Rebuilding trust and keeping older Australians safe through safeguarding

The role of aged care providers is to support and care for older Australians, ensuring they live their best life and achieve the best possible outcomes through the provision of quality and safe care.

The Royal Commission into Aged Care and Quality and Safety (Royal Commission) was established to examine quality and safety in our aged care system because feeling safe and being safe, is core to the overall health and wellbeing of older Australians, and is why safety is the foundation of quality.

The Royal Commission paints the image of an outdated aged care system that is, far too often, failing to provide safe and quality care to its older Australians. Witness accounts detailed various instances where older Australians were not always appropriately cared for and didn’t always feel safe. Recommendations detail the fundamental reform and overhaul required to ensure that the way older Australians are provided safe and high quality outcomes, and the way government regulates, transforms to ensure we put the needs, safety and wellbeing of older Australians first.

Safety focuses on avoiding harm, quality focuses on doing things well. Simply put, safety raises the bar by making it less likely for harm to occur, mistakes to be made or incidents to transpire. Conversely, quality raises the ceiling, so the overall care experience focuses on the needs of older Australians, continuously improves and ensures things are done well, in an efficient, effective and purposeful way. Together, high quality and safe care improve outcomes by ensuring care is delivered in the right way, at the right time, and with the right outcomes.

Providing safe and high quality care means to provide care where older Australians feel empowered, valued, as though their rights are protected and in a comfortable environment that is free from abuse, neglect or harm.

Elder abuse is “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".¹ Elder abuse includes sexual, physical, emotional and psychological abuse, financial abuse and neglect.

In its 2017 report ‘Elder Abuse – A National Legal Response’², the Australian Law Reform Commission recommended that Adult Safeguarding laws be introduced to keep Older Australians safe. Further, The Council of Attorneys-General National Plan to Respond to the Abuse of Older Australians (2019–2023), highlights that States and Territories should strengthen safeguards and regulation for older Australians.³

The Royal Commission recommends the establishment of a new aged care system, with independent and authoritative accreditation and regulation are fundamental. Providers are being called upon to respond to the ongoing endemic of elder abuse in our society and required to continuously implement change to prevent and protect older Australians from harm. Compliance with the expanding remit of the Aged Care Quality Standards will be one measure. But key will be the implementation of safeguards to deliver safe outcomes.

Safeguarding ensures older Australians feel valued, safe and heard. It includes the policy, practice, risk management, capacity building, education, leadership, governance and culture, continuous improvement and assurance an organisation implements to keep the older Australians it supports and cares for, safe.

Safeguarding ensures providers are better placed to deliver safe and quality outcomes and reduces the likelihood of intervention; that is actions required to improve outcomes by understanding where risks might lie and what safeguards will prevent these risks from occurring. Safeguarding means that older Australians’ safety, health and wellbeing is always put first.

By 2050, there will be more people globally over the age of 60 than there are children, so the need for safeguarding of older Australians has never been more important.⁵

The Royal Commission heard numerous accounts of abuse that occurred at the hands of staff members, and of situations in which residential aged care providers did not protect residents from abuse by other residents.

It was reported that in 2019–20, 5,718 allegations of assault in residential aged care were reported under the mandatory reporting requirements of the Aged Care Act.⁶ However, research suggests that a further 27,000 to 39,000 alleged assaults occurred that were exempt from mandatory reporting because they were resident-on-resident incidents.⁷

Internationally, the concept of Adult Safeguarding is mature. For example, in England the introduction of the Care Act 2014 established a legal framework for how authorities and organisations should react to suspicion of abuse or neglect. The Adult Protection Act 2014 in Nova Scotia, Canada, articulates roles and responsibilities of responsible parties, both formal and informal, in the protection of vulnerable adults and legislates mandatory reporting. However, such responses and preventions of Elder Abuse are underdeveloped in Australia.

The Royal Commission has highlighted significant shortfalls in Australia’s aged care system, including how providers must better understand the relationship between quality and safety, and how safeguards can be used to improve the delivery of care and outcomes for older Australians. The need to hear the voice of, and ensure older Australians are at the centre of the aged care system has also driven the requirement to update and continuously review the Aged Care Quality and Safety Standards. However, providers need to go above and take action to prevent harm and provide a safe environment to help older Australians thrive. Providers and regulators are now presented with an opportunity to assess and evaluate how their safeguarding practices keep older Australians safe and support the delivery of quality outcomes.

As providers cautiously look beyond the global coronavirus pandemic and the Royal Commission, approaches to quality and safety will be in the spotlight. Contemporary safeguards are not linear, where a safety culture should be fostered at an organisational level through leadership, governance and strategy.

Additionally, safeguards should be embedded at a tactical level (for example, within incident management processes). For providers, this means strengthening their safeguarding framework, including the systems, processes and practices which support:

• participation, access and choice
• hearing the voice of older Australians and ensuring they feel valued
• quality and consistent practice
• recruitment and screening practices
• workforce capacity and capability
• provision of safe environments, including culturally safe environments
• complaints, incident and risk management.

Safeguarding requires leadership, and a culture that permeates through the organisation, coupled with capacity building, effective governance and continuous learning. This means more than policy; it means embedding the prioritisation of the needs, safety and wellbeing of older Australians across people, process and practice.

It requires organisations to take a preventative approach, as well as a developmental approach that enables older Australians to have a voice, a community and support networks, together with ongoing assurance to continuously improve and, above all, listen to and hear older Australians. People feel safe in an organisation when they are heard and valued. Older Australian’s needs and wellbeing must be prioritised.

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