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Royal Commission into Aged Care: Will we repeat the pattern of failure?

Imagine that your son or daughter are in pain. From the minute they wake up, throughout the day and as their head hits the pillow, they’re hurting. Imagine what they are feeling and then imagine that they are unable to tell you, or anyone, and can’t do anything about it.  What would you give to alleviate their pain even if it is just for a moment?

Now imagine that you are visiting your parent at an aged care facility. You walk into their room and find that they are agitated and irritable. The people looking after them tell you ‘they’re not having a good day’ and you know that your visit is going to be a challenging one.  What if chronic pain is the cause of the bad days and it can be managed? Chronic pain is a common condition among residents of aged care facilities and effective pain management can and should be the cornerstone of any serious response to improving the quality of life of our older citizens in aged care. 

As Painaustralia continues to point out, it is estimated up to 80% of aged care residents have chronic pain. More than half of residents (52%) in aged care facilities in Australia have a diagnosis of dementia while two in three (67%) require high-level care to manage behaviour.  This suggests a high proportion of people with chronic pain also have cognitive or communicative impairment and inability to report pain.  Evidence also shows that people with dementia are living with pain and are being under-treated compared with cognitively intact persons, despite having similar levels of potentially painful disease.

The Royal Commission into Aged Care Safety and Quality Final Report (the Report) was tabled in Parliament on 1 March 2021.  Painaustralia provided a submission to the Commission and in it we provided 11 recommendations, including:

  • The Commission recognises the prevalence of pain among residents of aged care and its relationship to incidents of mistreatment and severe behaviours.
  • Targeted national pain programs are developed and implemented in residential and community aged care for staff, consumers and family, friends or representatives, and
  • Implementation of the National Strategic Action Plan on Pain Management to enhance access to best practice, community-based pain management services for older people living with chronic pain.
  • We also noted the importance of promoting The Australian Pain Society guidelines on Pain in Residential Aged Care Facilities as a useful resource that aids best practice pain management.

The Royal Commission was extensive: the final report totalling 2828 pages and the word ‘pain’ being mentioned a total of 271 times.   The context in which it is mentioned is often from the mouths of consumers to describe their experience.

Despite this and tellingly, the 148 recommendations in the Report do not mention ‘pain’. While the executive summary does, most notably that ‘Their [people living in aged care facilities] pain must be minimised, their dignity maintained, and their wishes respected’, it does not provide a clear plan on how this will be done or how pain will be managed.

Following the launch of Royal Commission into the Victorian Mental Health System on 2 March 2021, we made a similar assessment that despite a report hundreds of pages long and a clear link to chronic pain, you would expect at least some of the recommendations would address pain as a significant factor in poor mental health. 

We know that despite multiple organisations including Painaustralia have stressed the importance of managing chronic pain in addressing fundamental problems in mental health and aged care, this call seems to have fallen on deaf ears. 

It is hard to imagine that Royal Commissions that continue a pattern of ignoring the fundamental factors contributing to key failures in these service systems can really make serious progress to overcome the enormous systemic problems facing these sectors. 

While we continue to look at these issues in silos and informed by a ‘stand and deliver’ system that is already in place, we won’t see the opportunities for achieving what is possible.  That’s a disaster for those relying on these services as well as those of us who may ever need to use them or place our families in them.

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