Is this culturopathy?

(1) Attacking the messenger

Very different perceptions: In some instances it is difficult to believe that people are talking about the same system. This is probably because there is simply no reliable information available. A good example is the gut response of the industry on their Aged Care & Community Services (ACSA) web site, to an ABC News report on 31 Jul 2014 which reported the observations and criticisms of a university academic who was studying nursing homes.

The people who adopt culturopathic patterns of thinking are often eminent, widely known, honoured and reputable. They are indignant and angrily deny criticism.  Here is an example.

Academic's criticism: Dr Bxxxxth, an Academic from NSW, expressed concerns that the 2014 revisions to the Aged Care Act would be ineffective. Bxxxxth has studied aged care and a list of her papers is here.  She is talking about what she has seen with her own eyes.

Like Bxxxxth, many of us saw changes to the aged care act as simply more of the same - a placebo to placate the public and a facade behind which the government could introduce its marketplace ideology and shift most of the cost of that to citizens.  It revealed the unwillingness of politicians and the industry to  grasp the nettle and do something constructive. Bxxxxth had previously given telling evidence to the three Commissioners at the Productivity Commission Inquiry on 5th April 2011.  There may already have been anger about this.

She was among those who spoke out to Lateline in 2013, exposing a situation that caused ACSA, the group representing not-for-profit providers, to apologise on their website. In 2014, a year later, she did not think that anything had changed. Evidence was simply being ignored and the same processes continued. The ABC reported her views and a contrary view by the CEO of ACSA.  ACSA's CEO may already have been incensed by what she had said in the past.

A suitable response: Dr Bxxxxth has spent 10 years studying aged care and sees it very differently to the providers of aged care. Many others including nurse whistleblowers have said the same things. I would have thought that they would have taken the trouble to discuss the problems with her and support the calls for a Royal Commission made in 2013. If there were no problems then this might have restored some trust to the system. If there were, they could have been addressed and resolved. Instead the industry apposed it ensuring that the complaints and adverse publicity would continue.

This is the response to Bxxxxth's claims reported by the ABC. It is from the ACSA website:

Good examples include Richard Eamer and John Bedrosian from National Medical Enterprises, Richard Scrushy from HealthSouth, and Andrew Turner(go to Part II: Culture) from Sun Healthcare. These are the sort of people who rise to the top in what I am calling a culturopathic situation. I could find more. All three companies indulged in fraud and misused those they were charged to serve.  They operated in Australia but were not accepted here because of their track record and left. We are as human as they are in the USA and simply cannot claim that this could not happen in Australia. It has.

Look at the response of Mayne Nickless in 1994 and at the behaviour of Mr Pratt in the packaging scandal in Victoria. Then there is the abuse of trusting investors by the Commonwealth Bank and not to forget the Catholic Church's behaviour. I describe these and multiple other examples on the web pages Failed markets and culruropathy and Contracting government services to the market. We have to get to the bottom of this. Is the same thing happening in aged care?

I wrote about what I called the Great Divide in Perceptions in a section of a web page I wrote 10 years ago. I suggested that to solve this "Any health care company, operating within a democratic society, would be expected to contribute to any debate and justify their position and actions".

Note that ACSA is not the threatened for-profit sector attacking a critic but the not-for-profit sector, representing church and community organisations, attacking the messenger and not addressing the issues.

On the Dilemma for not-for-profits page I indicated that because the not-for-profit groups were now trapped by having to operate using two conflicting paradigms, they could sometimes respond in unpredictable and inconsistent ways. This seems to be a good example.

Trust and Trustworthiness: We all share ACSA's desire for trust and trustworthiness, but this is now a competitive market in a vulnerable sector, and customers have been misused in almost every vulnerable sector where markets operate. It has happened in aged care in other countries - and, dare we say it, in Australia. The adage "customer beware" must apply. Potential customers should be warned, not reassured. We simply cannot afford to be trusting of the system as it is today. Too many are speaking out about failures. We cannot sweep it under the carpet and expect customers to gullibly swallow the "trust us we're credible and rich" line.

Compare the Catholic Church: The Catholic Church and Cardinal George Pell's conduct as revealed on ABC Four Corners In the Name of the Law on 11th August 2014 shows just how fallible claims to credibility and trustworthiness can be. Because of the priests' power and the nature of faith this was another example of a vulnerable and trusting at-risk community. What these senior priests rationalised as fair and reasonable behaviour over a period of probably 40 years has come back to haunt them. As in so many similar examples they simply did not look at what they did not want to know about.

Again at 8pm on Monday 25th August 2014, the ABC's "Australian Story" told the story of the attacks and criticism by the Catholic church and the catholic community (the same community whose children had been abused) on the award-winning journalist who wrote extensively about sexual abuse of children in the Hunter Valley. She was, as Prime Minister Gillard acknowledged, largely responsible for getting government to set up the Royal Commission.

Then we saw the same thing in the Jewish community in the program "The Code of Silence" on ABC's Compass program on the 12th August 2014. The family who spoke out were victimised and ostracised by the entire community. On 19 August 2015 on ABC News, we learned of the frequency of sexual abuse of children in state care, and the tardiness of the system in investigating these.

• Child abuse report calls for overhaul of residential care system ABC News, 19 Aug 2015

This is human nature. This is how we humans behave, singly and in groups. Usually we don't think we are doing anything wrong when we do so - or else we prefer not to know and look the other way. Is the same sort of thing now happening in aged care?

Perspective: These church groups saw it only from their own point of view. They made no attempt to enter into the lives of the community and the victims. Had they been forced by the community to confront what was happening; had they the courage to open their records at the time these things occurred; then it may have been very different. Had they transparently involved those communities who had been harmed, directly as partners in the process of investigation and remediation, the church might well have dealt with its problems. In doing so the church would have regained trust. It would not be where it is today.

But we humans simply don't behave like that. Gut responses, steeped in our need to survive, trump common sense much of the time. Have the providers of aged care been behaving in the same way?

We must act to protect our community: As a community we need to closely examine all of those vulnerable sectors where there is a lack of transparency, and restructure them so that things like this cannot happen again. Aged care is a very vulnerable sector and we should start there.

Addressing the problem: The only way to address this problem is to put knowledgeable customers in charge, and then expect the providers to clearly demonstrate trustworthiness. Trust must be earned, not claimed.

Con men trade on trust: Charlatans and con men succeed by claiming to be trustworthy, and those who trust are conned. If providers, particularly market-listed companies need more of the community's money to care for the old and frail, then the industry must convincingly persuade citizens that it is genuinely short of cash. Citizens need to be satisfied that there is really a shortage of staff, rather than diversion of money to profit. They need to be satisfied that staff are not leaving (and new staff not enrolling) because of working conditions, or because what they are expected to do is not compatible with their humanitarian mission.

This suspicion applies particularly to the market-listed corporations and private equity owned facilities. They do not have a good track record and it is clear from analysts' reports that they are doing very well in Australia, thank you. When citizens united against what was happening and took to the courts in Florida, staff leaked to them the instructions they had received from  central management directing them to reduce staff, or not to replace staff when they resigned, in order to boost profits. It happened there and without full transparency we cannot be sure that it is not happening here.

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(2) Is this culturopathy

Typically, culturopathic groups discount their critics and are derogatory about those who challenge their views. They angrily reject criticisms and attack the messenger. ACSA's outburst is not the first time academics have been attacked and attempts made to neutralise their findings by destroying the messenger. The objectivity of academics has been challenged and universities pressured to silence them. This is the sort of thing that culturopathic groups do and they don't see anything wrong with it. When I blew the whistle in Australia on the US multinational that I used as an example on the "Cultural Perceptions" page, my university was threatened.

Who should we believe - the industry protecting itself, the accreditation agency with its dodgy use of data, or the academics who have been trained to be objective, and who have been competitively appointed to university posts because of their skills. Bxxxxth is not the only aged care academic to be treated in this way.

Dr Axxxx De Bxxxxs in her PhD in 2007 detailed incidents of neglect concerning some aged-care facilities in South Australia. Her thesis indicated that:

De Bxxxxs and her supervisor were both alarmed by what they had seen not only during the thesis, but in supervising students placed in nursing homes around Adelaide.  They decided to go public.

In the article they detailed a long list of major failures in care which by any standards were "disgusting". Decide for yourself by visiting the links.

There was widespread support for what they had said including by a professor who was an expert in elder abuse.  The paper published again the next day and included another long list of failures in care.

Presumably the material was given to the minister and investigated by the department, but I do not know what happened to that investigation.

The industry strikes back

This was the response to the academics' attempt to initiate debate about failures in aged care, from Aged Care and Community Services SA & NT (ACCS), a not-for profit member of ACSA, as described on their website, presumably addressing their own members:

Universities are increasingly beholden to big corporations and depend on them for grants and other support. That industry feels that it can demand that universities muzzle their staff and crush free speech speaks volumes about the way they think and the challenges to academic freedom in Australia.  I could not track down the letter in response sent to The Advertiser.

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(3) The allegations should not surprise anyone

Dr De Bxxxxs and Dr Bxxxxth's observations should not have surprised anyone. After all, only a few years earlier the Minister of Health herself was telling industry that they didn't need trained nurses. Reports suggested that operators rapidly complied with the policy. Regulators could hardly act when nursing homes were simply doing what the Minister was telling them was OK.

Erosion of independent state oversight had commenced in Victoria in 1995. To keep a lid on the system, the government and the minister quoted above, had three years earlier in 1997 removed all oversight and complaints-handling from the states. What has been happening ever since was already clear in 2000. The inadequacy of the response to complaints was confirmed nine years later, in 2009, by the Walton Review of the complaints system.

After the 2013 scandals Professor Kxxxx apologised on behalf of ACSA:

In light of the facts, the industry had no choice but to apologise. But they immediately diverted the blame from the industry and turned it to their advantage. ACSA and LASA may be right and more money may be needed but in a sector at risk, one where, in other countries at least, vulnerable seniors have been fraudulently misused to generate profit on a massive scale, we need real across-the-board access to what is happening to our seniors and what is happening to the money.

When we look at the large profits being generated by the companies that listing on the share market and the wealth of some of their owners, then it is clear that we simply cannot accept these claims at face value. They sound like self-serving rationalisations. Dr De Bxxxxs claimed that nurses are leaving the sector in droves because of the system. That seems far more likely.

In the example of a culturopathic organisation I gave on the Culturopathy:A for-profit example page the company executives rejected the evidence when the scandals broke. They thought it was a media beat up and instead of going to their hospitals and fixing the problems, they went to a public relations firm for help. They could not accept that what they were doing was wrong. Is this similar?

I would have thought that any sensible community organisation would want to actively debate serious allegations that their seniors were being neglected by those responsible for their care.

But culturopathic groups typically turn to one another to reaffirm their beliefs and downplay the significance and veracity of the evidence they are challenged with. They are reluctant to seriously engage with evidence that is obvious to everyone else. Is this happening here? Do the other quotes on this web page similarly reinforce complacency and seek to counter doubt among believers?

If Professor Kxxxx is genuine in his desire to have a sensible community conversation, he only has to put his ear to the ground and listen.

Downplaying criticism is not new. The same happened in 2009. The ABC Four Corners program on 1st of June had presented a series of very confronting stories illustrating failures in care.

The industry and not the community "suffered" but what did the industry and the minister do? As 89-year old resident, Ms Clark, said in her evidence to the Productivity Commission in 2010 - "but the thing is, nothing gets changed". Instead the industry rejected the allegations out of hand and between them, ACSA and ACS wrote to every federal and South Australian politician protesting. The link to their letter to politicians in now broken so I could not find it.

If we consider the multiple allegations that have been ongoing since then, we can see that they were denying then and still are now. If only they had looked instead of going to politicians, and then joined with and enlisted the help of the community to have something done. Is this the Catholic Church all over again?

A glimmer of light: Amidst this attack on critics there was a glimmer of light.  The invitation of Ita Butrose, who had strongly cricised the providers, to address the ACSA was seen as controversial as she was a critic of the sector but, although not everyone in ACSA agreed, there was support for it. This is the correct and obvious way to deal with your critics.  You involve them and look at their concerns together to see how valid they are and where they are coming from.  What is worrying is that it was seen as controversial.

If we look at the second part of this quote and ACSA's outburst against Dr Bxxxxth in 2014 we can guess whose point of view prevailed.

The last word to Bxxxxth: Finally, in this stoush between providers and academics, Dr Bxxxxth should have the last word. Is the aged care industry blocking research, preventing even academics from studying aged care? Do we believe the industry's demonization of academics or do we believe the academics and wonder at the lengths to which the industry will go to neutralise their findings? Isn't this what the giant cigarette companies have been doing? Are we prepared to allow them to go to these lengths to stop information from getting out, or are we as a community going to step in and find out what is really happening?

It is our parents, and all too soon ourselves when we are old and vulnerable, who are going to be part of this. This is what Bxxxxth told the Productivity Commission.

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(4) Not-for-profits behaving like for-profits

The not-for-profit sector was once part of the community. It depended on them for funding and support, so was working with the community all the time. It responded to the concerns of that community. There was seldom a need for those with concerns to go public. Aggressive attacks on those who expose failures was something that I used to associated with the large corporate entities, whose prime responsibility was to their shareholders.

Intimidation strategies: Large corporations have a legal fiduciary duty to put their shareholders first. They usually aggressively discredit whistleblowers and subject many to the sort of treatment described by Dr Bxxxxth. Typically they threaten then mount SLAPPS (Strategic Lawsuits Against Public Participation). They do so even when they know that they cannot successfully prosecute the cases, or that it would do them too much damage to do so. Most of those who have tried to speak out are intimidated, withdraw the allegations, and give them the apologies they demand.

When I objected to Tenet Healthcare (at the time called "National Medical Enterprises") operating hospitals in Australia and supplied authorities with documents, Tenet Healthcare first threatened me, then my university, and when I refused to retract and apologise served me with SLAPPS in two countries.

They had already pleaded guilty to criminal conduct in the USA. The damning documents I supplied were obtained from lawyers and whistleblowers in the USA and another country. They were used in many of the court actions they settled.

Although they had initiated the action, the company resisted every effort I made to bring them to court in Australia. My lawyer told me that if Tenet had been his client it would have been his duty to advise them of the potential advantages of doing what they did. It usually worked.

Not-for-profit culture has changed: I believe that the attacks by ACSA and its subsidiary ACS illustrate how far the not-for profit sector has lost touch with the community and moved away from its roots. On the page Dilemma for not-for-profits, I suggested that not-for-profits put market and community patterns of thought into two separate mental compartments. To survive they had no choice but to ignore the logical conflicts, and then operate from one or other mental compartment depending on the situation and pressures on them. This seems to be an example where the pressures have caused them to respond from the wrong compartment to that actually required by the situation.

Many of its managers, including Professor Kxxxx have worked with or for for-profit groups. In his legal business, Kxxxx advised them. He would be well aware of the advantages of threatening litigation. What would he have advised his clients if the person, speaking out about failures in care in their facilities, was likely to buckle? Families who complain have been threatened. Are we going to get to the stage where organisations that arose because of the community's concern have become so far removed from that community that they will threaten defamation actions in order to silence critics and protect themselves - or are we there already?

Letter from a for-profit owned facility to family member who described problems in the care of a relative in a blog on the web:

Letter to family member who had gone to the press and had obtained assistance from a member of parliament (For-Profit company):

Lawyers' letters to a daughter who was quoted by the media after speaking out about her parent's death. From a not-for-profit nursing home and then by the CEO:

The proposed Hub and Strategic Lawsuits Against Public Participation (SLAPPS)

Threatening and even initiating lawsuits is a common response by legal departments in big companies anxious to silence critics. Here it is generally impersonal. But when you have a culturopathy, then those who are part of the culture will often genuinely see criticism as unreasonable and rush to their lawyers in indignation. In my limited experience this situation virtually always arises as a result of the failure to handle the initial situation well, to listen and try to see it as the person who is unhappy sees it.

I don't know enough about the cases above to comment on their validity, but what concerns me is that they are occurring, and the number of them. They are all within the last few years. Whether the allegations are valid or not, it is strongly suggestive of a culturopathy when people are so deeply concerned about what has happened to a relative that they will speak out and refuse to back down.  In the vast majority of cases it is because they have not been listened to, their concerns have been rejected out of hand, or no effort was made to address the problems exposed by the failure in care.  A cynical and evil provider who knew what it was doing would go through the motions and placate the person complaining. But in a culturopathy they believe in what they are doing and the critic cannot be right. The response is to deny and then rationalise and demonise the complainant to justify rejecting the complaint.  When the complainat persists the response is anger and action.

These are often people who have recently lost a parent or seen them suffer. Instead of empathising, culturopathic cultures will see these people as vengeful, vindictive or after money and respond aggressively to them. But in the vast majority of cases that I know of it is the determination to stop what has happened to them, or their loved one, from happening to anyone else. Sometimes it is to protect a loved one. It is always extremely stressful.

The proposed Community Aged Care Hub: This is the sort of thing that the hub would largely stop. It would be the hub that addressed the issue, involved the complainant in sorting it out and in fixing any problem. If there was resistance to sorting out a genuine problem then the hub would be behind the complainant. If it was a reasonable complaint they would support the complainant if they went public - and they would have the information to do so. This would not limit the rights of anyone if they did not agree with the hub, but they might not have its support.

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(5) Pulling this all together

Canadian John Ralston Saul in his Massey Lectures describes how, in our western civilisation, instead of using words and ideas to grasp and understand our world, we use them to serve an ideology and build an artificial world in which to live our lives. To do this words and beliefs are used to render us unconscious of the real world we live in. He quotes Mussolini to illustrate how it happens. While he does not use the word "culturopathic", he is describing how and why culturopathic cultures, like the fascist regime that developed in Italy in the 1930s, develop.

I think Dr De Bxxxxs and Dr Bxxxxth, who have both been so aggressively attacked, have by far the clearest view and understanding of what has happened in aged care and where the problems lie. Dr De Bxxxxs uses language to address reality rather than render us unconscious. Dr Bxxxxth tells us how language, that bears no relation to reality, has been used to create a false reality.

I will quote from De Bxxxxs' submission to the Productivity Commission in 2010. After that, I will give a real world example of an unconscious culture built on illusions, that had devastatingly real consequences for the people it was there to help. Finally in the next slider, I will quote from Bxxxxth's contribution to a recent ABC program: Do you think she is describing the same thing and have there been similar real consequences?

She is talking as an insider from a nursing perspective. In my long and detailed submission to the Productivity Commission in 2010, I made exactly the same points and proposed a community partnership very similar to the proposed hub to address the problem.

The commissioners did not hear or notice. De Bxxxxs' final paragraph accurately sums up the situation we have today but because it is underpinned by a culturopathic culture it extends much wider than just changing nursing structure, and wider than simply aged care. It is the culture that is the problem and the Community Hub is intended to address that.

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(6) Using language and finding real leaders

Dr Maree Bxxxxth, has spent many years studying aged care in Australia. She is even more direct in telling us how language has been used to obscure reality and render us unconscious of what has and is happening in aged care.

Even if they don't enjoy finding out, both sides of these very different ways of seeing the world of aged care need to know that their understandings about the sort of care being provided are firmly grounded on solid information about what is actually happening. That means that both need to gather and share information equally - and talk to one another about it.

In a market it is the customer who must own and control the information. The successful operation of a market in a socially responsible way depends on that. Until then it will continue to be a struggle and there can be no trust on either side. They will become more and more polarized.

My thesis is that, as Saul indicated in his Massey lectures, politicians, the industry, the commissioners and even the public have been rendered unconscious by the rhetoric of the ideology they serve. They are incapable of seeing or hearing what is put in front of them. What they see and consider as the real word is the words they hear.

They are unable to see or understand the real world that is repeatedly put in front of them because it, and the world they think is real, no longer bear any relationship to one another. They are incapable of doing anything about it. Aged care is in the grip of a culturopathic culture. It could be resolved by inspirational leadership from the sector to realistically confront what has happened.

What we need is Mandela-like leadership that recognises how badly the aged care system is broken and to seize the opportunity to fix it.  In it's absence we must do the next best thing and empower the community to examine the realities of what is happening, to seize the initiative, and to forcefully step in to address the myriad problems we are facing.

I am suggesting that the proposed community aged care hubs, if properly implemented, can be the tool which empowers society to act.

Not only Australia: It remains simply to remind you that the way "the system" turns a blind eye and the way failures in care are not confronted is not limited to Australia and the USA. You will recall the situation exposed in a INTFPCompanyB nursing home in Australia by an undercover journalist in 2010.  I wrote about it on the page Scandal after Scandal. As indicated there, similar exposures were made by a group of 7 nurses in a INTFPCompanyB nursing home in the UK. Then there were the multiple problems in Scotland.

INTFPCompanyB is a UK for-profit that professes a not-for-profit ethic. It has aggressively expanded into many countries, including Australia. The main whistleblower's account of the way INTFPCompanyB, the police and government responded is very revealing. INTFPCompanyB operates in many countries across the world. It's board and those who manage it are very distinguished people. This is worldwide and I argue a consequence of a culturopathic ideology and the countries that, like large groups in Australia, embrace that ideology.

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(7) Providers cannot logically reject a Community Hub

ACSA cannot credibly reject the idea of a community hub. They must support it. It is exactly what their CEO publicly indicated he wanted. What better way for the industry to engage with the community than to be working closely with them in every part of Australia.

Professor Kxxxx is speaking for ACSA, the largest group of aged care providers in Australia. He is in not-for-profit mode. Is he talking about genuine partnerships, as required by government, and informed discussion? Or is he mixing this up with simply selling the industry's views better? We saw this abused in the psychiatric scandal in the USA, where corporations ran "health fairs" in schools, running mental health education and discussion sessions. Thier primary function was to market the company and funnel the children of anxious parents into hospital, regardless of whether hospitalisation was actually required.

Rewards and praise for staff were based on measured "conversion of inquirers to admission" rates. This is what they recorded, entered into a tracking computer program and reported in their internal reports to management. The conversation and its agenda, were set by the industry, and the intent was to serve the industry and not the community.

If Professor Kxxxx is genuine, then he and ACSA should seize the opportunity. Community hubs meet their stated objectives. There can be no reason for their not supporting and advocating for the creation of community hubs. It is a way out of the situation that they now find themselves in.

A failure to address these issues can only lead to more adverse publicity, and more distrust. The debacle in the Catholic church is there to remind all of us.

Aged care cannot continue down its current path. And the lessons of the 2009 Walton Enquiry into the Complaints System should be heeded. You cannot simply pick and choose what you like from the community hub proposal. Those parts that are essential for it to work must be included.

If a working community hub of the type proposed had been present then:

• ACSA's criticisms of academic research: The local hub would have been working with any academic doing research in their facilities and would be in a good position to evaluate the findings and assist the academic to have needed action taken. The academic would be dealing with them.
  
  The hub's central body would certainly have been dealing directly with ACSA in regard to the statements made and the actions taken in lobbying the universities. If the findings were inaccurate, then they would have had the data to talk to the university about the accuracy of the research and have it peer reviewed. They would not have attacked the messenger.
  
  Universities will generally not tolerate unprofessional or fraudulent research. That the universities took no action indicates that the data was sound and the industry had no data of their own with which to challenge the findings. It is the duty of every academic and university member to report their findings accurately and to speak out in the interests of the community. The hub, with its collection and control of information, would be in a good position to provide the university with evidence to challenge any fraud and ensure it was addressed.
• Victimisation of critics and whistleblowers: The critics and whistleblowers would have come directly to the hub and not to the industry. The hub would be there to see that they were fairly treated, and when required would be there to protect them.
• The conflicting understandings: With the community firmly in control of objective data, and sharing it publicly, there would be little room for the wildly conflicting views about the services provided.

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