THE forensic investigation into the past systemic failures of Australia’s aged care sector is a major focus of the Royal Commission into Aged Care Quality and Safety and, perhaps unsurprisingly, the most attention grabbing, but it is just one avenue of enquiry under the Royal Commission’s terms of reference.
Arguably, just as important are the Royal Commission’s inquiry, deliberation and subsequent recommendations for the future of aged care services in Australia.
That work is well underway. Released late in August, but garnering scant media attention, was the eighth such study that will help underpin those recommendations; a report commissioned by the Royal Commission titled International and national quality and safety indicators for aged care.
Palliative Care Australia (PCA) welcomes the report, but the surprising feature of the study is not what is contained within its 189 pages, but rather what has been left out: a necessary focus on palliative care.
Prepared by the South Australian Health and Medical Research Institute (SAHMRI), the report is a first step in addressing a current gap in the aged care system – a paucity of evidence-based quality and safety indicators – one labelled by the Royal Commission as “unacceptable”.
Currently, Australia has a limited program of quality indicators for residential aged care. Since 1 July 2019, residential aged care providers have been required to report on pressure injuries, use of physical restraint and unplanned weight loss. But if Australia is to better ensure that “aged care services are of high quality and safe” as per the Royal Commission’s remit, there must be a more comprehensive program of indicators across all aged care programs. Along with improving the standards that address the accreditation and assessment of individual facilities and providers, we must also adopt a set of indicators that provide us with the bigger picture: indicators that tell us how the aged care sector is performing across states, the territories, regions and nationally.
That’s exactly what the SAHMRI study examined, concluding that an independent body is set up to oversee quality monitoring and reporting in Australia and stating that “a well-designed, comprehensive, and effective quality and safety indicator reporting system can be implemented to capture important indicators of care that will inform and ultimately improve health and wellbeing outcomes for Australia’s older population”.
Notably, SAHMRI found that a wide range of quality indicators can be produced from existing data without any burden to aged care providers.
Still, the absence of specific palliative care indicators in nearly all the 11 countries examined is a concern.
The recommended indicators have a strong focus on issues such as medications and pain management, wound care, care plans, nutrition and weight loss, hospital admission and falls and fractures. In several instances, the data collected actively excludes palliative care patients.
The only country with any palliative care indicators is Sweden and these indicators are very narrow in their scope. Sweden collects data on the share of persons deceased at age 65 years or older who before death had a conversation in which they were informed about their situation, as well as data on the percentage of persons deceased at age 65 years or older who had an assessment of pain during their last week in life.
More useful would be the collection of data that highlighted what level of access residents in residential aged care facilities had to specialist palliative care.
Another valuable metric is the number of avoidable hospital admissions and/or avoidable incidence of non-beneficial care by older people receiving palliative care.
With the inclusion of these, together with other valuable and meaningful metrics, Australia has the opportunity to lead the world in the development of a suite of robust quality palliative care indicators.
A reminder, if one was even needed, came in a follow-up article published by the Royal Commission late in August, which found that without meaningful investment in aged care services, monitoring of standards and quality indicators will only get us so far.
Conducted by the University of Queensland, Access Research Paper 9 – The cost of residential aged care, found that higher funding was needed for residential aged care just to meet basic standards. Even more funding was needed for reform to achieve high quality care in Australia.
Palliative care is a critical component of aged care and cannot be overlooked.
Speaking to the media in July the Prime Minister Scott Morrison acknowledged as much, stating: “The nature and demands on our aged care services have changed”, and reminding Australians that people are entering residential aged care with more complex and chronic conditions than in the past, and with many likely to require palliative care.
In our submissions to the Royal Commission, PCA has consistently called for the existing Aged Care Quality Standards to specifically include palliative care. PCA has already invested heavily in this space, releasing in 2018 the National Palliative Care Standards (Edition 5) following consultation with the palliative care community and other stakeholders. PCA is also engaged in the development of a supplementary standard for generalist palliative care
Just as important, the much-needed new system of reporting against quality indicators must also include specific indicators that can support access to quality palliative care, when and where it is needed.
Professor Meera Agar is the Chair of Palliative Care Australia.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.