Sep 19, 2018

Government funding for aged care must be tied to care outcomes, experts say

This week there has been an unprecedented level of attention on the aged care sector after the Government called for a Royal Commission to address quality concerns, and amid harrowing revelations by Four Corners.

Last night, the ABC’s ‘Matter of Fact’ continued the focus on the sector, speaking to three industry leaders, Annie Butler Federal Secretary of the Australian Nursing and Midwifery Federation, Ian Yates AM, Chief Executive of the Council of the Ageing, and John Pollaers OAM, former Chair of the Australian Aged Care Workforce Taskforce.

Aged care staff want to do more for residents, but can’t.

Ms Butler said she wasn’t surprised by Four Corners’ shocking revelations.

“We’ve been hearing stories like this from our members for way way too long,” said Ms Butler. But she said she was just as “distressed” by the report as anyone

“It’s hard to believe that we have taken a whole section of our society and and done what I can only describe as abandoned them,” she said.

Ms Butler  said she feels “terribly” for aged care staff who desperately want to give “so much more” to the people in their care, but they don’t have the resources to do it.

“Neglect is a form of abuse”

Mr Yates said COTA condemns behaviour revealed on Four Corners, saying that “Neglect is a form of abuse.”

He said the medication issues revealed in the report could breach Commonwealth aged care standards and professional and clinical ethics standards.

But Mr Yates also pointed out that some providers are delivering world-class care in Australia. There is “excellent care” here, he said. “Some of our providers are world class, who other people come to to learn from and copy, who have very high levels of staffing and pay better than others, and don’t have any of [the problems] we saw last night,” he said.

Royal Commission must take holistic view of aged care industry

The panel agreed that previous enquiries – Ms Butler said the ANMF had made 29 submissions since 2009 – had focused on parts of the aged care sector, but they hoped the Royal Commission would look at all aspect of aged care in Australia.

“I think it is important now that we take the opportunity through the Royal Commission to really do a root and branch review of not just the workforce issues, but of the entire system that sits around it, across the broader community – not just residential care but look at primary care and acute care and how to we interface those issues,” said Mr Pollaers.

He said the Royal Commission will generate “the very highest level of community awareness” of the issues, and stimulate the conversations the nation needs to have.

Reforms already underway must continue, says panel

The panel also hoped that reforms already underway in the industry can continue, and that the Royal Commission won’t stall progress that has already been made.

Mr Pollaers, whose report on the aged care workforce was only released a couple of weeks ago, said he hopes the report’s recommendations can still be implemented.

“I would expect workforce recommendations to be implemented while the Royal Commission is in place,” he said.

Combating ageism

Ms Butler said she believes that some of the inaction on the aged care workforce stems from ageist attitudes.

“Part of the problem… sadly is the regard our society has for the elderly. We’ve made them voiceless, we’ve shut them away, and we’ve just ignored them,” she said.

“We’ve been trying to bring this to light, and now finally, as distressing as it was, at least now we’re going to get what’s really going on,” she said.

Mr Yates agreed that some of the problems are “indicative of the way we treat elderly people in Australia”.

He said ageism “permeates” our society, devaluing older people.

“We don’t like to think about ageing and death, and that leads us to downplay thinking about aged care, and this we need to confront,” he said.

Mr Yates said the most recent Federal budget was the first government attempt to establish a more “positive engagement” with Australia’s ageing society.

Supporting the aged care workforce

“It’s not possible for [aged care workers] to do the work they need to do with the level of staff they have,” said Ms Butler, noting that staffing had become “significantly worse” over the last ten years.

“There’s been a significant decline in qualified nursing staff over the last decade. But there’s not enough of any staff, including care workers.”

Ms Butler said that in the absence of any types of staffing model or benchmarking in Australia, the ANMF had undertaken its own research into the staffing levels required to “provide safe care” to every residential aged care resident.

Ms Butler also noted thataged care requires “specific knowledge” and skills that require specialised training.

“It’s impossible to train someone in six weeks,” she said.

As an example Ms Butler said being trained to give someone a shower was very different from learning how to give a frail elderly person a shower.

“Because there is no proper minimum mandated standard you don’t actually have to have a qualification to be a care worker,” she said.

Although there are national qualifications, the way they are delivered around the country is “extremely variable”, she said.

Aged care funding – transparency is key

Mr Pollaers said the Royal Commission needs to define the kind of care the nation wants to provide, and then work out how to fund it. He said his consultations show the sector is “underfunded”.

“If we’re going to have a universal aged care system, then is it a government issue to resolve. The community is going to have to vote in favour of additional funding to the sector,” he said.

“If we choose over time to make that means tested, then we have to open up the ways to let the community make a contribution.”

Mr Pollaers said funding needs to be included in the Royal Commission’s terms of reference.

“There is money in the system in its entirety but it’s siloed between federal, state and at other levels of government, so there’s no doubt in my mind that, if you take a holistic and deinstitutionalised view of care, then we can make and create a more efficient system.”

“I wouldn’t recommend increasing funding without any strings attached,” said Ms Butler.

“Not all providers are struggling. There’s no point increasing funding unless we make that funding completely transparent and we make providers accountable for its use. It has to be tied to the provision of care.”

“We do have some concerns that a small portion of providers, quite a large number of beds, a profit motive is getting in the way [of care],” she said.

“We’ve seen some business models where perhaps money is being distributed elsewhere and it is not going to care,” she said.

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  1. It is inconceivable to me to me to hear the CEO of LASA Sean Rooney, state on Four Corners recently that he was completely unaware of incontinent pad restrictions in RACFs or the rampant use of anti psychotics to help staff manage residents who pose a risk to themselves or other residents, because staff simply don’t have the time to observe residents because they are so pressed for time to deliver basic are needs, is inexcusable. Having worked as an aged care workforce consultant for several years and former aged care employee myself, I find it inexcusable for decision makers in the sector to be so disconnected from the real challenges facing frontline staff. I have a mother in residential care, whom I personally cared for, for many years, and know only too well that providing personal care (showering and dressing) alone takes considerable time when assisting someone with cognitive deficits. The vast majority of care staff are at breaking point, both physically and emotionally and have been for many years. Countless enquiries and reports into where the system is failing our elderly have been conducted, and yet it seems those making the reforms are not listening to those providing this service. Human contact and compassion is an essential part of care, yet many staff are simply burnt out and leave the sector, full of despair knowing full well that those they care for deserve so much more. Aged care is not simply a place to park people, it is not a storage facility. Consumer directed care is impossible when there is simply not enough staff to ensure basic care is delivered let alone consideration for the individuals happiness. For peak bodies not to know that staff are unable to manage and have to resort to restraints, sedatives just so that they can avoid risk to residents is deplorable.

  2. It is inconceivable to me to me to hear the CEO of LASA Sean Rooney, state on Four Corners recently that he was completely unaware of incontinent pad restrictions in RACFs or the rampant use of anti psychotics to help staff manage residents who pose a risk to themselves or other residents, because staff simply don’t have the time to observe residents because they are so pressed for time to deliver basic care needs, is inexcusable. Having worked as an aged care workforce consultant for several years and former aged care employee myself, I find it inexcusable for decision makers in the sector to be so disconnected from the real challenges facing frontline staff. I have a mother in residential care, whom I personally cared for, for many years, and know only too well that providing personal care (showering and dressing) alone takes considerable time when assisting someone with cognitive deficits. The vast majority of care staff are at breaking point, both physically and emotionally and have been for many years. Countless enquiries and reports into where the system is failing our elderly have been conducted, and yet it seems those making the reforms are not listening to those providing this service. Human contact and compassion is an essential part of care, yet many staff are simply burnt out and leave the sector, full of despair knowing full well that those they care for deserve so much more. Aged care is not simply a place to park people, it is not a storage facility. Consumer directed care is impossible when there is simply not enough staff to ensure basic care is delivered let alone consideration for the individuals happiness. For peak bodies not to know that staff are unable to manage and have to resort to restraints, sedatives just so that they can avoid risk to residents is deplorable.

  3. ‘Experts’ have bureaucratized and over-complicated our aged care industry. Because organisations are encouraged to compete and market far too much money has gone into sleek campaigns, re-badging and image management. This money should go toward direct resident care by care workers, nurses, OT/Physios and lifestyle coordinators. Get rid of the race to increase incomes via ACFI. Base incomes with supplements for increased needs should simplify that entire stupidity.
    I believe that on-the-floor staff truly want to care for and love elderly people but cant because they’re being given an impossible, undeliverable listing of tasks to achieve.

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