| Transparency in aged care |
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Of the nearly 8,500 visits and/or reports made to a little under 3,000 nursing homes by the Aged Care Standards and Accreditation Agency (Agency) and by the Department of Health and Ageing in the 2007-2008 year, only the 517 accreditation reports are publicly available. Recent announcements by the Minister for Ageing in July 2009, introducing a new register which displays the number of non-compliances found for each facility, seems to be re-laundered information extracted from audit reports (failing 1 or more standards out of the 44 Accreditation Standards) on the Accreditation Agency website, usually found as a result of a facility's cyclical 3 year site audit. This announcement may be due to the minister's reporting methods which were heavily criticised in her yearly report of the Aged Care Act where she quoted "as at 30 June 2008 46 homes failed non-compliances" - when in fact there were 199 homes for the 12 month timeframe. As a result, the minister has agreed to This recent initiative unfortunately, excludes useful information such as substantiated complaints made to the Complaints Investigation Scheme (CIS), as well as any "breaches" by approved providers (of the Aged Care Act). According to the Report on the Operation of the Aged Care Act 1997 - 1 July 2007 to 30 June 2008, the CIS received over 11,323 contacts, with nearly 7,500 complaints identified as "in-scope" cases which related to an Approved Provider's responsibilities under the Act. "Breaches" of an Approved Provider’s responsibilities were identified in 930 cases. The 214 number of Notices of Required Actions (NRAs) represents the service providers who have not already taken action to address the breach at the time of the annual report (30 June 2008). Quality of information publishedNot only is the terminology confusing in the annual report, but the way in which the figures are quoted - some figures quoted in the yearly report are a one day snapshot (ie, "as at xxxxx xxxxx"), whilst other figures are for the 12 months. It appears that Aged Care Crisis weren't the only ones confused with the figures quoted in the annual report: "...Opposition ageing spokeswoman Margaret May said an annual report should include annual figures only and accused Ms Elliot of misleading the Parliament and the public..." Acquisition of what little information there is on nursing homes, coupled with seemingly alien terminology, the little data that is available on each nursing home in Australia is on average 2-3 years old, little wonder consumers feel like they're hitting a brick wall when there are many questions, but unfortunately no answers. The cyclical (Accreditation) audits occur on average once every 3 years and often, no other data is available. This situation makes it impossible for community members anxious to find suitable accommodation for their loved ones. The only other avenue of obtaining information about a facility is to keep a watch on the odd news article or report that may pop up in the media - but this can be difficult to access depending upon the locality and availability of material. Information published on the Department's website on the operation of the Complaints Investigation Scheme is nearly 2 years old (checked as at 26 Aug 09). Example: Acquiring nursing home informationThe example below illustrates how little relevant information is available to families when faced with choosing an aged care-home. Although this facility was found to breach the Aged Care Act, information about the six breaches of the Act was not disclosed on official web sites. Background: Family lodged a complaint with the CIS – as a result, six breaches were found. Sample of information available on official Department and Agency websites:
Transparency: mission impossible?It is still not possible for anyone in the public to find out the (total) number or nature of 'breaches' found by the Department of Health and Ageing (DOHA), OR the number and nature of complaints by the DOHA's Complaints Investigation Scheme (CIS), for any particular aged care facility in Australia. It is still possible for a home to breach their responsibilities as an approved provider, as well as having serious complaints substantiated against the facility, AND avoid any public scrutiny whatsoever. Aged Care Crisis finds this particularly concerning for prospective aged care residents and families who are deciding on options for the best care. The pie chart below, illustrates these points (indicated by the slices and pie chart markers in grey). Only 5% of monitoring activities are made public. *supporting information for pie chart in Table 1 (below).
Table 1 legend and glossary:
Source: No information or reports are released to consumers about:
Aged care regulation and various agency interactionThe regulation of residential aged care (and community care packages) is supported by a range of different bodies, outlined below:
Aged Care Standards and Accreditation Agency (the Agency)The Agency is an independent company limited by guarantee, and subject to the Corporations Act 2001 and the Commonwealth Authorities and Companies Act 1997. It is the body appointed by the Department of Health and Ageing as the accreditation body under the Aged Care Act 1997. The Agency fulfils its functions using processes and principles set down in legislation, notably the Aged Care Act 1997, the Accountability Principles 1998, and the Accreditation Grant Principles 1999. The Agency assesses and monitors Australian Government funded aged care homes against the Accreditation Standards. This includes the cyclic 3 yearly audits that every home receives to be able to maintain funding from government subsidies related to aged care, in which the Agency assesses and monitors aged care homes against the Accreditation Standards. If the Agency identifies a failure by an aged care home to comply with the Accreditation Standards (or other responsibilities under the Act) and that failure has or may place the safety, health or wellbeing of residents at serious risk, then the Agency must inform the Department of Health and Ageing in writing, about the failure and any concerns it may have. Note that sanctions are not imposed by the "Agency". The Department of Health and Ageing may take appropriate action consistent with the Act and in proportion to the nature and level of non-compliance, including the imposition of sanctions. Useful links:
Department of Health and Ageing (DOHA)The Department of Health and Ageing's - Ageing and Aged Care Division (AACD) is responsible for the National Ageing and Aged Care Program which provides care and support services to older people and their carers, and promotes healthy ageing. DOHA is required to take appropriate action where Approved Providers of aged care homes are non-compliant with their responsibilities of the Act. This includes taking into account providers’ compliance with the Accreditation Standards. Where the Agency’s regulatory role is focused on a home’s compliance with the Accreditation Standards, the Department’s role encompasses an Approved Provider’s responsibilities in matters such as certification, fees and charges and specified care and services. Departmental authorised officers may also monitor compliance with accreditation standards, mostly in circumstances where notices of non-compliance or sanctions are contemplated. In order to monitor compliance by Approved Providers the Secretary to the Department may appoint Authorised Officers under Section 90-3 of the Act. Authorised officers may be directed to conduct unannounced visits to an aged care home. Spot checks/unannounced visitsThese visits are known as 'spot checks'. On other occasions authorised officers may be directed to conduct a 'site visit', which would include notifying the Approved Provider of the intended visit and agreeing to a mutually acceptable time. The authorised officer must at all times be able to produce an identity card verifying his/her authority to conduct a compliance monitoring visit. The authorised officer must obtain an occupier's permission before entering the home. Consent to such a visit may be withdrawn at any time. If, however, the Approved Provider or staff deny access to, or fail to cooperate with, the authorised officer, this action may result in the imposition of a sanction. More information:
Useful links:
Department of Health and Ageing: Aged Care Complaints Investigation Scheme (CIS)The Office of Aged Care Quality and Compliance (OACQC) is located within the Australian Government Department of Health and Ageing. The Office is responsible for ensuring the quality and accountability of Australian Government-subsidised aged care services and manages national programs in relation to compliance with legislation (Complaints Investigation Scheme); User rights; Aged Care workforce; Clinical care; and Prudential Regulation. The Complaints Investigation Scheme (CIS) is available to anyone who wishes to provide information or raise a complaint or concern about an Australian Government-subsidised aged care service, including:
Members of the community making complaints have done so, to an arbitrary and largely impersonal and legalistic process concerned with rights more than resolution. They are often left bruised and unhappy about decisions that seem incomprehensible and unjust to them. This is what you would expect from an agency distant from the homes and that during the 2007-2008 year was asked to address 11,323 'contacts' (a large proportion of those complaints) made by people it did not know and often did not meet. The recent ABC Four Corners program illustrates this well. As a result of a number of cases investigated by the CIS, 930 breaches were identified where an Approved Provider has breached its responsibilities under the Act or Principles. No information is released about the nature of number of breaches an aged care facility receives. More information:
Useful links:
Links to guidelines and legislation links:
Aged Care CommissionerThe Aged Care Commissioner is a statutory appointment and the Commissioner is independent from both the Department of Health and Ageing and the Agency. The Commissioner's functions are set out in subsection 95A-1 of the Aged Care Act 1997 (the Act) and Part 6 of the Investigation Principles 2007. The Commissioner can review certain decisions made by the CIS (the 'Scheme') and to examine complaints about the Scheme's processes for handling matters under the Investigation Principles. The Commissioner may also examine complaints about the conduct of the Agency and the conduct of persons carrying out audits, or making support contacts, under the Accreditation Grant Principles 1999. The Act also gives the Commissioner the power to examine particular matters on the Commissioner's own initiative. The Office of the Aged Care Commissioner was established to review the way in which the CIS handles complaints, but unfortunately, is unable to enforce any rulings or decisions. An aggrieved person or relevant provider who is dissatisfied with an examinable decision may, within 14 days after being told by the Secretary about the decision, apply to the Aged Care Commissioner for examination of the decision. The Aged Care Commissioner has no power to force the Department of Health and Ageing's Complaints Investigation Scheme to adopt her decisions. More information:
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