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Tighter controls threaten choice for aged care consumers

14th August 2019

This week the Royal Commission into Aged Care is focusing on regulation, exploring how regulatory instruments might assist in improving the safety and quality of aged care services. More regulation, or tighter regulation, may seem an obvious response to failures of care such as those that have been highlighted by the Commission.

But there are risks with a more heavy-handed approach to regulation. First, a top-down approach is likely to engender a ‘box-ticking’, compliance-focused attitude to quality standards and result in a minimum-standards culture. An externally-driven, compliance-focused approach does not foster a culture of good quality and continuous improvement in which all employees understand and embrace their role in ensuring quality of care.

Second, and more importantly, a more burdensome regulatory regime is likely to reinforce the traditional risk-averse culture which permeates many aged care services, particularly residential care. This culture prioritises safety and protection rather than choice and quality of life. It is at odds with current policy directions to support greater freedom of choice for people receiving aged care services.

Under the new Aged Care Single Quality Standards which took effect from 1 July this year, the first, foundation standard requires that aged care consumers can “live the life they choose”. There is a tension for providers under current arrangements to balance enabling these choices against other requirements, including ensuring that residents will be free from harm and provided best-practice care. If a person’s preference is to walk the local streets around the residential facility where they live, unaided and unaccompanied, despite being assessed as at risk of falling, what should a provider do? If a resident insists that they want to have bed poles (poles to assist getting in and out of bed) despite these being inconsistent with current best practice, what should a provider do? Tighter regulations will push providers to err on the side of preventing possible harms, at the expense of residents being able to exercise choice about things which matter to them.

There is no disputing that there needs to be an appropriate regulatory framework which holds aged care providers to account for the quality of care they provide. Everyone has the right to expect minimum standards of care. The new Single Quality Standards have raised the bar significantly in terms of respecting the rights, preferences and choices of people using aged care services, and that is a welcome change. Accreditation processes have similarly shifted to a greater focus on feedback from consumers and their close associates about their experiences of care. These processes provide good mechanisms for monitoring quality of care.

Instead of building more extensive regulation for aged care in an effort to improve quality, government would be better off investing in policies which incentivise person-centred care and quality of life outcomes. This includes funding instruments which align with quality outcomes rather than deficits or clinical needs and the new Standards in addition to regulatory policies. Consistent principles across these will support aged care providers to have enough staff, with the right skills and attributes, to deliver high quality care. When providers focus on understanding each individual; their preferences and their story as well as their health and medical needs; they come to know what matters to them and how they can support their quality of life, not simply meet their health and medical needs. In the end, this is what will deliver the care that is expected and valued by older people and their families.

Dr Catherine Joyce is General Manager, Quality, Outcomes and Research, at Benetas.