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Good quality care shouldn't be a matter of luck...
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Thursday, 19 April 2012 00:00 |
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| eNews: April 2012 |
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The Australian public is waiting, with anticipation and some anxiety, to learn what changes the government is proposing in the wake of last year's Productivity Commission Report.
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Missing: voices of residents and their
families
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Many older Australians and their families fear that true reform will not occur. They fear that the many and varied problems currently besetting the system will remain and that the vocal aged-care provider lobby will have prevailed in keeping the focus solely on funding.
Furthermore, there was no recommendation from the Productivity Commission that there be compulsory disclosure of care acuity or staffing structures in aged-care homes. In the absence of compulsory staffing ratios, this is the most critical information that any family will need when choosing care.
Sadly, the Commission's Report predominantly reflects the interests of aged-care providers - responding to their demands for even further staffing flexibility, relaxation of regulations and their demands for increased funding. |
Profit vs care
The primary focus of market- listed entities is profitability. Private equity groups now own a majority of private-for-profit aged-care homes in Australia. The dominating factor for these organisations is short term profitability. Too often the process undertaken after purchase is to squeeze the system by cutting back staff even further then selling out.
Within this setting, managers distant from the provision of care, make top-down financial decisions with little understanding of the consequences for the residents for whom they are ultimately responsible.
It is therefore profoundly disappointing that the Productivity Commission's recommendations do little to address the critical issues concerning failures in care that are endemic within the system.
Learn more:
'Caring for older Australians: an opportunity lost (media release: Aged Care Crisis)
A tale of two providers
A Critical Examination of the Productivity Commission Report (Dr J M Wynne)
Mission Impossible? Transparency
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What family members tell us
Residents and their family members care about whether...
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their family members live in a caring, compassionate and supportive environment |
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there is consistency of staff so that residents get to know their carers |
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residents receive nutritious and tasty food, are assisted with meals and are sufficiently hydrated |
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there is enough staff on hand to assist residents as needed |
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medication is appropriately administered by trained staff |
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residents receive assistance with hearing aids, mobility devices and other equipment |
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bed-bound residents are turned regularly in order to prevent painful bedsores |
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residents are assisted with toileting and do not lie, for long periods, in pads soaked with urine and faeces |
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residents are inappropriately restrained - physically or chemically |
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the managers of homes listen to families and residents when things go wrong |
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What aged-care staff tell us
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residents should be supported by staff familiar with their medical and other requirements |
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good staff leave because they don't feel valued and do not want to work in situations where it is unsafe for residents and themselves |
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there are not enough trained staff and registered nurses employed in aged-care homes |
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there is inadequate mentoring and little ongoing professional development for staff in aged-care homes |
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carers are given responsibilities far beyond their training |
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staff are being employed who have poor language skills and are therefore unable to communicate effectively with residents and families and are unable to follow care plans and case notes |
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Jean's story
A recent news article, Care the key in ending aged hell, relates the experiences of "Jean" as she attempted to ensure that her husband received adequate aged care during the last years of his life.
Sadly, Jean's story is repeated over and over in homes across Australia as evidenced by correspondence received by Aged Care Crisis from distressed family members:
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 "... Aged care has become a business, not a service,'' Jean writes. ''At best, there is nothing in place to nurture [the residents'] spirit, to prepare them for a peaceful end. At worst, they are neglected, antagonised and frightened...." |
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Jean's journal, A Fly on the wall... In Hell  (517kb) is a detailed account of day-to-day life in three Australian aged-care facilities - all fully accredited. |
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Stand Up 4 Better Aged Care
Here is a website that chronicles a daughter's journey as she supported her father in aged care.
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"... My Dad had all of his wits about him and knew exactly what was happening, which makes me think if this is how they treated him, then heaven help the ones that didn't know what day it was! ...." |
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Funding and accountability: why have the clocks turned back?
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Prior to the introduction of the Aged Care Act 1997, a fixed percentage of funding received by owners of aged-care homes was dedicated to care - including the salaries of nursing staff.
Funding could not be diverted to non-care staff, to capital maintenance or to profit. This requirement was removed under the Aged Care Act 1997.
Currently there is so little transparency or accountability in aged care and it is almost impossible to see just where the money is being spent. |
The recent revelations about rorts in aged care provide even more evidence that funding and regulatory processes should provide transparency at all levels.
Aged care: Once upon a time...
How our twilight years are ripe for the picking |
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Aged Care Funding Instrument (ACFI)
- where does the money go?
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Under the Aged Care Act 1997, aged care providers may re-classify residents according to their care needs under an assessment system called the Aged Care Funding Instrument (ACFI). Residents may be reassessed from time to time and if their needs classification requires it, application may be made for a higher funding subsidy from the Department of Health and Ageing.
The objective of the ACFI system is to cover the extra staffing costs which are involved in caring for persons with higher needs.
However, when an application is successful and a higher subsidy is granted, the funds go directly to the aged care provider who appears to disburse or spend funds according to the discretion of management.
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The real question is whether the resident receives the benefit from this extra funding. Anecdotally, this appears not to be the case.
Considering that extra daily subsidies can exceed $100 as a result of reclassification with under the ACFI system, it may be that significant and very helpful assistance can be sought by the resident and should be offered by Provider as a logical outcome and obligation under the residential care contract itself.
Read the full article: Aged Care Funding Instrument (ACFI) - where does the money go?
Ageing in place: false assessments?
Crackdown on aged care 'price gouging'
Immobile mute Melbourne man a 'threat', carers claim on funding application |
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Nearly 4,000 breaches identified
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A Notice of Required Action (NRA) is issued when a provider is found to be in breach of the Act or Principles, and has not already taken action to address the breach.
Each NRA sets out the details of the breach, what the provider must do to address the breach and the timeframe in which this action must be taken. The intention of a NRA is to give the provider an opportunity to address the breach before compliance action is considered.
Disturbingly, the number of NRAs is increasing. The Department of Health and Ageing does not disclose where these breaches occurred. It is therefore impossible for family members to make informed decisions about aged care placement.
There is something very wrong with a system that protects the commercial interests of aged-care providers at the expense of frail, aged individuals requiring care.
Commercial-in-confidence should not be used to protect corporations and provider organisations when lives are at stake.
Figures: Report on the Operation of the Aged Care Act 1997:
2007-08, 2008-09, 2009-10, 2010-11 |
View the FOI documents: 393 Notices of Required Action documents (partial release) that were issued by the CIS in financial year 2010-2011:
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Genuine consumer advocacy means
listening to users of the system
Peak bodies of providers and organisations which receive the majority of their funding from government do not generally reflect the true interests of frail aged Australians and their families.
Various campaigns backed by such aged-care industry lobby groups and funded agencies appear to have considerable influence over politicians. These groups have conducted various campaigns - some of which may be viewed as thinly veiled attempts to enlist the community to lobby on their behalf in their quest for higher subsidies and relaxation of regulations.
While no-one doubts the need for reform of the current system, it should be noted that one of the key demands of these lobby groups is to increase the bonds asked by providers when an aged person enters care. A further demand is to hasten the introduction of reverse mortgages for those requiring care.
Sadly, very little has been said about the staffing and care issues that should be at the heart of aged care reform. |
Further financial assistance should not be given to aged-care providers without requiring transparency and accountability and a greater level of staffing.
Learn more:
Essential traits of advocacy groups
Pensioners warned: "Age Well" campaign = "Lose Your House" campaign
Pensioners slam misleading numbers put out today by aged care sector
Home exemption under threat
How our twilight years are ripe for the picking
COTA Australia: Consumer Watchdog or Government Lapdog?
Beware the Nursing Home Industry's 'Grand Plan'
Your gift to nursing home barons
Flog off the family home for a nursing home bed? Over my dead body
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Raising a toast to kerosene baths
An email exchange started with a questionable
joke, but it led to concerns over the independence
of some aged-care advocates. |
Recently, many people were shocked to learn of a series of matey, 'bad taste' emails between NACA members joking about the kerosene bath scandal of the 1990s as disclosed by The Global Mail in an article titled "Let's raise a toast!" Aged Care leaders joke about kerosene baths published in February.
In his response to this article, Ian Yates, chief executive of the Council of the Ageing (COTA), celebrates the provider dominated NACA's success, and proudly confirms his role in persuading COTA to join NACA and be part of an "important national vehicle for aged care reform" - working closely with providers of aged care, which he described as a, "provider, professional dominated body".
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