbreak’.140 The aged care advisory body we propose should consider this issue and provide guidance to governments and the aged care sector about the future use of Hospital in the Home in COVID-19 outbreaks.

On the broader question of whether residents who test positive to COVID-19 should be transferred to hospital for treatment, the independent Newmarch House review was clear. Another ‘key learning’ it identified was that an ‘expert panel’ of suitably qualified medical practitioners should make decisions about clinical care and:

as soon as an outbreak is declared…residents should be transferred to hospital until the residential aged care facility is deemed safe and appropriate for residents to return.141

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There is no single answer to whether residents with COVID-19 should be transferred to hospital or whether they should receive treatment at the home. There is no ‘one size fits all’ answer because facilities vary in their capacity to separate negative and positive residents and in the numbers and skills of their staff. And as we have seen, the States, which run the hospitals and act as ‘gatekeepers’, apply different policies.

What is clear is that:

• The starting point must be to recognise that equal access to the hospital system is the fundamental right of all Australians young or old and regardless of where they live.

• The decision about whether to transfer a resident with COVID-19 to hospital or to care for them through Hospital in the Home must be made considering both the wishes of the resident who has tested positive and the right of the other negative residents to remain negative.

• The decision should be informed by broader public health considerations, such as the ‘precautionary principle’ and the ‘population-focused principle’.

• Any policy on the use of Hospital in the Home in residential aged care facilities must be developed in consultation with the aged care sector and should ordinarily be confined to small outbreaks, as recommended by the independent Newmarch House review.

• If Hospital in the Home is to be implemented in an aged care facility all relevant pre-conditions must be met before implementation.

In June 2020, Aged & Community Services Australia (ACSA), a national peak body for not-for-profit, chur ch, charitable and for-purpose providers, released a framework that

addressed the interconnections between aged care and health care during COVID-19. In it, ACSA called on the Australian and State and Territory Governments ‘to develop and adopt clear protocols for the management of the interface between…residential aged care and hospitals’ during the pandemic. According to ACSA, the proposed protocols would achieve the following:

• Ensure aged care residents can access their right to acute care in hospital, or another location that is well set up to manage infection control and treatment, if they clinically require it;

• Ensure aged care residents at a facility where an outbreak occurs are not put in harm’s way by any obstacles to transferring aged care residents diagnosed with COVID-19 to the appropriate acute care setting; and

• Develop clear guidelines for the additional support measures to be provided by the health system should an outbreak require the establishment of ‘hospital in the home’ arrangements in an aged care facility.142

We commend this proposal. In its submissions responding to the submissions of Counsel Assisting, NSW Health agreed that there should be clear protocols and stated that ‘the protocol between the Commonwealth and NSW seeks to address this need’.143 These matters should be considered by the national aged care advisory body which we propose. There is a need, as Mr Millard said, ‘for a much closer collaboration as an entire health system’ at a State and Australian Government level.144

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5. Infection control expertise and personal protective equipment

Recommendation 5

All residential aged care homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body we propose.

Recommendation 6

The Australian Government should arrange with the States and Territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.

5.1 Infection control There is nothing more important to help providers prepare for and respond to COVID-19 outbreaks than access to high level infection prevention and control expertise.145 Providers of aged care are required under existing Standards to minimise infection-related risks by implementing ‘standard and transmission-based precautions to prevent and control infection’.146 But for COVID-19, there are particular challenges associated with infection control in aged care homes as explained in a report dated 24 May 2020 about the Newmarch House outbreak by the NSW Clinical Excellence Commission:

Newmarch House not unlike many aged care facilities is a challenging environment to implement such high levels of precautions, isolation and enhanced use of PPE. This is then compounded by the lack of onsite Infection Prevention and control expertise or external oversite of Infection Control where onsite may not have been possible.147

The Clinical Excellence Commission report made some important observations about infection control that we consider are of general application to the aged care sector:

RACF [residential aged care facilities] such as Newmarch would have some experience implementing transmission based precautions and outbreak management particularly for management of other respiratory borne illnesses annually such as influenza, however I suspect given the communicability of COVID-19, the high transmissibility and the unusual enhanced approach implemented, this scenario,

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despite national recommendations in place is unprecedented and relies heavily on specific environmental contr

ols that would require Infection control expertise to set

up, monitor, evaluate and at times interrogate further. Successful management of this magnitude also relies on an existing culture of compliance to and emphasis on basic and ongoing infection control education and training in addition to operational accountability for Infection Prevention and Control; again something not necessarily unique to Newmarch.148

Professor Gilbert made similar observations and identified similar needs in a report she was commissioned by the Australian Government to prepare about the outbreak at Dorothy Henderson Lodge. So too did Professor Gilbert and Adjunct Professor Lilly’s report into the Newmarch House outbreak.149

Based on the findings of these various reports, it is apparent that high-level infection control expertise is needed by aged care homes:

• to assist with the preparation and implementation of outbreak management plans

• to provide training to staff on the use of PPE and infection prevention and control

• to provide assistance on day one of an outbreak.

Ms Kathy Dempsey of the NSW Clinical Excellence Commission explained the process by which infection control and prevention specialists are accredited. Ms Dempsey said that credentialing is carried out by the Australasian College of Infection Prevention and Control. There are currently 66 credentialed infection control and prevention specialists across Australia, mainly in major hospitals.150

Several witnesses agreed that access to accredited infection control and prevention specialists could assist the aged care sector.151 We consider that the Australian Government should make arrangements with the States for easy access by providers to these accredited specialists. This should be able to be achieved on a regional basis. It is true, as the Australian Government submitted, that ‘infection control specialists are organised and engaged by the public health units of each State and Territory’.152 However, we consider that the Australian Government, as the government responsible for residential aged care facilities, should be working closely with the States to make infection control expertise available to the sector.

We accept that there are clearly limits to what the relatively small number of accredited experts can contribute through their direct involvement in the aged care sector. The best approach may be to use their expertise in training and mentoring roles to increase capacity in the aged care sector.153 Professor Gilbert considered that:

infection control professionals within hospitals in the local districts…could probably provide advice and training to staff outside of this outbreak scenario which would probably make everybody more prepared to respond quickly when the situation arises.154

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We consider that the ideal model is for each aged care home to have at least one dedicated ‘infection control champion’. Anglicare Sydney has identified two staff members from each of its homes to be trained to fulfil this role. These staff members have been enrolled in a six-month course and are being mentored by Ms Dempsey.155 This is a model that should be spread throughout the sector without delay.

We note that this is not a new idea. Long-term care homes in Hong Kong have been required to have designated Infection Control Officers since 2004. The requirement was introduced after the Severe Acute Respiratory Syndrome (SARS) epidemic and has greatly assisted the response to COVID-19 in 2020. Their role is to coordinate and implement infection control measures in accordance with the Guidelines on Prevention of Communicable Diseases in Residential Care Homes for the Elderly.156

Closer to home, the Victorian State Coroner recommended in 2012 that the Victorian Department of Health, in consultation with the then Australian Department of Health and Ageing, require aged care facilities to have a designated Infection Control Manager.157

5.2 Personal protective equipment Training in the use of PPE across the aged care sector was described by a representative of a trade union with members who work as personal care workers as ‘completely inadequate’ in the context of a pandemic.158 Personal care workers do not receive training on the use of PPE as part of their Certificate III. 159 Graduate nurses receive a working knowledge of PPE and gain an understanding of universal precautions and basic infection control principles as part of their training.160 Mr Lye agreed that training in the use of PPE should be compulsory and of a much higher standard.161 This is a matter that requires urgent attention by the Australian Government, aged care providers and those responsible for the content of the Certificate III.

In her report about the Dorothy Henderson Lodge outbreak, Professor Gilbert recommended that aged care staff be provided with regular, perhaps annual, training in infection prevention and control and the use of personal protective equipment.162 We agree with this recommendation. Providing this training should be a core responsibility of providers.

Providers need to appreciate the risks associated with COVID-19. While the tragic events in NSW and Victoria may have assisted unaffected providers to learn about the need for infection prevention and control expertise, this need must be made absolutely plain in the national aged care COVID-19 plan. We need only to look at the experience of Newmarch House to understand why. Ms Roy, an experienced aged care nurse, explained that when she assessed Newmarch House as ‘best practice’ in relation to infection control and preparedness, she relied on the CDNA Guidelines which she explained caused her to treat COVID-19 ‘as a flu-like illness’. 163 With the benefit of hindsight, she told us that she now considers that ‘the level of expertise that someone like Ms Dempsey brought was unparalleled, because of her extensive experience in dealing with infection control’.164

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Professor McLaws explained that COVID-19 is different to influenza from an infection control viewpoint because there is no vaccination and a person with it can be infectious for four days after exposure while having no symptoms at all.165 This has proven to be of grave significance to outbreaks in the aged care sector.

It is not enough to tell providers, as the Australian Government’s First 24 Guideline does, that if they request help, they will be provided with a ‘Clinical First Responder’.166 Unless a ‘Clinical First Responder’ possesses the level of expertise that Professor Gilbert described, they will not be able to provide the high level of assistance that providers need.

Infection control is important not only for the health, safety and wellbeing of residents. It is important to those who work in aged care. We heard concerning evidence about unsafe conditions for aged care workers.167 Large numbers of aged care workers have contracted COVID-19. Nurses, personal care workers, cooks and cleaners are required to work in close proximity to residents who are, or may be, COVID-19 positive. This was graphically described for us by Ms Diana Asmar, Branch Secretary of the Health Services Union, who told us that her union’s members ‘right now feel like they’re on the bottom of the Titanic ship’.168 Aged care workers perform intimate tasks which place them on risk of catching the virus.

Insufficient supplies of PPE and infection control training for the aged care workforce were the subject of evidence in the form of union surveys and accounts.169 We heard of workers being told they could only use one glove rather than two, and a guideline at a residential aged care facility that only permitted two masks per shift.170 This is deplorable.

6. Conclusion The COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced. Those who have suffered the most have been the residents, their families and aged care staff. The suffering has not been confined to those homes which have experienced outbreaks. Thousands of residents in homes that have not suffered outbreaks have endured months of isolation which has had and continues to have a terrible effect on their physical, mental and emotional wellbeing.

We decided to hold this hearing to identify what lessons can be learned from the experience of the aged care sector’s response to COVID-19 in the first eight months of 2020. We have identified a number of lessons and made six recommendations for the Australian Government to implement that we consider will better prepare the sector, its staff and its residents for any future outbreaks of this pernicious virus.

Longer-term reform of the aged care sector will be the subject of our Final Report in 2021.

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7. Endnotes 1 Royal Commission into Aged Care Quality and Safety, Interim Report: Neglect, 2019, vol 1, pp 186-190; 217-227.

2 Transcript, Sydney Hearing 2, Annie Butler, 12 August 2020 at T8613.30-31; Transcript, Sydney Hearing 2, Diana Asmar, 12 August 2020 at T8615.15-23.

3 Transcript, Sydney Hearing 2, Carolyn Smith, 12 August 2020 at T8613.9-11.

4 World Health Or

ganization, ‘WHO Director-General’

s statement on IHR Emergency Committee on Novel Coronavirus

(2019-nCoV)’, 30 January 2020, https://www.who.int/dg/speeches/detail/who-director-general-s-statement-on-ihr-

emergency-committee-on-novel-coronavirus-(2019-ncov), viewed 19 August 2020; W orld Health Organization, ‘WHO Director-General’s remarks

at the media briefing on 2019-nCoV’, 11 February 2020, https://www.who.int/dg/speeches/ detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020, viewed 19 August 2020; World Health Or

ganization, ‘Virtual press conference on COVID-19’, 11 Mar ch 2020, https://www.who.int/

docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-confer ence-full-and-final-

11mar2020.pdf?sfvrsn=cb432bb3_2, viewed 19 August.

5 A Clark, M Jit, C Warren-Gash, B Guthrie, H HX Wang, SW Mercer, C Sanderson, M McKee, C Troeger , KI Ong, F Checchi, P Perel, S Joseph, A Banerjee, H Gibbs, CMMID nCov working group and RM Eggo, Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study, 2020, https://cmmid.github.io/topics/covid19/Global_risk_factors.html and https://www.thelancet. com/journals/langlo/article/PIIS2214-109X(20)30264-3/fulltext, viewed 11 September 2020.

6 United Nations, Policy Brief: The Impact of COVID-19 on older persons, May 2020, p 3, https://unsdg.un.org/sites/ default/files/2020-05/Policy-Brief-The-Impact-of-COVID-19-on-Older -Persons.pdf

, viewed 11 September 2020.

7 Australian Department of Health, Coronavirus (COVID-19) current situation and case numbers

, https://www.health.gov.

au/news/health-alerts/novel-cor onavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#total-cases-recoveries-deaths-and-new-cases-in-the-last-24-hours, viewed 20 September 2020; Australian

Department of Health,

COVID-19 cases in aged care services - residential care, https://www.health.gov.au/resources/

covid-19-cases-in-aged-care-services-residential-care, viewed 20 September 2020.

8 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0008 [30].

9 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0008-0009 [31]-[32].

10 T

ranscript, Sydney Hearing 2, Joseph Ibrahim, 12 August 2020 at T8576.1-7; Australian Department of Health, Coronavirus (COVID-19) current situation and case numbers, https://www.health.gov.au/news/health-alerts/ novel-cor

onavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#total-cases-recoveries-deaths-and-new-cases-in-the-last-24-hours,

viewed 20 September 2020; Australian Department of Health,

COVID-19 cases in aged care services - residential care, https://www .health.gov.au/resources/covid-19-cases-in-

aged-care-services-residential-care, viewed 20 September 2020.

11 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 30, RCD.9999.0366.0121 at 0125 and 0142.

12

Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 30, RCD.9999.0366.0121 at 0147.

13 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0009 [33].

14 Commonwealth of Australia, Letters Patent, 6 December 2018 as amended on 13 September 2019 and 25 June 2020.

15 Aged Care Act 1997 (Cth), ss 54-1(1) and 54-2.

16 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0010 [38].

17 Commonwealth of Australia,

Letters Patent, 6 December 2018 as amended on 13 September 2019 and 25 June 2020.

18 Exhibit 18-23, Sydney Hearing 2, Statement of Brendan Murphy, RCD.9999.0447.0001 at 0001 [7]; The Hon Scott Morrison MP, press conference, Australian Parliament House, 27 February 2020, https://www.pm.gov.au/media/pr

ess-conference-australian-parliament-house-4, viewed 19 August 2020.

19 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0011 [42]-[44].

20 Australian Department of Health, Letter from Chief Medical Officer to aged care providers, published 27 February 2020, https://www.health.gov.au/resources/publications/residential-aged-care-infection-control-and-emergency-planning, viewed 20 August 2020.

21 These are helpfully detailed in the Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0014-0044 [57]-[227].

22 Initiatives of the Aged Care Quality and Safety Commission are detailed in the Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0020-0022 [81]-[82], [86]-[87], 0024 [96], 0024 [98], 0025-0026 [104]-[111], 0027 [116], 0029 [130], 0030 [134]-[135], 0036 [169]-[172], 0041 [208] and 0046 [231].

23 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0010 [39]. The various funding announcements are detailed at 0016 [66], 0022 [85], 0029-0030 [131], 0031 [139], 0043 [219] and 0043 [221].

24 Exhibit 18-21, Sydney Hearing 2, Statement of Janet Anderson, WIT.0772.0001.0001 at 0007 [33].

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25 Exhibit 18-20, Sydney Hearing 2, Statement of Michael Lye, WIT.0773.0001.0001 at 0016 [74].

30 Transcript, Sydney Hearing 2, Brendan Murphy, 12 August 2020 at T8679.20-21.

35 Transcript, Sydney Hearing 2, Jonathon Anderson, 11 August 2020 at T8545.35-44; Exhibit 18-16, Sydney Hearing 2, Opal Car e tender bundle, AWF.600.01703.0001 at 0007.

40 Exhibit 18-12, Sydney Hearing 2, Statement of Erica Roy, WIT.0739.0001.0001 at 0009 [45]-[47].

45 Exhibit 18-07, Sydney Hearing 2, Statement of UY, WIT.0971.0001.0001 at 0005 [28].

50 Exhibit 18-5, Sydney Hearing 2, Supplementary statement of Merle Mitchell, WIT.0972.0001.0001 at 0002 [12].

55 Transcript, Sydney Hearing 2, Julie Kelly, 11 August 2020 at T8559.33-37.

60 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab14, RCD.9999.0379.0001 at 0029 [7.6.5]; Exhibit 18-16, Sydney Hearing 2, Opal Car e tender bundle, tab 15, AWF.600.01703.0001.

65 Transcript, Sydney Hearing 2, Stephen Judd, 11 August 2020 at T8550.11-17; T8550.28-36.

Aged care and COVID-19: a special report

26 Aged Care Quality and Safety Commission, Letter from Aged Care Quality and Safety Commissioner to aged care providers, 2 March 2020, https://www.agedcarequality.gov.au/sites/default/files/media/Lettter%20to%20aged%20 care%20service%20providers%20-%2002%2003%202020.pdf, viewed 25 August 2020.

27 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab 14, RCD.9999.0379.0001 at 0003, 0041.

28 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 72, RCD.9999.0437.0001.

29 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 7, RCD.9999.0366.0023 and tab 71, RCD.9999.0442.0001.

31 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 41, RCD.9999.0389.0068 at 0070.

32 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 41, RCD.9999.0389.0068 at 0070.

33 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 41, RCD.9999.0389.0068 at 0070.

34 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 10, RCD.9999.0381.0001 at 0002.

36 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8883.

37 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 104, CTH.1000.0005.7777.

38 Exhibit 18-12, Sydney Hearing 2, Statement of Erica Roy, WIT.0793.0001.0001 at 0004 [18].

39 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 12, CTH.4026.1002.0008.

41 Transcript, Sydney Hearing 2, Erica Roy, 11 August 2020 at T8482.19-27.

42 Transcript, Sydney Hearing 2, Erica Roy, 11 August 2020 at T8482.36-37.

43 Australian Department of Health, Australian Health Protection Principal Committee (AHPPC) statement on the national COVID-19 response for r esidential aged care facilities, 22 August 2020, https://www.health.gov.au/news/australian-

health-protection-principal-committee-ahppc-statement-on-the-national-covid-19-response-for-residential-aged-care-facilities-0, viewed 26 August 2020.

44 Exhibit 18-07, Sydney Hearing 2, Statement of UY, WIT.0971.0001.0001 at 0005 [26].

46 Exhibit 18-07, Sydney Hearing 2, Statement of UY, WIT.0971.0001.0001 at 0007 [38].

47 See, for example, Exhibit 18-1, general tender bundle, tab 5, RCD.9999.0366.0149 at 0153 [cl 4(1)(b)(iii)].

48 Transcript, Sydney Hearing 2, Carolyn Smith at 12 August 2020, T8616.35-43; T8617.4-14; Transcript, Sydney Hearing 2, Annie Butler , 12 August 202 at T8617.25-36.

49 Transcript, Sydney Hearing 2, Annie Butler, 12 August 2020 at T8618.4-10; T8618.45-8619.4; T8619.6-18.

51 Transcript, Sydney Hearing 2, Carolyn Smith, 12 August 2020 at T8617.4-24.

52 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 27, AWF.600.01744.0001 at 0006.

53 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 11A, RCD.9999.0404.0003.

54 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 79, RCD.9999.0442.0001 at 0015.

56 Transcript, Sydney Hearing 2, Julie Kelly, 11 August 2020 at T8560.36-38.

57 Transcript, Sydney Hearing 2, Angela Raguz, 11 August 2020 at T8559.7.

58 Transcript, Sydney Hearing 2, Stephen Judd, 11 August 2020 at T8550.28-36; Exhibit 18-15, Sydney Hearing 2, Statement of Stephen Judd, WIT .1367.0001.0001 at 0009-0010 [53]-[58].

59 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab14, RCD.9999.0379.0001 at 0026 [7.4.3]; Exhibit 18-16, Sydney Hearing 2, Opal Car e tender bundle, tab 15, AWF.600.01703.0001; Transcript,

Sydney Hearing 2, Jonathan Anderson, 11 August 2020 at T8554.31-41.

61 Transcript, Sydney Hearing 2, Angela Raguz, 11 August 2020 at T8553.16-20.

62 Transcript, Sydney Hearing 2, Annie Butler, 12 August 2020 at T8627.4-18; Transcript, Sydney Hearing 2, Car olyn Smith, 12 August 2020 at T8626.27-31.

63 Transcript, Sydney Hearing 2, Annie Butler, 12 August 2020 at T8627.42-43; Submission in response of the Australian Nursing and Midwifery Federation to a Submission of COT A Australia in Relation to the Development of the Residential

Aged Care Visitor Code, 9 September 2020, ANM.0027.0001.0001 at [3]-[4].

64 Submissions of COTA Australia, Sydney Hearing 2, 4 September 2020, RCD.9999.0507.0001 at 0009-0010.

66 Transcript, Sydney Hearing 2, Michael Lye, 12 August 2020 at T8668.28-46; T8669.6-7.

67 Transcript, Sydney Hearing 2, Julie Kelly, 11 August 2020 at T8559.33-45 and T8560.44-8561.2.

68 Transcript, Sydney Hearing 2, Julie Kelly, 11 August 2020 at T8560.21-32.

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69 Transcript, Sydney Hearing 2, Rik Dawson, 11 August 2020 at T8561.26-34.

70 Transcript, Sydney Hearing 2, Rik Dawson, 11 August 2020 at T8561.39-8562.2.

71 See, for example, Public Health (COVID-19 Aged Care Facilities) Or der (No 2) 2020 (NSW), cl 5(1)(a), (c)(ii)-(iii). See also, Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 33, RCD.9999.0366.0285 at 0287 [12]. Transcript, Sydney Hearing 2, Rik Dawson, 11 August 2020 at T8563.1-11.

72 Transcript, Sydney Hearing 2, Julie Kelly, 11 August 2020 at T8559.14-17.

73 Transcript, Sydney Hearing 2, Rik Dawson, 11 August 2020 at T8563.1-11; Exhibit 18-1, Sydney Hearing, general tender bundle, tab 17, A WF.600.01805.0001 at 0008.

74 Australian Department of Health, Looking after your mental health during coronavirus (COVID-19) r estrictions, 2020, https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/ongoing-support-during-cor

onavirus-covid-19/looking-after-your-mental-health-during-coronavirus-covid-19-restrictions#mental-health-support, viewed 13 August 2020; Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0040-0041 [204].

75 Australian Department of Health, About Communicable Diseases Network Australia, 2015, https://www.health.gov.au/committees-and-groups/australian-health-protection-principal-committee-ahppc, viewed 20 August 2020; T

ranscript, Sydney Hearing 2, Brendan Murphy, 12 August 2020 at T8639.5.

76 Transcript, Sydney Hearing 2, Brendan Murphy, 12 August 2020 at T8639.5-16.

77 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 75, RCD.9999.0443.0016 at 0021.

78 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 53, NDH.0017.0001.0001 at 0007.

79 Australian Department of Health, Aged Care Advisory Gr oup, 2020, https://www1.health.gov.au/internet/main/ publishing.nsf/content/cda-cdna-cdna.htm, viewed 20 August 2020.

80 Transcript, Sydney Hearing 2, Michael Lye, 12 August 2020 at T8643.25.

81 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0052 [258]-[259].

82 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 79, RCD.9999.0442.0001 at 0006.

83 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8886.

84 Exhibit 18-17, Precis of evidence Professor Joseph Ibrahim, RCD.9999.0411.0001 at 0011.

85 The Hon Scott Morrison MP, the Hon Senator Richard Colbeck, Media release, 21 August 2020, https://www.pm.gov.au/media/reinforcement-australias-aged-care-sector, viewed 25 August 2020.

86 Australian Department of Health, Aged Care Advisory Gr oup, August 2020, https://www.health.gov.au/committees-and-groups/aged-care-advisory-group, viewed 14 September 2020.

87 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 26, RCD.9999.0366.0238.

88 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8886.

89 Exhibit 18-14, Sydney Hearing 2, Statement of James Branley, WIT.0769.0001.0001 at 0007 [53].

90 Transcript, Sydney Hearing 2, Grant Millard, 11 August 2020 at T8485.42-43; Exhibit 18-10, Sydney Hearing 2, Statement of Grant Millard, WIT .0787.0001.0001 at 0025 [128].

91 Transcript, Sydney Hearing 2, Grant Millard, 11 August 2020 at T8486.43-45.

92 Exhibit 18-14, Sydney Hearing 2, Statement of James Branley, WIT.0769.0001.0001 at 0007 [54].

93 Transcript, Sydney Hearing 2, Michael Lye, 12 August 2020 at T8665.33-36.

94 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 26, RCD.9999.0366.0238.

95 Exhibit 18-18, Sydney Hearing 2, Statement of Nigel Lyons, WIT.0782.0001.0001 at 0015 [83].

96 Transcript, Sydney Hearing 2, Michael Lye, 12 August 2020 at T8666.39-41; T8667.1-22.

97 Exhibit 18-18, Sydney Hearing 2, Statement of Nigel Lyons, WIT.0782.0001.0001 at 0015 [82].

98 Transcript, Sydney Hearing 2, Mary-Louise McLaws, 10 August 2020 at T8399.26-28

99 Sydney Hearing 2, Exhibit 18-1, general tender bundle, tab 74, RCD.9999.0443.0011; tab 75, RCD.9999.0443.0016; tab 76, RCD.9999.0443.0013; tab 77, RCD.9999.0443.0025; Australian Department of Health, Australian Health

Protection Principal Committee statements, 2020, https://www.health.gov.au/committees-and-groups/australian-health-protection-principal-committee-ahppc#statements, viewed 26 August 2020.

100 Australian Department of Health, Victorian coronavirus (COVID-19) data, 2020, https://www.health.gov.au/resources/ covid-19-cases-in-aged-care-services-residential-care, viewed 6 August 2020.

101 Australian Department of Health, COVID-19 cases in aged care services - residential care, 2020, https://www.health.gov.au/resources/covid-19-cases-in-aged-care-services-residential-care, viewed 13 September 2020.

102 Transcript, Sydney Hearing 2, Mary-Louise McLaws, 10 August 2020 at T8399.30-31.

103 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 31, RCD.9999.0382.0001.

104 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 47, RCD.9999.0392.0001.

105 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 48, RCD.9999.0392.0008.

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106 The Hon Greg Hunt MP, Face masks required for aged care workers in Melbourne hotspots, Media release, 13 July 2020, https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/face-masks-required-for-aged-care-workers-in-melbour

ne-hotspots, viewed 20 August 2020.

107 W orld Health Organization, Advice on the use of masks in the context of COVID-19, Interim guidance, 5 June 2020, https://www .who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-

healthcare-settings-in-the-context-of-the-novel-cor onavirus-(2019-ncov)-outbreak, viewed 11 September 2020.

108

Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 90, ANG.514.001.00012 at 0017.

109 Transcript, Sydney Hearing 2, Grant Millard, 11 August 2020 at T8490.25-36.

110

Transcript, Sydney Hearing 2, Grant Millard, 11 August 2020 at T8490.33-36.

111 Transcript, Sydney Hearing 2, Erica Roy, 11 August 2020 at T8496.35-36.

112 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab 15, RCD.9999.0394.0001 at 0018.

113 Exhibit 18-4, Sydney Hearing 2, Precis of evidence - Mary-Louise McLaws, RCD.9999.0384.0001 at 0005 [25].

114 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 10A, RCD.9999.0374.0001.

115 Transcript, Sydney Hearing 2, Nicola Spurrier, 10 August 2020 at T8395.2-6.

116 Transcript, Sydney Hearing 2, Nicola Spurrier, 10 August 2020 at T8394.44-8395.4.

117 Transcript, Sydney Hearing 2, Nicola Spurrier, 10 August 2020 at T8397.32-34.

118 Transcript, Sydney Hearing 2, Nicola Spurrier, 10 August 2020 at T8390.31-45. The principle finds statutory form in section 10 of the South Australian Public Health Act 2011 (SA).

119 Public Health and W

ellbeing Act 2008 (Vic), s 6; see also Transcript, Sydney Hearing 2, Nicola Spurrier, 10 August 2020 at T8389.46-8390.7.

120 Exhibit 18-18, Sydney Hearing 2, Statement of Nigel Lyons, WIT.0782.0001.0001 at 0010 [55].

121 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 7, RCD.9999.0366.0023 at 0039; tab 71, RCD.9999.0437.0001 at 0017.

122 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0069 [331].

123 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab 14, RCD.9999.0379.0001 at 0021 [6.9.3].

124 Exhibit 18-10, Sydney Hearing 2, Statement of Grant Millard, WIT.0787.0001.0001 at 0011 [54].

125 New South W

ales Ministry of Health, NSW Health response to final r eport of the independent review into the Newmarch House COVID-19 outbreak, New South Wales Government, 24 August 2020, p 3, https://www.health. nsw.gov

.au/Infectious/covid-19/Pages/newmarch-house-response.aspx#:~:text=The%20NSW%20Health%20 response%20was%20delivered%20in%20the%20absence%20of%2cNewmarch%20House%20or%20Anglicare%20 management.&text=On%2011%20April%20%28Easter%20Saturday%2clockdown%20the%20facility , viewed 8 September 2020.

126

Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 1, RCD.9999.0366.0181 at 0187-0188 and 0196.

127 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 1, RCD.9999.0366.0181 at 0198.

128 Transcript, Sydney Hearing 2, Erica Roy, 11 August 2020 at T8492.4-26.

129

Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 67, RCD.9999.0425.0001.

130 Exhibit 18-28, Sydney Hearing 2, Bundle of correspondence regarding NSW Ministry of Health and consultation in relation to guidelines for Hospital in the Home, tab 3, RCD.9999.0482.0003 at 0004.

131 Exhibit 18-08, Sydney Hearing 2, Statement of Virginia Clarke, WIT.0790.0001.0001 at 0006 [42].

132

Transcript, Sydney Hearing 2, Virginia Clarke, 11 August 2020, T8473.7-17.

133 Transcript, Sydney Hearing 2, Virginia Clarke, 11 August 2020, T8472.32-36.

134 Exhibit 18-08, Sydney Hearing 2, Statement of Virginia Clarke, WIT.0790.0001.0001 at 0007 [46].

135 Transcript, Sydney Hearing 2, Melanie Dicks, 10 August 2020 at T8422.45-46.

136 Transcript, Sydney Hearing 2, Melanie Dicks, 10 August 2020 at T8423.31-34; see also T8424.16-21.

137 Submissions of Anglican Community Services, Sydney Hearing 2, 4 September 2020, RCD.9999.0503.0002 at 0019-0022 [46]-[54].

138 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8894-8895.

139 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8895.

140 Submissions on behalf of State of New South Wales, Sydney Hearing 2, 4 September 2020, RCD.9999.0505.0001 at 0013 [92].

141 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8896.

142 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 13, RCD.9999.0381.0134 at 0138-0139.

143 Submissions on behalf of State of New South Wales, Sydney Hearing 2, 4 September 2020, RCD.9999.0505.0001 at 0008 [54].

144 Transcript, Sydney Hearing 2, Grant Millard, 11 August 2020 at T8495.9-10.

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

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145 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab 10, CTH.1000.0004.7114 at 7121; Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8901; Transcript, Sydney Hearing, Melanie Dicks, 10 August 2020 at T8420.26-34.

146 Quality of Care Principles 2014 (Cth), Sch 2: Aged Care Quality Standards, Standard 3(3)(g)(i).

147 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 89, NDH.0012.0002.0001 at 0003.

148 Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 89, NDH.0012.0002.0001 at 0006.

149 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab 10, CTH.1000.0004.7114 at 7120- 7121; Exhibit 18-3, Sydney Hearing 2, Newmarch House tender bundle, tab 121, CTH.1000.0005.8876 at 8897-8901.

150 Transcript, Sydney Hearing 2, Kathy Dempsey, 11 August 2020 at T8508.41-8509.18.

151 Transcript, Sydney Hearing 2, Kathy Dempsey, 11 August 2020, T8530.35-38; Transcript, Sydney Hearing 2, Gwendolyn Gilbert, 10 August 2020 at T8441.39-41, Transcript, Sydney Hearing 2, Melanie Dicks, 10 August 2020 at T8422.8-15; Transcript, Sydney Hearing 2, Ross Low, 10 August 2020 at T8422.20-23.

152 Submissions of the Commonwealth of Australia, Sydney Hearing 2, 7 September 2020, RCD.9999.0509.0001 at 0060 [285].

153 Exhibit 18-12, Sydney Hearing 2, Statement of Erica Roy, WIT.0793.0001.0001 at 0014 [77]; Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab 14, RCD.9999.0379.0001 at 0010 [6.3.3].

154 Transcript, Sydney Hearing 2, Gwendolyn Gilbert, 10 August 2020 at T8440.15-18.

155 Transcript, Sydney Hearing 2, Erica Roy, 11 August 2020, T8498.17-36; Exhibit 18-3, Newmarch House tender bundle, tab 89, NDH.0012.0002.0001 at 0006.

156 T Lum, G Shi, G Wong and K Wong K, ‘COVID-19 and Long Term Care Policy for Older People in Hong Kong’, Journal of Ageing & Social Policy, 2020, Vol 2, p 376.

157 Finding into Death with Inquest (Broughton Hall Nursing Home), COR 2007 1399, COR 2007 1397, COR 2007 1371, COR 2007 1423, 25 June 2012, p 57.

158 Transcript, Sydney Hearing 2, Carolyn Smith, 12 August 2020 at T8622.2.

159 Transcript, Sydney Hearing 2, Diana Asmar, 12 August 2020 at T8621.12-13.

160 Transcript, Sydney Hearing 2, Annie Butler, 12 August 2020 at T8622.20-22.

161 Transcript, Sydney Hearing 2, Michael Lye, 12 August 2020 at T8678.15-18.

162 Exhibit 18-2, Sydney Hearing 2, Dorothy Henderson Lodge tender bundle, tab 10, CTH.1000.0004.7114 at 7121.

163 Transcript, Sydney Hearing 2, Erica Roy, 11 August 2020 at T8482.19-27; Transcript, Melanie Dicks, 10 August 2020 at T8416.41-44.

164 Exhibit 18-12, Sydney Hearing 2, Statement of Erica Roy, WIT.0793.0001.0001 at 0014 [75].

165 Transcript, Sydney Hearing 2, Mary-Louise McLaws, 10 August 2020 at T8388.30-34.

166 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 31, RCD.9999.0382.0001 at 0008.

167 Transcript, Sydney Hearing 2, Annie Butler, 12 August 2020 at T8613.38-43; Transcript, Sydney Hearing 2, Diana Asmar, 12 August 2020 at T8611.37-40.

168 Transcript, Sydney Hearing 2, Diana Asmar, 12 August 2020 at T8611.4-5.

169 Exhibit 18-1, Sydney Hearing 2, general tender bundle, tab 15, ANMF.0020.0002.0001 at 0025-0032; tab 37, AWF.600.02042.0001 at 0016-0017.

170 Transcript, Sydney Hearing 2, Annie Butler, 12 August 2020 at T8620.46-8621.3; Transcript, Sydney Hearing 2, Diana Asmar, 12 August 2020 at T8630.2-3.

30

Appendix 9: The Royal Commission’s Finances

Appendix 9: The Royal Commission’s Finances

Our finances The Royal Commission was appropriated $93.3 million in total for 2018-19, 2019-20 and 2020-21. This comprises $90.1 million in operational funding and $3.2 million in capital funding.

The Royal Commission’s total estimated expenditure over its life is $91.7 million. This comprises $67.2 million in actual expenditure to 30 June 2020 and an estimated $24.5 million for the 2020-21 financial year.

The Royal Commission’s expenditur

e is broken down below under its key activities:

Conducting hearings:

$37.5 million over the life of the Royal Commission (41% of total expenditure). Expenditure included all costs associated with: coordinating and conducting public hearings including Commissioner, Counsel Assisting, Solicitor Assisting, Special Advisors and related staff matters; the preparation and printing of case studies and submissions; courtroom hire and related logistics; witnesses and support people; information technology services including electronic court, data management and transcription services; media announcements and liaison; and counselling and support services.

Research, policy and reports: $29.4 million over the life of the Royal Commission (32% of total expenditure). Expenditure included all costs associated with: the development of policy and recommendations; the Royal Commission’s extensive research program; and work contributing to the development of the publications entitled Interim Report: Neglect, Aged care, COVID-19: a special report and this Final Report. This also included: the commissioning of a large number of research projects related to many aspects of the Royal Commission’s work; report production costs, including writing, editing and printing; and costs related to employees who contributed to this work.

Engagement: $6.1 million over the life of the Royal Commission (7% of total expenditure). Expenditure included the cost of: managing call centre services; correspondence; and coordinating and implementing the Royal Commission’s extensive engagement activities with the community. This also included costs related to coordinating and conducting site visits, community forums and stakeholder meetings, including venue hire, Commissioner and staff costs and travel, and associated media liaison and advertising.

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Business support services: $18.7 million over the life of the Royal Commission, including $3.2 million in capital costs (20% of total expenditure). Expenditure included all costs related to supporting the operation of the Royal Commission. This included: organisational leadership costs; staffing costs for providing services such as human resources support, finance and procurement, travel coordination, and facilities management; rent and property-related costs; information technology infrastructure and support; security services; employee wellbeing initiatives; telecommunications; and office supplies.

Table 1 shows the total cost of the Royal Commission’s expenditure by major categories (actual expenditure for 2018-19 and 2019-20 financial years, and forecast expenditure for the 2020-21 financial year).

Table 1

Summary of costs for the period December 2019 to February 2021 1

Expense Total cost ($m)

Commissioners 2.430

Counsel Assisting 10.942

Solicitor Assisting 22.036

Senior Advisors 3.902

Staff cost (including labour hire) 14.901

Research and policy program 2 9.059

Financial assistance to witnesses and support persons (non-legal costs) 3 0.311

Information and communication costs including electronic courts and document management 8.219

Travel and accommodation 2.050

Venue hire 4 0.292

Office accommodation 3.342

General administration 10.983

Capital expenditure 5 3.241

Total expenditure 91.708

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Royal Commission’s Finances Appendix 9

Endnotes 1 The Royal Commission into Aged Care Quality and Safety delivered the Final Report on 26 February 2021. The expenditure reflected above includes actual costs incurred from December 2019 to October 2020 as well as estimates of the costs of the final four months of operations to February 2021, and winding

down and decommissioning costs.

2 Includes payments made to external research and policy contractors.

3 Includes travel and loss of wages entitlements to witnesses appearing before a public hearing. The Attorney General’s Department offered financial assistance to witnesses requiring legal assistance to prepare witness statements, which is not included here.

4 Includes venue hire and associated costs to hold public forums and hearings.

5 Costs associated with fit-out and information and communications technology (ICT) infrastructure.

Appendix 10: The Team of the Royal Commission into Aged Care Quality and Safety

Appendix 10: The Team of the Royal Commission into Aged Care Quality and Safety

Royal Commissioners

The Honourable Gaetano (Tony) Pagone QC

September 2019 - October 2019

Chair of the Royal Commission: October 2019 - February 2021

Ms Lynelle Briggs AO

October 2018 - February 2021

The Honourable Richard Tracey AM RFD QC

Chair of the Royal Commission: December 2018 - October 2019

The Honourable Justice Joseph McGrath

Chair of the Royal Commission: October 2018 - December 2018

151

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Royal Commission into Aged Care Quality and Safety Final Report Volume 5

Official Secretary

James Popple

Counsel Assisting

Peter Gray QC

Timothy McEvoy QC (until March 2019)

Peter Rozen QC

Richard Knowles QC

Paul Bolster

Zoe Maud

Erin Hill

Brooke Hutchins

Eliza Ber

gin

Senior Advisors

Barbara Bennett

Barbara Carney

David Cullen

Roger Fisher

Rodney Halstead

Glenn Harrison

Charles Maskell-Knight

Mary Ann O’Loughlin

Carolyn Smith

Solicitors Assisting

Louise Amundsen

Rodger Prince

Alice Bitmead

Sarah Bohmer

Nadia Bonalini

Izabela Bozym

Hanna Daych

Olivia Doray

Laura Ferguson

Adam Flynn

Isabelle Gatley

Laura Gr

oves

Meredith Hagger

Judith Jefferson

Matthew Jorgensen

Brittany Law

Brian Lian

Zoe Maxwell

Mollie McKendrick

James Middleton

Jodi Moore

Clara Palumbo

Alyssa Sallis

Cabrini Shepherd

Sam Thorpe

Anthea Windsor

Policy and Research Branch

Sara Samios

Patrick Allington

Samantha Atkins

John Avery

Aar

on Blanco

Andrew Boucher

Kylie Burgess

Samuel Bye

William Chau

Lok Chiu

Lindsay Cole

Angelica Costi

Michael Cousins

Alistair Davey

Mitchell Docking

Matthew Edge

Mary Farrell

Zoë Gill

Anna Gregory

Marlene Hall

Sallie Harrington-Downie

Sophia Harryba

Marie Heartfield

Jan Idle

Sue Jarrad

Adam Jarvis

Christopher Jones

Mikaela Jorgensen

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The Team of the Royal Commission into Aged Care Quality and Safety Appendix 10

Craig Kavanagh

Ryan Kennedy

Ellen Kerrins

Catherine Lang

Nicole Lungershausen

Rachel McDonald

Todd McInnis

Briah McKinnon-Collins

Helen McLean

Peter Meere

Beth Midgley

Rebecca Morris

Jana Norman

Kirstin Paine

Celia Painter

Olga Pandos

Thomas Pear

ce

Nicole Prouse

Nikki Quirke

Jenny Rea

Arusyak Sevoyan

Elizabeth Shears

Chloe Stoddart

Zoë Stokes

Jennifer Taylor

Joanne Tran

Melissa Vine

Di Wang

Grant Whitesman

Operations Branch

Daniel Cox

Scott Brooks

Rebecca Abbott

Natalie Ambrus-Bonazzi

Adam Bassani

Joe Bradstreet

Alana Br

ennan

Caroline Brown

Jenny Brown

Mallory Comyn

Jayne DiSotto

Joachim Dore

Mark Dowsett

Megan Eterovic-Soric

Damien Fazzalari

Danielle Grant-Cross

Angela Gregory

Kate Hannon

Halina Herring

Melanie Higashioka

Bronson Horan

Anna Javier

Belinda Lines

Claire McAlary

Mhairi Mills

Mikaela Minge

Hung Nguyen

Darcy Paine

Tara Philip

Amanda Pix

Shayl Prisk

Karen Robinson

Sam Senaratne

Louise Sheppard

Jacinta Starick

Br

ouc Trestrail

Susan Trestrail

Eli Twigg

Andrew Veimuli

Katherine Vukmanovic

Gail Ward

Carmen Yates

Consultants and advisors

David Allen

Stephen Bartos

Bridget Browne

Kathy Eagar

Brett Kaufmann

Megan Morris

Clinical Advisors

Susan Hunt

Susan Kurrle

Debra Rowett

Commonwealth of Australia

Royal Commission into Aged Care Quality and Safety

ISBN: 978-1-921091-79-7 (print) ISBN: 978-1-921091-80-3 (online)

Published February 2021