Mandatory staff ratios in residential aged care and new laws to protect the rights of elderly people are among 124 recommendations put forward to a royal commission probing the sector.
The inquiry heard on Thursday the system has systemic failures, is rife with abuse and should be overhauled to ensure people receive high-quality care.
Lawyers assisting the inquiry have submitted a 500-page document of recommendations which will be considered by commissioners before they deliver their final report in late February.
Peter Rozen QC said there has been an absence of leadership by successive governments but this was a once-in-a-lifetime chance to make change.
“Even though the aged care system caters for more than 1.2 million older people, governments have treated it as a lower-order priority,” he said during the first day of closing submissions.
Key recommendations include a new planning regime based on demand-driven care access rather than a rationed approach, an independent process for setting quality standards and mandatory worker registration.
There is also a desire for an independent authority to determine care prices, as well as an independent Australian Aged Care Commission regulator.
Mr Rozen said a new Aged Care Act based on human rights principles should be enacted to protect the rights of older people.
After 97 days of hearings and 641 witnesses across more than two years, he said it was evident the amount of substandard care is “far too high” and abuse “remains rife”.
Almost half of the 10,000-plus public submissions referred to substandard care, he added.
He said 588 mentioned sexual assault, and the number of allegations reported to the federal health department increased from 426 in 2014-15 to 790 in 2018-19.
“It is more than two reports per day of sexual assault on average, every day of the year.,” Mr Rozen said.
He said the rate of alleged sexual assaults per 100 residents nearly doubled over that period.
Mr Rozen said the true figure of sexual assaults in aged homes was likely around 50 a week.
“The weight of the evidence before the commission supports a finding that high-quality aged care is not being delivered on a systemic level in our system,” he said.
“The level of substandard care is unacceptable by any measure.
“At least one in five people receiving residential aged care have received substandard care.”
Mr Rozen said systemic failures included a lack of skilled staff, poor planning, poor governance and leadership from providers and a lack of transparency generally.
“First and most importantly the aged care system needs to put people first. The preferences and needs of older people really should drive aged care,” Commissioner Lynelle Briggs said.
National president of the Health Services Union, Gerard Hayes, said the recommendations were a breakthrough moment and deserved support from both sides of politics.