The following letter was sent by a concerned daughter whose mother currently resides in a nursing home, to Minister for Health and Ageing Nicola Roxon, in an effort to raise their concerns about lack of staffing ratios and skilled staff working in aged care, as well as the lack of care. As well as providing a first hand view of these issues, the author has also provided some practical views on resolving those issues:

The current limited system of late release and early removal of adverse reports from the Aged Care Standards and Accreditation Agency website is unsatisfactory. Consumers are entitled to disclosure of all past, as well as present, reports. Information needs to be presented in a digestible format. Frail older people are one of the most vulnerable groups in society and their protection should outweigh all other considerations.

The NSW State Government is transferring the remaining 11 state owned aged care faculties to the private sector.

The Wallsend Aged Care Facility is one of these facilities. Growing community opposition, frustration, and betrayed individuals are protesting their opposition to this mishandled and demeaning privatisation by stealth.

George Vassiliou applied for the EACHD (Extended Aged Care at Home - Dementia) package to help his then 84 year old mum to stay in her own home - but was shocked to find that two thirds of the money was eaten up by overheads. 

After arguing his case for years, George finally won the right to administer the EACHD package for his mother. 

George's mother's health deteriorated some time later and she now requires full time nursing home care. 

The following correspondence was sent to the Ageing Minister, Justine Elliot, in October 2009, regarding the concerns of care for George Vassiliou's mother.  It highlights the difficulties faced with many consumers, wrestling with a less than satisfactory system.

The Minister quoted: "The data speaks for itself. It shows the vast majority of nursing homes are providing a world class service, but there is a small group - 46 nursing homes - that had failed to meet 44 accreditation standard outcomes under the Aged Care Act." The problem here is that there is an inbuilt assumption that says that if homes pass accreditation then they are 'ipso facto' delivering a world class service.

Thank you Linda Sparrow for speaking so very well on behalf of the residents and staff of nursing homes. I work as a registered nurse at weekends (I teach ethics at a University during the week) at a nursing home, this is my seventeenth year in the job. The facility has over 50 high care and approximately 40 low care beds; 15 of the high care beds are for dementia patients. At weekends we have two registered nurses and one enrolled nurse for these 100 residents.

I began my career in 1994 , as an Enrolled Nurse (EN)working in Nursing homes. There were quite alot of us back then, we had no Personal Care Attendants(PCA) and I was one of 15 ENs over seen by 2 supervising Registered Nurses (RN). We heard of places that were utilising untrained staff, they were cheap and basically it gave the organization "flexibility".

The PCA had to do whatever role was required back then. Slowly the PCA role seeped into most areas of aged care but there was still a large Trained staff componant.  But in time, and because PCAs were cheaper and more pliable, there was more and more of them.

Many Aged Care Homes have a range of facilities. These include some form of catering as an alternative (and for visitors to purchase food) and hairdressing. Usually there some craft facilities and social/entertainment areas for guests as well as residents. There may well be others at different homes.

One rare but necessary facility which seems to be missing is a consulting room for medical practioners when they visit patients who are residents of homes. A consulting room would allow privacy, provide more appropriate surroundings and include some relevant equipment.

Where are we headed with this Government?

Aged Care Homes that people entered in good faith assuming that they would be cared for in their old age are now closing in greater numbers than ever before forcing Residents to find other places to live.

I am a Recreation Activity Officer (RAS) at a (large) nursing home. This home has a mixture of hostel and nursing home accommodation. I work two 6.5hr days per week for $17 per hour (care service employee grade 2 + 3% negotiated in an AWA 2007). The management restructured all staff's working weeks to 6.5hr days around 3 yrs ago...

As you will understand it is difficult for me to share my frustrating experiences working in aged care...I have been conditioned to expect to be punished for speaking out...

I am a registered nurse working in aged care. Since June 2004 I have worked for an organisation that has used bullying tactics from the highest level of management. This bullying has allowed residents to be bullied and their rights ignored...

I had an interesting question put to me not long back by a carer, what do I get paid an hour to provide respite?. I replied $20, he replied with, "where does the other $37 an hour go, paid for by the State government for me to go in the first place?"...

I would like to see all aged care facilities located with in kindergarten and child care facilities so they do not become forgotten...

"The best good news stories are right under our noses..."

One of many being short staffed and being told by management not to say that we are short staffed....

I feel that the difference between the amount of money spent on the first seven years of life and that on the last should be addressed.

If the government really knew what it was like to be worked like a horse for the said $16.20 per hour, they would have to feel shame.

I have been a personal carer for several years now, and for the last few months working in nursing homes.

I care deeply for my residents and treat every one of them as I would my own grandparent and Iam dissappointed that many people believe that Personal Carers (PC's) are careless or abusive. I guess there are people like that out there, but given that where I work Iam pressured to carry out the ADL's with speed... (aim for 15 minutes/ resident), I am not surprised that residents are injured at times.

My darling mother has been in a W.A. Nursing Home for just over 1 year, and yes I do have concerns about the aged care system.

MEMBERS of the Central Highlands community have again been meeting with consultants appointed to assess the feasibility of a multi-purpose service.

We found out something -- two of the residential aged-care licences allocated to Central Highlands and administered by Ouse District Hospital have been given away by the Department of Health and Human Services to a private residential aged-care facility in Hobart.

I really just want to make a comment on buzzers. I noticed one of your questions of things to look out for was: ""How long does it take for staff to respond to the buzzer?""

I have been browsing the internet to try to find information on staffing levels for dementia specific.  I was horrified to see there are no legal requirements, just 'adequate'.  What is 'adequate'?  I have had the responsibility of careing for 16 dementia specific residents, 9 high care with aggressive and challenging behaviours, and 9 low care.  I did regular  7.6 hour evening shifts, 5 nights a week, for 4 months, alone on the wing,  I repeatedly asked for assistance but was told it was a 1 staff wing.

With so many PCA's working in nursing homes and especially when there are PCA's IN CHARGE of wards (working as TEAM LEADERS) wouldn't you think that they would all be knowledgable in administering oxygen.

Well at the nursing home I work at apparently it is NOT the duty of a PCA to administer oxygen!!?? They are apparently not taught this in their course - if they actually have done one...

Uh oh. Poor Ms Elliot. The Minister has incurred the withering wrath of Aged & Community Services SA & NT chief executive Alan Graham.

Apparently, the Minister was "grossly negligent" in releasing the complaints report over Easter "without proper explanation"...

Families are struggling to care for their older parents or grandparents. We need to act now before we are completely overwhelmed by the baby boomers who are just reaching the age where they will require more care. We must not forget our elderly...

The care of the Aged has been off-loaded from well run government facilities to the private sector and so called Not for profit organisations...

FEDERAL Minister for Ageing Justine Elliot's statement that an extra 3000 inspections of nursing homes and police checks of employees will ensure the frail, aged and vulnerable will be protected is simply bureaucratic jabbering at its best (Courier Mail, Mar 24).

AS a registered nurse in an aged-care facility, I have noticed a significant increase in the complexity of the task in caring for residents over the past decade.

SOCIETIES should be judged by how they look after the old, the young and the sick.

In Australia, the elderly have been out of sight, out of mind for too long.

2005. Your loved ones dementia is deteriorating much further than first suspected and you discover that the public trustee has already taken financial control of your loved ones partner, who is also suffering dementia, without notification. 17 years of shared funds simply disappear, leaving one with close to $100,000 and the other with less than $20,000.

a friend of mine has her husband in a nursing home, (this was fairly recent), and it was undergoing accreditation. This lady's husband has been in the facility for 7 years, and this is the first time she has even seen an accreditation team through the nursing home (they're supposed to be accredited on avg. every 3 years, i thought).

Nursing homes are governed by standards and acreditaion and have been for a number of years now. It costs a facility lots of money to gain accreditation.

• So why are residents still being gotten out of bed and showered at 4.30 am and sat in the day room?
  why are residents only allowed 1-2 incontinence pads per day?
  why are residents clothes changed in the dinning room during the day?
  and why is the person who just took 20 residents to the tiolet preparing the food for all the residents..

I work in community services - a non-government incorporated body doing the impossible on a grant. In today's mail I was outraged to find the glossiest, most expensive useless claptrap from the Minister for Aged Care, a booklet for the Minister's Awards for Excellence.)

As a PCA I was told on one of my shifts to give the meds out via Webster packs. I said I was not comfortable with this at all. I have a lot of common sense and been around a long time and have trained as a Div 2 many years ago..but still I did not want to do this. Because I was basically begged to do this I did with trepidation and a lot of cross checking. The very next day I told the DON never to expect me to do this again and I never ever did. One evening shift an staff member did the meds at 4pm. It was discovered a short while later that this person had given the 4pm 6pm 8pm 10pm and anyother meds ALL AT 4pm!

Story, from a girlfriend, care assistant at a high/low care facility. Female resident, dying, vomiting. Unable to tolerate Maxolon by mouth, and documented thus over several days. Doctor declines to prescribe substitute.
A carer leaves cotside down, resident falls out of bed. More pain....

My MIL was showing symptoms of flu but informed us that a doctor had been called and would visit her. After the 5th day, we approached the nursing staff who looked at the book and stated that a doctor had not been requested. We requested that one be called the next day.

Having just gone through accreditation recently at the facility I work in, I cannot understand how assessments by the accreditation team can be THOROUGHLY assessed in a time frame of generally 2 days from 8am to 5pm.

What about the evening and night shifts? Even though it could be said that morning shift is the busiest time, evening shift too can be a tremendously busy time.

"I am writing in regard to the terrible lack of care at a facility which eventually lead to the death of my mother. "

I will do my best to keep her at home and look after her myself, hopefully with the help of her other four children!  Although those intentions are good, it may not be practical if her medical condition deteriorated to a point where we were unable to accommodate her needs.

My darling mother has been in a W.A. Nursing Home for just over 1 year, and yes I do have concerns about the aged care system. 

I have been a personal carer for several years now, and for the last few months working in nursing homes.

I care deeply for my residents and treat every one of them as I would my own grandparent and Iam dissappointed that many people believe that Personal Carers (PC's) are careless or abusive. I guess there are people like that out there, but given that where Iwork Iam pressured to carry out the ADL's with speed... (aim for 15 minutes/ resident), I am not surprised that residents are injured at times.

Both my grandmother's were residents of nursing homes in which they passed away. As well, my mother-in-law has just recently passed away earlier this year (2005).

I am now in my mid 40s (a baby boomer) and for most of my working life have worked as a trained nurse...

"I am glad people are stating to take notice - it could be us one day."

"My dear mother-in-law passed away 18 months ago aged 92. I felt that I had to go every day to supervise her care. So many things happened, little things and big things in the end I became so exhausted just trying to keep on top of all the problems that would arise. Most of the staff are wonderful but understaffing is a real problem and there is often only one trained sister in the evening to up to 100 or more residents.

My mother in law had lots of falls and was often there for some time as the nurses rounds are only every few house through the evening and she seemed to manage to fall between checks. One morning I found her on the floor at 8 am. Never new how long she had been there. She had a dislocated shoulder.

"...changing conditions meant that carers did not always know what the situation was with care and medication..."

I have a Brain Injured son in a Nursing Home who requires 24 hour care. He has no short term memory and is confined to a wheelchair. He has been in the current home for 6 years, and I can relay to you the times they have left him sitting on the toilet (forgotten about him), and he got impatient and tried to get up himself, and finished up on the floor.

Two years ago, he was taken outside by one of the residents and left out there in a 30c heat, when I arrived at 11am, I couldn't find him, and when I eventually found him, he was found outside in the hot sun, I brought him inside immediately, gave a shower to cool him down, and a drink for dehydration.

"...Could you please advise what the situation is concerning MRSA/golden staph in NSW/Australia Aged care facilities. My grandmother has recently been admitted to hospital where they swabbed a wound on her sacrum. It came back +ve for MRSA. At the same hospital in the isolation section, is another woman from the same facility with MRSA.

With so many PCA's working in nursing homes and especially when there are PCA's IN CHARGE of wards (working as TEAM LEADERS) wouldn't you think that they would all be knowledgable in administering oxygen.