There are very different understandings of the way the aged care system is operating between the different groups that are interested, including the general public. This is at least in part because there is simply not enough reliable information available about what is happening in the sector. This fuels the perception that there is much that "they" don't want us to know.
It may be that government and the industry are simply blind to what is happening or that the multiple reports of poor care and disturbing cultures are exaggerated. But we don't have the information needed to resolve this. In fact, we have hardly any useful information. The information we get is so tainted by misrepresentation that we no longer believe it.
I have closely examined similar situations in health and aged care and in my view it is unlikely that the government and industry are correct. While there will always be some misunderstandings, I have never seen so much smoke without a large fire.
The sliders on this page: I could go back many more years but have only selected two examples in 2007. This shows that there were wide differences in viewpoint then. The other examples are more recent and the complaints are unchanged.
The section/slider 'The Age Well Campaign' explores different views of the 2012 Age Well Campaign that was based on the 2011 Productivity Commission Report.
The way in which the industry and government ignore and fail to address public exposure of issues as well as key community concerns is illustrated by a 2015 example.
In 2014, COTA promoted the government's inclusion of aged care in trade agreements with China. I contrast COTA's views of our aged care system with those of other senior's groups.
The recently rebadged Australian Aged Care Quality Agency's claim to steadily improving standards of care in Australian nursing homes over the years is contrasted with what others are saying about the system of accreditation of aged care homes.
The final slider is a selection of typical comments coming from the community.
I round off the page by looking at the key issue of staffing, which comes up repeatedly and where, unlike those countries where aged care research is done, there is no information to research in Australia.
Australian Aged Care: 'World Class' ... or is it?
We are confronted with claims to high standards and a world class system. Do we believe that or should we listen to what people who see what is happening are saying?
Accreditation: Making the industry look good - but others disagree
Here is another example expressing the views of the new Aged Care Quality Agency, which is really the old Aged Care Accreditation Agency, transferred to the federal Department of Social Services and then in October 2015 back to the Department of Health.
Is the Aged Care Accreditation process simply a marketing strategy?
Example: LASA is the body claiming to represent for-profit and not-for-profit aged care providers. The new Aged Care Quality Agency is doing the rounds of provider organisations reinforcing their, and politicians', perceptions of the improvements in care they have attained over the years. They are telling this LASA audience what they want to hear, so they will accept it uncritically. The figures below are from a presentation to LASA by the General Manager of Accreditation at the new Quality Agency. The CEO of the new Quality Agency was LASA's CEO a year ago.
Source: General Manager, Ross Bushrod's (Accreditation Agency) presentation to LASA Queensland, May 2014 (Slide no. 13)
This is certainly not the impression that those of us who listen to the rumblings, and the ongoing adverse reports, get. We take note of what people who have experienced the system are saying and the assessments made by more objective organisations like universities. The Age reported on a study of staffing undertaken by academics in Victoria in 2009.
AGED care has deteriorated in Victoria over the past two years, with some nurses looking after 47 elderly people at a time at nursing homes, compared to 39 in 2007.
The surveys, by Melbourne University, found that in 2007, (staffing) ratios ranged between one to six and one to 39, at worst, at Victorian facilities. This year, the ratios ranged between one to nine and one to 47.
Source: Aged care goes from bad to worse The Age 30 Nov 2009
In 2011, another nurse academic at Latrobe University expressed her concerns about the adverse impact of the care provided by untrained staff since 1997 in nursing homes in Australia. She described the progression of aged care from the provision of care by untrained convicts in the early colonial days to trained nurses in the 19th and then 20th centuries - with a regression to untrained aids starting in 1997 just before the beginning of the 21st.
She indicates that "aged care is going backwards" and that "registered nurses are becoming 'a scarce commodity' in the aged care industry".
The aged today are largely cared for by untrained staff, with supervision from a Registered or Enrolled nurse. The role of the Registered Nurse is onerous where they could be responsible for up to and more than 60 residents in a shift.
Despite regulation and inspections by the Department of Health and Ageing, we are continuing to hear of mistreatment of the aged in Residential Aged care Facilities, which shows that not much has changed in the history of the sector.
Unfortunately in these early days of our colony there were those in the community who believed that untrained staff were sufficient to care for the elderly. Is it any different today?
The needs of the elderly in our facilities are becoming more and more complex. Even this is not enough for Governments to identify the need for more Registered Nurses in Aged Care.
Source: Aged care and untrained staff - Dr Jean Booth, La Trobe University (18 Oct 2011)
Criticism of accreditation in aged care
The accreditation results in Australia as revealed in departmental documents, in their reports and in their magazine have steadily improved over the years with the number meeting all 44 standards increasing from 64% in 2000 to 95% in 2012. But the figures they are reporting are deceptive.
They are not the total number who failed in the year, only the number who had not yet corrected problems and been re-accredited at the time the agency reported to government on 30th June each year.
When the figures were challenged in 2008 it turned out that 7% and not 1.8% of homes had actually not met all standards over the year. But that said, the rate of successfully meeting all standards has increased over the years. These findings contrasts with the information coming out of the community, various academic research and journals, and being published in the press.
Many are critical and distrustful of the Accreditation Agency. In December 2008, Aged Care Crisis discovered that the Accreditation Agency reported its results selectively in order to give a positive impression. The qualification "as at last audit" in the presentation above, rather than giving an annual number or percentage of failures per year, suggests that they are still doing so in their presentations.
The number per year or better still a bar graph representing the failures per year is the more usual and more accurate way of presenting figures and comparing them. In 2015 the Agency was still presenting its results to LASA in the same way.
These figures are the *three-yearly accreditation reviews, for which each home has months to prepare. They don't represent what happens for the remainder of the 3 years. Also, the Agency does not actually measure outcomes so there are reasons, other than improved standards of care, why the Agency's figures might have improved. These include that providers and their staff are now aware of what they need to say and do, so the process has become routinised.
*The Budget 2015 announced a raft of measures - including a reduction in audits (eg, site audits reduced from once every 3 years to five years) and plans to privatise provision of accreditation services, allowing providers to choose their own agency to accredit their facility.
The results don't reflect what is actually happening on a day-to-day basis, and because they don't look at the actual results of care and probably never have.
There have been recurrent allegations that the process has been "gamed", with providers bringing in teams with extra staff and equipment just prior to the accreditation inspections. There is no information to indicate how common "gaming" is. Documents released under freedom of information in December 2014 "show that almost one-in-five new nursing homes failed to meet quality standards last financial year". This undoubtedly reflects a learning curve but whether that is in improving standards, or learning how to game the system, is debatable.
Nutrition and accreditation: A thesis study of nutrition in aged care facilities from Monash University in 2013 shows that 64% of aged care participants were undernourished and this had significant adverse consequences for health, for quality of life and for mortality.
The study gave the reasons and found that accreditation standards had failed to address the problems. Nutritional status like other markers of real care are not measured in aged care. The argument critics make is that this finding is very probably representative of what happens with accreditation because it does not measure anything real.
Accreditation standards are meant to ensure quality of care but in this study, they failed to sufficiently ensure a high standard of nutrition. A number of factors were found to explain this, including lack of prescriptive standards, poor staff knowledge and attitudes, very stringent budgetary constraints, and a general failure to perceive the importance of nutrition as a part of clinical care.
Source: Nutritional status and its consequences in low level aged care: implications for aged care accreditation standards and guidance - Monash University - Thesis 2013
A nutritionist doing a doctorate in Queensland was inspired to do this because of the malnourishment that she saw in Australian nursing homes.
Ms Abbey said she is inspired by her own experiences of poor nutrition in residential aged care.
"I have gone into a number of frail aged facilities and seen so many residents who are malnourished or teetering on the edge of malnutrition," she said.
Source: Pioneering nutrition study Australian - Australian Ageing Agenda (18 Mar 2010)
External reviews of the Accreditation (Quality) Agency
An outside review of the accreditation process in 2002 identified the agencies failure to collect the sort of data that would allow it to assess its own effectiveness. It made a number of other criticisms that have been repeated over the years. The agency agreed to collect data but never did so. Instead it commissioned another organisation that embraced the same patterns of belief to review it and give it a pat on the back in 2007. This review agreed that it was 'not necessary' to monitor actual outcomes.
Another review was undertaken in 2009 to which submissions were invited. Many of us made submissions but if a report ever resulted from that, then it and the submissions were not made publicly available. Some of us wanted to see that overdue report before making final submissions to the 2010/11 Productivity Commission inquiry into aged care. We complained, but that did not help!
As recorded above, we have academics in Victoria and Queensland making criticisms about nutrition and staffing. There have been press reports describing allegations about the quality of food in Canberra as well. Below on this page, academics from NSW and from South Australia are even more critical. While the focus is different, each is describing deficiencies in care. But the accreditation process does not record them or their incidence. They don't look.
Perhaps we should let someone from the community say what they think of the care being provided in our nursing homes. This was the response on a comment page reporting on FPCompanyG's plan to float on the stock exchange. Obviously the person wanted the view known. I have taken the liberty of printing it here without the name. It's the sort of thing that is coming from those who see what is happening in the nursing homes. The accreditation agency does not see these things. Is that because it lives in a different world and just doesn't have the same view as the families.
"... I have a close relative in a FPCompanyG facility and my observation on regular, monthly visits over the past 3 years on the statement "the business had grown by offering premium services, optimising government funding entitlements and delivering efficiencies." is a load of rubbish.
The service is definitely not "premium" because the "efficiencies" have been gained by being constantly short of essential items such as catheters and continence pads, by serving boring, repetitive, low quality food and by never having sufficient staff.
Floating on the stock market will surely exacerbate these problems as shareholders wring their profits from the poor old buggers warehoused and waiting to die.
Source: Response to Second aged care provider prepares to float on ASX - Australian Ageing Agenda (24 Sep 2014)
Criticism of aged care over the years
There is an ongoing and steady flow of information coming from those who see what is actually happening and this contradicts what we are being told by the providers and by the agency responsible for monitoring standards of care.
The agency's conduct in its handling of data goes to its credibility as a regulator. Provider's willingness to hide information and fire those who disclose failures in care goes to their integrity.
Contrasting solutions
Some have a very different approach to the way social services including aged care should be provided.
Staffing numbers and skills
What has been done to staffing in nursing homes is a constant theme and emerges over and over again in complaints by residents, by staff and by critics who have examined the system.
There is a large amount of international literature linking staffing directly to standards of care. But in Australia, there is no literature because nobody knows how many staff there are in nursing homes. If it is known then, like so many other aspects of the system, we are all being kept in the dark. We can only surmise that there is something to hide.
It is clear that some nursing homes exploit this loophole in our regulations and the poor standard of oversight provided. There are some that have no staff at all for long periods of time.
In 2012, Aged Care Crisis wrote to the minister about a recently accredited nursing home, one with a poor record for care, because no staff at all were rostered on at night - a period of 10.5 hours. But the department has always been a black hole and little is ever done.
Anyone who knows anything about care has known the critical role that adequate staffing plays - for at least 19 years and realise that it has been a key problem in the sector.
In Australia, every effort to get government to set minimum staffing numbers and standards, or to disclose staffing numbers and skills, has been tenaciously resisted by industry and all governments.
Nowhere is their lack of integrity and lack of accountability to the public more vividly illustrated. They do not deserve our trust if they try to hide things that impact the wellbeing of citizens from us. We should not give it to them until they have earned it.
As a community we need to get in there, see what is happening and try to sort it out. This is much too important to all of us to leave to the self-interest of businessmen and the politicians they control. We should not allow the cost of staffing to become part of their gladiatorial contests. We need to take control of aged care and set the agenda.