Apr 29, 2019

Do The Families Of Residents Expect Too Much From Aged Care Facilities?

Making the choice to place a loved one in an aged care facility can be one of the most difficult decisions that a family will ever have to make, and unfortunately, a lot of the time this decision is being made against the will of the loved one in question.

Often, the choice is inevitable for families, be that through a lack of available family support or due to medical advice, but regardless of the reasoning for the move, taking someone who spent their lifetime caring for you and placing them in the care of strangers against their will brings with it a large serving of guilt and remorse.

Combating these emotions can be difficult for families, and part of their process for dealing with these feelings is trying to ensure that their beloved elderly family member ends up in a facility that cares for this person in a way that they feel their loved one rightly deserves.

Unfortunately, they are not alone in their thinking, and almost every elderly person currently residing in an aged care facility has at least one family member that believes that the care of their loved one should be that facility’s main priority.

While buzz words and terms like ‘person-centred care’ get thrown around an awful lot by providers and those in the aged care industry, it seems that very few families have a realistic idea about what level of care is actually attainable given current conditions.

Hardworking aged care staff often bear the brunt of the backlash that occurs when family members feel that their expectations have not been met regarding the care of an elderly loved one, and this begs the question as to whether these families are simply ill-informed about the realities of the aged care system in Australia? or if they have been sold a pipedream from providers who will say anything that they can just to get you in the door?

Regardless of the reasoning, as Australians, we should all aspire to have the best aged-care services in the world, but in order for this to happen, ultimately, someone will have to actually pay to make that happen, and families need to understand exactly what their money is paying for right now regarding the care of their loved ones, and also what it would actually cost to make their expectations regarding aged care a reality.

What Do Families Want?

Basically, and as unrealistic as it is, families want their loved ones who are living in aged care facilities to receive the same level of warmth, care, and engagement that they would receive if they were being cared for at home.

No one is willing to accept shortcuts when it comes to the wellbeing of a vulnerable and beloved relative, but the fact of the matter is that there are a number of shortcuts being taken that would conflict with their expectations.

If a provider offers ‘fantastic food,’ the family will expect to see fantastic food, not fantastic food by aged care standards, and the majority have no idea what it would take financially to create the type of meals that they may have had in mind.

If a provider offers ‘activities and an engaging environment,’ families will expect that there will never be a moment in the day when their loved one is bored or feeling lonely, without giving any thought to what it would take in terms of staff to make that happen, and how impossible it is to create activities that appease the interests and capabilities of all residents.

And lastly, if a provider says ‘high-quality care,’ you can bet your bottom dollar that most families like to picture that as one staff member designated to the safety and entertainment of their loved one, and this is where some of the biggest problems stem from.

While not all families have this level of unrealistic expectations, those that do may have these hyper-inflated hopes as a way of dealing with the guilt of having their loved one in an aged care facility, or as a way of justifying the fact that they may not visit their loved one as much as they would like to , but ‘it’s o.k .. because the brochure said they would be in an engaging environment anyway.

Dr. Sarah Russell is a public health researcher with a long history of research and innovative thinking in the aged care space, and Dr. Russell shared her thoughts with HelloCare on what she believes families expect from aged care providers.

“In 2017, I undertook research on relatives’ views of aged care homes. Although relatives’ perceptions of an aged care home may be seen through the lens of emotions, perhaps grief and sometimes guilt, their views remain valid,” said Dr. Russell.

“Relatives want residents to be happy and engaged and treated with respect and kindness. They also want residents to be as independent as possible and have opportunities to form friendships with other residents and staff.”

“They expect meals to be nutritious and tasty. Most importantly, they expect resident-centered care. Surely this is not too much to ask.”

 

Are Aged Care Providers At Fault?

Dr. Rodney Jilek started his aged care journey as a nurse in the early 90’s and by 1997 Dr. Jilek was already a Director of Nursing (DON) and managing a high care nursing home with over 90 beds. Over the next 20 years, Dr. Jilek worked in a number of corporate and advisory roles within the aged care industry and knows all too well the expectations of families and the reality of an aged care sector that is being pushed to its breaking point financially.

“My issue has always been, not that families have unrealistic expectations, but that the government has done a really bad job in defining what aged care is,” said Dr. Jilek.

“If often used the analogy that a lot of aged care providers sell themselves like a 5 star Michelin restaurant, but when residents arrive they actually get McDonald’s, and there’s actually nothing wrong with getting McDonald’s if that’s what your expecting to receive, but in many cases that’s not what happens.”

“No one wants to actually explain to residents and their families exactly what it is that they get for their dollar and everyone is trying to oversell what it is that they provide.”

“If providers were honest from the start and said to residents families ‘look, you’re paying $50 and you get your bed, your laundry, your activities, your nursing care, and your food,’ most people would agree that’s a great deal, and being honest about what you are able to provide goes a long way to giving realistic expectations.”

“When you tell a family that you provide ‘24-hour care’ they automatically think that their loved one will have a staff member near them every second and that’s not reality, there isn’t even enough staff to provide the right level of care, let alone anything else.”

“Aged care providers have failed to sell what they actually do in any great manner and instead embellished on their capabilities, and the reality is that you just can’t afford to provide all the things that people expect.”

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 families and shared his thoughts on what it is that they expect.

“Expectations have certainly changed over the last few years. People used to be primarily concerned with the care that their family member would receive – meals, call bells, nice furnishings and gardens, but they didn’t expect to see the opera house from every window,” said Anton.

“There is too much emphasis on a single private room with ensuite and people are harming their loved ones by staying in hospital or believing that Home Care is any sort of alternative which it is not.”

“The home care Utopian view is nieve and already failing the client and even after a good home care experience you will still spend time in a facility, that is if you don’t die alone in your home.”

“People’s expectations are out of touch with reality, we are living 30 years longer than the previous generations but expect all that time to be quality but on many occasions, it’s just quantity. As we age as a society we will have a greater need for residential care facilities, not less!”

Is The Government The Problem?

The Australian Government fund the majority of the aged care industry and it can be said that both the amount of staff in aged care facilities and the quality of that staff are a direct result of the amount of funding that the government put into the aged care sector.

“People need to realise that the Government controls residential aged care 100%, they control education, funding, quality, and essentially staff. This is all done by strangling funding which the liberals have taken to a new level,” said Anton.

“If the Government seriously wanted better wages for care staff they would change the awards and fund appropriately. If they wanted a higher degree of training they would set the levels of skills required.”

“Funding must increase – that’s a given, but equally, the way facilities document care needs to be uniform across all facilities. Identical forms and procedures in every home are the only way to get a clear understanding of the care being delivered and more even treatment from those assessing accreditation.”

Dr. Rodney Jilek believes that having unrealistic expectations of aged care in Australia is not limited to the families of residents and that the government has failed to do the most basic of calculations in order to ensure that they are doing the right thing.

“The government’s expectation is that once you take a resident, you will provide everything for that individual until the day that they die, but they do this without taking into account how much their care needs increase, so they are also building up this expectation, because they know that’s what voters want to hear, but they don’t provide the funds to make it happen,” Said Dr. Jilek.

“No one has actually ever done a realistic evaluation of the actual cost of care. How can we have a funding tool that funds care when they don’t even know what care actually costs? It’s literal insanity.”

“Then you can make a choice, then you can say,  this is how much it actually costs to meet your expectations – which means we need more money from you, or you need to adjust your expectations so that they align with what you are able to pay for.”

“What I found over the years is the reason that the really beautiful looking aged care facilities are so popular and able to charge so much money is – because the look of the place appeases the guilt, when a family walks in and see a place that looks like a high-end hotel they that helps to remove the guilt.”

“If you walk into a facility and it looks great people think that the care must be of a higher quality as well, when in reality a lot of the time the amount of staff and care being dished out at the small place down the road is the same, it just doesn’t look as good.”

“Almost 20 years ago I used to run one of the first ‘extra service’ facilities and the expectation back then from families was that they were paying more so they should have more staff, that the number one thing that everyone wanted us to provide was more staff, and the one thing that the department said ‘Extra Services’ is not – is more staff.”

“If you’re getting in $50 a day from a resident and $200 a day from the government – which is $250 per day – How do you bring in more staff when an RN costs $40 an hour? We need the government to actively want to know what it costs to care for people, and we need the families to understand that they might have to pay extra, to make their expectations a reality.”

 

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  1. In an industry driven by competition for profit, success comes from marketing and branding so unrealistic expectations are built into the system. But that is only a small part of the problem. Income is fixed and profit comes from cutting cost and the biggest cost is staffing. Government supported this and connived in 1997 by removing all accountability and then neutralising union power in 2005. They were repeatedly warned of the consequences so no one should be surprised.

    When companies are recruited to the sector with promises of profit and you then ration resources you will get rationing to maintain profit. But we should remember that between 2014 and 2016 there was a massive injection of funding and this simply fuelled greed. There was rorting of the system, and overcharging. As profits rose the proportion of trained nurses continued to decline.

    In Australia trained nurses have been declining since 1993 when economic rationalism was introduced by Keating. In the USA staffing levels have slowly improved over this period. A leading researcher has worked with a group advising families. They divide staffing levels into 5 groups based on numbers and skills. Available data suggests that over half of Australias nursing homes fall into the lowest ‘dangerously low’ group. In the absence of data about staffing or care in Australia that is an indication of how bad it has become.

    The argument is that more funding will not solve our problems until we solve the problem in the sort of market we have in aged care. Government has shown itself to be incapable of accepting their failures and of addressing this problem. Central regulation has failed. None of the current and recommended changes will do that and the Royal Commission is unlikely to.

    Surely we as a community need to get off our butts and take charge of this market. We have doctors, nurses, and many others with more expertise than most managers in our communities. We should insist that the management and oversight of aged care is brought back into our communities where we can be directly involved and see what is happening. We can then work with the local nursing home operators to resolve problems as they occur and confidently support them in staffing better and seeking more funding because we will see where the money goes. If rationing is necessary, we can accept that.

    An empowered visitors scheme (power to examine records and oversee care with resident’s consent) was first suggested in 1989 but industry lobbied against it. There have been recent recommendations for this from Queensland and Victoria. They should be local people working with and responsible to the community.

    For several hundred years we have known that for a market to work you need an effective customer and an involved community that decides what is acceptable. The economic rationalist theories of the 1980s and 1990s rejected that and believed in a metaphysical hidden hand that made any market work if you did not interfere with it. That strange experiment has failed. Surely it’s time to step forward into the past.

  2. Reasonable article, but when a Nursing home has only 2 personal carer’s on for 26 residents on a weekend & the Private Owner refuses to employ agency nurses due to the costs Our expectations as relatives for our elderly vulnerable parents is NOT 1-1 but actual a requirement to have adequate staff in the first place. This Nursing home is in a well to do suburb of Sydney, & I pay an extra $3000 a month for the 1 -1 care you are talking about but what about advocating for ACTUAL ADEQUATE staffing at least! Pay them a suitable wage & train them more than 3 weeks as personal carer’s who many are struggling with English!

  3. No other industry and Aged Care is a industry has to to go through the rigours and compliance that age care goes through. If society want a aged care industry that has one staff to one resident 24 hours a a day seven hours a week is that same society willing to pay more taxes for that staff ratio to be achieved??
    Even though the resident does not need that level of care. Staffing ratio’s are just a drive by the nursing union to employ more nurses.
    Why do private hospitals not have to go through the the same rigours and compliance that aged care does?? They also receive Govt funding from medicare.
    Does the public really want governments owning aged care facilities and running them after the terrible examples of care and service seen last year from a state government owned and run aged care facility in South Australia.Most states in Australia can not run their public hospitals even with the billions of unaccountable tax payers dollars given to them. Is the previous person really suggesting that local and state governments own and run aged care facilities again?? You must be joking.
    Until the Government pay what it really cost to run a aged care facility 24 hours a day seven days a week and some of the public accept that is normal for a business to make a profit aged care will not improve in Australia.
    Its a disgrace how the unions are using the elderly as a way of increasing their union membership fees a absolute disgrace.

  4. Some Family members think that it is 5 star service and yes we do have a lot of backlash from some family members they come to visit and forget about all the other residents that we are caring for they expect you to drop everything and deal with them which makes it very difficult at times most aged care facilities are doing yhe best they can eith what thry have got csrers are already pushed to the limits and yhey csn grt vrry upsrt ehen families are telling them they are doing the we wrong thing but they still push on and try and keep evrrything moving in write direction for there residents thankyou

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