Overview of this example

This remarkable drama illustrates the wide differences in perspective between different sectors of the industry. It started as a difference between staff and management leading to a confrontation with the press and the regulator both of whom saw it very differently to the company. It ended in threats, lawsuits and retractions with differences between the government, the judge and the regulator.

Why so important

This is a particularly important example in explaining why a local organisation like the proposed hub is essential if we are going to continue with a market system in aged care,  The company and its management were totally convinced about their position and their actions.  The Australian newspaper that published the allegations was equally convinced by what it was told. The Quality Agency visited the company's other facilities and found that there were many problems and it sanctioned one so they must have been convinced.  The company was furious, took the Quality Agency to court and won their case forcing the agency to pay their expenses. It was a horrible mess where everyones reputation was tarnished.  They also took action against The Australian but it has not retracted or withdrawn its articles.

This example is very important for us as we look at what is wrong with the aged care system and the way it is run. Here the company, its staff, a manager, the press and the agency responsible for oversight were all looking at the same situation and they all understood it very differently.  Could this have been prevented and resolved much earlier. I am arguing that the proposed hub had it been in existence would have been in possession of reliable data and been in an excellent position to do so.  It is the extreme examples that bring deep seated issues into sharp focus and can show us how to address the problems. We should not sweep them under the carpet or be afraid to criticise.

Outline of the story

The Australian newspaper broke the story describing a shocking situation in a not-for-profit nursing home in Queensland. Whistleblowers had spoken to the reporter describing a problem nursing home manager and a flawed company administration. The paper accused the company of attempting to cover up the scandal and of not reporting incidents they should have.

The CEO of the company angrily rejected most of the allegations putting the blame on the now sacked facility manager claiming they had responded promptly and appropriately. The company tried to stop publication by lodging an injunction but failed. Another manager in the company eventually spoke out confirming the attempt to cover up in order to protect the company's reputation.

The Quality Agency promptly visited all of the company's other nursing homes.  Its assessors found deficiencies in the majority of them. In one they considered these to be major problems which posed a serious risk to the residents. The government promptly imposed sanctions.

The CEO angrily rejected these findings claiming that the company had been unfairly treated. It objected particularly strongly to the sanctions which the Quality Agency soon agreed to lift on the basis that the situation had been corrected. The original finding of serious risk was maintained and not withdrawn.

In the meantime the company blocked further whistleblowing with threats of legal action against staff who did so and fired the manager who spoke out.

The Company was still not happy and took the Quality Agency to court claiming damages. An agreement was negotiated in which the serious risk finding was withdrawn and the Company’s legal costs but not the damages claimed were paid. The judge in his ruling agreed that the company had been unfairly treated. The CEO claimed that he and his company had been totally vindicated.

To the best of my knowledge there are still court actions ongoing including an attempt by The Australian to have documents from the Quality Agency released under FOI.

In the dark about what happened

Clearly we will never really know the full details of the problems and their extent although it is clear there were some. Once again the community will not know because they were not there.

My interest in this is what can be inferred from the claims made by the various participants, what it reveals about their thinking, how the situation came about, what it reveals about the system and how this situation can be prevented in the future.

Some deficiencies?: It is reasonable to assume that there were some deficiencies and the company has not denied that there were some problems in the first home targeted. I am interested in the extent to which this supports my theses that the Quality Agency is flawed and that focus of nor-for-profits is shifting towards marketplace activities and marketplace performance. Attention and effort is increasingly shifted towards financial performance as a measure of success and away from care which consequently suffers. That the CEO was trained as an accountant and that the company was claimed to have become very profitable is therefore of interest to me.

No solid data: At the end of the day the absence of data means that my assessments remain speculative. But this is a serious matter. There are vulnerable people at the receiving end. We do need to look at what might have gone wrong in the company, in the Quality Agency and in the system itself and ask ourselves how we can prevent this in the future. Would the proposed Community Aged Care hub have prevented this. I think it likely that it would have.

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Staff confronting management

The press reports

On 16 Feb 2015, The Australian published several devastating stories about care in a home, K******* G****, run by the not-for-profit XXXXXX Community Services in Queensland where it is known as NFPCompanyE Aged Care. This is one of Australia's premier newspapers and can be expected to get its facts right.

The experienced senior (and Walkley award winning) journalist Hedley Thomas has a distinguished career in investigative reporting and has written books about problems in health care. We would not expect them to make these serious allegations lightly and without good reason.

The comments below are based on what has been said by reputable newspapers. When management were told of the planned report, NFPCompanyE was already being advised by lawyers and, presumably on their advice, sought an urgent court injunction to prevent the material being published.

Hedley Thomas was interviewed by Wendy Harmer's online magazine The Hoopla, and this is what he said:

The alleged failures in care

The press reports allege that there were appalling failures in the care provided to residents. After families complained directly to Queensland management, NFPCompanyE did an internal investigation in December 2014. As a consequence, two managers were fired. The matters were not referred to authorities but instead taken to lawyers and public relations experts so that they could deal with the problem should there be publicity. The reports suggest that they did less than the minimum legally required to be reported to authorities and allegedly did not follow the advice of their lawyers.

In The Australian, the facility is described as a "house of harm". Reported allegations made by families and staff relate to "claims of serious neglect, cruelty, bashings by residents, untreated pain, physical and emotional abuse, fabricated reports to cover up serious incidents, and deaths - all linked to gross mismanagement".

Other allegations relate to the quality and quantity of food with nurses claiming that they were instructed to serve smaller portions. There were allegations of poor resident hygiene, verbal abuse of residents, a refusal to take residents to hospital when needed, and not taking action about the repeated assault of residents by another resident who was violent. Almost all of the blame was put on to the home's manager who was "condemned by staff, residents and relatives". She was alleged to have directed staff to falsify records and altered records herself in order to conceal the poor quality of care.

The response to an internal investigation

What is particularly revealing about this case, is the amount of information that has been leaked by someone to The Australian newspaper since the internal investigation. Someone was very disturbed about what was happening. The leaked material includes the lawyer's letters instructing managers how to deal with the problem, how the fired nurses were used as scapegoats and allegedly doing the absolute minimum legally required in reporting.

Whistleblowing

There is always a risk and a cost to speaking out to expose bad things, and those who do so seldom do so lightly. What is so striking here, is the extent of the leaked documents and the number of staff who have spoken out since the internal investigation. There is strong feeling.

These staff clearly did not see management as blameless nor did they consider that the investigation done was adequate. The leaked lawyers letters indicate that the prime concern of management was reputational damage and legal consequences. The lawyers even suggested that a legal investigation should be commissioned so that the matters could be protected by legal privilege and so remain confidential.

They indicated that there is no requirement under the Act to report critical incidents and by inference a minimum should be done.  I think anyone reading that would see it as an intention to keep what was happening away from the public who need to know if they are to protect their fellows.

Management response

The CEO of NFPCompanyE is Jxx Cxxxxxx and he has been the only public face of the organisation. He looks like a reasonable person and speaks in measured formal terms. He doesn't look or talk like a villain.  He clearly sees this very differently to the staff and believes that he and NFPCompanyE have been unfairly targeted by The Australian. He has clearly been well drilled by his legal team and public relations advisers.

He addresses the issues and puts his point of view in an interview on ABC radio.  Please listen to what he has to say to hear the other side of this.  He contradicts what The Australian said claiming that they got it wrong.

• Concerns raised about aged care facility ABC PM interview 16 February 2015

He categorically rejected "the allegation that NFPCompanyE has engaged in any sort of cover up". In his interviews he admits some of what happened in general terms, flatly denies those that can be disputed, and places all of the blame on the fired managers. What is clear, is that NFPCompanyE and its CEO see what has happened and NFPCompanyE's conduct very differently to staff and those who read the allegations.

It is the sort of interview that backfires badly, because it is scripted and so clearly based on legal advice that it lacks conviction - so it is in fact counterproductive because even if what Cxxxxxx said is true, it is not going to be believed by listeners. He is doing what he has to do and it is his job to do that. It is how our system works. Cxxxxxx has given multiple interviews all strongly denying much of what has been alleged.

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An unfolding saga

To clarify the way this saga unfolded, here is a time line of events gathered through media reports:

Legal actions are still outstanding so the issues are still not fully resolved and may never be.

17th February: Denial

Blaming the local managers: Cxxxxxxx claimed that "all of the issues centred around the actions of the manager of K******* G**** and as a result of that investigation that manager was terminated" and "All of the issues have been resolved as far as the complainants are concerned."

Government investigates: He indicated that the facility had been visited by the Department of Social Services who had started an investigation on January 22nd. They stayed one day instead of two and "commented on the happy attitude of both staff and residents and how pleased everyone was with the action's we'd taken."

Senator Fifield indicated that the department had acted swiftly in response to a complaint with an unannounced visit on 22nd January and "Matters relating to this particular complaint are currently under investigation and the provider has been working to resolve the issues."

Legal response: The Australian reported that NFPCompanyE had "threatened legal action and heavy fines against whistleblowing staff". It also revealed that NFPCompanyE "has also demanded that The Australian destroy all confidential information and reveal its sources". It should "cease use of our client's confidential information and or any improperly obtained information". The Australian also revealed that NFPCompanyE lawyers had earlier urged NFPCompanyE to get them to do an investigation so as "to obtain the benefit of privilege (legal confidentiality)".

The Australian subsequently pointed out that Cxxxxxxx had indicated that NFPCompanyE had lodged a notification to the Queensland Ombudsman in regard to the two sacked managers.  But that only arrived after the article on 16th February was published. This was explained away as a postal delay.

Reputation: If NFPCompanyE were worried about their reputation, was there anything more damaging than to take legal action to stop the public from learning about what they had been doing in fulfilling their responsibility to care for our aged citizens?  It simply becomes more difficult to believe.  Was there something terrible to protect? It is more likely that they found it impossible to accept that this had happened to them? Cxxxxxxx is clearly following the advice of his lawyers, but their action only fuels the perception that they are desperate to shut this off because there could be worse to come.

Once again, we have two very different ways of looking at what happened with the staff blaming management and management rejecting their claims but blaming the press. They cannot all be correct.

On 20th February: Failure to report?

The Australian indicated (Paywall present) that NFPCompanyE's legal advice was that "Known bashings at a scandal-hit aged-care home needed to be reported to police and the federal agency, according to strongly worded legal advice provided confidentially to XXXXXX (religion) group executives in December." 

If this is true then it does not support Cxxxxxxx's claim that they were not covering up.  NFPCompanyE also wrote to The Australian claiming that all of the lawyers letters were privileged and illegally obtained.

21st February - A senior manager alleges harm to residents and cover up:

What NFPCompanyE had been doing and saying became too much for Dxxxxx Txxxxx, the Human Resources head of XXXXXX Community Services. He was one of the team who had been involved in planning the alleged cover up. He broke ranks and spoke out.  He claimed that NFPCompanyE had known what its responsibilities were and had deliberately covered up everything it could in order to protect its reputation. 

His decision to break ranks and speak out must have taken much soul searching and enormous courage. He clearly saw it very differently to Cxxxxxxx.  We all owe him an enormous debt of gratitude for being honest and taking this risk.

2nd March - Quality Agency finds serious and immediate risk at second NFPCompanyE aged care facility

The department had been checking all of NFPCompanyE's nursing homes and had received complaints about K######, a home in Lyyyyyy. The department visited the home and urgent actions were put in place.  Reports indicated that K******* G**** and K###### Village were both issued non-compliance notices by federal authorities.

The second facility, K######, was given a "notification of a serious and immediate risk from the Quality Agency and sanctions were immediately imposed." It was "required to appoint a Commonwealth-approved adviser --- within five days, and to train staff" in a number of deficient areas within three months. The adviser would remain for 6 months. Sanctions and withdrawal of funding for new residents was imposed for a 6 month period.

In regard to K*******, NFPCompanyE was required "to address identified deficiencies at this facility" and was given 14 days to respond with the options of sanctions remaining.

The Australian understood that a failure to do "mandatory reporting of missing residents and reportable assaults" figured prominently in internal reports by the agency. They also reported that 'Jxx Cxxxxxxx and communications manager Jxxxs Wxxxs sent a letter to all staff urging them to trust in the Lord and not be troubled by "unrelenting persecution" by The Australian'. Decisions about accreditation of the two facilities are to be taken after the facilities have been given an opportunity to respond.

More details about this became available eight months later

In October, The Advertiser described what some of the findings (including 12 performance criteria not met) had been. These were described in court documents lodged by the company disputing these findings. These included a failure to meet basic privacy and dignity standards. Those mentioned were ‘wounds were dressed in the dining room, large quantities of expired medications were found in fridges and residents were referred to as “feed one” and “feed two”’.

There were also instances of resident on resident physical aggression and residents escaping onto a road. The last two seem to be the only two posing a serious risk. The Courier Mail also later went to court to obtain documents under FOI. These showed that an auditor from the agency noted that some residents of the Kxxxxya home were “left in wet beds” and a resident claimed they had been “grabbed” by another resident.  The assessment was later overturned in court and the agency was found to have treated the facilty unfairly.

• NFPCompanyE nursing home launches action against federal department following audits The Advertiser October 26, 2015 (Paywall)

NFPCompanyE's public response

Jxx Cxxxxxxx complained bitterly of the blitz to which NFPCompanyE had been subjected by the agency. He considered that "The decision by the Department of Social Services - - - is based on factually incorrect information in an agency report and is the culmination of a flawed process driven by a media agenda". He said that "None of these claims have been substantiated despite the unprecedented investigations by the department and the agency". NFPCompanyE would work with the department "while we challenge the agency's report."

NFPCompanyE "strenuously rejects the report from the Australian Aged Care Quality Agency on which a sanction decision was made against our K###### aged care facility yesterday". Cxxxxxxx indicated that "We have been caring for Queenslanders for 65 years and this is our first sanction. We will be pursuing every avenue of appeal to overturn this decision".

17th March: Allegations about a 3rd nursing home

The Australian responded by making further allegations. On 17th March, Hedley Thomas (in The Australian) named a third NFPCompanyE nursing home in Brisbane.  Once again, it was staff who leaked information and documents.  An investigation of a senior nurse had started in 2011 and was still ongoing. The accusation was that this nurse administered an unauthorised mixture of intravenous sedative drugs to three patients who would have died from the effects of the drugs.

The allegations are that the residents "were given a cocktail of life-threatening drugs infused continuously from a syringe­driver, contrary to the ­direct instructions of doctors". A palliative care specialist reviewing the matter "highlights a range of serious lapses in clinical care in the treatment of the three residents" and "entirely outside of nursing scope practice".

One not very ill resident "was wrongfully denied water and food, and given continuous infusion by syringe driver which, without legal prescription, was illegal".  The specialist indicated that "if the infusion had not been ceased, that the medications may have contributed to a decreasing level of consciousness, respiratory depression and the inability to take fluids. This is likely to have resulted in death."

It was other nurses who remonstrated about what was happening and one of them stopped the infusion. This nurse, "a nurse for almost 40 years, went to police because she suspected something was seriously amiss with the treatment of this resident, and others, who were not palliative in her view."

Cxxxxxxx indicated that NFPCompanyE staff "met individually with the family members of each of the alleged victims and expressed deep sympathy about the ­situation". The relatives of one of the residents who died after the infusion, claims they were not told of the investigation until contacted by The Australian. The 93 year old's niece indicated "I feel deceived because we have had no idea about any of this or that there were any suspicious circumstances with my aunt's death."

The nurse strongly denied any intention to euthanise. One again, it was leaked documents that revealed that NFPCompanyE were preparing a public relations strategy including a Q&A primer to guide managers in press interviews. NFPCompanyE in its leaked draft media release, denied wrongdoing, claimed that "we referred the matter to the police" and "the actions of the nurse who spoke up triggered a quick-­response investigation". NFPCompanyE CEO Jxx Cxxxxxxx said "NFPCompanyE then referred the matter to authorities including Queensland Police, the State Coroner's office and the Australian Health Practitioner Regulation Agency (AHPRA)".

26th March - Accreditation/Agency findings

When NFPCompanyE received the accreditation report on K*******, it immediately issued a positive statement putting a positive spin on the fact that the home had passed 42 of the 44 standards.  In spite of all the pressure and the effort starting in December, three months later, this home had still failed two of the accreditation standards.  What was described by staff including D****l T***er, is not disproven by this.

But there was more to come.  Five of the remaining seven nursing homes were found wanting and did not meet all of the accreditation standards but none of the nursing homes were sanctioned or closed.

The Australian reported this on 28th March making the point that only 2 of its seven nursing homes met all accreditation standards.

Challenging the sanctions

What happened now is difficult to sort out because of conflicting press reports. ABC News reported on 18 May that "The ACQA revoked the serious risk ruling about 10 days later (after original finding), but still imposed sanctions, including the appointment of a government adviser and mandated training for staff". This is clearly incorrect.  They may have decided that there was no longer a serious risk but they did not revoke their original finding.

NFPCompanyE  decided to fight the regulators.  On 18 May 2015 it launched Federal Court proceedings for a judicial review of the ACQA's decision because it says "the sanctions are causing unnecessary grief for residents and their families". NFPCompanyE insisted the decision was based on incorrect information.

Reporting this the next day, The Australian suggested that profits had slumped and that this is what had precipitated the court action.  They clearly had no doubts about what was happening.

Coincidentally, I was sent a Case Study by Font, a public relations firm, in regard to a similar problem in K****gal, a Victorian not-for-profit. There had been banner headlines “HORROR HOME Frail elderly residents abused” in 2007.  NFPCompanyE was indignant and saw it very differently. This was not the path it followed and it wanted to be vindicated.

Claims and counterclaims

NFPCompanyE claims to be vindicated: According to The Chronicle (11 Dec 2015) a Federal government audit "found the sanctions had been imposed on false accusations of mistreatment of residents and that the sanctions should never have been imposed.  Reference to the sanctions was expunged".

On 8th July headlines in The Queensland Times read “Audit clears Lyyyyyy aged care centre” with a photograph and statements by Jxx Cxxxxxxx.

But the Quality Agency was far from happy and had a very different view.  The Australian Ageing Agenda reported this backdown and also reported the AACQA's explanation.  They did not back down from their original assessment that there was serious risk at the time they visited and The Chronicle indicated that this was left on their website.

On 26th July, The Australian published an article Aged-care provider 'not vindicated':

In its response, NFPCompanyE maintained its position claiming “The accuracy of the agency’s serious risk decision at K###### is currently the subject of legal challenge before the Federal Court,”.

A week before, whistleblower Dxxxxx Txxxxx had been summarily sacked.

The Australian reported on a court case where it is trying to force the Quality Agency to publish deidentified documents arguing “that the regulatory agency’s descriptions of their negligent care should not be secret”.

• NFPCompanyE aged-care group fights bid to open documents The Australian, 11 Aug 2015 (paywall)

Court action quashes 'serious risk' findings

The 59 bed Lyyyyyy nursing home took the Quality Agency to court claiming that the findings were misleading and sensationalised.

The Courier Mail in reporting on the quashing of the serious risk finding, indicated what the findings quashed were:

The Chronicle gives more detail about what happened

The CEO Jxx Cxxxxxxx commented on the stress caused to residents indicating that “court order vindicated the organisation’s position that there was never a serious risk to residents”.

• Aged care risk report ‘was unfair’ The Australian 18 Dec 2015 (Paywall)

Assessment

There seem to be a large number of people who believed implicitly in what they were saying and doing but obviously they can't all be correct.

K******* G****

• Staff and residents in the K******* G**** nursing homes were so concerned about care that they spoke to the newspaper in spite of the risk of losing their jobs
• Some other nurses indicated that similar problems were widespread across the sector.
• A member of the management team was so convinced that there were serious problems and that management were attempting a cover up what had happened at K******* G**** that he spoke out publicly and lost his job
• The Australian Newspaper were convinced and pursued the matter aggressively in the face of demands and threats from the company.  They believed that the company had not responded appropriately to the situation and had attempted to cover up what happened.
• The company and its lawyers believed that the Australian had received and published confidential legal documents they were not entitled to.
• The company believed that it had identified the problems in K******* G**** properly and responded appropriately. 

Remaining facilities

• The Quality Agency visited all of the company's facilities and believed there were multiple problems in most of them.  One posed a serious risk and was sanctioned by government.
• The company was indignant about this claiming that the process was flawed.  It took legal action.
• Government did their own assessment some time later and did not support the agency.  They lifted the sanctions.
• The Quality Agency considered that its initial assessment had been correct and refused to remove the information from its web site.
• There was a great deal of adverse publicity which was damaging for the company.
• The company claimed $100,000 damages
• In a negotiated settlement the judge found that the company had been treated unfairly.  The Quality Agency paid $25,000 in legal costs but not damages.
• The company was vindicated and the Quality Agency forced to retract its assessment of the nursing homes.

Conclusion

The agencies assessments were flawed and the company was vindicated, but we don't really know what was happening as there was no data about staffing or standards of care available.

NFPCompanyE's CEO was angrily defiant to the end - denying and challenging. He called on the Lord to protect them from The Australian. He was eventually vindicated although the extent of this vindication is unclear.  No damages were awarded.  The legal case related to only one of the nursing homes.  The judge found that he was correct and that he and his company had been treated unfairly.  But this does not mean that there were no problems.  We simply don't know.

He sounds absolutely genuine and I think that he is.  His indignation has led him to persevere even though that perseverance resulted in many more press reports, dragging it out for months and causing much more damage than simply allowing the matter to die out.  After 65 years with an unblemished not-for-profit record he does not accept that anything like this has happened under his watch.

In a sector where almost all facilities are fully accredited with a 44/44 rating there does seem to have been some suboptimal performance.  We need to analyse why and how this has happened and see what we can learn from that.  There are lessons to learn.

We have very limited information but this was a critical event in the aged care sector and we do need to look at how it may have happened and what we can do to prevent it from happening again.  We should do that as sympathetically as we can.

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Articles on which these comments are based

Some newspapers put their material behind a paywall and this critically important and revealing material is not readily available to the public at large who need it to drive this important community issue.  Those who need it are going to have to pay for each of the articles.  The latest articles from ABC News, the Daily Examiner and others are available and do tell some of the story.  Note that these are statements made and quoted in the press. They may or may not be accurate and most have been denied.  The comments on this web page are made on the basis that these people genuinely believed what they were saying and that there is likely to have been some substance to then even if they were exagerated and overblown.

• Inside the house of harm The Australian, 16 Feb 2015
• Bashings, abuse in aged care The Australian - The Nation, 16 Feb 2015 
• Powerless to help a husband and father The Australian - The Nation, 16 Feb 2015
• Qld aged care centre denies abuse cover-up AAP, 16 Feb 2015
• Qld aged care abuse claims investigated Herald Sun, 16 Feb 2016
• A Queensland aged care facility has denied claims it covered up the abuse of residents. The Courier Mail, 16 Feb 2015 
• Qld aged care centre denies abuse cover-up SBS New,s 16 Feb 2015
• Concerns raised about aged care facility ABC PM interview, 16 Feb 2015
• Bundaberg nursing home assaults prompt call for Queensland aged care review ABC News, 16 Feb 2015
• Aged care facility issues statement after abuse allegations News Limited, 16 Feb 2015
• The federal government says an independent investigation is underway to look into claims that an aged care facility in Bundaberg covered up abuse. SBS News, 16 Feb 2015
• A Royal Commission into elder abuse? The Hoopla, 16 Feb 2015
• Aged-care abuse scandal signals system in crisis, say advocates The Australian, 17 Feb 2015 (paywall)
• K******* G**** nursing home in Bundaberg denies cover-up of alleged abuse and neglect Courier Mail 17 Feb 2017
• K******* G**** to be investigated as CEO denies cover-up. The News Mail, 17th Feb 2015
• XXXXXX group threatens legal action against aged-care whistleblowers The Australian 17 Feb 2015 (paywall)
• K******* G**** under review by Quality Agency Australian Ageing Agenda, 18 Feb 2016
• QLD provider insists abuse cover-up claims are wrong Hospital and Aged Care, 19 Feb 2015 (Aug 2016 Now goes to blank page)
• Nurse's Letter: aged care more about business than care CQ News, Feb 19 2015
• Home didn't report harm, despite advice The Australian, 20 Feb 2015 (paywall)
• NFPCompanyE's full statement to The Australian NFPCompanyE web site 20 February 2015 (This web page and related pages on this site have now been taken down)
• We covered up abuse: aged-care manager The Australian, 21 Feb 2015 (? paywall)
  
• (Another reason for abolishing cover up contracts Victims website repeats above)
• Estimates - Social Services Portfolio Community Affairs Legislation Committee Hansard, 26 February 2015
• Statement by Jxx Cxxxxxxx, Chief Executive Officer NFPCompanyE website 1 March 2015 (This web page and related pages on this site have now been taken down)
• Second home hit as aged-care cops rush in The Australian, 2 Mar 2015 (paywall)
• XXXXXX-run nursing homes K******* G**** and K###### Village issued non-compliance notices by federal authorities ABC News, 2 Mar 2015
• Bundaberg, Lyyyyyy aged care centres face probe The Daily Examiner, 2 Mar 2015
• Lyyyyyy aged care facility sanctioned Gatton, Lockyer & Brisbane Valley Star 3 Mar 2015
• Qld union urges aged care nursing reforms Daily Mail, 3 Mar 2015
• "False claims" place Lyyyyyy aged care centre in spotlight Queensland Times, 6 Mar 2015
• Fears aged residents euthanased The Australia,n 17 Mar 2015 (paywall)
• Drug regime branded ‘improper' The Australia,n 17 Mar 2015 (paywall)
• Nurse accused of euthanising residents Sky News, 17 Mar 2015 (No longer available)
• Aged care advocacy group Care Opinion Australia urges more nursing home industry transparency ABC News, 18 Mar 2915
• Audit clears K******* G**** home News Mail, 26 Mar 2015
• Nursing home audit finds care failures at five Queensland facilities run by NFPCompanyE ABC News, 26 Mar 2015
• NFPCompanyE to work with regulators: ‘no serious risk' The Australian, 28 Mar 2015 (paywall)
• NFPCompanyE vindicated by K###### Lyyyyyy audit findings Gatton, Lockyer & Brisbane Valley Star, 31 Mar 2015
• Lyyyyyy nursing home K###### Village Care to fight regulator's sanctions in court ABC News 18 May 2015
• Aged care operator NFPCompanyE sues over losses after sanctions The Australian, 19 May 2015 (paywall)
• Audit clears Lyyyyyy aged care centre The Queensland Times, 9 Jul 2015
• Sanctions overturned in unprecedented decision Australian Ageing Agenda, 10 Jul 2015
• Aged-care whistleblower sacked for 'talking to the media' The Australian, 20 Jul 2015 (paywall)
• Exclusive; Aged-care provider 'not vindicated' The Australian Onlin,e 26 Jul 2015 (paywall)
• NFPCompanyE aged-care group fights bid to open documents The Australian, 11 Aug 2015 (paywall)
• NFPCompanyE nursing home launches action against federal department following audits Courier Mail, 26 Oct 2015 (? paywall)
• Federal Court clears Lyyyyyy aged care home The Chronicle 9 Dec 2016
• Finding that residents at NFPCompanyE-run aged care home placed at serious risk quashed Courier Mail, 10 Dec 2015 (paywall)
• Federal Court overturns serious health safety risks against NFPCompanyE Aged Care ABC News, 11 Dec 2015
• Aged care risk report ‘was unfair’ The Australian, 18 Dec 2015 (paywall)
• Complaint about ABC article on 26 Mar 2015 resolved ABC News Online, Dec 2016

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Looking at what happened differently

I try to see things differently and avoid blaming things on evil people or accusing people of deliberate lying. As an outsider I simply don't have the knowledge to know exactly what happened here but there are clues.  High staff turnover is such a familiar situation to anyone who has tracked the major scandals in the health and aged care industry that you can make some good guesses. Lets look more closely.  My interest is in the pressures in the system to which the people are responding.  I am raising issues here looking at how good people doing good things can get it wrong.  What might have been going on here.

The staff

Much of the initial information comes from staff and ex-staff from K******* or is supported by them. There are plenty of ex-staff as there was a 50% staff turnover. This is a critical and glaringly obvious red flag to management indicating that there are problems in the K******* home. They could not have missed this, but they could have elected not to look. Nurses only resign at these rates because they are very unhappy. The Australian described management's "thorough investigation" as "a rushed and limited internal probe". That would have been based on what the staff told them.

The staff indicated that the fired manager "kept costs down and was protected by others higher up the chain". The employees indicated "systemic issues including a relentless focus on cost-cutting that compromised care". A staff member says that staff felt that management was aware of what was happening and had "stuck your heads in the sand" and "that's why most of us gave up saying anything". The staff indicated that they were told to serve smaller portions of food - so small that they were not adequate. The manager threatened to sack staff who complained and they were frightened of reprisals.

One of the staff indicated that this had gone on for several years and was not detected because of "systemic issues and culture of the organisation." The resident who assaulted others was not sent elsewhere because he was a big source of funding. There was a "strong focus on profitability in XXXXXX Community Services facilities in Queensland (and it) has been positive for the balance sheet but taken a heavy toll on care". This allegation of an excessive focus on profits is what we see in the worst for-profits.

There had been a serious complaint in July 2014 which was dismissed and it was only when angry relatives went to head office that management took action.

The reason that the staff finally decided to speak out publicly may well have been, as one staff member indicated, that "they have rushed to hire lawyers and spin-doctors in case the story gets out". That would have sent an appalling message to staff, especially in a not-for-profit facility where care is usually driven by humanitarian motives. Another staff member said there would be resistance from XXXXXX Community Services to any external investigation because they "want it all to go quietly away now".

We need to ask about the managers who were fired.  They may have been evil or incompetent but in many instances where this happens they are doing their best to meet the demands of management and get their approval.  If the nurses felt that there was pressure to keep costs down and the manager said this to them then it is very likely that the managers felt that they were required to do this and that there were pressures from management to keep costs down.  They took steps to do this.  Management who have no experience in care are usually unaware of the way staff interpret this and the consequence for care.  When things go wrong it is the managers who are blamed.  We don't know if this happened here.

Whether the views of staff are accurate or not can be debated, but they are certainly sincere and this is how they perceive the way management was running the nursing home. At the very least, management are out of touch with staff and their concerns. One reason for this may be that they no longer see and understand care in the same way as their staff - the primary objectives are now different.

Summary - conflicting perspectives

It simply cannot be a conspiracy by staff when so many of them make such serious allegations. While we may be wrong on some issues, the chances of Hedley Thomas fabricating all this must be small.

It is difficult not to conclude that there was a worrying culture in the nursing home, and the nurses felt that this came from above. Its equally difficult to conceive of a church based organisation deliberately tolerating such poor standards of care simply to be more profitable, but clearly that is what the nurses saw happening.

None of this is unique: This sort of thing has been happening in for-profit facilities across the world and sometimes in not-for-profit as well. Robert Kuttner writing about health care in the USA during a period of corporate consolidation indicated that not-for-profits are forced into the same mould by market pressures - the same thinking and the same things happen.

I have been arguing for years that failures in the system are a consequence of the way the sector is structured and forced to operate and not because of the people who are there.  The system is structured in such a way that the wrong people for the sector succeed and prosper and the people who should be there are pushed out. People who would otherwise behave very differently are put in positions where they have little choice but to comply.  To live comfortably with themselves they don't see or don't acknowledge.  But it is the system that is responsible.

The system drives people to do what the system requires in order for them to prosper - or just survive there.  There is no room for humanitarianism. This might work elsewhere and these wrong people might be the right people there, but in aged care they pose a threat to the residents.

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Looking at it as a system problem

Another way of thinking about this

Problems like this are almost never local and isolated. They are systemic and red flags to what is happening progressively across much of the sector - but often to a lesser degree. Insight, into the systemic aspects, is usually lost in the heat of the blame game as each group indignantly blames the other, and as industry or politicians claim that what has happened is isolated.

This is exactly what happened on the ABC News on 2nd March 2015 and we should not doubt that the comments were genuine.  Someone was there to assure us that this was isolated and care was generally good.  There were also interviews with the residents of Lyyyyyy who were positive about the nursing homes which were well established institutions in the town.  It was not disclosed how many of those interviewed were XXXXXX church members as they were likely to rally behind their church, much as the Catholic and the Jewish communities did when allegations of paedophilia were made.

But it is citizens who have looked around that realise the systemic nature of the problems.

To understand why these things happen we need to start looking much more widely and track back to see what is happening in the sector. I explained much of what could be happening in the Cultural perspectives section.

Background to this explanation

On those pages I quoted Robert Kuttner's analysis of the way that not-for-profit organisations in the USA were emulating for-profits and bringing in management to address financial issues, usually from the for-profit sector.

On the Dilemma for not-for-profits page I quoted from an article Profit is not a dirty word which reported on a meeting of Australian not-for-profit executives. It was clear that a majority of the not-for-profit sector no longer saw themselves as significantly different to the for-profit providers. Only a few maintained that their sense of mission made any difference and suggested that it was threatened. It is clear that not-for-profit providers in Australia are also increasingly thinking and behaving like the big marketplace operators.  With less experience in this marketplace new believers might even go much too far.  In religions new converts can become the most ardent believers.  Does the same happen with markets?

It is interesting and reassuring that Reverend Dr Lxxy Mxxxxs, the CEO of XXXXXX Care (same religious group) in NSW, is an ardent supporter of ACSA as a separate organisation representing not-for-profits and is strongly opposed to amalgamation with LASA which includes both for-profit and not-for-profit but is dominated by the former.

Also in the Cultural Perspectives section and on later pages analysing government's illusions, I describe the strategies we all use when we find ourselves in the difficult situation where we have to cope with conflicting paradigms (patterns of thinking). I indicate on those pages that we distance ourselves from the real world and instead substitute positive sounding words believing them to be real so that we can manage the conflicts.

Also near the top of the Conflicting cultures page in the Cultural Perspectives section I look at how staff with a humanitarian mission become alienated when forced to work in a situation dominated by profit pressures. They become emotionally blunted and can sometimes take out their anger on the residents. There is a high turnover as the motivated staff and junior managers who are best suited to provide care find that they are unable to bring themselves to do what is required of them and leave. Those who can do what is asked of them prosper but are often the least suited to provide care. I don't know if this is what has happened here but we need to consider it.

So lets look at it from this perspective but please remember that this is speculation because there is insufficient information to confirm it.

K******* G**** and accreditation

I understand from a comment in The Australian here that K******* G**** was last accredited in September 2012 when it got a perfect score.  Management was taken over by NFPCompanyE in April 2013. I have seen a Facebook comment dated 31 May 2013 with a woman claiming her father was in K******* G**** in Bundaberg suggesting she was unhappy and had lodged "numerous complaints". 

K******* most probably, would have had additional visits by the Agency in late 2013 and again in 2014. Those reports are not publicly disclosed but, if the nurses allegations about the problems and their claim that this had been happening for years are correct, then it is clear that neither the accreditation agency (now known as the 'Australian Aged Care Quality Agency') nor the management of NFPCompanyE were doing their job well and protecting the residents.  But facilities we know, can game the system and put on a show.  If the subsequent visits were indeed unannounced, then this would suggest someone was not doing their job, but we think that facilities often do know in advance. Its part of the game and no one sees anything wrong with it..

A nurse in Bundaberg who has worked in many facilities including K******* G**** tells us what happens.  She could have added that the management usually knows who is likely to have lodged the complaint and a pretext will be found to fire them.

But there is another aspect to this. The industry believes and claims that accreditation is effective and a measure of good care. Management not in touch with the coalface may be only too ready to accept that full accreditation and compliance visits actually meant that the facilities they were operating provided the sort of care they claimed on their web site.  Many examples show that this is not so. But these reports may have encouraged XXXXXX Care to shift its focus from care and instead focus on its bottom line.

As is revealed on this website, it is unlikely that the accreditation process accurately reflects care and it is frequently unreliable and wrong.  It is not a measure of standards of care in Australia. If management did in fact think that they were providing good care because of this, then this would illustrate the harm that having inadequate processes in place and providing misinformation has. This sort of data collection is a feature of culturopathy and the adverse consequences of misinformation are also a consequence.

XXXXXX Care and the profit motive

I did not see a contribution from NFPCompanyE to the discussion reported on "Profit is not a Dirty Word", but it is likely that, like the majority, they were thinking this way. They may have been struggling in this market and not making enough profit to compete. They may have been influenced by the sort of advice and scare tactics from specialist business advisers that I illustrated with an example on the Driving cultural change page in the Cultural Perspectives section.

They responded to this and looked around for someone to manage them in this market. They found an accountant who was already working in the industry as Blue Care's "regional director" - so had aged care experience. It is likely that he had helped Blue Care manage their finances successfully. He was made CEO of NFPCompanyE (QLD) and a Director of XXXXXX Care Australia on its board.

Jxx Cxxxxxxx: Jxx Cxxxxxxx's qualifications include a Bachelor of Business (Accountancy); Grad. Dip in Securities and Investment, and Australian Society of Accountants CPA Program. He had 16 years of aged care experience before joining NFPCompanyE in 2009. It would be interesting to know how much of that was dealing with accounting issues and how much supervising care.

There is a press report in 2003 which does relate to care and particularly staffing at Blue Care. Cxxxxxxx was involved.  The article reported a dispute with nurses "over concerns they do not have appropriate staffing levels to provide appropriate care". They were concerned that "management intends to further reduce rostered hours". On that occasion "Jxx Cxxxxxxx, said staffing levels are adjusted according to residents' needs and resident care is not being compromised". It sounds familiar and is the sort of explanation given by others for reducing staff in order to increase profitability.  One wonders what experience of nursing care Cxxxxxxx, or whoever made those adjustments without compromising care, actually had.  If they did not emulate others who are reducing staffing they would not perform well in the marketplace.

Dealing with the contradictions

We have a facility where staff indicate there have been problems for years. It was purchased by NFPCompanyE in 2013 and clearly management should have had a good look at what was happening then and introduced its own management practices and policies. Cxxxxxxx's attempt to justify what happened on the basis that he inherited the staff from the previous operators is simply nonsense - not when made 18 months later and when those staff are the ones complaining.

If the allegations are correct then, not only has this been going on under his nose as CEO for all of this time, but there was a significant complaint 6 months before. His interest in the care provided and his oversight of the facility he was responsible for was, if the nurses are to be believed, does suggest that management was out of touch.

I suspect that Cxxxxxxx was appointed to sort out NFPCompanyE's finances and that he did that very professionally and successfully. It was the most profitable of this religious groups operations. He was not brought in to provide good care and probably was not experienced or trained to do so. As an accountant he was not focused on that.

From what the nurses said, strong pressures were passed down the system to reduce costs and increase profitability. This is what you would expect an accountant to advise if he was doing his job and trying to keep costs down - but you would expect that other managers responsible for care would carefully consider the consequences for care and, if they did proceed with the recommendations made by the accountant, closely monitor care.  But a successful CEO would have received strong support from above and been able to override any opposition. If so then there would have been unhappiness and perhaps conflict between senior managers.  This would explain why only 5 days after The Australian first published its expose another manager spoke out publicly about what he believed was happening. He is unlikely to have done so in this facility if relations were good.

If this hypothetical analysis of what happened is correct then junior management in the nursing home might have responded and done what they thought they had to do to keep their jobs. Perhaps NFPCompanyE was under financial pressures and Cxxxxxxx's job was to reverse its fortunes. He did this and this was quite possibly seen by XXXXXX Care who were not looking at the consequences as a good outcome for them.  They would have seen his performance as exemplary.

Cxxxxxxx is clearly a resolute and forceful character and one might wonder if he was receptive to criticism or disagreements about his policies. A focus on team players and compliance with management's directions has characterised most of the big dysfunctional companies that I have written about. Some kept score cards on staff and those who were not team players were soon out of work.  In this market no one else wanted them.  This sort of management was very successful for the bottom line.

Likely response to explain this

In this situation, management including Cxxxxxxx are trapped between the two contradictory paradigms that both insist on compliance to their requirements (market and community paradigms). This is stressful and disorientating. Managers are likely to employ selective perception and compartmentalisation. They would be likely to respond by using positive words as a substitute for actually looking at what was happening.  They would believe the words instead of what they see and hear. The words they would use and come to accept as real are often the words they use in their marketing and on their web pages.  They have no doubts and this creeps up on them. This is perfectly normal behaviour and most of us would behave similarly in this situation

None of us like to admit that we are not accurate when we say things publicly, yet we must make glowing claims to market our business and be successful in the marketplace. The solution we too often adopt is to accept the words as real. We simply don't acknowledge the information that is in front of us disproving what we are saying (or the PR companies are saying on our behalf).

What about the other findings?

If what happened at K******* was due to a problem manager, as the company claimed, then it is likely that care in the other facilities was good.  If on the other hand the problems were as suggested by the nurses then it is likely that K******* was a red flag and there might have been problems elsewhere.  It really depends on the extent to which managers in these other facilities resisted the pressures on them.

In conclusion

I don't see these people as evil or abnormal even if the allegations are correct. This divide in the way the two groups (nursing staff and management) see things and respond is because they see, understand and respond to what is happening using two very different and mutually exclusive paradigms (ways of thinking). Each has a very different understanding of what is happening. You cannot adopt both at the same time and think coherently.  You choose the one within which you plan to, or already have, built your life - or the one which gives you the greatest protection.

In this section I have suggested an explanation of the bizarre events and the contradictions.  This is  based on what I have seen elsewhere in similar situations - not evil people doing the wrong thing but people responding and behaving normally. Because of the stressful and inappropriate situation in which they find themselves they end up by doing things that are harmful to others.  Because they believe in what they are doing and have no doubts they can get very angry when challenged.

I do not know if this speculative assessment is accurate but it fits with my experience and what I have seen elsewhere and tried to explain.  Others may have different understandings.

Is this part of a systemic problem in the aged care sector?

On the previous pages I have suggested that aged care has become what I have called culturopathic - a pathological social process. So I ask whether the sort of crisis that erupted following the allegations in Bundaberg are red flags and not rare exceptions. It is the tip of an iceberg exposing what the pressures introduced into the aged care sector by government are doing to the not-for-profit sector in multiple less startling ways.   In this instance it may have been blown out of all proportion but there do seem to have been some problems that deserve critical attention and you cannot do that without looking at what happened. All of the people involved including the Quality agency are a part of this failed system.

That it is a red flag is suggested by another Bundaberg nurse who has worked at several nursing homes including K*******.  She is saying in simple terms (see quote below) very much what I have been saying and analysing in vast numbers of words on these pages.  It is well worth your while to link to this letter and read it.

The comments by other nurses on that page confirm what she is saying. But she is calling on government and providers to do something about it and that has never worked  The political system is paralysed and business is just business.  Business does what it has to do and it will only do what the community expects it to do if the community takes charge and forces it to do this.

Giving them more money without putting a real customer in charge will mean more profit will be taken, rather than more care provided.  Here are some extracts from the nurses open letter.  She starts by referring to K******* G**** where she has worked before.  She confirms that pressure was being put on the facility from higher up the chain and that this was a large part of the problem.

More people are coming out of the woodwork to confirm what is happening. Aged Care Crisis has had contacts confirming what the nurse said about incontinence pads.  Rationing incontinence pads is not an uncommon cost saving strategy. I have seen reports of this happening in Canada and in the USA.

The nursing union in Queensland has spoken out again pointing to the issues raised in NFPCompanyE facilities. They are well aware of the problems for nurses in nursing homes in Queensland and like Aged Care Crisis, have been calling for mandated staffing levels.

The union stressed that:

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Implications for the Quality Agency

As I have indicated elsewhere government regulation and oversight is simply incapable of addressing the pressures generated by a competitive market place that is vulnerable for whatever reason. It has not worked in Australia or in other countries with failed markets. To have any worthwhile impact the regulator needs to be on site - and on site frequently. Governments can't do this.

In addition the accreditation process used by the Quality Agency is not fit for purpose as its underlying philosophy is inappropriate for a regulator and because it is closely aligned with industry thinking.  It draws its membership and assessors from industry. The usual criticisms of the agency are a lack of efficacy in detecting problems and if the nurses are correct then that criticism should certainly apply to K******* G****.  Nurses have claimed that the problems had been ongoing for a long time, well before this company purchased the facility. 

Other issues: unrelaibility, bias, reputation, appeals and the proposed hub

There are other issues that are well illustrated in this case.

The first is the unreliability of isolated three (or five) yearly or even once a year visits.  All facilities have good and bad days and a single visit is not going to give an accurate assessment.  It can be hopelessly out of step. In most assessments the facility has prepared for the assessment for weeks or is usually warned of unannounced visits. Serious failures will not be detected.

Assessors doing a truly unannounced visit as seems to have happened in this case can be surprised at what they find - and staff can be panicked by a truly unexpected visit.  This can result in an assessment that goes from bad to worse as seems to have happened here.  Wide errors can occur in either direction either missing serious failures or finding something which is really an exception.  Neither residents, staff nor management are well served by this.

The second issue here is confirmation bias. There had been serious allegations about another of this company’s nursing homes and that its management was covering up and hiding failures in care. Once assessors started finding problems they would get on a roll and start looking for more and more.

The third possibility is inherent bias, one that the participants themselves can be totally unaware of. On a web page "Objectivity and conflicts of interest" in a later section I showed that even judges are influenced by their backgrounds and it is impossible for anyone to be totally objective. Their ideas, the self evident truths about the world that they accept and which they use to guide them come from their pasts.   All pasts are different and they determine how we think and how we view others.

If we look at the background here we see that there has been a considerable amount of dispute among the not-for-profits who have been urged by the for-profits and by many not-for-profits that think like them to merge the not-for-profit ACSA into LASA to form a single organisation.  Discussion has been quite heated but a hard core of not-for-profits has insisted that not-for-profits are different, have different interests and priorities and that a sense of mission is critical.  ACSA has twice rejected LASA’a overtures and there must be resentment about this. Someone even described these recalcitrant not-for-profits as Mastodons. One of the strongest critics of the proposed merger was a priest from the same church organisation as NFPCompanyE in another state. The “widely contrasting views” surrounding this dispute are addressed on the web page Views among not-for-profit.

Those who think like this are likely to see these out of date mastodons as providing an inferior service and clearly believed that the not-for-profits who did not identify with the modern thinking were inferior. Dr Richard Baldwin has recently produced evidence indicating that for-profits are sanctioned twice as often as not-for-profits. This would have irked the for-profits who would have considered themselves the future and superior.  Those who were unhappy about being sanctioned in the past may even have felt that the previous CEO of the old accreditation agency was biased towards not-for prpfits. The publicity in this case may have confirmed their suspicions that not-for-profits were actually inefficient and out of touch so provided inferiors care.

The next question to ask is who were selected to be the assessors. Which sector did they come from and what were their views and the views of the company they came from? While all of this speculation may be irrelevant and have had nothing to do with the finding of a "lack of procedural fairness", that is a pretty good description of what might happen in a situation like this.  This may also explain why Jxx Cxxxxxx was so upset and so aggressive in his response.

An organisation like the Quality Agency not only has to be free of bias but needs to be seen to be free of bias. When someone that it is critical of is unfairly treated you have to consider whether bias was possible. Without being there you cannot make confident allegations about bias but it leaves a decidedly nasty taste and does not fill anyone with confidence.  It is not the fault of the CEO of the Quality Agency, although he can be criticised for accepting the position.  The fault lies with the government appointing him.  It reflects very poorly on them.

Fourth is reputation damage and credibility. The Quality Agency has been sued and shown to be fallible. Its findings were faulty and the company did suffer as a result. Others will undoubtedly try their luck and challenge the agency’s findings in court and that will not be in the interest of the residents as the agency will be constrained by the fear of litigation.

The fifth is its inability to resist a challenge in court. The agency does not collect accurate data about staffing or failures in care so depends heavily on demonstrating failures in process and on hearsay accounts that can be challenged as in this case. Not only is its data collection unrepresentative, inaccurate and flawed but it is inherently difficult to defend so compounding the problem and making them doubly wary about imposing sanctions.

The proposed Community Aged Care Hub is intended to address all of these issues by regularly collecting and documenting information independently, and reporting on the care provided in an ongoing manner. With the hub in place the Quality Agency will have solid data on which to base its assessments and will know what has been happening in the facilities.  It will also be accountable to them as they will also have this information.

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Let's learn instead of throwing bricks: How would the proposed hub work?

We must face the fact that whatever happened here, many of us if we were in their shoes would have behaved similarly.  Its a social problem - part of being human. Whatever happened it was highly dysfunctional probably on both sides. I argue it occurred because we have a dysfunctional system - a culturopathy. But how do we address it?  Once again I am assuming that there is substance to some of the information we are getting but we will probably never know what actually happened.

 The Community Aged Care Hub: preventing all this

This is an excellent example showing just how important the hub proposal is and how it would address the problems that are developing in aged care.

1. It would already have known exactly what was happening in the K******* G**** nursing home before it was purchased and would have had a role in deciding who the purchaser would be so would have made enquiries from other hubs where the company operated.
2. It would have been in contact, first with the proposed purchaser, and then the new owner making it aware of any concerns it had and what it expected from the provider.
3. The hub would have been working with residents, family and staff in order to collect data, monitor care and quality of life, and manage any complaints from staff and management anonymously. They would know exactly what was happening in their local nursing home and if they were unhappy about the way local managers addressed any issues they would have gone to management earlier rather than later. Neither residents nor staff would fear for their relatives safety or for their jobs.
4. In the event of adverse events and press coverage the hub would be in a position to provide a balanced point of view.
5. The Quality Agency would be in a position to make informed decisions about all of an owners facilities because these would be based on data collected over a period of time and not on a biased and unrepresentative snap shot at a time of crisis. It would be briefed regularly on performance and would decide with the local hub when and if it needed to visit. Companies would not waste time and staff effort spending weeks to prepare  for a visit because accreditation would be based on everyday performance and not on the show they were able to put on for the occasion.
6. The Quality Agency would be able to support its decisions in a court of law because they would be underpinned by accurately validated and confirmed evidence collected over a period of time and showing changes.
7. Any new management strategies whether staffing or otherwise would be discussed with the hub as well as staff and a program to monitor outcomes would be in place so that any changes in performance would be apparent.  When changes to staff impacted on care this would be discussed and this would be set against the financial situation.  Decisions would be transparent and taken in the full knowledge of their advantages and disadvantages.

We would know exactly what had happened in this case and instead of being left wondering and in the dark the community and families would be working with a knowledgeable group and management to sort out any problems.  All of this and the damage to the reputations of the company and the Quality Agency could have been avoided.

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NFPCompanyX

A break down at the top

The Courier Mail published an article about what seem to have been some shenanigans at another faith based aged care provider NFPCompanyX in Queensland.  Two directors who were unhappy about what was happening were forced out amidst demands that money they had spent inappropriately be reimbursed. There was clearly bad blood. 

The articles allege that executives and senior management had their fingers in the charity's piggy bank.  There was a fracas with two directors making allegations about the way the business was run.  They were accused of having spent money they were not entitled to and they were driven out of the company.  Amidst all of the allegations and counter allegations it is impossible to know who was right and what was happening.  Bad Apple Bullies, a website that exposes inapproriate behaviour described the two who were pushed out as whistleblowers.

• NFPCompanyX whistleblowers "threatened with Supreme Court action". Bad Apple Bullies accessed Aug 2016

If I am right in the analysis I do, then both groups probably believed what they were saying but saw the same things very differently.  The allegations suggest a culture of entitlement. This suggests that the board are operating out of their new corporate mental compartment which sees not-for-profits as operating no differently to for-profits.  Rather than getting a reasonable reward for their efforts they think they should be paid what they are worth. Rather than realising their social selves through their work they are focusing on their entitlements and themselves. In a charity this leads to internal conflict.

The revelations of large salaries and lavish perks angered the union who compared that with the stinginess of the company when negotiating salary increases and allowances with its members.

• NFPCompanyX Executive Salaries And Perks Jar Against The Latest NFPCompanyX EBA The Services Union 25 September 2015

The Jobadviser website has only two responses. They suggest that staff are reasonably happy working for NFPCompanyX but one reviewer considered that management was out of touch because it did not intereact with residents.

The allegations that whistleblowers were ignored and a suggestion that complaints that were not investigated are reminiscent of the reports about NFPCompanyE. In this case the company successfully kept further details under wraps and there has been no more information about what happened.

These comments may look like nit picking but when we see the allegations made about one of the nursing homes in South East Queensland in 2016, they become more relevant.

Serious failures in care

Oxxxxx Vxxxx, a NFPCompanyX 167 bed facility “received $8.6 million in federal government funding in 2014-2015”. It passed all 44 standards in an audit on 4th June 2015.

But residents were so concerned that within months a group of them contacted the Quality Agency who performed an unannounced visit 9 months later on 31st March 2016. The findings were startlingly different.  The group were less than impressed with the company’s response to the failures found although the company claimed that the agency was pleased with its progress. The families also complained to the governments complaints system.  Several press reports describe the failures and offer explanations for them.  None were aware of the battle at board level 6 months earlier.  No one asked whether the problems were because those who had won the battle had their eyes on profitability and not on care.

What happened at the 2015 Audit that they passed

“A NURSE who has worked at Ozanam Villa for more than seven years said staff were told to “smile and shut their mouths” when Federal Government auditors arrived for the June 2015 audit.

“The auditors only finished up here on June 7 and afterwards we were told there would no longer be any more agency staff to boost staff numbers. That was just to get through the audit,” she said.”

These unannounced audit reports are normally kept confidential but in this instance a copy of the confidential report was leaked to the press.  They quoted from it .  They also found families and staff who were willing to describe what they had seen.

As one nurse explained “It used to be a happy, friendly, homely place but that has gone.” Another said “This used to be such a lovely place. We were all like family. Now residents are just numbers.” Something had changed and “If staff complained, we were told by management that if we didn’t like it, we could leave”.

The Gold Coast Bulletin indicated that the report “raised alarming allegations about the centre, including staff shortages, neglect of bedridden patients, catheters not being emptied in a timely manner and one occasion when residents were not sufficiently fed.

The allegations reported included:

• - - primarily insufficient staff including registered nurses. - - Eighty per cent of the workforce are really great nurses but they can’t cope with the heavy load - - Staff are not turning up for work and some are having breakdowns - - staff would take turns in sleeping during their shift - - a facility manager, who had tried to improve the situation, had resigned last week - - It’s horrible what is happening down there,
• Fecal matter and blood stains were not cleaned for several days - - a ‘large blood spot in a communal area had not been cleaned for six days and faecal stains were not cleaned for five days.
• - - a patient’s catheter not being changed and nurses were not informed a ­resident had antibiotic-resistant bacteria — gentlemen on catheters and their penises became inflamed and infected because they weren’t cleaned often enough
• Residents - - - had to “constantly remind staff” to provide eye care for “crusty eyes” and mouth care after meals.
• many patients were left in bed for up to two weeks - - recipients may only be out of bed once a week and if they miss that day due to staff not being able to get them up, then they would not be out of bed until the following week
• - - - did not provide enough food or liquids for residents, 17 of whom had “unplanned weight loss” but had not been referred to health specialists for a review.
• - - the cuts and conditions had become so bad the home had replaced its wound-dressing trolley with a plastic bottle marked “wound water”.
• - - - residents are left lying in pain without medication because of staff shortages in nursing homes
• - - fallen and broken bones while going to the toilet unattended because of understaffing
• - - reports of residents left to lie in their own waste
• Local management not responding — I reported this (rough and rushed handling of residents) to my supervisor. Other staff informed me that this staff member had been reported before and management would do nothing about this issue or do a mandatory report. I was the only one on duty and did not have a clue as to what my role was and I was given no support at all. - - - - I was afraid that I would rock boats and get fired.

Sources included:

• Complaints pour in over inadequate care at Gold Coast aged-care facility Gold Coast Bulletin 8 June 2016
• Burleigh aged care centre under fire for mismanagement Gold Coast Bulletin 11 June 2016
• Residents ‘neglected’ Gold Coast Sun Central 15 June 2016
• Queensland aged care residents left lying in pain without medication The Courier Mail 22 June 2016

Families and residents planning legal action

A group, Aussie Seniors Care Watch who were pressing these matters were concerned that the company had made about $50 million over three years. They expressed the community’s views about not-for-profits who lost their commitment.

They saw what was happening as “deplorable, especially in a supposedly not-for-profit organisation, that the annual public report of the organisation reports with a certain amount of pride an increase in the total asset value of the organisation and the millions in profit being made out of the care of the aged, sick, dying and disabled”.

The group understood that claims about care were referred to “their insurers who were settling claims under a confidentiality clause”. The group were planning a class action.

• Watchdog group aims to sue aged-care provider Gold Coast Sun - Central 15 June 2016

Advocacy services

The information that Aged Care Crisis researched when making a submission to an inquiry into advocacy suggested that Queensland had the most organised and active advocacy service.  The chief executive of the Queensland Aged and Disability Advocacy (QADA), in referring to what had happened at Oxxxxx Vxxxx, expressed his concern “that things have escalated there to this point before there was formal intervention,”. QADA has “dealt with 463 complaints in the (Gold Coast) city” including “58 complaints about residential aged care”. Serious matters are referred “to the Aged Care Complaints Commission or police” and in the last year, three facilities in Queensland had been referred. One of their functions is to “conduct educational sessions with people in aged care’.

• Fears vulnerable are afraid to report Gold Coast Sun Central 15 June 2016

The CEO of QADA did not say whether his organisation was involved in the case of Oxxxxx Vxxxx nursing home and if so why advocacy had failed . There are several issues that arise here.

• Had the QADA education program been ineffective and not reached the families and staff in this facility?
• Had the facility not told residents and families of this option and referred them to QADA?
• Did the families and staff not have any confidence in QADA?
• Were they worried that their complaint would not remain anonymous and they would have been victimised ?
• This is one of the few instances in the many complaints made in the press in which the advocacy service is ever mentioned. Why don’t we hear more about it and why do advocacy services not get mentioned even in cases where family members are barred from visiting their frail parents after complaining?

The Community Aged Care Hub

The proposed hub would be working with staff and managers in each region and would have a central structure integrating its activities and assessing information. The hub would soon be aware if there were conflicts in a company especially if they related to policy issues. They would be part of any policy changes in the sector. A dispute as occurred in this company would be a red flag and all local hubs would become more vigilant.

The hub would be working with staff, with relatives and with residents taking oversight of care and complaints handling to the bedside and into the community. This would give them a broad overview of what was happening. They would be the first to detect trends and would be well positioned to address any issues that arose.  Their interest would be totally focused on the welfare of consumers and their responsibility would be to their community.

Advocacy would be performed through or in close cooperation with the proposed hub so would also be available at the bedside on a day to day basis so that matters would be addressed before opinions hardened.

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NFPCompanyW

NFPCompanyW has a long and excellent not-for-profit record going back many years.On its web site it lists awards for excellence from LASA (industry body) to a director, for Gender Equality in employment from WGEA, and certificates for best practice in risk management and for being breast feeding friendly.

Aged Care Crisis heard good reports until recently. Under its most recent chairman, along time board member whose background is as a management consultant, it seems to have accepted the marketplace challenge and to have become strongly profit focussed. 

In 2015 it made a net profit of $3.9 million. During the year it paid an estimated $5 million for a new refurbished head office accommodating 50 staff in Malvern, a select Melbourne suburb. It bought six facilities from NFPCompanyV, a group that decided to vacate the sector. NFPCompanyV gave its members assurances that this sale would maintain a high quality service and individual facilities gave the same assurances to their local communities.

NFPCompanyW is targeting the luxury market and building palatial facilities. Of 6 facilities in Melbourne charging bonds of over $1 million one of NFPCompanyW’s facilities is the most expensive and “lists a maximum deposit of $1.8 million, or a maximum daily fee of up to $326, and offers its residents a theatre, library, club room and on-site hairdresser”.

• Golden oldies pay $1m bonds for aged care at lavish centres Herald Sun 27 June 2014

Concerns expressed about care

We are aware of at least one NFPCompanyW facility where resident families are very concerned about what has happened to care. The relative of a former resident wrote a letter to The Age about this.

Another family member writes about the way in which an incontinent resident was managed in the same facility. This family member describes a long list of concerns relating to insufficient staff with insufficient time, harm to a resident whose stroke was undiagnosed, deteriorating meals, constant staff changes and poor morale, rostering problems, management not listening to staff, poor communication with relatives, lifts and other equipment unserviceable, violent psychiatric residents not screened and more.

• Personal experience of care Contribution to Inside Aged Care 9 August 2016

 The Community Aged Care Hub

Because it would be working within the facilities and because it would be part of a network anxiety about falling standards in one facility would be known to local hubs in other areas. It would soon be clear whether problems were isolated to one facility and so due to a local failure. whether they provider wide or even system wide. The local hubs would be well placed to work with the facility, to cooperate in working with the company or to deal with provider organisations and government centrally. Challenges and solutions would be addressed together.

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Regional

Its different away from the cities

The vast majority of rural and remote facilities are operated by not for profit government, community of religious owned facilities. There are logistic problems associated with distance from the expertise in metropolitan areas. There are problems with staffing and resources. Accreditation data shows that rural and remote facilities perform worse in meeting accreditation standards. Baldwin also found that rural and remote facilities are sanctioned more frequently.

But we need to consider how care and quality of life are considered and measured and how care and life are defined. Local communities are far more closely nit than in rural areas so that management and staff often know the residents and their families personally. Friends are closer and maintain contact. This impacts positively on relationships between staff and residents and on the links maintained with the community. These benefits are not measurable under the current system.

A community that does everything right comes unstuck

One such facility is a small nursing home Txxx Lodge in Donnybrook in SW Western Australia. It started 35 years ago as a small low care community facility of about 16 beds.  In the early 2000s the community had rallied and raised money to grow their aged care facility. By 2006 they had raised enough money to add 10 beds at a cost of $1.7 million - receiving an award as “Best Commercial Building at the MBA South West Awards”.

But they did not rest on their laurels and continued to volunteer at the facility and to raise money for further expansion. Government funding changes in 2012 under the Living Longer, Living Better program threatened small regional facilities which were disadvantaged and put under pressure. At first this seems to have put a damper on their plans for expansion but in 2013 the shire received $2.76 million from the Commonwealth towards the $4.16 million cost of adding another 14 beds. Whether the change of government and the support of the local member played a part is not clear. This council and the community had worked hard for this. Work started in June 2014 and the new wing was opened by the federal MP in October 2015.

Nola Marino federal MP for Forest expressed her admiration and other sentiments about the local community in a speach in parliament on 12 October 2015 after opening the new wing.  This expanded the facility to 40 beds. She acknowledges the dedicated actions and involvement of the local community. They have raised over a third of the funding themselves. It is this involvement and fund raising that has enabled the shire to retain ownership and not be acquired by a predator as others have.

But there were problems in Donnybrook

But this support for the board and community was given in the midst of a crisis and bitter dispute in which this board were accused and being investigated.

This had all come apart rather catastrophically 6 weeks earliey on 30 August 2015 shortly before the opening of the new wing. There wwere headlines in the media. Two nurses had raised issues twice at meetings a year and 6 months before.  When this had little impact they had submitted a 52 page document describing a “toxic culture” and showing multiple problems including bullying. One of them was offered $10,000 in compensation by the shire but refused.

An investigation followed and there clearly were problems. It seems that other staff supported these nurses. There were also problems with the facility's accreditation resultsl.

In spite of this ongoing investigation “the lodge was recognised with a prestigious award for “most outstanding regional care provider” at the Australasian Over 50s Housing Awards in Melbourne on November 6.

Sacking the board

On the 19 November the council sacked the entire board including the chairman who had been the driving force behind all the community effort. It started looking for an administrator to take over. There was a massive backlash from the community who identified with and supported the board who had done so much. Several street signs were erected supporting the board. A resident explained that “the disappointment stemmed from the fact that community volunteers had poured time and money into the facility over its 35 years of operation”. Many businesses had donated. They started a petition against this. There was acrimony and anger at the nurses who had caused the problem and the community was deeply divided.

Protest meetings

A 300 strong public meeting protested the sacking and the failure to make the findings public.

This was a community facility funded by the community and largely run by community volunteers. They were “angry at the councillors treatment of the board, loyal staff and volunteers, the community who have donated to the board, the treatment of the memory and legacy of those passed on who contributed to the Lodge, and the residents who call Txxx Lodge home” Multiple family members and a doctor testified to the quality of care given. The councillors were blamed for ripping the town apart and should be ashamed.

A lone nurse who had resigned earlier supported the decision explaining that “she had left because she did not want to be a part of the practises she saw there. I went to management, but I may as well have hit my head on a wall”.

Twelve staff, firmer staff and other witnesses had been advised to stay away in case they were attacked by their angry critics.  A spokesperson for them was there and indicated that the issues they had raised had been verified.  They called for the report to be released. It was “the alleged acts of the management and Board that are jeopardising the residents and staff in the facility.”

More information

On 25 January 2016 the shire council released an update. Apparently issues raised in early 2015 and taken up by the council had not been addressed by the board. There had also been issues surrounding accreditation of the facility since 2013.  In December after another accreditation visit the facility failed 5 of the 44 standards.   A Certificate of Non-Compliance was issues on January 12th. Sanctions had only been avoided because the shire, which was the approved provider had taken control itself. The board had not even understood how to claim money and there was considerable ACFI money still unclaimed. Compliance had to be demonstrated by mid-march to avoid sanctions.  They were looking for a manager to take over.

The council was seeking a solution that would still include the community, the fund raisers and the volunteers.

Sources of information

• Txxx Lodge Redevelopment | $1.7m | 2006 Civilcon Construction  2006/7
• Donnybrook aged-care facility under threat The West Australian Regional 20 Sept 2012
• Major works begin on Donnybrook's Txxx Lodge Donnybrook Mail 26 June 2014
• Donnybrook Txxx Lodge aged care workers claim residents are ‘at risk’ Perth Now 30 August 2015
• GRIEVANCE DEBATE – Forrest Electorate: Txxx Lodge Nola Marino web site 12 Oct 2015
• Donnybrooks council sacks long-standing Txxx Lodge board Bunbury Mail 25 Nov 2015
• Hundreds support Txxx Lodge Donnybrook Mail 30 Nov 2015
• Txxx Lodge Update Shire of Donnybrook-Balingup - 25 January 2016

Accreditation record

• In May 2012 the facility met all standards and was accredited to June 2015.
• In May 2015 the facility met 41 of the 44 standards failing 3 (1.8 Information systems, 2.8 Pain management, and 2.13 Behavioural management). It corrected the deficiencies and was then accredited to 26 June 2018.
• An early accreditation visit was conducted in December 2015 only 6 months later presumably because of complaints received. It passed only 39 of the 44 standards failing 5 (1.4 Comments and complaints, 1.6 Human resource management, 2.4 Clinical care, 2.7 Medication management, 3.7 Leisure interests and activities). Accreditation was reduced to 1 year (January 2017). The problems found with inadequate management and poorly skilled staff would have resulted in the other failures.  The problems have since been corrected.

What really happened here?

This a particularly interesting example because it is not the market or conflicting cultures that have caused a schism but two groups that ultimately have the same intentions but come from different backgrounds. One group is a group with status in the community giving it credibility and confidence in its achievements. But clearly it does not have the experience and skill needed to manage this aged care facility. They are hurt and understandably angry at the shire council’s action in firing them.

The other group are poorly paid nurses and carers who have little credibility but have practical experience and direct contact with the residents.  They see what is happening. Instead of listening and taking account of their concerns management sees them as the problem and the situation seems to have become abusive. The community, which does not understand the issues gets behind the credible management. To its credit the shire took a broader view.  It probably had no choice if it wanted the agency to renew their accreditation.  We don't know what pressure was applied.

 The Community Aged Care Hub

We need ask how a local community aged care hub would have handled this. They would already have developed considerably more knowledge and skill than the rest of the community and would have been working closely with staff, residents and the board. They would have been supported by the broader hub structure and its central committee who would have provided support and advice when needed. The issues would have been detected earlier and pressed harder from within the community itself. There would have been additional support and help for community, board and staff and this would have been supported by solid data about the failures that were occurring. There would hopefully have been a better outcome and it would only have been recalcitrant members of the board who refused to address problems that would have lost their jobs.

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Keeping it hidden

Another not-for-profit nursing home in South West Australia is interesting. The owner claims to be the largest regionally based Aged Care provider in Western Australia. It offers “Home Support & Care, xxxxx Adult Day Centre, Independent Living and Residential Care” and one 112 bed nursing home in a village that has additional independent living units.

MyAgedCare: A visit to the myagedcare web site in August 2016 reveals that the home is fully accredited for 3 years.  There is no link to the accreditation report. Any prospective resident would have been unaware that there had been any problems in this facility. An attempt to find the accreditation report on the myagedcare web site was unsuccessful. If its there its not easy to find.

Quality Agency: A search of the Quality Agency web site in late August 2016 revealed a summary of 2014 and the 2015 accreditation reports with links to both.

The 2014 Summary stated that the home had been accredited for 3 years to December 2017.

The 2015 summary documented 9 failures and records the decision “to vary this home's accreditation period”. It gives no further information about why an early accreditation was necessary or about the time to the next accreditation.

A web search did not reveal any press reports of problems at this facility in 2015.

The audits were downloaded. These revealed that

• In 2014: The facility failed one standard in an audit in October 2014. This was soon corrected and it was then accredited for 3 years until December 2017.
• In 2015: There was another accreditation visit only a year later at the end of November 2015. This is likely to have been because of a complaint or some other reason which is not stated anywhere.
  
  This early visit found multiple problems and the assessors failed the home on 12 of the 44 standards which is a very poor performance. After taking account of “the approved provider’s submission and a subsequent assessment contact visit” three more were passed by the agency leaving 9 failed. The facility was accredited for a period of 1 year to December 2016. The home was “placed on a timetable for improvement and we will continue to visit the home to assess progress”.
  
  There is an undated “Actions Following Decision” note indicating that all of the standards have now been met. The table below lists all of them as met. There is no entry indicating that the period of accreditation had been extended.

Summary

This is a facility which for some reason required an urgent accreditation review only a year after it had been almost fully accredited and was given 3 years accredidation. It performed very poorly in this. It was able to patch this up within a few months.

This might have been helpful to the provider but it was of no value to any prospective customer being pressured by hospital administrators seeking to discharge a relative. The family would not know how carefully they needed to research the facility before making a decision and even then would not know what happened and if it really was safe now.

This makes a mockery of any claims to transparency and a policy whose legitimacy is based on giving the consumer increased choice.

Why such leniency and why are those who need to know kept in the dark?

When anything is out of order the cynically wise look around to see who has influence and is taking the side of the nursing homes.  Politicians have influence and that is a good thing because we all need their support when things are wrong.  But they also get funding from corporate interests and local communities and they need to support them.  Not-for-profits are strugging and do need our support but just how far does this go.  When is it no longer in the public interest?  When does it become corruption?

For example

In 2009 the state member for the region claimed that he had previously had a relative in this facility and he spoke highly of it.  He claimed to be concerned about the poor remuneration that the nurses received. He claimed that he had “been working for years with XXXX (nursing home) to try to help it pay its staff more”.  Clearly this was helpful and few would argue.

• Ms Lisa Baker; Mr Troy BuswellExtract Hansard 11 June 2009 p4904b-4906a

In the Donnybrook example in the previous slider the local federal member spoke glowingly about that facility, the way the community had raised funds and the performance of the board and its chairman.  This was two months after nurses had spoken out about failures in care and a toxic culture. There had been adverse publicity, an investigation was underway and one month later the board was fired.  There had been some problems with accreditation for some time.

Again in early March 2016 this member spoke in federal parliament to the Aged Care Legislation Amendment (Increasing Consumer Choice) Bill 2016.  She claimed that “The aged-care system in Australia is a world-class system. It is well respected, with high-quality services that work to meet the needs of a very diverse population. It is the envy of much of the world.”  She then went on to describe the services provided by this second provider in glowing terms. This was only 4 months after it had failed 9 standards.  The example disproved the assertion.

• Aged Care Legislation Amendment (Increasing Consumer Choice) Bill 2016; Second Reading  Hansard 2016

As the local member was this MP really unaware of what was happening in her electorate and of what the local press was reporting?  Its one thing to support the local not-for-profit sector - but how far should that go and when are the interests of citizens and justice not served?  Where do you draw the line?  This is a community based organisation and serves the community.  Surely they need to know.

In a democracy politicians should be at arms length but in a system where there have been so many failures by politicians we need to be very wary.  Both the accreditation and the MyAgedCare website are under the control of the Minister for health and this minister was the Chief government Whip so not without influence.  Should we be worried?

The Community Aged Care Hub

The Community Aged Care Hub would have been there, been part of the accreditation process and would know exactly what had happened and why. It would be in a position to give prospective residents an accurate report and they would have had real choice. There were two other local facilities to choose from.

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