Sep 18, 2018

Four Corners lifts the lid on the darker side of aged care

Last night Four Corners aired the first episode of its two-part series exposing the “everyday” suffering experienced by aged care residents, and the serious problems staff have observed the industry.

The programme went to air only one day after the Government announced a Royal Commission into aged care in response to growing numbers of risk reports, facility closures, and accreditation failures.

The programme, titled “Who Cares”, reveals the personal stories of families who watched their loved ones struggle in nursing homes. The stories are dovetailed against the observations made by aged care staff, who describe the shortcomings they see in the aged care system – the lack of qualified staff, poor personal care, cost cutting – and who say the aged care system is in crisis.

Introducing the programme, Sarah Ferguson said that while horrific stories of abuse make headlines, Four Corners’ coverage of “everyday stories of neglect and inattention, poor quality food, lack of personal care, boredom and heartbreaking loneliness” equally require our attention.

“How we care for and respect older people is one of the measure of who we are as a society. This is a story for everyone,” she said.

There simply aren’t enough staff

The most damning complaint from the program was that there simply aren’t enough staff employed in aged care facilities, and those who are employed are too often not the most qualified or experienced. Personal care attendants, some with as little at six weeks training, make up 70% of the workforce.

Melanie Whiteley, Personal Care Assistant, said, “I think families think that they’re getting their loved one looked after. I think that they think that they’re paying for that to happen, and in reality it’s just not. It can’t happen. It can’t happen. There’s not enough staff.”

Tony Northcote, Facility Manager and Clinical Consultant, said the numbers of highly qualified staff employed in aged care is actually declining. “We’re going the other way at the moment, we’re reducing the number of skilled staff and increasing the number of unskilled carers,” he said.

Rebecca De Haan, who worked as a personal carer for 10 years, said she believed that increasing staffing levels could fix most of the problems in aged care.

“I just think that homes need to get more staffing, just way more,” she said.

“That would be the first thing. And then the quality of this staff. You need people that are educated in a way so that they know how to deal personally with the residents and people that have a love of the job.”

Katrina Legzdins, enrolled nurse, said, “There was just the sheer number of people that you have to look after. So, there was myself and a registered nurse in charge of 72 residents.”

Could staffing ratios improve the quality of care?

Many expressed their belief that resident-to-staff ratios should be introduced.

“There’s no ratio, I guess, for number of staff to residents, so they can just get away with bare bones, bare minimum,” said Ms Legzdons.

But Sean Rooney, CEO, Leading Age Services Australia disagreed. “With regards to staff ratios… that is a very blunt instrument in order to deliver person-centred flexible care to meet a growing and changing set of needs,” he said, adding there was no research to say that staff-to-resident ratios would improve the quality of care.

Aged Care Minister Ken Wyatt appeared to leave the door open to considering staff ratios in future.

“Now we’ve not mandated a staffing ratio… but if I find that there is continued failings after we establish the Commission and after the new standards come into place, then certainly there’ll be further discussion in respect to workforce,” he said.

Heartbreaking neglect

Dayna Vereguth shared the story of her grandmother, World War II veteran Catherine Logan, who moved into a nursing home in 2016. Ms Logan wasn’t properly showered – only her face was wiped, her hearing aids weren’t kept working, her meals were removed too quickly for her to eat, her drinks weren’t filled, her commode wasn’t emptied, and on hot days, staff didn’t think to turn on fans.

Ms Vereguth complained to the nursing home’s management, who were shocked by her observations, but there was no change in the care her grandmother received.

A year after she moved into the nursing home, Ms Logan died.

Michael Borenstein shared the story of his mother, spirited Holocaust survivor Neta Borenstein, who was  ignored by staff when she woke during the night. The scheme in which she cried out “help, help, help” in the night was one of the most distressing of the programme.

Mr Borenstein said his mother “when she woke up in the morning she would be wet and often soiled and so you can imagine lying in bed wasn’t very pleasant.”

Mr Borenstein secretly filmed footage of his mother, and that film convinced the family to remove her from the facility.

Restricting continence pads   

Ms Borenstein’s case raised another common theme – restrictions placed on the use of continence pads.

Wayne Beasley, who worked in aged care, said, “People would get an allocation of three. There was a pad room, and sometimes you would need more, and you’d have to go and ask to get the key, and you would be referred over there, and you’d be questioned why you’re needing more.”

Others said they had had similar experiences, and some were told that they weren’t allowed more continence pads.

Unpalatable, low quality food

A recent study showed on average aged care facilities spend $6 a day on food. Other research revealed that around 50 per cent of aged care residents are malnourished.

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Image: a meal served in aged care. Source: ABC.

Many sent the ABC pictures of food their loved one had been served to eat. Party pies and other fast food were often served, and the food often looked unpalatable.

But Mr Rooney did not appear to be concerned about the quality of food in aged care or the high rates of malnourishment. “These meals are being prepared for people that have a low nutrition requirement. This is not people that are eating four-course meals,” he said.

Exaggerated care needs to maximise Government funding

Another issue raised more than once was that aged care facilities exaggerate the care needs of residents so they receive more money through the Government’s Aged Care Funding Instrument (ACFI).

Ms Bain said, “The ACFI manager actually said that he wanted every woman that came into the aged care facility to be classed as high care incontinence and that meant more funding for the facility and also for the individual person.

“I could not believe what I was hearing actually. It really beggars belief,” she said.

Overuse of medication for people with dementia

A recent study found that nearly two-thirds of aged care residents have been given psychiatric drugs, including anti-psychotic medications that are mainly used for illnesses such as schizophrenia. Yet it’s known that medication is actually not terribly effective in treating agitation for people with dementia.

The programme revealed that doctors are often asked for medication and medication is being administered “as required” by care workers, some of whom have only minimal training, with very limited medication training. Consent was also often not sought from families, though it is legally required.

Pamela Passlow moved into an aged care facility, and her daughter, Deanne Morris, quickly came to the view that staff there had limited experience with residents with dementia. Ms Passlow was given anti-psychotic Risperidone without her family’s knowing, and she ended up in a psychiatric hospital twice. Ms Passlow is now cared for at home, and now no longer taking the medication, has returned to her old personality.

Are nursing homes putting profit before care?

The revelations from the programme point to the fact that operators are trying to maximise income and keep costs down – the low staffing levels, the employment of lower cost, less experienced staff, the alleged minimal spending on food, and restricting use of continence pads, all point to a culture of cost minimisation.

“Whether they’re doing it intentionally or not, I don’t know, but certainly if we look at the reduction in care staffing, it’s pretty obvious that something’s not working,” said Mr Northcote.

“I saw them trying to save money by cutting staff hours down and adding to staff loads. I saw the food that was served, really poor food,” said Ms Bain.

The second and final episode of Four Corners’ ‘Who Cares?’ will be aired next Monday night.

While last night’s Four Corners’ report into aged care highlights failings in the system, we must also acknowledge the dedicated employees and operators who do put quality of care ahead of any other factor. There are thousands of committed people working in aged care who are absolutely passionate about caring for our elderly – and we commend them.

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  1. I know quite a few people that work in nursing homes,, I agree homes need more staff, my friend get txt messages all day , there home looking for staff to work extra shifts, because they don’t have enough workers.. he has worked 17 days straight, then to take a day off, you have to beg… i have to say what these guys put up with, and the jobs they do so well, there pay is so poor. no wonder no one want’s to work in a nursing home, you get so much more working in a supermarket,, less stress…the residents do need help i agree, but the homes will not spend the money on staff , and party pies is not a good meal,

  2. I work in aged care and often go home frustrated. We are short staffed everday and the workload is too much for staff to give proper care to these vunerable residents.
    There is high turnover of staff and high rate of sick calls due to physical and mental burnout.
    The sick calls are not replaced.
    If residents are slow, food gets thrown out as there isn’t enough time.
    Residents are left sitting in soiled and wet pads for long periods of time due to shortage of staff.
    The priority is paperwork and assessments. We are told , if it’s not documented, it didn’t happen. Maybe now we can say – it is documented but it didn’t happen.
    How is it physically possible for 3 staff to toilet 24 residents as per toileting schedule, attend 2 hrly PAC for at least 12 of these residents while supervising the ones ( at least 6 at a given time) who are wanderers.
    Just take a look at the rate of incidents and infections and the number of pressure injuries to figure out the quality of care with shortage of staff.
    I challenge the politicians to spend 24 hrs in any aged care to see what really happens.
    Our seniors deserve better.
    Please bring back the ratio and more qualified staff.

    .

    We see lots of skin tears, bruising, agitation , aggression by residents as staff are rushing in order to complete their work.
    The RN’s are expected to replace staff if there is a sick call, answer phone calls after 5 pm, do care evaluations apart from assessments , administering medications, liasing with GP’s , accompanying GP’s on their rounds, wound dressings, booking bloods, following up test results and be on the receiving end of aggression from relatives. This leaves little time for patient care/ interaction.Residents are left for sometimes an hour or more with wet and dirty pads causing excoriations and pressure wounds. Any smart person can figure out that resident care is compromised due to shortage of staff and resident care will certainly improve with staff ratio.There is a very high rate of sick calls and staff turnover due to physical and mental burnout.

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