May 16, 2019

Should Aged Care Providers Be Subjected To Unannounced Visits Over The Weekend?

With the sudden increase in sanctions of Australian aged care homes over the last few years, it’s difficult to understand whether the quality of aged care homes has declined, or if the Aged Care Quality and Safety Commission has been forced to reassess what they deem to be acceptable practices of care due to recent public scrutiny.

Aged Care Minister, Ken Wyatt AM, announced in October 2017 that scheduled accreditation visits were going to be replaced with unannounced accreditation visits following the appalling review into the notorious Oakden Aged Care facility in South Australian, and from that point on, sanctions of aged care facilities have absolutely skyrocketed.

It is undeniable that having unannounced visits have given assessors a level of insight that was previously unachievable due to aged care providers being able to prepare and plan for scheduled accreditation visits, but should there be a limit to when this visits can occur?

Up until recently, unannounced visits were only being performed during business hours when the majority of staff are present, but recent reports of these visits being performed over the weekend have many providers up-in-arms.

Generally speaking, aged care facilities operate with what is often referred to as a ‘skeleton staff’ on the weekends as both senior and mid-level management are absent, which usually results in a registered nurse being placed in charge of the facility.

While highly skilled, a registered nurse may not have the answers to the information that the Aged Care Quality and Safety Commission requires, which may result in sanctions being placed on a facility that are unwarranted.

Peter Vincent is the Director and Principal Consultant at Aged Care Management Australia and has 25 years of experience working in the aged care industry.

These days, Peter provides advice and works closely with aged care providers that are preparing for accreditation checks, and Peter was nice enough to share his thoughts with HelloCare on whether unannounced weekend visits provide further insight to assessors or if they actually increase the risk of facilities that provide good care being sanctioned.

“There are two sides to the coin, the expectations by the government and consumers are that a facility should run at the same level of safety and operational function 24 hours a day, 7 days a week, so the Commission has decided to test this by going in on the weekends,” said Peter.

“That’s a fair and reasonable thing to do on a superficial level, but the reality is that a provider can have the best systems in place and all of the information that the Commission would want when they come through the door – but the staff that are rostered on over the weekends don’t necessarily know how to deal with the type of requests that the Commission would have.”

“Things like, which residents are having chemical restraint? what types of chemical restraint? what is the percentage of residents are having chemical restraint? These are fairly complex questions that are being asked on every unannounced visit.”

“Most facilities will have an RN on duty, that RN would be in charge, and a well planned and managed organisation would ensure that they are briefed on what to do in the event of an unannounced visit and should know where everything is.”

“Your not so well run organisation might not have that information readily available, but that’s not to say that they aren’t providing good care, they just might not have that information available.”

“During a normal Monday to Friday visit, the facilities manager, the CN’s, and normally someone from corporate office nips down to support the facility staff which will not necessarily be the case on a weekend visit, so the Commission can’t ask legitimate questions about high-level governance to an RN (Registered Nurse) and expect those answers.”

“An RN can say – these are our residents, this is the care we’re providing, these are the people with wounds, these people are palliative, etc – but if the Commission starts wanting to know information on the staffing roster from 6 months ago, then they probably won’t be able to help with that.”

“I personally can not see any creating any advantage other than trying to trip people up, unnecessarily, by doing these visits on the weekend. Because these facilities may be providing excellent care and they still might fail an outcome or two from simply not having someone present with that high level governing knowledge of the facility.”

Anton Hutchinson, whose family has proudly owned Canberra Aged Care Facility for over 30 years, has been a long time contributor to many of the articles, discussions, and topics, across HelloCare’s platforms.

Being a provider, Anton knows first hand, the expectations of the accreditation process and he believes that unannounced visits on the weekend prove that assessors have become the enemy of providers as opposed to a legitimate method of inspection.

“This weekend inspection from the quality agency has been talked about for a while and its typical of the “us and them” mentality of the new agency. Once we were all on the same team trying to deliver care. Now they want so badly to “catch” facilities doing something some particular assessor doesn’t like,” said Anton.

“The absolute fact is that most information should be supplied by the Facility Manager or similar. That information is secure and unavailable to both night and weekend staff for a very good reason. The “agency weekend warriors” will immediately try to bully staff that are only there a couple of shifts a week, or in a lot of cases, only every second weekend.”

“What is to be gained?  The agency knows that weekend staff has little contact with doctors or families, they aren’t involved in case conferences. All that weekend patrols will achieve is another scalp for an assessor, and weeks of paperwork, and undoing some of the assumptions of how evil we all are.”

Regardless of whether you feel that unannounced weekend visits are a good thing or not, this does raise a question regarding the lack of upper management staff at aged care facilities over the weekend, and whether all staffing numbers should be the same regardless of what day of the week it is.

A large number of aged care providers are already struggling to cope financially, and having to roster-on additional administrative staff and employees with a higher level of clinical knowledge over the weekend may be a burden that a number of aged care facilities are not funded well enough to deal with.

This is a problem that Anton Hutchinson and a number of other providers already know too well.

“It’s strange to me that there is endless money to check and query the silliest complaints – but not enough to help aged care providers pay the bills. Where is the money coming from to put assessors on the ground over the weekend?” said Anton.

“Aged care is at breaking point, underfunded by millions and exaggerated non-compliance. Most places are doing their best, and I don’t see any improvement coming when we can’t pay the bills now, can you?”

Despite the financial ramifications, Peter Vincent believes that rostering-on staff to handle administration and others that have more clinical expertise, should be mandatory on weekends as well as weekdays, and he has employed these tactics in the past to improve the level of care in a sanctioned facility.

“I believe that we should have a complement of administration staff and a compliment of higher-level clinical knowledge and expertise across all 7 days,” said Peter.

“In fact, the last time we handled sanctions at a facility in Canberra, we recommended and put after-hours coordinator’s in place across all 7days, and we had a clinical nurse consultant (who was a coordinator) sitting above the standard complement of weekend rostered staff. We did that on both morning and afternoon shifts.”

Like most of the problems that the aged care industry is facing, it seems that the core of this issue revolves around finance.

There should be absolutely no doubt in anyone’s mind that an increase in good staff equates to an increase in the quality of care that elderly people will receive, but the real question that both aged care providers and families want to know is – who is going to pay for it?

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  1. Aged care facilities need to improve and I agree with ‘unnouced visits’ and inspections. Witnessing the process at the facility where my Mother resided, I saw long overdue maintenance carried out, and the number of management staff in the building completing necessary paperwork for at least 2 weeks before the ‘due date’ was surprising. Once over, the paint smell remained but not much changed. I am also aware of paperwork, conditions and regulations required by Early Childhood providers and as our aged population is so often likened to ‘children’, regulations are certainly lacking for the latter. It also bugs me when providers complain about the cost involved! If owning a facility is so difficult financially, why do so many own more than one? Having witnessed the process I hope improvements will be mandatory before my time and that voluntary euthanasia will be an option.

  2. Weekend staffing should be no less on weekends than weekdays.So if it takes spot checks to be held on weekends to enforce this then so be it,

  3. It is hard to say where Aged Care is going now that the LNP has won the election. My feeling is that it will be business as usual. Profits off to the Cayman Islands. Staff nowhere to be seen. Falls, neglect through missed care, PRN sedation and restraint followed by the hum of daytime TV and inedible food.

  4. Having worked as a doctors assistant visiting ACF outside normal hours I got to see some really slack work due to under staffing. The reporting of assaults between residents was not done to ‘save’ the extra work it would cause and to prevent a person with dementia being investigated even though this resident was known for using aggression against others. Having an almost full complement of staff rostered on who have not worked with these people before and barely know them. Some places were really bad with high staff turnover due to the work conditions. Hearing of staff being so burnt out and stressed because they just don’t have enough time to stop and actually interact with the residents. I think spot checks outside normal hours should be all about the care needs being met. An example is the home that bought bulk cooked hot chips on the Thursday of Easter weekend and then microwaved them three times over that long weekend as a part of the meals.
    I’ve worked many jobs outside normal hours And find these businesses that want workers and production 24/7 should have adequate support staff during these hours not just left to muddle through to save money. Monday to Friday 9-5pm work is a fallacy in so many fields and as such needs to ensure business flows even on weekends/evenings/public holidays.

    1. Absolutely agree with your comment.
      i live less than a block away from a residential nursing home. Which on enquiry has approximately 80 residents full time. During the week the car park is full of cars. Weekends. When there are still the same amount of residents there are only 4 or 5 cars in the car park. WHY!!!??????
      I personally think that pay rates has a lot to do with this, ,along with people not wanting to work on weekends.which is their choice.
      We need to take a good long look at our wage system. Job sharing isn’t working and people want more continuity in their work place.

  5. Having worked in aged care for over 30 years I feel that yes the accreditation team should call in any time. As having been a manager as well as an RN in the floor I feel that in some places the level of care falls due to not having the management around to ensure work is being done to a high standard. This goes for night shift too the most complaints from families are around weekend and night shifts.

    Don’t get me wrong I’m not saying this happens in all homes but unfortunately there are a few. And it’s these few that give the rest of the homes whose care is if the utmost highest care 24/7 a bad name.

    I’m all for accreditation coming in whenever. If you are doing everything by the book you should have now worries and they can walk in anytime and the day will just continue as normal.

  6. Aged care providers should be ready for unannounced visits at any time they are responsible for giving care.

  7. I support Quality teams visiting in weekends & evenings. The reason being where my 94 yearly mother resides in a nursing home. there is short staff on the weekends. Example : 2 Personal Carer’s & 1 RN for 26 Dementia residents on a Saturday from 3-9pm. Most needed feeding & assistance in hygiene & settled to bed as most have Dementia. The Manager when called about this, said ” We have the legal requirement of staffing & we have been approved by Quality & Safety Accreditation” As this is NOT the truth, how else can we make this Organisation accountable ( certainly not by their paper work ) consequently we have had to have a Royal Commission to expose the regulators of their acceptance of inadequate care to the most vulnerable for years.

  8. Absolutely! Anytime. The care should always be the same no matter what time of the day or night.

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