Sep 27, 2018

Decades of Decadence: The Downfall of the Aged Care Complaints System

When it comes to the issues regarding complaints in the aged care industry, Professor Merrilyn Walton might have more insight than just about anybody.

With a career spanning over 30 years and a CV that boasts half a decade as the inaugural commissioner of the NSW Health Care Complaints Commission, it would be safe assume that she had seen it all.

Unfortunately though this is not the case. After a lifetime of crusading for societies most vulnerable, Prof Walton’s professional recommendations seem to have fallen on the same deaf ears that residents and families have grown accustomed to.  

This week, Professor Walton sat down with HelloCare and explained that not only is she horrified by the current state of the aged care complaints regulatory system, she is even more shocked that stronger regulations have not been introduced since the federal government asked her to investigate the complaints system almost 10 years ago.

“In October 2009, the federal government asked me to review the aged care complaints system because of an investigative editorial similar to the one on 4 corners recently.”

“I found that it needed to put residents and elderly people’s well-being at the center of what they were doing, because to be honest, that’s not what was happening.”

“Facilities that I visited were not focused on resident well-being, rather the focus was on getting work routines achieved.”

“Every complaint that was made had the term ‘investigation going on’ attached to it, but there was actually no real investigating going on.”

“They did this because they had a low bar for assessing a matter that required an investigation, for fear of missing a complaint that might end up in the media.”

“I made the recommendation that they need to separate the aged care complaints investigation scheme and establish an aged care commissioner,” she said.

While Prof Walton felt strongly that resident well-being was at the bottom of the priority list for the aged care complaint system, she was definitely more adamant about what she felt the top priority was.

“Getting residential facilities accredited.”

“Accreditation is not regulation. There are many hospitals and private hospitals that get accredited but that actually doesn’t say much about their ongoing quality of care.”

“The complaints system was within the Federal Health Department and that is a significant conflict of interest.”

“They develop the policy for aged care, and they dealt with complaints, so they simply did not want facilities to close down because beds aren’t available, and that’s the incentive to treat complaints as things that are trivial.”

“The government also had significant relationships and communication with the aged care proprietors; their influence in the design of policies and the system is far greater than the influence of families and residents.”

“This is perhaps why the aged care system follows an improvement model rather than a regulatory one with penalties that match the severity of the complaint.”

“When something went wrong, they would help to fix the problem in question but had no power to ensure ongoing compliance. So breaches that happened were fixed initially, but still tended to reoccur,” she said.

While Prof Walton’s revelations regarding the level of care awarded to residents is shocking, it was not as surprising to her. What did stand out though, was the how politicized the simple act of doing the right thing had become.

“As the first health care commissioner I had already dealt with a number of nursing homes and residential facility complaints.”

“I knew there were major concerns around polypharmacy, over medicating residents, use of chemical and physical restraints, and the lack of medical reviews regarding resident medication. That experience showed me just how vulnerable the residents are and in need of protecting.”

“What I was surprised about though, was how bureaucratic the complaints system had become inside the federal department of health.”

“It needed to be independent, and they needed to have a philosophy quite different to the initial philosophy that was geared towards proprietor accreditation and keeping facilities going.”

“The Productivity Commission report on aged care in 2011 similarly recommended that complaints be removed from the Department of Health and this occurred in 2016.

“I think it’s also important to know that the people in the department who were responsible for complaints wanted to do a good job, and were passionate about their work, but the design of the system was just wrong,” she said.

When asked about her thoughts regarding the recent 4 corners investigation into aged care, Prof Walton echoed the sentiments of most Australians. Unfortunately for her though, the shock was coupled with a feeling of familiarity.

I had to hide my eyes.”

“I was so shocked at how rough the treatment was and shocked by the level of bullying that went along with the abuse.”

“These people were humiliating the residents and I was horrified.”

“I thought it might have been an isolated incident or incidents initially, but to be honest it appeared to  show the way that went about their work.

This was institutionalized behavior, and I’ve seen it before.”

“If the culture of the institution is not one where residents safety and well-being is paramount, then it allows these behaviors to occur.”

“Nursing homes need the skills of health professionals such as nurses and doctors- similar to a hospital.”

We have residents who have significant health care issues who are in nursing homes, where in the past they may have been treated in a hospital. Nursing homes do not routinely have staff who are trained to manage their conditions.”

“Private hospitals are regulated for nurse to patient ratios. I don’t see why residential facilities do not  have that same requirement,” she said.

While the state of the current aged care system deals with a number of complex issues, the fact that an expert who was asked to investigate flaws in the complaint system had her own complaints fall on deaf ears, is telling.

In light of the government’s announcement of a Royal Commission into aged care, Professor Walton, like the rest us, is hoping that finally someone is listening.


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