Issues of Nursing and Midwifery in Aged Care: Royal Commission Report

This report analyzes the Royal Commission into Aged Care Quality and Safety, initiated by the Australian government in response to concerns about the treatment and care of the elderly. It highlights the role of stakeholders, including policymakers, service providers, and residents, and addresses unmet needs such as healthcare access, economic challenges, and social isolation. The report delves into ethical considerations, the involvement of organizations like the Australian Association of Social Workers, and the challenges faced by aged care facilities, particularly concerning staffing shortages and the impact on patient care. The report also explores the problems encountered by nurses, midwives, and social workers, emphasizing issues like homelessness, poverty, and the traumatic experiences of the elderly, ultimately advocating for improved standards and policies to ensure the well-being and safety of the aged population. The report also emphasizes the importance of staffing ratios and the need for skilled workers in the aged care system, highlighting the impact of inadequate staffing on the quality of care provided. The report also explores the challenges faced by nurses, midwives, and social workers, including homelessness, poverty, and mental health issues. The report concludes by advocating for improved standards and policies to ensure the well-being and safety of the aged population.

Running head: ROYAL COMMISSION INTO AGED CARE AND SAFETY
ROYAL COMMISSION INTO AGED CARE AND SAFETY
ISSUES THAT ARISE IN AREAS OF NURSING AND MIDWIFERY IN AGED CARE
May 2019

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Introduction
Royal Commission into Aged Care Quality and Safety was formed on 8th October in
the year 2018 by the initiative taken by the Government of Australia under the Royal
Commissions Act 1902. The present commissioners of the Royal Commission are Mr.
Richard Tracey and Ms. Lynelle Briggs. The construction of the body can be rested on the
case of a male patient who was attaining treatment at the Oakden Older Persons Mental
Health Services that is situated in Adelaide in the South of Australia. He was referred to
Royal Adelaide Hospital where it was discovered that there were bruises on his body that the
hospital could not back with any significant evidence. The authorities from that incident
noted that there were a number of issues that are faced by certain people from the older age
group. There are incidents where individuals who belonged to their families and at the
organizations harassed the patients who suffered from many psychological issues where they
were sent for attaining medical care. In order to assure that those who suffer from any
problem that was physical and psychological. After the organization of Australian Aged Care
Quality Agency failed to provide heed to the issues experienced by the older population, the
Royal Commission into Aged Care Quality and Safety came into being. The situation arose
from many incidents that were reported about the beatings and harassments of people who
belonged to the old age.
The stakeholders
Stakeholders are the individuals who form a group and are primarily affected by the
policies that are implemented in the society. The stakeholder groups include those who are
involved in policymaking, the participants who perform the research and the advocacy groups
(Lawrence & Weber, 2014). Social mechanisms are necessary for implementing the policies
and their effects on them. Various branches of the government work for the welfare of the

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elderly and for this purpose they employ professionals who hear the needs of the affected
people and provide response to them. The service providers, residents of the area or the
country and those who make the policies of welfare are the ones who are the primary
stakeholders in the society.
Unmet Needs
The aged people in the society suffer from the lack of healthcare needs that is the
prime issue that they are facing. Health concerns are constantly on the rise due to the non-
availability of free healthcare facilities. The aged people suffer from economic crisis that
result in the reduction of their health standards. The unemployment issue increases the
economic crisis and there is a need to address them. The lack of justice adds to the problem
that is further aggravated by the increase in poverty rates. The aged people are banished from
the society by their families has increased number of people in the aged care homes. The
increased number has led to pressure on the facilities that are made available for them. Social
workers and nursing staff who are involved in the process of providing care face the tough
conditions and leads to the substandard facilities (Head & Alford, 2015). The clinical patients
are often reported to suffer from the adversities at the hands of the staff in the nursing homes
and aged care homes. The is the factor that contributes to the growing need of including
policies that are aimed for the development of the aged people who are left in the homes and
require immediate care of the staff.
Social impact of the issues
The issue of violence and harassment of the people in the society are witnessing an
upward trend that has led to conflicting situations regarding the health and safety of the old
aged. A number of challenges faced by the elderly patients who suffer from psychological
and social issues (Rueschemeyer & Skocpol, 2017). The social structure has suffered a lot

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due to the fact that the elders are constantly facing issues of violence despite various
measures being adopted by the government to stop the issues.
Ethics and Values in Royal Commission
The concept of ethics and values are familiar in the every activity that takes place in
the society. There is difference of opinion amongst the individuals who co-exist in the
society. The difference in opinion is contributed by the customs and traditions in the society.
The ethical issues that are faced by the commission is that they strive for the welfare of the
aged that in the opinion of some is viewed as the negligence of the youth in the country
(Lawrence & Weber, 2014). It takes care of the safety of the elderly people who often face
abandonment from their families.
The Australian Association of Social Workers
The Australian Association of Social Workers is an organization that consists of
professional individuals who work for the welfare of the society. This organization came into
existence in the year 1946 and from that time, it has worked for the well-being of the society.
They follow a set of practices for bringing reforms in the sector of education, justice and
rights of the individuals (Wadsworth, 2016). The organization carries the research on the
basis of the social and economic changes in the society and publishes a journal about the
results obtained. The Australian Association of Social Workers employ professionally trained
individuals who are capable to handle the issues with precision.
The policy proposal is a detailed document that provides insight in the policies that
are adopted by the government for the welfare of the stakeholders. It is created by keeping in
consideration the issues that arise in the society. The policies were proposed including the
healthcare and disabilities of the old people irrespective of the areas where they reside. The
proposals were made regarding the safety of the old aged people. Standard care measures

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should be applied that will reduce the impact of poverty on the elderly. They should be
provided with housing facilities that will lead to proper shelter facilities. The rights should be
guaranteed that will ensure the proper working of the social structure. The elderly people in
the society require attention from the policy makers that will help in making laws that are
friendly towards their needs. Proper enquiry should be carried out that will help in the process
of identification of the individuals who are in need. The success of the policies depend on the
accurate identification of the individuals who are involved in the process of making the
policy. The communication between the individuals should be clear that will ensure smooth
functioning of the process of policy making. This body of social workers work with the royal
commission for the wellbeing of the aged.
Challenges in the Royal Commission
Staff Challenges in operating in the Aged Care System
The main challenge in the areas of aged care is related to staffing because the care that
is provided to the people in the aged care homes and hospitals are the substandard quality of
the treatment. The skills that are required for providing care to the aged requires precision of
skills and reliability (Stein-Parbury, 2013). It has been observed that after providing
healthcare in the aged care system that there is a severe lack of staff that possesses skills
necessary to take care of the aged. Aged Care and Community Services Australia is an
important body that has looked into the matter. The need for the full time workers who are
related with this industry is on the rise (Andrew Scanlon et al., 2014).
Staffing ratios
To ensure that proper care is provided to the patients, there should be a proper
mandate that should be included to provide proper care to the patients. Staffing is a primary
step to ensure the safety of the patients whereas any discrepancy in the staffing leads to

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threats to the life of the patients by lowering the standard of services. The areas when the
nurses face threat in their job and suffer from excessive workload that leads to the
termination of services. There are about 300 public reports received by the Royal
Commission into Aged Care about the low standards of care that are provided to the aged.
Inadequate staffing is the main issue that has been raised into the healthcare sphere (Chiarella
& Adrian, 2014). The Royal Care Commission into Aged Care prescribed that there should
be improvements in the structure to meet the demands of the patients. Most of the reports are
concerned about the incidents that are faced by the aged in the nursing homes and aged care
homes (Daly, Speedy & Jackson, 2017). The elderly population deserves best quality services
with high safety and that assures them proper respect and well-being. The lack of staff in the
healthcare facilities proved that there is a need to mend the gap between the staff and the
number of patients. The Australian Nursing and Midwifery Federation is an active body that
works for bridging the gap in these ratios. The New South Wales Nurses and Midwives’
Association is a body that provides skilled nurses who are active in the process of providing
healthcare (agedcarequality.gov.au, 2019). The NSWNMA consists of 64,500 members who
are registered with the union. They try to solve the problem of ratio by providing over 10,500
skilled nurses and midwives who work for the welfare and well-being of the aged care (Scott
et al., 2015).
Care in aged care home
The above issues mentioned show how the elderly population is suffering and how
their values have been reduced in the society. As the aged population is unable to contribute
to the society the value that they earlier had in the society is reduced. Residential aged care
homes that provided facilities to the aged are under threat. The issues that are faced by the
people living in the aged care homes as the workers lack the skills required for providing care
to the aged (Katsikitis et al., 2013). The lack of precision in providing care is also rested on

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the fact that many individuals who are engaged in the work of providing care to them are
mainly over aged and cannot adapt to the modern skills required in nursing (Gardner,
Gardner & O'connell, 2014). The over-burdened workers due to the lack of skilled staff
increases the problem in the healthcare sector. As the organizations who provide care to the
individuals in the aged care homes do not get sufficient financial gains that also contributes to
the lack of interests they have in their services. It is noted that in an aged care home there
were was only a single nurse who had the duty of providing care to 73 people. This resulted
in the delay of identifying the problems of that are faced by the patients in the nursing homes.
This has created deterioration in the health of the patients. The reliability on the nurses and
the midwives has decreased as the behaviour and the standard care provided has become low
(Verrall, et al., 2015).
Problems faced by nurses, midwives and social workers.
The social workers, nurses and midwives often face issues that are related to
homelessness, poverty, lack of healthcare facilities and mental issues (Roche et al., 2015).
They work in adverse conditions in the society where they have to experience several
barriers. The traumatic experiences that the elderly people have experienced are a major
concern for them The trauma makes them vulnerable and they do not want to take the help
from any unknown and external sources (Sheen, Spiby & Slade, 2015). They work with the
nurses and the midwives in the aged care homes at the local level that help them to identify
the problems in that particular area which helps them to help the affected individuals
(Kirkevold et al., 2013). In most of the cases the nurses, midwives and social workers fail to
avail help from the community centers and provide proper solution to the issues that are faced
by the aged people. The workers lack the skills to cope up with the situation faced by the
patients and that creates conflicting situation amongst them (Greene, 2017).

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Recommendation to the Royal Commission
The implementation part of the policies should be carried out at the governmental
level. It should include the legislators, bureaucrats, courts and the organizers of the
community events in the process of implementation. It should be implemented by proposed
legislations by the government. Legislative monitoring should be done to prevent any
discrepancy. The governments at the federal and local level should help in the implementing
the policies that are to be adopted for the welfare of the elderly. Different agencies that are
working together for the welfare of the people residing in the society should implement
policies keeping in view the provisions that are required by the people (Owen, 2014).
Professional organizations should adopt new programs that are suited to the needs of the
society to monitor and control the activities of the organisation. The participation from the
volunteer groups should be necessary for the process of implementing the policies. The
barriers in the adoption of the new policies should be removed as they generally arise due to
the difference in the opinion of the individuals involved in the adoption of the policies.
Demands of the public should be kept in mind and the resistance from the public should be
dealt carefully without creating dispute in the society. There should be an authoritative
backing of the laws that are enacted for the implementation of the policies that will ensure
proper implementation (Lawrence & Weber, 2014). Skillful professionals should be involved
in the process of making policies that will ensure effective policies. A separate authority
should be given the charge for the implementation part that will ensure that the process is not
biased (aph.gov.au, 2019).
The government should adopt the means of providing positive sanctions such as
providing favorable public opinion, price supports, financial aids and direct benefits that are

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related to the direct services. Administrative decision-making, rule-making, adjudication,
enforcement of laws and operational activity of the programs and policies. The senators
should be exposed to the issues that are faced into the sector of aged acre by the patients as
well the workers that will provide them a clear picture of the difficulties faced by both the
stakeholders.
Active Participation from the Aged Community
The aged should have a say in the legislations that are used in the sphere of aged care
as they are the ones who are exposed to this process (Williams & Elmore, 2014). They should
be called for the sessions that are held for the formulation of the policies and suggestions
should be taken from them to evaluate and analyse the effectiveness of the policies that are to
be formulated. Active participation helps in the efficiency of the policies.
Conclusion
Thus, it can be concluded that the Australian Association of Social Workers is the
body that comes under the Royal Commission into Aged Care Quality and Safety that works
to solve the issues that are faced by the elderly population in the society. They work to solve
the problems and maintain the rate of their well-being. Different policies are adopted to
tackle the issues and the plans for their proper formulation and implementation are discussed.
The barriers that possibly arise in the areas of implementation and adoption of the policies
can be removed by the proper execution of the plans that are adopted. This creates a sense of
responsibility in the policy makers to achieve the desired rate of well-being in the elderly
population. The elderly population deserves the attention of the policy makers helping them
to develop policies that are best suited to them.

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List of supporting documents
agedcarequality.gov.au (2019). Home | Aged Care Quality and Safety Commission. [online]
Agedcarequality.gov.au. Available at: https://www.agedcarequality.gov.au [Accessed
18 May 2019].
Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N.,
Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues
impacting advanced nursing practice worldwide. Online journal of issues in
nursing, 19(2), 1.
aph.gov.au (2019). Home – Parliament of Australia. [online] Aph.gov.au. Available at:
https://www.aph.gov.au [Accessed 18 May 2019].
Chiarella, M., & Adrian, A. (2014). Boundary violations, gender and the nature of nursing
work. Nursing ethics, 21(3), 267-277.
Daly, J., Speedy, S., & Jackson, D. (2017). Contexts of nursing: An introduction. Elsevier
Health Sciences.
Gardner, G., Gardner, A., & O'connell, J. (2014). Using the Donabedian framework to
examine the quality and safety of nursing service innovation. Journal of clinical
nursing, 23(1-2), 145-155.
Greene, R. R. (2017). Social work with the aged and their families. Routledge.
Head, B. W., & Alford, J. (2015). Wicked problems: Implications for public policy and
management. Administration & society, 47(6), 711-739.

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Katsikitis, M., McAllister, M., Sharman, R., Raith, L., Faithfull-Byrne, A., & Priaulx, R.
(2013). Continuing professional development in nursing in Australia: Current
awareness, practice and future directions. Contemporary Nurse, 45(1), 33-45.
Kirkevold, M., Moyle, W., Wilkinson, C., Meyer, J., & Hauge, S. (2013). Facing the
challenge of adapting to a life ‘alone’in old age: the influence of losses. Journal of
Advanced Nursing, 69(2), 394-403.
Lawrence, A. T., & Weber, J. (2014). Business and society: Stakeholders, ethics, public
policy. Tata McGraw-Hill Education.
Owen, G. T. (2014). Qualitative methods in higher education policy analysis: Using
interviews and document analysis. The Qualitative Report, 19(26), 1-19.
Roche, M. R., Duffield, C. M., Dimitrelis, S., & Frew, B. (2015). Leadership skills for
nursing unit managers to decrease intention to leave.
Rueschemeyer, D., & Skocpol, T. (Eds.). (2017). States, social knowledge, and the origins of
modern social policies (Vol. 4847). Princeton University Press.
Scott, A., Witt, J., Duffield, C., & Kalb, G. (2015). What do nurses and midwives value about
their jobs? Results from a discrete choice experiment. Journal of health services
research & policy, 20(1), 31-38.
Sheen, K., Spiby, H., & Slade, P. (2015). Exposure to traumatic perinatal experiences and
posttraumatic stress symptoms in midwives: prevalence and association with
burnout. International journal of nursing studies, 52(2), 578-587.
Stein-Parbury, J. (2013). Patient and person: Interpersonal skills in nursing. Elsevier Health
Sciences.