Summary: Recommendations made to the Royal Commission into Aged Care Quality and Safety

Summaries of Recommendations: Royal Commission into Aged Care

Between October 2019 and January 2020, The National LGBTI Health Alliance (The Alliance) made three submissions to the Royal Commission into Aged Care Quality and Safety. These three submissions used material gathered from a series of consultations with LGBTI elders, their family, friends and carers in a number of locations around the country, as well as input from online surveys from our members and the broader community.  

We are also running 2 online surveys. One with general questions for people who may not be able to attend a face-to-face consultation and also one specifically aimed at the Bisexual community. Please share these surveys in your social media and through your networks.

General submission October 2019

Our first submission was a general exploration of the issues for LGBTI older people who access aged care.  We held a series of consultation workshops around the country, and an online survey, to collect experiences and views. You can find the full submission here.

Key recommendations include:

  1. Require all government-funded aged care providers to develop policies and organisational processes to combat discrimination and promote inclusion of LGBTI people, that are:
  • Mandatory
  • Provide evidence of implementation
  • Annual Reporting
  • have a complaints process
  • Enforceable penalties (e.g. tied to funding)


  1. Ensure the cultural safety of LGBTI elders and older people by:
  • Ensuring LGBTI elders and older people feel comfortable and safe with divulging personal information including their sexual orientation, gender identity, or intersex status and giving them multiple opportunities to do so (as their comfort and trust builds over time they are more likely to inform staff about who they are)
  • Ensuring that aged-care staff, at all levels of the organisation, and volunteers are adequately and appropriately trained to provide LGBTI-inclusive services
  • Ensuring LGBTI elders and older people can easily and confidently access these services through the implementation of welcoming physical environments within aged care facilities
  • Ensuring LGBTI residents are consulted about, and participate in, the planning, development and review of services relevant to their needs
  • Assessing and analysing LGBTI-inclusive aged care practices to identify elements that will improve the cultural safety of residents.


  1. Improve the everyday experience of LGBTI older people living with the behavioural and psychological symptoms of dementia (BPSD) by:
  • Adopting a person-centred approach to dementia care that includes culturally appropriate assessment of (BPSD)
  • Using consistent language across organisational policies, procedures and staff training practices
  • Working closely with identified family of choice members to inform individualised strategies to support their LGBTI older person with BPSD
  • Appreciating and recognising LGBTI diversity through encouraging active participation in LGBTI-cultural activities and events
  • Putting strategies in place to minimise homophobic, biphobic or transphobic abuse from co-consumers, some of whom may also have dementia.


Submission on Workforce Issues, November 2019

In October 2019, the Royal Commission called for submissions on workforce issues.  Our newly established Royal Commission Advisory group guided the content in this submission, which was gathered from previous consultations and an online survey. The recommendations matched the areas of concern raised by the Royal Commission. See the full submission here.

Staffing levels

Recommendation 1: The Alliance recommends that work be done to develop sustainable appropriate staff ratios that can adequately meet the needs of older LGBTI people.


Registration Schemes

Recommendation 2: Implement a national registration scheme, that includes pre-employment screening, minimum-entry qualifications, and ongoing education and training.

Recommendations 3: Create a national database to monitor breaches in standards and quality of care within the aged care workforce.


Remuneration and working conditions

Recommendation 4: Remuneration should be benchmarked and matched against other comparable industries, against workers with comparable qualifications.

Recommendation 5: Strategies should be developed which challenge ageism and improve the value placed on aged care work.

Recommendation 6: Timeframes and targets for care should be reviewed.


Skilled, knowledge and competency levels of staff

Recommendations 7: Strategies to be developed to attract, recruit and retain LGBTI aged care workers.

Recommendation 8: Training in LGBTI inclusivity should be mandated for all aged care workers, and repeated regularly.

Recommendation 9: Strategies should be developed to improve staff retention in aged care services.

Recommendation 10: Initiatives to support family and friend carers should be developed and delivered.


Workforce leadership

Recommendation 11: Aged care workforce leaders performance agreements should include reporting against diversity targets and key performance indicators.

Recommendation 12: Robust and protective complaints and feedback mechanisms need to be in place and to be protected and taken seriously by workforce leaders.

Recommendation 13: Maintain and fund LGBTI advocacy bodies.

Recommendation 14: Establish an official visitors’ scheme for aged care services.


Institutional changes

Recommendation 15: That Section 37 (2) (b) of the Sex Discrimination Act 1984 (Cth) be repealed

Recommendation 16: Aged care providers actively eradicate rules and practices which reinforce heteronormative and cisnormative assumptions that actively exclude the lived experiences of LGBTI elders and older people.

Recommendation 17: That the Aged Care Diversity Framework and supporting Actions for LGBTI Elders – A Guide for Providers and A Guide for Consumers are attached to the Aged Care Quality Standards.

Recommendation 18: Meaningfully and appropriately collect data on sexual orientation, gender identity and intersex status of the aged care workforce in the National Aged Care Workforce Census and Survey.


Submission on System Design January 2020

In December 2019 the Royal Commission called for submissions on the system design of the Aged Care system. This work was guided by the Royal Commission Advisory Group, with input from previous consultations and an online survey. The recommendations matched the areas of concern raised by the Royal Commission. The full submission can be found here


What should be the underlying principles of a redesigned aged care system, which meets the needs of LGBTI people?

Recommendation: Trauma-informed and person-centred care approach be embedded in the principles to ensure high quality and culturally safe care.


How could we ensure that any redesign of the aged care system makes it simpler for older LGBTI people to find and receive the care and supports that they need?

Recommendation: Establish a case management and care coordination model within the aged care system.

Recommendation: Ensure that information around aged care is available at multiple access points.

Recommendation: Adopt a ‘no wrong door’ approach to the aged care system.


What is the most appropriate way for older LGBTI people to access the aged care system initially? (for example, by phone and website or face-to-face services)

Recommendation: Easy to understand and accessible information including printed materials.

Recommendation: The Royal Commission address the potential adverse implications of the government’s proposed Religious Discrimination Bill on older LGBTI people.


How should government support older LGBTI people to meet their domestic and social needs? 

Recommendation: Funding provided to LGBTI Community Visitor Schemes to ensure it is delivered in every jurisdiction.

Recommendation: Further investment in local government and local services to provide LGBTI specific social supports and foster connection with LGBTI communities.


What are the most important interventions for older LGBTI people experiencing a crisis?

Recommendation: Care coordinators and Case managers regularly reviewing documents and plans.

Recommendation: The aged care system is flexible and responsive to multiple crises.

Recommendation: Culturally appropriate and safe respite care available to LGBTI older people.


How could existing provision of personal care, as well as nursing and allied health, be reoriented so that they are focused on individual needs, and not on whether the older LGBTI person is at home or in a residential facility?

Recommendation: Community nurses and allied health service providers undertake LGBTI-awareness training.

Recommendation: Community nurses and allied health service providers enact processes to ensure continuity of care.

Recommendation: LGBTI older people are treated with respect and dignity in their own home and in residential settings.


How could the aged care and health systems work together to deliver care which better meets the complex health needs of LGBTI older people, including dementia care as well as palliative and end of life care?

Recommendation: Access to quality, inclusive and individually tailored palliative care.

Recommendation: Heteronormative standards of behaviour should be challenged in the context of providing care to LGBTI older people living with dementia.

Recommendation: The Aged Care Quality and Safety Commission support the collection data on sexual orientation, gender identity and intersex status of the Australian population in the 2021 Census.

Recommendation: At the interface of aged care and health services, there needs to be an understanding of the unique needs of trans and gender diverse people, andintersex people.


How should the design of the future aged care system take into account the needs of LGBTI people in urban, regional and remote locations?

Recommendation: Maintain and expand CVS schemes to capture isolated LGBTI older people.

Recommendation: System design ensures confidentiality and privacy of the individual is enforced.


How would the community be assured that the services provided under a new model are being delivered to older LGBTI people to high standard of quality and safety?

Recommendation: Collection of data in relation to accessing the aged care system.

Recommendation: Robust processes to assess Diversity Action Plans.

Recommendation: Robust and protective complaints and feedback mechanisms to be in place.

Recommendation: Better resource, build the capacity of, and provide appropriate powers to the Aged Care and Safety Commission to adequately resolve complaints in a timely manner.


Recommendations made to the Royal Commission into Aged Care Quality and Safety – Summary document

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