May 21, 2020

Boardroom decisions affect care at the nursing home bedside

 

Criterion’s second Governance in Aged Care conference kicked off online on Wednesday morning with two powerful speakers who both emphasised the importance of culture in aged care.

In a sector still reeling from the structiny of a royal commission and in the throes of the COVID-19 pandemic, weaknesses in corporate governance have been under the spotlight this year.

The examination of governance at the conference was timely.

Chair of Opal Aged Care and Chancellor of the University of Western Sydney, as well as academic and former public servant, Professor Peter Shergold AC, opened proceedings as the keynote speaker. 

Professor Shergold has performed a vast array of senior leadership roles across the for-profit, not-for-profit and government sectors. As well as the roles mentioned above, he was CEO of the Australian Public Service for twenty years. He chaired the Aged Care Reform Implementation Council and the Aged Care Sector Committee. He was CEO of the Centre for Social Impact from 2008 until 2011, and is now its chair, among many other roles. 

Professor Shergold said Australia’s aged care sector has “top rate” corporate governance, and this has been evidenced by our low infection and mortality rates from COVID-19. 

He praised aged care workers, who daily demonstrate their commitment and “courage” continuing to care for older people through the pandemic, a fact has been brought into “stark relief” by the virus.

Aged care boards shoulder a greater responsibility 

Professor Shergold said aged care organisations are different to other organisations because they play a unique social role. 

“The statutory responsibility placed on the shoulders of residential aged care boards needs to be greater than in other areas of the economy,” he stated.

No board member today will be in any doubt that they will be held responsible for failures of care, he said.

Boards need to be held accountable for the health and safety of residents. Decisions boards make affect the decisions made by aged care workers “at the bedside”, Professor Shergold said.

Aged care is largely government funded and regulated, and it faces higher levels of sovereign risk, he said.

There are many excellent guides for aged care boards, but they alone are not sufficient, he said. 

Professor Shergold proposed a six-point guide for boards to ensure good governance.

  1. Aged care organisations must show strong ‘organisational governance’ in order to comply with Standard 8 of the Aged Care Quality Standards. He said the Aged Care Quality and Safety Commission must monitor and assess organisations to ensure this standard is being complied with.
  2. He recommended an enforceable and mandatory ‘code of conduct’ for aged care providers to set out clear ethical expectations, to ensure integrity, and to set out obligations based on how residents and families want to be treated. 
  3. The board must be accountable for corporate performance across “the full gamut” of operations. As well as being financially viable, they must deliver social returns.
  4. Boards must establish an organisational risk framework to include, for example, finances, training, responsiveness to complaints, and regulation.
  5. Establish oversight of complaints procedures. Professor Shergold said boards must hear bad news, which will often present opportunities for improvement. Sometimes minor infractions may need attention at board level because they can have broader implications, and even lead to “brand destruction”.
  6. And finally, Professor Shergold said boards need to be held accountable for corporate culture. The tone is set from the top, he said. Boards must set behavioural expectations of all those who work in the organisation. For Opal, this comes down to the board committing to “bringing joy” to residents. The board must proclaim that message and exhibit it, he said.

Boards must recognise residents and families as individuals

Aged Care Quality and Safety Commissioner, Janet Anderson PSM, said before the pandemic the commission was aware of weaknesses in corporate governance in the sector.

She said monitoring and inspections have been ongoing during COVID-19, with 165 site visits conducted between 1 March and 15 May (43 per cent unannounced, 35 per cent at short notice, and 22 per cent announced).

Complaints have peaked during the crisis, she said. Weekly complaints peaked in the week of 27 April, with 363 complaints. So far in May, 57 per cent of complaints have been about lockdowns or visitor restrictions. 

Ms Anderson said problems about visitor restrictions arose when providers turned a “tin ear” to residents and their families, and were not able to “find a pathway” to a solution that would ease residents’ and families’ concerns. 

These concerns were most notable during end-of-life care and in situations when families had been visiting residents regularly to help with their care, and they stem from corporate governance weaknesses. Boards must be able to recognise each resident and family as individuals, she said.

Ms Anderson said the keys to good governance are:

  • How an aged care service is led and managed,
  • Having strong organisational processes, where roles, responsibilities, policies, processes and procedures are all clearly defined,
  • Having the appropriate staff skillset, including on the board,
  • Having a shared culture, 
  • Placing the customer at the centre of decision making,
  • Strong monitoring and reporting mechanisms, and
  • Good communication between all levels of the organisation, including among staff, residents, families, and the board.

‘You can’t change culture overnight, but you can work towards it,” Ms Anderson said.

 

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  1. Peter Shergold ‘s presentation was timely and presented a picture of hope that a cultural change may come to fruition. As a former carer and volunteer advocate for people with dementia the first 3 presentations on the day (Peter Shergold, Janet Anderson , Ian Yates) made me feel optimistic about the voice of the consumer being heard. There is stiill a long way to go before we reach the true “consumer Directed Care philosophy.

  2. I wish all new staff were buddied up with more qualified staff before being thrown in the ‘deep end”. So many of our new and often very young staff have only had 2 buddy shifts before being exposed to the aged care industry. So many new Australian staff recently hired at my place of employment have left due to this important oversight. Another missed opportunity for good carers lost in an industry of “talking the talk” with no positive outcomes. Alot our our new staff have only had one buddy shift and often used as the other rostered on person when in actuality, the company should have had an experienced staffer rostered on with the new staffer an extra. The “extra” staffer is to observe mostly and should never work alone while in training (buddying). We all know what it is like in a new job. Where there is good mentoring of new staff they flourish. It brings confidence and new staff feel valued and part of a large family. Management should be asking new staff on a regular basis how they are and if there is anything they need to discuss. Caring for staff is detrimental to the quality of care that is given to our sick and elderly. When you throw staff to to the wolves they feel neglected and the danger here is that they could be trained by less than perfect staff who also don’t feel nurtured by the organization. This merry go round of neglect for staff begets a culture of “They don’t care so why should I” mentality. Good outcomes start at the very top! A wage increase should also attract good people to the care industry as well. This should never be underestimated as the Aged Care sector has been neglected and seen as “women’s work” for too long. Society and governments need to see the work as important and a better hourly rate of pay should reflect this. And no, not everyone is cut out to be a great carer. They need to interview prospective staff “inhouse” by reputable staff that actually work with the elderly. Not administration or outsiders. Let’s get REAL and instead of “talking the talk”, take the initiative and make these important changes that are actually not that difficult especially when you have the right people running the show that aren’t puppets for reginal managers and huge companies that only look at the $$$. Governments need to step up now and follow the money trail of where the care is really going.

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