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19 February 2018
Thank you, Uncle Chicka for the Welcome to Country.
I pay my deepest respects to you and other elders of the Gadigal People, the traditional owners of this land, and I pay tribute to your Elders, past and present.
I also want to acknowledge:
- Russell Westacott, CEO of the Seniors Rights Service.
- Dr Jane Barratt, Secretary General of the International Federation of Ageing.
- Our international guests and speakers.
- Tanya Davies, New South Wales Minister for Ageing.
- Age Discrimination Commissioner, Dr Kay Patterson.
- Distinguished speakers – and there are many.
- I also make special mention of those among us who have been affected by abuse.
- Ladies and gentlemen.
The World Health Organisation defines elder abuse as: “A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.”
The UN says senior people see abuse in three key areas:
- Neglect - through isolation or abandonment
- Violation - of human, legal and medical rights, and
- Deprivation – of choices, decisions, finance, status and respect.
This makes it even more contemptible.
It’s fair to say that appalling acts of abuse have been tolerated or gone unseen in the past, to a greater or lesser extent.
Eyes have been averted, ears have been blocked. In many cases, accountability has been found wanting.
We’re here today because we also know that abuse continues, in many forms.
The Australian Law Reform Commission, researchers and multiple Parliamentary inquiries consistently point to a lack of reliable data capturing the prevalence of abuse of our older population.
Estimates range from between 2% and 10%, with neglect possibly occurring at even higher rates.
But accuracy of data is compromised by lack of agreed definitions of elder abuse, with under-reporting also known to be significant.
Such abuse usually occurs within families, is often intergenerational - for example, with adult children as the perpetrators - and is an acknowledged form of family violence, which is also under-reported.
Much has happened in the two years since Australia’s last national elder abuse conference.
Incidents, revelations, reviews and reports - that all serve to highlight the critical theme of this week’s event: Together making change.
Before I go on, I want to reiterate that Australia has incredibly dedicated, highly trained and compassionate aged care staff, and hundreds of thousands of our seniors and their families rely on them every single day.
Nurses, carers, clinical experts and managers, who work tirelessly to provide the respect, care, dignity and support that the people who built this nation deserve.
However, a number of cases of abuse and alleged abuse continue to hit the headlines.
As appalling as these are, the publicity plays an important role in the process of driving change and reducing and averting future injustice.
Our elders must be honoured and respected.
More than a quarter of a million Australians, including some of our most vulnerable citizens, use residential care each year, including respite services.
The average age of those entering residential care is 83 – and very often, they only take that step when they become too frail or ill to remain at home.
The vast majority will enter an aged care facility and receive the additional assistance and security they require, to be able to enjoy many good years.
But there are also senior Australians who will need a lot of extra support.
When you put yourself, your parent or your partner into fulltime care it’s an act of good faith, an “expectation of trust”.
We must ensure that trust is justified - for every single person, 365 days of the year.
As the United Nations says, neglect and negligence can be key components of elder abuse.
But let’s think about that further, especially in context of our lengthening lives, and the rapidly rising percentage of seniors in our society.
By the middle of the century, it’s estimated one-quarter of Australians will be aged 65-plus, with well over 40,000 of us aged 100 or more.
I believe the time is fast approaching when we must analyse and re-consider our elders’ fundamental rights.
In broad legal terms, negligence is proven when duty of care is breached, and a person suffers foreseeable injury or loss as a result.
As I have mentioned, it’s believed that neglect of our elders may occur at even higher rates than other, more overt, forms of abuse.
If a parent neglects a child, they can be charged, because they have failed to fulfil their fiducial duty and parental responsibility.
But what about the case of an aged person in a similar situation - for instance, suffering dehydration, malnutrition, emotional trauma or other forms of neglect?
Should there be avenues of redress for our seniors, for actions that may appear far more subtle than physical assault or theft - but still represent appalling and sustained abuse?
These are some of the challenges I put to you, as we work to make a difference.
The past 10 months has been a watershed time for the issue of elder abuse.
A time of dramatic revelations, that have sparked anger and sadness - but also deep and continuing consideration of how better to safeguard senior Australians.
This increased scrutiny, particularly around aged care, began with the release last April of the Oakden report, an examination prompted by a grieving family who raised the alarm.
The Oakden Older Persons Mental Health Service was a specialist facility for people aged 65 and over, with enduring and severe mental illness, including dementia.
Since the commencement of the Aged Care Standards and Accreditation Agency and the introduction of national Accreditation Standards in 2000, Oakden had been expected to operate in compliance with those regulations.
Instead, the Oakden Report detailed years of resident neglect and abuse - especially overmedication and physical restraint – which shocked me and, I think, many Australians.
I was deeply concerned that our national system of aged care quality control had failed to protect the vulnerable elders at Oakden.
I ordered an immediate a review of Australia’s Aged Care Quality Regulatory system, appointing two highly respected independent reviewers, Kate Carnell and Professor Ron Paterson.
As it happened, as the review was gathering pace, the Australian Law Reform Commission delivered its comprehensive report on elder abuse.
The Commission had been asked to consider Commonwealth laws and legal frameworks and how they might better protect older persons from misuse or abuse and safeguard their autonomy.
Its scope was much broader than aged care, but this was an important focus, and the Commission made 14 recommendations on the sector.
These related to a new serious incident response scheme, strict protocols for the use of restrictive practices, standards for staffing and screening of workers, appointment of decision makers, and guidelines for the Australian Government’s Community Visitors Scheme.
It is only when people become more involved and shine the light into dark places, that change for the better can occur.
I want to thank the Commission, its advisory council members and everyone who contributed to this very valuable report.
I also want to thank the people who came forward to provide input to the Carnell-Paterson review.
It took more than 400 submissions and conducted over 40 consultations – and because of the scale of the response, the review was extended.
I received and released the Review in October.
It found that overall, and compared with other countries, Australia’s aged care regulatory system performs relatively well.
While complex, our current regulations and safeguards also align well with some accepted best practice regulatory principles.
But areas in need of improvement were highlighted, to ensure the fundamental and non-negotiable quality of care we expect, is delivered consistently and universally.
The reviewers said they heard from many sources, including the media, that significant problems at Oakden were known as far back as 2007.
That is when it first failed to meet certain Commonwealth aged care standards - but it continued receiving accreditation.
The Review concluded that aged care must deliver quality of life for care recipients, as well quality of care, listing 10 recommendations to improve accreditation, monitoring, complaint handling and compliance.
I moved immediately to implement Recommendation 8, introducing unannounced re-accreditation audits for all aged care homes.
Residential facilities previously had advance warning of re-accreditation inspections - this will no longer be the case.
The Turnbull Government accepts the broad direction of the Carnell-Paterson Review and is considering all the recommendations.
This includes establishment of an independent Aged Care Quality and Safety Commission to centralise accreditation, compliance and complaints handling. This would encompass the functions currently undertaken by the Quality Agency.
Like the Law Reform Commission inquiry, the Carnell-Paterson report also recommended a new Serious Incident Response Scheme, and a limit on the use of restrictive practices in residential aged care.
The recommendations represent significant changes to aged care regulation, and our full response will be announced in the context of this year’s Budget.
Any mistreatment or assault of a care recipient is unacceptable and all instances are taken seriously.
This is why providers must make reports when there is a suspicion or an allegation of assault, with these reports also directed to the police.
Residents must come first.
But we know, from evidence provided to the Carnell-Paterson review, the Law Reform Commission and this month, from the ongoing Senate inquiry into aged care quality assessment and accreditation, that this is not always the case.
As I made clear at the beginning, the overwhelming majority of senior Australians receive outstanding care from dedicated staff - but our measuring stick must be “all of them”.
Staff are fundamental to the provision of a safe environment that minimises the chances of neglect, violation or deprivation – the three grim pillars of elder abuse.
Though the rise of technology is already rapidly advancing our aged services and promises even more efficiencies, there will be no substitute for human skills, touch, consideration and compassion.
That is why ensuring Australian aged care has a strong and adequate supply of appropriately trained, skilled and resourced staff is a top priority.
Starting last November - and with a $2 million budget to support detailed consultation and research across the country – Professor John Pollaers is leading a taskforce to produce Australia’s first aged care workforce strategy.
With staffing needs predicted to grow from around 360,000 now, to almost one million by 2050, skills and workforce development is critical.
As Professor Pollaers said recently:
“We all need to be proud of the care provided to older Australians, and to achieve this we must be able to attract and retain a well-trained workforce that has a clear sense of purpose and belonging.
“A wider, shared belief by the community as a whole is also required if we are to age well and create a system we are all proud of.
“To truly connect with the community, aged care providers must never forget the human element and need to view families, communities and carers as a resource to be harnessed.”
I agree totally with these sentiments and I look forward to receiving the workforce strategy in July.
Aged care has changed greatly and will continue in transition, as we work together on further change to guide excellence, safety and choice in care for decades to come.
While the Government is implementing unannounced re-accreditation audits and responding to the Carnell-Paterson Review, the Quality Agency has conducted its own independent review and tightened quality monitoring and accountability.
This includes close collaboration between the Agency and the Aged Care Complaints Commissioner, and improved information sharing and case coordination when there are risks identified and breaches found.
A new digital audit tool has also been introduced, to streamline inspections and the gathering of randomly selected aged care residents’ opinions on key issues including safety, healthcare and their treatment by staff.
Since September, these consumer experience reports have been published for public scrutiny, on the Quality Agency’s website.
Last month the draft new Aged Care Quality Standards were released and I expect the final standards will be implemented from the middle of this year.
This is an important step in strengthening the quality of care and ensuring we are setting best-practise benchmarks for providers.
In July last year, I also launched the national Older Persons Advocacy Network, a service dedicated to standing up for the rights of senior Australians, by giving them and their families a stronger voice.
The free program provides confidential, personal advocacy in every State and Territory, around home care packages, residential aged care services and the Commonwealth Home Support Programme.
All senior AustraIians have a fundamental right to expect safe, dignified treatment, devoid of any kind of abuse.
Whether concerns are raised by aged care residents, family members, staff, community visitors or government officials – they must be heard and they must be acted on.
Those responsible must be called to account.
We must keep on uncovering these injustices, continuing to shine light into dark corners, and searching deeply for forms of abuse that may be less obvious.
This is a time of considerable social change, in terms of addressing power imbalances and inequities.
Like you, I am determined that it’s also time for significant improvements in relation to elder abuse, whether in aged care or within the broader community.
I wish you every success in our shared mission to respect, and protect, senior Australians.
Together, we will make change.