Bizarre Rumours that come true
A rumour
It started with a ridiculous rumour that providers were pushing to remove the legislated requirement for Registered Nurses in nursing homes and replace them with 'Case Managers'. This sounded wildly improbable but in a world built on illusions few look at evidence or argue logically. So anything is possible. Those who believed that you do not need trained nurses to care for elderly people were about to press for just this. Almost anything, if it is believed and asserted strongly enough can become 'real’. Provided you are not too close to the real world the words come to replace the real world (See John Ralston Saul in 'The Unconscious Civilisation').
The background
Prior to 1995 when aged care was handed to the commonwealth states like Victoria required one third of nurses in facilities that provided high care to be registered nurses (RN). The new 1997 legislation also specified when facilities required RN’s but after a charismatic US businessman who did not think you needed nurses visited them these requirements were removed. Only NSW maintained a requirement that a registered nurse be on duty all of the time. This is what they wanted to abolish. In other states it was possible to have as few trained staff as you could get away with. Few of us understood or realised this. We only saw the consequences.
You don’t need trained nurses
The idea that you do not need trained staff to care for the elderly was strongly promoted by a very successful con man called Andrew Turner who promoted himself as a world authority on aged care. He persuaded politicians in the USA during the 1990s that you did not need trained people to bath and change diapers which was all aged care was. He met with our politicians in 1997 and his company then entered Australia. Fortunately his business and credibility imploded before he entered aged care.
In spite of this the Howard government embraced that idea enthusiastically and it has underpinned their policies since. Turner's ideas have been so appealing to cost conscious politicians that they have been unable to abandon them. While minister for aged care, both Bronwyn Bishop and Christopher Pyne have said things that show how influenced they were. Turner’s ideas had enormous impact in the USA and Australia. He can be seen as responsible for vast human misery and increased premature deaths in the aged.
If you think an illusion is real, then this will be real in its consequences
The illusion here is so attractive that it has survived for 19 years. The aged are simply getting old and are not sick so do not need medical care. Abbott was health minister during the Howard government soon after Turner visited. When prime minister he and his government were so persuaded by the idea that old people were not sick people that he moved aged care from the Department of Health to the Department of Social Services. He excluded it from the rollout of the PCEHR, the ehealth digital record for patients. After strong lobbying by the medical profession Malcolm Turnbull, who replaced Abbott in a political coup, agreed to move aged care back to the department of health.
When adopting ideas is profitable then those who benefit will push the envelope. There have been allegations that untrained people are claiming to be nurses and are being used to provide care that requires trained and registered nurses. In this instance it was INTFPCompanyB and it denied doing this.
In the section 19 years of care I described the real consequences of illusionary beliefs for our aged care system. Turner can be seen as at least partly responsible for vast human misery and increased premature deaths in the aged.
Getting rid of trained nurses
The power and influence of the aged care lobby was revealed when it was reported that the NSW government was considering removing the requirement that a registered nurse be on duty at all times. The argument was that the federal government had removed the distinction between low and high care and this requirement was no longer necessary or practical.
The debate
An article published by ACSA's Australian Ageing Agenda makes it clear that providers are actually pushing for this and that government is considering it. The move by providers and their justifications for reducing staffing and not having registered nurses on duty was challenged strongly by nurses - those at the coal face.
- - that ratios and staffing requirements were a blunt measure that did not respond to the actual needs of clients and would contribute to unsustainable costs.
- - - an RN on duty at all times in every facility with a high care resident would also be impossible to manage due to a lack of available staff and would be a waste of limited resources.
- - - as the care they require is not acute or curative, it is about comfort and quality of life
Comments by readers:
- - - indicates a poor understanding of resident care requirements.- — - it’s disingenuous to state that RNs are only needed for acute care.- - - illustrates Ms Hxxxxx’s unfamiliarity with real-world care demands;
- - (Prof Rhonda Nay) - - of course access to a highly qualified nurse 24/7 is essential.
- - - Narrow minded opinions like this do not assist the expertise,
- - - It is simply madness to remove the Registered Nurse from their role.
- - - It’s time to reassess the qualifications of those running our peak bodies. The litany of uninformed and dollar-driven decisions is a consequence of having accountants and bureaucrats at the helm; not one has ever actually cared for an elderly resident.
Source: Providers push to review RN staffing requirement - Australian Ageing Agenda, 25 Jun 2014
The suggestion that nursing homes are about 'comfort and quality of life' is a restatement of an illusion that politicians have found irresistably attractive - in the face of evidence and logic.
A letter to the Newcastle Herald soon after expressed the community's concern about what was happening.
Where the pressure were coming from, how real the romours were is revealed by the Sydney Morning Herald. The horror of the nurses, the medical profession and even the normally reticent Alzheimer’s Australia is revealed.
She (nurse) says if this move goes ahead, it could leave elderly people without the medical care needed to keep them alive and prevent unnecessary suffering.
Nurses and specialist geriatric doctors say the change should not go ahead, while Alzheimer's Australia NSW says it threatens the "basic human rights" of some of the state's most vulnerable people. However, the body representing high-care nursing homes says the law is unnecessary red tape that is not adequately policed anyway.
Alzheimer's Australia NSW chief executive John Watkins wrote to NSW Health Minister Jillian Skinner in January to express concern about potential harm arising from changes.
- - "It is inappropriate and unacceptable that steps could be taken to downgrade the qualifications of those who care for aged people with dementia in nursing homes. I cannot understand the push for such a change."
- - - Australian and New Zealand Society for Geriatric Medicine, said doctors who specialised in aged care were concerned that the current laws provided an important safety net
But Charles Wurf, the chief executive officer of Leading Age Services Australia NSW-ACT, the peak body for high-care operators, said the law was a hangover from the days when aged care facilities were primarily regulated by the states, but were not relevant now the system had shifted towards federal regulation.
He said it was flatly wrong that removing the law would negatively impact elderly residents.
But registered nurse Jocelyn Hofman says nurses are increasingly seeing the pressure on aged care facilities to do more with less. "It's all about money," she said. "The elderly are not a commodity, they are a loved one - - “
Source: Plan to remove nurses from nursing homes - Sydney Morning Herald, 21 May 2015
History tells us that the providers have ready access to NSW politician’s pockets on both sides of politics via political donations, and to their open ears through the lobbyists they pay to press their case.
It may take a community backlash sufficient to compromise electoral prospects to stop this from happening - and the community is not sufficiently engaged or interested.
I revisit the issue of staffing in NSW when I look at the widely different ways different groups in an information free zone see things. Its on a later page Coalface vs business that will come on line in due course. There was intense debate in the media. The opposition partiess in the legislative Council, the NSW UpperChamber mounted an inquiry.
This parliamentary inquiry attracted a large number of submissiions by very worried people who knew the importance of staffing. To the relief of many the report rejected the proposal and urged the federal government to legislate staffing levels. As the government did not have a majority on the review and as those government members on the review panel supported the providers it is not clear what will happen.
The transcipts and documents give a fascinating insight into the thinking of providers, of government regulators, of staff and community groups as well as the behaviour of politicans in Australia. There is more revealed here than just staffing!
NSW government goes with providers
As predicted the NSW government rejected the inquiries recommendations . It intends to remove the requirement for registered nurses. Everyone with a genuine interest in the welfare of seniors opposed this and warned of the consequences. Most were aware of what was already happening in the sector.
The requirement for NSW aged care homes to have a registered nurse on duty around the clock for frail residents will be abandoned after the Baird Government decided it was the federal government's problem.
NSW Nurses and Midwives, Alzheimers Australia, National Seniors and the Australia and New Zealand Society for Geriatric Medicine were among the groups urging the Baird Government to keep nurses in aged care homes around the clock for high needs patients.
"Doctors, nurses, gerontologists, academics, health professionals, older people and their families were unanimous in their call for 24/7 registered nursing," said Ms Barham.(Greens MP)
Source: NSW Government abandons 24/7 nursing in aged care homes Sydney Morning Herald, 30 April 2016
The consequences in the real world
The illusion that old people are not ill leads to the conclusion that you can treat them like anyone else in the community. They don’t need skilled nurses able to tell if they are sick or not or to give them pain relief when they need it. They don’t need examination rooms or doctors on call to come in diagnose and treat their ailments.
The aged are among the sickest in our community because aged organs progressively fail and that is what eventually kills us. Doctors and nurses are able to support those systems while life is still worth living and make the decisions with family when it is time to stop. When residents are in pain and need medication or are unwell then untrained carers have little choice but to send them by ambulance usually to a public hospital where those who need not go there block the emergency system.
The outcome is that many patients suffer pain needlessly, have long delayed diagnosis of illnesses and injuries and do not get properly treated.There are periodic reports showing that this happens.
Many others are subjected to the trauma of an ambulance ride and sometimes many hours in an emergency department when they could have been managed in the nursing home. Facilities like this are unable to provide effective palliative care.
Eight of the top 10 locations calling for an emergency ambulance last year were nursing homes, as frail residents were unable to receive the medical attention they needed on site.
"An example of this would be sending a 90+ year old in at 03:00 due to vomiting, even though the patient has set medication charted for said event ... So this poor elderly person is pulled out of bed and into the cold, to an already busy emergency department for treatment."
She (Emergency Department Nurse) said elderly patients can spend hours waiting for ambulance transport back to their homes.
Source: Data reveals nursing homes are top locations for ambulances Sydney Morning Herald 15 May 2016
And federally
The persistence of this illusion about ageing across all sectors of politics is illustrated by the sort of priority given to staffing in aged care. This is a crisis area in Australia. In the 2014 budget, the coalition targeted money that the labour government had already provided to encourage more nurses into aged care and increase their skills. Even the body representing the for-profit groups could not welcome this.
Assistant Minister for Social Services Mitch Fifield has confirmed the decision to cut 15 per cent from the Aged Care Workforce Fund in last week’s budget - - was a cost savings measure.
The decision, which saw $40 million stripped from the workforce fund over the forward estimates, has been criticised by employer peaks and unions as short-sighted and poor policy in light of the aged care workforce needing to triple by 2050
Leading Age Services Australia CEO Patrick Reid said he was concerned that workforce was not being seen as critical - - governments could not abrogate their responsibility for workforce development and the resourcing of a strategic workforce plan.
Source: Fifield defends workforce cut, says dementia funds are safe Australian Ageing Agenda, 20 May 2015
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