Mar 06, 2018

Growing Expectations in Aged Care: “Overcooking” Quality and Making Complaints

Consumer expectations for aged care have evolved greatly over the past few years. Aged care is more than just a bed in a home, it’s a place where an older person is safe and cared for, a new “home”.

Good enough is not enough anymore, and with higher expectations, there is increased pressure on aged care operators, as well as the regulatory bodies, to meet those expectations.

This was the topic of discussion during the panel at the Quality in Aged Care conference by Criterion Conferences and COTA Australia.

Chaired by Ian Yates from COTA Australia, the panel featured Amy Laffan from the Department of Health, Andrea Coote from the Aged Care Quality Advisory Council, Sally Ross from the Aged Care Complaints Commissioner and Pam Christie from The Australian Aged Care Quality Agency.

Andrea Coote started the session be explaining that in terms of quality, “we have to be careful not to overcook it”.

What she means by this is quality it talked about “all the time” but talking isn’t enough. There needs to be assurance that quality is provided.

“We need to get it right now, so that in the next few years it’s going to make it easier for all of us to talk about we know what we really mean about quality.”

In everyday life, people choose what they want and where to go and get it – and that should apply to aged care too. But, as Andrea explains, people need to be “realistic”

“We have to help consumers to understand that it’s not always going to be possible to get all of the options at one place. We have to be very clear about the options that we’re giving and ask them what their expectations are. We need to help them meet them.”

“In my experience the public want to know their hospitals run well, their roads are are efficient, that their country is protected and all of those things are in a row.”

“What people don’t want is government sitting in their sitting room. They don’t want to government making their decisions for them. And I think we all have a part in that”.

Andrea highlighted the greater need, in the aged care industry, for more psycho-geriatric facilities.

“We’re going to have more mental health issues, we’re going to have more people who are going to have a disability and we have to make certain that the sector provides for these very specific needs.”

“But we can’t all be lumped in with the bad news that was Oakden. We have to make it our responsibility to talk up the good services and the good reforms that have been put into place.”

Australians, according to Andrea, need to be “given the confidence that this sector is really working well”.

Pam Christie spoke from the perspective of the regulatory vision of expectations. She explain that The Australian Aged Care Quality Agency take a risk based approach to regulations.

“Risk based regulation has been adopted by contemporary regulator,” which is focussed less on enforcement and more on prevention.

What does this mean in the aged care sector? “Typically, in a traditional based regulation you would only be looking at you might only be looking at procedures and policies as a way of meeting a compliance threshold.”

“But under a risk based approach there is much more focus on practices and what is actually happening. While having systems and processes is still important, it is not all that we are looking for.”

“We will be expecting providers to demonstrate good self-assessment and that they have those things in place.”

Sally Ross, as a part of the Aged Care Complaints Commissioner, reflected on the importance of the complaints system and ensuring the public’s confidence in the system.

“The Carnell-Paterson enquiry concluded that ‘an effective Complaints Commissioner  provides answers, shares lessons that providers can use for quality improvement and acts as a public watchdog and notifies oversight agencies of red flag information about patterns of concern or serious incidents and complaints.”

Sally believes that fits quite well with what they are currently doing to meet the objectives to “resolve, protect and improve”.

“So what we do now with complaints is seek resolutions and outcomes for individuals where we identify risks to quality and safety, we take actions on those or we make referrals to the Department or Quality Agency, and we work with the provider and the industry more generally to learn from complaints and make improvements.”

The main focus of the Complaints Commissioner is to bring more awareness to their service.

“How do people know how to make a complaint? Do they know about internal complaints? And do they know about us [the Aged Care Complaints Commissioner]?”

This is especially the case for vulnerable care recipients or people who don’t have families to speak on their behalf.

Sally says they are looking to work with advocacy groups such as Older Persons Advocacy Network, who she says are “a very important part of this mix”.

The Aged Care Complaints Commissioner also wants to “change the conversation around complaints”.

“To help people feel that making complaints is a safe thing to do and that it’s a normal thing to do, and in a lot of cases, it’s actually a positive thing to make complaints”.

“Recognising the value of complaints in a quality system is really important and to create that sort of conversation, that is where we hope consumers start to feel more confident to come forwards and raise those things themselves.”

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  1. Whilst I applaud all the Inquiries, senate hearings, aged care experts, government bodies etc etc , nowhere do I see any involvement from the people who are trying their best with budget reductions, staff reductions, hours cut, and that is us, people at the coal face who do the best they can, with what they are given or allocated, At the level of staff who are the caregivers the resentment and disillusionment with aged care and where it is headed would really surprise most people, so maybe someone needs to listen to us.

  2. Well said Chris. It is very important that staff understand that the criticism of aged care is not a criticism of them but of the government, the bureaucracy and the industry leaders who have created a market system that does not collect useful data. It is not forced to acknowledge, and so does not accept the extent to which it is exploiting the vulnerability and lack of voice of staff, residents, their families and the communities they should be serving. The regulatory system is deeply flawed in concept and so ineffective. Oakden is different only in that it went through the state system so that publicity could not be controlled. What was revealed, while more challenging, was not unique.

    This advertorial for doing very little shows that, like the Carnell/Paterson review, these industry leaders and a community organisation that benefits from working closely with industry and government are ignoring the strong criticisms and pleas from staff and families, who see what is happening across the sector, made to these reviews and inquiries.

    This is simply another attempt at tinkering with a system that is deeply flawed in concept and implementation so cannot be ‘fixed’. We need the sort of reform that acknowledges the mistakes that have been made and makes real change to address it.

    At a very basic level the sensible elderly like their predecessors, want to be treated with care and consideration and have control over their lives. Unrealistic expectations are created by marketing the unattainable. Their and their families’ disappointment when they experience real ageing, dying and under-staffing is understandable as is the anguish of the staff.

    Aged Care Crisis is pressing for change. Change that is based on evidence rather than belief, carefully considered, constructively addressed, carefully introduced and closely monitored – the very antithesis of what has been happening since 1997 and the reforms that are being promoted.


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