Dec 03, 2019

Is Bupa Too Big To Fail?

There have been so many negative stories involving Bupa Aged Care over the last 12 months that information regarding fresh scandals or care failings barely raises an eyebrow from the general public anymore.

Sexual assaults, violence, residents with maggots in their wounds, scabies, and staff using a resident’s credit card are only a sample of the scandalous headlines involving Bupa this year, along with the 13 homes that have been sanctioned.

The Australian aged care sector is currently under the spotlight for all the wrong reasons, and with 45 of their 72 nursing homes failing to meet all of the health and safety standards this year, many wonder what on earth would have to happen in order for Bupa to have their accreditation status revoked?

Over the years, a number of smaller providers have been forced to shut down operations due to consistently failing to meet standards, including ARK Health Care who were forced to sell in 2018 after failing to meet standards in their NSW based homes.

Bupa on the other hand currently has four sanctions in NSW, one in South Australia, and one in Victoria as of today, as well as eight current notices of non-compliance. 

Aged Care Minister Richard Colbeck recently described Bupa’s “persistent failure” to meet standards as “simply unacceptable,” declaring that he and the Department of Health were “closely monitoring” Bupa’s performance.

Yet despite this tough talk, the two months following the Minister’s statements were littered with even more stories of Bupa’s failings. 

Stories from the royal commission’s recent trip to Hobart showcased Bupa’s shrewd staff cutting policies, while the Bupa Seaforth facility recently failed to gain accreditation yet again after being unable to meet minimum standards for over a year.

With all of this added scrutiny, you would think that one year would be more than enough time to meet the minimum standard of care for older people, but the latest report that says Bupa Seaforth failed 21 of 50 requirements for accreditation proves that this is not the case.

It’s hard to imagine any other business or institution being given the type of leniency that the Department of Health and other industry figures are willing to afford Bupa.

If Bupa sold cars, there would be a nationwide recall. If Bupa sold produce, it would be pulled from the shelves. But somehow, Bupa retains their ability to rake in millions of dollars every year while constantly failing to meet the bare minimum standards of care. 

Sanctions are clearly not a deterrent that garners any real respect for this country’s most notorious healthcare provider, and HelloCare sat down with an expert on the aged care accreditation process to find out why Bupa can’t seem to turn things around.

Dr. Rodney Jilek worked in a number of corporate and advisory roles within the aged care industry and was actually a Clinical Advisor for the Aged Care Quality & Compliance Division of the Department of Health and Ageing.

These days, Dr. Jilek is the Principal Advisor at Aged Care Consulting and Advisory Services, where he provides advice and works alongside aged care providers who have failed aged care accreditation.

Dr. Jilek shared his thoughts on the ongoing compliance issues that Bupa face, and the reasoning behind the lack of meaningful punishments for repeated failures. 

“The Department of Health will never shut Bupa down because they simply don’t want to be tasked with finding homes over 6,000 people, they are simply too big to fail at this point,” said Dr Jilek.

“The sad thing is, from what I hear in the sector some of the Bupa homes are really good and actually have great management and staff, but the problems in some homes are so appalling and frequent  that it tarnishes everyone.”

Homes that are sanctioned are often made to appoint advisors and administrators to oversee workplace processes and make recommendations. 

Previously, advisors would supply the Department of Health with information regarding the current state of a sanctioned facility, but according to Dr. Jilek, this does not appear to be the case anymore. 

“Advisors are now effectively an employee of the provider they are advising, which means that they don’t have the power to do anything,” said Dr.Jilek.

“Providers can actually terminate advisors that provide the Department less than flattering information because this is no longer seen as their role. They have basically become puppets for the system. The providers don’t always want to listen to the truth and neither do the regulatory bodies. 

“So advisors now basically do what the providers want them to do, and that’s not being an advisor, that’s being advised – and that’s certainly not a good thing for aged care residents,” said Dr. Jilek.

Bupa’s Seaforth home that has remained under sanction for over a year currently has an administrator and a nurse advisor that were appointed while under sanction, as well as further support from an outside consultant.

“I am aware of at least three advisors who have terminated their contracts from sanctioned Bupa homes allegedly because of a perceived lack of cooperation and where they were no longer providing independent information to the Department.

“We cannot have a situation where a sanctioned provider is able to sanitize the reports going to the Department on their own performance of non-compliance rectification.

“As it is, the Department does all its checking over the telephone and rarely visits a sanctioned site. Years ago they used to do daily visits,” said Dr Jilek.

Having sanctioned providers report on themselves does not sound the most advisable plan for aged care improvement, but it may help to explain Bupa’s continued failures. 

“Anyone in the role of a nurse advisor under a sanction situation must be there to ensure the delivery of safe, competent care and to advocate for the residents in care.

“To pervert this role into some kind of meaningless tick box without any power to enforce change just so a non-compliant provider and a bureaucrat can be satisfied with a process is just madness. They may as well have no sanctions at all,” said Dr. Jilek.

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  1. I agree with much of what Rodney has said, but the issue is not so much about relocating residents. The problem lies in the complexity of the BUPA financial model and its public listings. Finding another provider to take over the business is proving to be the problem. There have been many rumours in the sector that BUPA is wanting to silently slip away and sell off its aged care empire. The cost structures to that process are a significant barrier.

  2. Why can’t /won’t the government just take over the facility? No compensation, nothing! This is taxpayer $, keep it in Australia, and care for the residents appropriately. As a country, we have lost so much health care $ to O/ seas investors and the private sector investors. Health and aged care should be monitored very closely.
    Perhaps the department of health should employ people to “go visiting”, a bit like the individuals who check out businesses and restaurants to see how well various standards are met ?

  3. New Zealand Bupa are also failing to meet standards of care. With the recent findings for StKilda Cambridge, Waikato and a family are now pursuing Bupa Rossendale Hamilton for a number of failings to meet care standards including the Nurse practitioner for failing to apply interventions to a dehydrated resident and their GP for failing to communicate with the same family when their loved one lay unresponsive for 30 minutes. They failed to apply any intervention. Poor standards and more families need to come forward

  4. Dr Jilek is right, and unless the regulators find the courage to revoke approved provider status from companies like BUPA, then the issues he has highlighted will continue on forever…

  5. This story has a long history going back to 1997 when the government abolished the probity regulations that restricted ownership of providers of aged care to those whose track record showed that they were fit and proper to provide aged care. They claimed that ownership had no impact and called owners ‘passive investors’. Any corporation could buy a company and take control of it if it already had approved provider status without any sort of assessment of its conduct and several have done so.

    Some of us strongly opposed this and corresponded with ministers and the department about this. Objections were lodged against corporations whose records showed that they were unsuitable but the department did not have the power to investigate. The department sided with the government and defended this. Pressure was exerted prior to the 2007 election and letters from the ministers suggested that something would be done.

    BUPA had a very questionable track record when it entered aged care in 2007 by buying Amity Healthcare, a company that already had approved provider status. After not getting a response from the department to a letter dated 4th October asking whether regulations had changed a formal objection was lodged with the department on 11th October 2007 describing BUPA’s culture and history of unsuitable conduct and objecting to licenses on probity grounds. In spite of inquiries no response was received making it difficult to take the issue to the public. An FOI request was then made. The response on 20 February 2008, over 4 months later months speaks for itself, It said

    “Despite an extensive search the department has been unable to identify any document relevant to your request.   I must therefore refuse access – – – .
    As you are aware an organisation which acquires a controlling or significant interest in an organisation that already has Approved Provider status is not required under The Aged Care Act 1997 to apply for approved provider status.  BUPA, therefore was not required to seek approval from the Department of Health and Ageing.”

    No changes have been made but what we are now seeing confirms that BUPA was unsuitable and should never have been allowed to be involved in aged care. These matters are described and the story told at http://www.corpmedinfo.com/bupa_approval.html

    The other changes described by Jilek were introduced by the Abbott government in 2014/15. His party did not believe in regulation and initiated a “Red Tape Reduction” program to eliminate it. Bureaucrat Peter Shergold was tasked to work with industry to implement this. At a behind closed doors international policy meeting in 2015 he claimed that “aged care in Australia is over-regulated” and that “regulation in the aged care sector is misplaced”.

    We should have no doubts who is responsible for the situation now revealed. But to develop a solution we need to understand the thinking that lay behind the commercial values, perverse incentives, the belief in free markets, minimal regulation and small governments – the policies both parties adopted.

    They originated in undemocratic bizarre mid-20th century neoliberal beliefs that saw collective action and control of markets by citizens, their values and their elected governments as socialist and so evil.

    This is why Aged Care Crisis is urging the Royal Commission to advise re-involving and re-empowering community structures in a restructured aged care system. In such a system community and professional values should dominate commercial values and counter perverse financial pressures.

    It is time to discard this belief system and recognize it as debris from the 20th century that is holding us captive. Aged care can break free and belatedly lead the way into the 21st century.

  6. I loved my job as a carer, and then Bupa came along and took over…and it’s never been the same. I could tell you some stories, true stories. They can not go on for much longer!!!!!

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