This week, the Royal Commission into Aged Care Quality and Safety (Royal Commission) held its Hobart hearing from 11-15 November 2019. It inquired into the operations of selected Approved Providers that operate residential aged care facilities in Tasmania and elsewhere in Australia. Here, we summarise the activities of each day.

Day 1 – Monday 11 November

The first day of the Hobart hearing began with an address by Senior Counsel Assisting, Peter Rozen QC, who stated that the focus of the hearings would be the governance of aged care providers and that this would be examined by looking at two case studies – Southern Cross Care and Bupa South Hobart. Helen Valier was the first to give evidence, speaking about her husband's experience as a resident in Yaraandoo Hostel (Yaraandoo), followed by Tammy Marshall, the Clinical Care Coordinator at Yaraandoo who spoke of the poor communication between operational staff and executive management. The third and fourth witnesses, Jo-Anne Cressey Hardy and Kylie Bennett, spoke of the challenges they experienced as nurse advisers and administrators at Yaraandoo, before former Facility Manager, Patrick Anderson, told the Royal Commission about the inadequate level of staff training provided to employees at Yaraandoo and the limited engagement of the Board in the operation of the facility. The final two witnesses for the day, Mary Sexton and Ann McDevitt, gave evidence regarding their experience with Glenara Lakes residential care facility where their relatives were given inadequate and insufficient care.

Day 2 – Tuesday 12 November

The case study on Glenara Lakes continued on the second day of the Hobart hearing, with the first witness for the day, Judith King, detailing the inadequate care her husband experienced at Glenara Lakes. The next two witnesses, both former Facility Managers at Glenara Lakes, together spoke of the outdated and inefficient reporting processes deployed and the lack of support offered by senior management. The fourth witness, Andrew George Hamlyn, is the ACFI Coordinator for Southern Cross Care (Tas) and he outlined the institutional funding arrangements currently in place. Former Director of Finance for Southern Cross Care (Tas) then gave evidence about the 'Pathway to Break Even' program which was to reflect a movement towards 60% of the operational income to be spent on the cost of operations at facilities. Pauline Robson, former Executive Manager for Home Care and Residential at Southern Cross Care (Tas) elaborated on the operation of the 'Pathway to Break Even' program which noted that there was not a correlation between high staffing levels and high quality outcomes. The final witness for the day was the CEO of Southern Cross Care (Tas), Richard Sadek, who apologised to residents and families who had similar experiences at Yarandoo and Glenara Lakes to those described during the course of the hearing. He took responsibility for the appointment of inexperienced facility managers and acknowledged the lack of support provided to staff generally, as well as the deficiencies in reporting structures

Day 3 – Wednesday 13 November

The Southern Cross Care (Tas) case studies continued on day three, with the Chairman of the Board and former Chairman of the Board, Stephen Shirley and Raymond Groom respectively, detailing the role of the Board in operational practice and identifying areas for improvement. The final witness to give evidence in in the Southern Cross Care case study detailed her positive experience residing at Fairway Rise, where she found the Facility Manager was experienced and the staff were helpful. Senior Counsel Assisting then introduced a further case study, relating to Bupa Aged Care South Hobart (BSH) which had sanctions imposed upon it in response to instances of misconduct and the provision of substandard care. Diane Daniels was the first to give evidence on BSH, describing the physical and verbal abuse her 95 year old mother encountered at BSH. Dr Elizabeth Monks, a GP employed at BSH, then described her experience working at BSH where she observed a bullying culture amongst staff and poor management which she attributes to the sanctions which were eventually imposed.

Day 4 – Thursday 14 November

Day four of the Hobart hearing began with Merridy Eastman describing her parents' experience at BSH which she found to be poorly staffed and not efficient in meeting her parents' care needs. The second scheduled witness was David Neal, former General Manager of BSH, however he failed to accept service of the summons and therefore did not appear to give evidence. Elizabeth Wesols, Regional Manager at Bupa Aged Care Australia and Stephanie Hechenberger, former Regional Director of Bupa Aged Care Australia then gave joint evidence on the clinical arrangements at BSH. Both attested that the model of care at BSH had undergone a transition that resulted in a reduction of staff and nursing hours. The fifth and six witnesses also gave evidence together, with Linda Hudec, former Head of Clinical Services Improvement at Bupa Aged Care Australia and Davida Webb, former Head of Operations, speaking on the role of clinical services improvement at BSH which relied on an ineffectual audit system, that reduced the standard of care, along with several other management failings. A former adviser to BSH, Tiffany Wiles, then spoke of the issues she encountered at BSH where she found cost cutting to be the key focus for management, rather than caring for residents. The final witnesses for the day were three former administrators at BSH, who outlined their views as to the reasons for the many failings at BSH, which included a lack of transparency, poor management and no scope to provide feedback and views.

Day 5 – Friday 15 November

The final day of the Hobart hearing opened with two witnesses who gave evidence about the experience of their father who resided at BSH and the poor level of care he was provided. Bethia Wilson AM and Dr Penny Webster then gave evidence regarding their engagement as consultants to inspect Bupa facilities, following the imposition of sanctions. The Managing Director of Bupa Villages and Aged Care New Zealand then outlined the effect of high staff turnover and loss of corporate memory on aged care organisations, with unstable leadership being responsible for these trends. The final witness for the Hobart hearing was Catherine Maxwell, General Manager Policy and Advocacy at the Governance Institute of Australia, who outlined her view as to the three most important factors for successful clinical governance being a skilled and effective board, good culture and good management practices. The hearing concluded with Senior Counsel Assisting summarising the week's evidence, noting that, in the context of the case studies, the provision of quality care had been insufficiently prioritised in favour of financial considerations, with troubling and disturbing consequences.

The Royal Commission hearings will resume in Canberra on 9 December 2019. The Canberra hearing will inquire into interfaces between the aged care system and the health care system, including both Commonwealth and state/territory programs. It will examine whether older people, particularly those living in residential aged care facilities, are able to access the health services they need as they age.