The faces of grieving family members at the memorial service for the residents of the Quakers Hill Nursing Home speak a thousand words. How to even imagine what it might be like to be frail, bedbound and to be caught up in a maelstrom of fire! 

At the time of writing nine residents have died, more are still in critical care and many more have suffered the trauma of relocation.  Quakers Hill was home to 88 residents at the time of the fire.

The police are still conducting investigations, a Quakers Hill staff member has been arrested and charged and Premier O'Farrell has called for a review of the state’s aged-care system.   Presumably there will be a coronial inquiry into these deaths – as occurred with the deaths of people at the Victorian Kew Cottages in 1996 and the Childers Backpacker Hostel in 2000.  We all hope that these investigations will be far-reaching and will provide both answers and solutions.

Such a tragedy brings to mind some of the critical issues around aged care - many of which were sadly neglected by the Productivity Commission Report which was released earlier this year.  This columnist has already commented on the failure of the Productivity Commission to fully address staffing issues.

The fact is that there is a staffing crisis in aged care that is being ignored by those whose job it is to ensure the well-being and safety of frail, older Australians.

This is evidenced by the refusal of politicians and aged-care bureaucrats to mandate minimum staff/resident ratios in aged-care homes and by the ongoing staff roundabout currently occurring within the system. Providers try to do more with less. Dedicated staff often find the strain too much. And skilled new staff are not attracted to a poorly-paid job that is never done.

We should not forget that aged-care workers are among the lowest paid in Australia.

Many earn less than $600 per week. Furthermore, nurses who work in aged care are paid considerably less than those in the acute sector. A survey completed just this month finds that many nurses and carers are planning to leave the sector because of low pay and poor conditions.

We would expect that that investigation into this tragedy will include reviewing the various building regulations and fire safety measures required by aged-care homes. The debate around some fire-safety measures has already started.

Jim Smith, a NSW Fire and Rescue Deputy Commissioner, states

The effectiveness of sprinklers is also now being debated. Jim Smith comments that 'sprinklers would have saved lives'.  Some reports from overseas also suggest this.

• A 2009 investigation into the use of sprinklers in healthcare premises (PDF 1.1mb) in Wales states that sprinklers are underused yet their potential contribution to life safety cannot be overestimated.
• An extensive report from the US National Fire Protection Association - Fire Analysis and Research Division: U.S. Experience with sprinklers and other automatic fire extinguishing equipment (PDF) just last year also affirms that sprinklers saves lives.

Strangely, NSW Planning and infrastructure minister Brad Hazzard says that there is no way of knowing how many homes do not have sprinklers installed.

The heroes of the terrible day at Quakers Hill Nursing home were the brave emergency crews and aged-care staff who rescued infirm people trapped in an inferno.

The government has vowed to reform aged care during this term of office. We now need courageous decision-makers to make the changes that would give us all confidence in how we will be cared for as we approach the end of life. 

How is it possible that a man who has been unable to move any part of his body and is unable to speak is labelled as verbally abusing and physically threatening? Yet this is how he was described in an Aged Care Funding Instrument (ACFI) document.  

His daughter, shocked when discovering this assessment, states, 'He cannot do anything for himself, he can’t even call out for help, he pretty much just sits there'.

A further resident who suffers multiple sclerosis, and who can only move one hand, was described as being 'physically abusive'.

A Victorian coroner has said that the recent nursing home toilet death should not be allowed to happen again.  "If it’s happening here, it might have happened elsewhere, it might be happening elsewhere," Coroner Olle said. 

Of course it is. That is because many staff in aged-care homes regularly take short cuts in order to get the job done. And they will continue to do so until something is done about the appalling staff/resident ratios in many of our aged-care homes.

This Column drew attention to the appalling lack of dental care given to older people right back in 2008. 

The article was written after ABC’s Lateline Program interviewed dentistry lecturer, Dr Clive Rogers, who stated, ‘that the neglect of dental care in nursing homes amounts to abuse’. He showed graphic photographs of ravaged mouths and teeth.

Politicians generally profess much empathy for frail older Australians. They like to visit aged-care homes – usually when making some funding announcement. They front up to homes at election time and seek photo opportunities with happy, smiling, older people.
We hear the rhetoric over and over again - that Australia has the best aged-care system in the world - no matter which side of politics is in government. And yet one always has the feeling that, in spite of the various statements of support, often there is little real understanding of what it might be like to be very old, frail and needing assistance to achieve the most basic of tasks.

The Productivity Commission believes that exposing aged care to further competition and freeing up the market even more - by removing regulatory restrictions on the number of bed licences - will solve many of the problems besetting the sector.

This is the basis of the Draft Report, 'Caring for Older Australians', which was released for public comment last week...

Mark Butler, the new Minister for Mental Health and Ageing, recently commented in the West Australian, ‘ that Australia has one of the best aged care systems in the world’.

Well, he would say that, wouldn’t he? Because that’s what they all say... the various Ministers who have been given the responsibility for the care of Australia’s frail and vulnerable! At least Minister Butler had the grace to qualify his statement with .....‘but the Government was aware it needed reform’.

The Productivity Commission’s Inquiry, Caring for Older Australians is underway. 

The Commissioners are expected to report on their findings by April 2011 with an interim report by December this year. Submissions to the Inquiry were due at the end of July and are still being received now. You can read the submissions here.

Some of us were extremely cynical when the Labor Government announced it was dispatching the fraught issue of aged care off for another review. Surely there have been enough reviews, inquiries, committees etc exposing the many cracks in Australia’s ageing aged-care system in recent times. 

Aged care is one of the few areas where consumer action has been slow in coming. Research has shown us that hospitals are safer and better when the consumer voice is heard. That is why they employ patient advocates and support community advisory committees.

Those who have actually experienced a particular health service often have a fresh perspective to offer. They see things through a different glass.

A new funding arrangement for hospitals looks like happening. Included in the deal are new initiatives affecting the delivery of aged care across the country. The Commonwealth is to be responsible for all aged-care programs and more aged-care beds are to be provided.

One of the announcements that has not received much publicity is that $96 million dollars, over four years, is to be provided to improve access to GP and primary health services in aged care.

The CEO of the peak industry body, Aged and Community Care Victoria, Gerard Mansour, must live on a different planet from most of us.

Just this last week he stated that mandated staff/resident ratios were 'outdated and inappropriate'. He claims that this is because 'staff skills were matched to residents' needs which can vary substantially from one location to the next'.

Tell that to the overstretched and undervalued carers and nurses who feel that they can never get the job done or to the residents who must wait for long periods to receive the care they urgently need.

There are mandated staffing levels in child care centres, kindergartens, schools and hospitals. They, too, cater for people with different levels of  need in different locations.

Why should vulnerable frail, older people miss out on this protection?

The much publicised My School web site goes online today. 

Deputy Prime Minister, Julia Gillard, states that, for the first time, parents across Australia will be able to get accurate information about how their child’s school is performing. The results of each school’s performance in the National Assessment Program tests are published online for all to see. Colour coding shows at a glance whether the school is performing above or below similar schools and how it compares to the national average...

How do they get away with it? Year after year we hear politicians and aged-care bureaucrats waffling on about "appropriate levels of care" – words that mean nothing at all and allow shonky aged-care providers to staff their homes with dangerously low levels of nurses and carers...

A friend of mine, aged 96, died this week. Death is always sad but my friend remained living in her own home until the very day she died and so her friends and family are able to take great comfort in that.  I have heard it said that there are more deaths in nursing homes at Christmas than at other times of the year. It would be interesting to know if this is, in fact, true.

Tuning in to local ABC radio the other night I heard some aged-care guru telling the world how ageing baby boomers would expect chai soy lattes along with their residential aged care. Sure! Along with their blackberries, lap tops and iPhones! At times, you wonder whether some of these experts on aged care have set foot in the door of an aged-care home lately.

Forget the latte and worry about whether you can get someone to help you get to the toilet in time.

The National Health and Hospital Reform Report purports to provide the basis for a series of promised reforms to Australia's system of health care.

It is 'the culmination of 16 months of discussion, debate, consultation, research and deliberation by a team dedicated to the cause of strengthening and improving our health system for this and future generations of Australians'...

Sometimes you see, or read, something that makes your brain just snap. This did it for me today. It is a son's account of the lack of services provided for his mother who is in now in residential care.

'My mother left hospital unable to walk independently. She was placed in transitional care with the promise of intensive physiotherapy.'
Of course, his mother never walked again.

The management at the nursing home I visit has decided that having a registered nurse on duty is a luxury it can no longer afford. 

They now think it is enough to have an RN on call. This one person, who does not need to be on the premises, is responsible for the health and well-being of 30 high care residents and approximately 150 low-care residents.

The much-awaited report from the National Health and Hospitals Reform Commission has just been released.   The Prime Minister and the Minister for Health and Ageing are now engaged in a 6 months consultation process with various health bodies and stakeholders.

There are 123 recommendations.  Some of them pertain to how we care for people at the end of life. One that has received much publicity relates to the possible introduction of bonds for high care – 'that consideration be given to permitting accommodation bonds or alternative approaches as options for payment for accommodation for people entering high care'. This did, of course, immediately send everyone to their entrenched positions. Providers see bonds as the answer to all their problems. Others are worried about people having to sell their homes at a time of crisis and great trauma...

The most disturbing aspect of the recent Four Corners Program featuring four families dissatisfied with aged care was that the complainants’ voices were not heard – by anyone! They were not heard at the home providing care and the Commonwealth complaints investigators did not listen...

The Australian Medical Association (AMA) has called for more nurses to be employed in aged care homes.  They say that this needs to be done to prevent dangerously sub-standard medical care from occurring.

Of course, many of us have known this for years. We have seen our family members sent back and forth in ambulances to emergency departments for minor complaints because there have been no trained health professionals on the premises.

We have sat with our mothers and fathers as they have waited for stressed and harried staff members to attend to them. We have seen the reliance of homes on agency staff who don’t know, or understand, our family member’s care needs and we have noted the increasing dependence on immigrant carers who are unable to communicate adequately with the residents in their care...

Sanctions have just been imposed on another Victorian nursing home. It is reported that lack of food, drinks and inadequate health care were just some of the problems found by the accreditors.  There are now four facilities in Victorian experiencing sanctions. Nationally, there are 11 under sanction.

The news reports on these latest sanctions are just coming in as this Column is being written. They contain several interesting features.

During the January holiday period, it was reported in one of the broadsheets that, due to the global financial crisis, more families would be seeking residential care for aged relatives. This, explained the journalist, was because families under pressure would not be able to run around looking after Mum. Too costly in both time and money! Thus, he opined, aged care would be one of the few areas which would actually be expanding its workforce and therefore a sector for the unemployed to keep in mind.

ABC’s Lateline Program last night featured the appalling lack of dentistry within many of Australia’s aged-care facilities.

Who looks after the mouths and teeth of those who live in facilities for the frail and old? Hardly anyone, it seems? I can’t remember ever seeing a dentist, dental therapist or dental hygienist, in any of the homes that I regularly visit. 

The dentist on Lateline, Dr Clive Rogers, said that it was not uncommon to find several abscesses in the mouths of the residents he sees. Ouch!! Ever had an abscess on a tooth?? He goes on to tell, and show, us the massive build up of food and plaque in the mouths of the frail older people he is checking. It is not a pretty sight.

While the media covers the horrendous world news of terrorist attacks and airport closures, it is easy to see that most people will not have noticed the further lowering of aged-care standards here at home.

Victorian Uniting Aged Care has just retrenched ten division one nurses from two of their aged care facilities – joining the ranks of the private-for-profit facilities that place cost-cutting and budgets over people and quality care. 

How many of us know who actually owns the aged-care homes where our frail, older friends and relatives live? 

Often there is a web of complex structures behind the day-to-day management of the facility. It is hard to know just who is responsible.

This week ABC Lateline viewers were treated to the spectacle of the Minister for Ageing, ex-policewoman, Justine Elliot, totally not up to the task of explaining to Tony Jones, and to the rest of us, how it is has come to pass that commonwealth-funded aged-care facilities catering for remote Indigenous communities are not even expected to meet the 44 standards required by all other facilities within Australia. 

Furthermore, she was unable to explain how it is that people experiencing dementia and those who are bedridden can be left overnight unattended and unprotected - with no staff on duty at all. Of course, the inevitable occurred, with the tragic death of a resident.  

A Victorian nursing home fails 30 standards out of 44. How did it get to this? 

There are issues with hygiene, nutrition medication delivery and much more. The latest audit by the Aged Care Standards and Accreditation Agency has revealed these problems – thankfully, at last. That is what the Accreditation Agency is there to do because these are people who cannot speak for themselves. They just have to take what they get – in terms of care and respect. And clearly these residents were taking buckets and buckets of poor care and neglect – and for some considerable time.
But the thing that is so worrying about this is that it is reported that action was only taken after complaints were forwarded to the Department of Health and Ageing. Relatives of residents claim that the complaints go back to 2005 when this place opened. It is also reported that the facility has had eight directors of nursing in three years. Now you would think that that, in itself, might tell somebody something.
No wonder people are frightened of being placed by their family in a nursing home when they hear of such things.

This columnist is not surprised by what has been found, given the huge, unresolved staffing issues around aged care.

I also think that the public need to know what is going on behind some of these closed doors. But it should never be allowed to get to this stage.

It seems from the reports that some family members knew that the care provided at this facility was way below standard.

The question is … why was their voice not heard?

A common theme of much of the media comment made by our current Minister for Ageing, Justine Elliot, is that she makes no apology for the fact that her priority is ensuring that frail aged and vulnerable seniors are protected.   

If only she did - ensure that frail people receive proper protection - that is. Because, in spite of her repetitive, ‘no apology’ statement, current protection measures for vulnerable people in residential care are just not good enough...