The Consumer, The Provider and How The Sector Moves Forward

The Australian public increasingly lacks confidence in the aged care sector. Which is not a surprise when stories of elder about, neglect and poor quality care is reported on a regular basis all around the country.

So how can the industry move forward and improve at a time like this? Like any balance analysis, you need to look at things for multiple angles. In the case of aged care, you have to look at consumers – the residents and their families – and the providers – the aged care facilities and their staff.

The Consumer Perspective

While there are plenty of example of excellent care and service, there is a lot more just passable and mediocre care than most providers will admit.

There are also too many failures, not all of which see the light of day.

Consumers lack confidence that providers will address these failures on their own – mainly because too many have not.

This leads consumers to call for more regulation and oversight.

Consumers also see a lack of competition. Poor providers are protected by bed licences. Good providers can’t grow as quickly as consumers want.

Consumers want to see regulation changed to promote competition so that great providers are rewarded and poor providers disappear.

They also want to see regulatory oversight to protect the vulnerable and to protect consumers until provider behaviour improves.

Aged care residents and their families have also said they want to see more codesign where providers genuinely engage with consumers in developing aged care services.

The Provider Perspective

Most providers work hard in a tough environment to provide great service.

It is believed that in the vast majority of cases, providers deliver very good to excellent outcomes.

However, there is no agreed way to measure these outcomes and to reward those providers who out-perform or over-perform.

The current regulatory environment promotes a compliance culture and discourages innovation or the delivery of value-added services.

The key to good aged care is that it’s delivered by people. There has been an underinvestment in people, leadership, education and culture.

Some stakeholders even argue that the debate about staff ratios does not cover off this point, rather, it tends to mask the key issues.

There is insufficient investment in obtaining customer feedback early and often and addressing and using it. Feedback is generally received post failure and often in a highly charged atmosphere.

The Way Forward

1. Changes in regulation

Deregulate the supply side (bed licences) to enable competition to develop in real terms – based on consumer demands.

In return modify demand-side regulation to promote innovation allow price differentiation on a fair and equitable basis.

Enhance consumer protections through stronger oversight including unannounced visits regime and new Commission.

2. Engage consumers

Design products and services using codesign principles.

Genuinely involve residents and relatives in the management of residential aged care facilities.

Proactively gauge customer satisfaction and act on the feedback. People know what they want, and they understand what does and doesn’t work for them.

3. Invest in people

Develop and support leaders. Most failures can be traced back to poor leadership and poor communication.

Attract high-quality clinicians. Don’t put struggling nurses in positions of responsibility. This requires all stakeholders to work on an effective strategy.

Create new career pathways that support and incentivise people from the entry level care worker upwards.

Investment in continuing education is key. There are new researches and new theories of care, the industry should stay up to date and encourage their staff to upskill.

4. Address culture

Be transparent in everything if this comes at a short term cost. Includes complaints, failures, challenges and successes.

Engage all consumers – residents and families. This requires clear and consistent strategies, not just good intentions.

Determine and live values. Respect is core – respect for the families, respect for the staff and, most importantly, respect for the residents.

As discussed at the recent Criterion/COTA conference – Quality in Aged Care.

What do you have to say? Comment, share and like below.

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  1. If the Aged Care sector wants (?) to improve outcomes they need to employ Registered Nurses. In addition to this they have to ensure that staff are trained and that these competencies are assessed regularly. Partially competent or incompetent staff should not be allowed to work. The sector is churning staff on low pay with poor conditions and non-existent job security and career pathways. Policies and procedures also have to be improved so that minimum standards of care (esp., in pain management) are delivered. This model of care does not work for vulnerable people who cannot advocate for themselves.

  2. I think they should all be non profit. It is disgusting to see owners of chains of facilities living the millionaire lifestyle whilst consumers eat for $6 a day. Aged care should not be a business. Communities should own and run the facilities.

    1. June Price. Thank you. I wholeheartedly agree. Aged Care, Child Care, and Health Care should not be in the hands of “for profit” providers. As an Aged Care Assessor people would often ask “can you tell me which ones are good?” Apart from having to be independent, all I could say was that independent and community facilities are often bought up by large providers which often changes the way they operate. Therefore there is no way of guaranteeing what you look at today will still be the same in 12 months time.

  3. Your comments are all valid but how do you get from where we are to where we would like to be. The writer is writing about what should be done. I agree that the proposals in this article will not work. The analysis is superficial and ignores root causes.

    Government and central regulators are a long way away as are the offices of big business. They think differently. When we get good care it is in spite of the system and not because of it. Staffing data alone shows that care must be worse than anyone is prepared to acknowledge. Responsible rivalry constrained by social responsibility is good. Unrestrained commercial competition in vulnerable sectors i seldom if ever responsible and is a recipe for failure whether in banks or aged care. It must be constrained.

    Government and central regulators are not capable of delivering and have all failed us. Big business cannot be trusted to do so. Recent aged care inquiries show that none will accept responsibility for failures and poor outcomes. As a community we are ultimately responsible for what happens to our vulnerable members and if government refuses to be responsible then we must take it back ourselves.

    It is up to each local community to take some control over the services that are provided to their members, decide who will provide services and ensure that they meet the community’s expectation. Almost every community has some nursing, medical and other expertise to deploy.

    Aged Care Crisis in its many submissions is pressing for an aged care system where aged care services are delivered and overseen by empowered local structures that are mentored and supported by government and directly responsible to their communities as well as government.

    Like others we are pressing for an empowered visitors scheme, but that should be located locally and be supported by local people with the necessary skills. This would be the nucleus for building a supportive community with the capacity to assume greater responsibility for managing their own services. This has the potential to address political and regulatory failure as well as social issues like ageism and disengagement that currently exist in our communities. It should be carefully considered, closely monitored and carefully introduced in stages – the very opposite of what happened when the system was ‘reformed’ in 1997 and is still happening under the government’s aged care roadmap.

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