Apr 10, 2019

Who Should Be Held Responsible When An Aged Care Home Fails Accreditation?

From an outsider’s perspective, the current way in which the majority of sanctioned aged care providers deal with a publicised negative incident or a failure of accreditation standards are as follows:

Firstly, remain silent for a while – because unless there is enough media scrutiny, nobody needs to know that you are unable to meet minimum standards, and this also gives you a chance to draft up an impersonal corporate statement.

Begin your drafted statement talking about how disappointed the organisation is by the news of the incident or failed accreditation, highlight the fact that you are working with industry experts (that you have chosen) to help rectify any problems, and then try to assure people that you are having meaningful and candid discussions with residents and their families.

Next, if it’s gotten to the point where you must say something publicly, release this generic statement into the backend of your website and also use it as something that you can tell journalists to refer to when they try to ask you the type of questions that the families of your residents would want to know.

And last, but not least, rinse and repeat.

For those of us on the outside looking in, it is extremely frustrating to watch matters that involve the safety and wellbeing of vulnerable human beings being watered down with insincere statements that offer very little reasoning and even less accountability.

This dismissive approach to dealing with responsibility following a sanction, has helped many poor quality aged care organisations and personalities avoid the limelight of scrutiny for decades, and now as the industry reluctantly begins to reveal many of its flaws to the Royal Commission, HelloCare had the pleasure of sitting down with someone who knows more about how facilities deal with accreditation scrutiny more than anyone else.

And his views, are just as insightful as they are troubling.

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 was actually a Clinical Advisor for the Aged Care Quality & Compliance/Department of Health and Aging.

These days, Dr. Jilek is the Principal Advisor at Aged Care Consulting and Advisory Services, where he provides advice and works alongside aged care providers who have failed aged care accreditation, which gives him a unique insight on the problems and attitudes of the people who seem to go silent when people want nothing more than a real explanation.

“I’ve been around for a very long time, on both sides of the fence,” said Dr.Jilek

“I currently work as a consultant with homes who have failed accreditation and are under sanction, and I’m flabbergasted at the polar differences between the way that providers handle these situations.”

“There are some providers – usually smaller providers – who put their hand up and own their mistakes, and many of these providers come to the realisation that they don’t have the capacity to provide the minimum level of care and choose to walk away from the industry altogether or merge with another provider to ensure that residents are well cared for.”

“But, more commonly, you actually get the polar opposite response, where a provider who has failed accreditation saying that ‘its the governments fault, they changed the rules’, ‘we’re doing a great job’ -and there’s no insight into how they got into that mess, how to get out of that mess, and how that mess affects residents.”

Sadly, when it comes to topics of importance within the aged care industry, it seems that the higher you go in terms of tax brackets and job titles, the less often you hear conversation regarding the actual wellbeing of residents.

According to Dr. Jilek, the current list of 44 outcomes that must be met in order to pass accreditation are far from lofty or unreasonable, and failure to meet these minimum standards of care have a number of providers trying to shift blame rather than taking responsibility for their poor level of care.

“From a resident’s perspective, these are minimum standards – we’re not talking about restaurant missing out on a Michelin Star, we’re asking can you run a Fish’N’Chip Shop? And if you can’t, you’ve failed in your duty of care. For me professionally, If I was running one of these homes I would hang my head in shame and run away even if I failed even one of these standards because they are the bare minimum.”

“I actually work with providers who have failed one accreditation outcome and are absolutely mortified, and yet, I work with others that have failed as many as 43 out of a possible 44 outcomes and they still argue the point that they provide great care

“At audit one provider failed all 44 accreditation outcomes, but in their submission, the agency actually gave them a tick for their ‘planning and leadership,’ so they only actually failed 43 on paper. How you can fail every single outcome yet be rewarded for your ‘planning and leadership skills is beyond me.”

“And, to highlight the type of mindset that we are dealing with- in the public meeting that was held for the sanctions, the CEO of that aged care provider actually stood up and basically blamed their failings on a government conspiracy and proclaimed that they actually provide great care.”

A History of Silence

If media coverage is anything to go by, it may seem as though the aged care sector is currently in a worse state than it has ever been, but the truth is that there has always been a number of problems with the Australian aged care industry, but this is the first time we are really starting to hear about what these problems are.

According to Dr. Jilek, aged care accreditation has changed a lot over the last two decades, and the problems that we face today may just be a byproduct of an aged care accreditation process that had a don’t ask, don’t tell, approach to investigating the inner workings of Australian nursing homes.

“The department has protected and been soft on organisations because the political will for the last 15 years has basically been to keep aged care out of the media,” said Dr. Jilek.

“I met a former minister who actually said ‘my role as the minister for Ageing will be judged on if I can keep aged care out of the media,’ and this has been the ethos of the aged care industry culture.”

“I have friends in the agency that were pressured for years not to mark aged care facility outcomes as being unmet, and this has only started to change over the last few years.”

“The head of the agency used to stand up at Senate estimates hearings and brag to the government about how small of a percentage of nursing homes actually failed accreditation, and people thought that the accreditation scheme was working well because such few homes were actually failing, which meant that everything was good and that there was nothing to see.”

“But the problem was that the agency didn’t actually look at anything, and the process was flawed because they came in with the preconceived notion that you had passed all 44 outcomes, and there would have to be an enormous amount of evidence to make them change that belief.”

“Now though, auditors come in with a clean slate and facilities actually have to prove that they are meeting standards and that is the way that an audit should be.”

A Closer Inspection

While there can be no debate that this country was in desperate need of a Royal Commission into Aged Care Quality and Safety, one topic that certainly raised a few eyebrows was the timing of the announcement.

Was this an industry that had just become sick and tired of seeing older Australians being treated poorly in the twilight years and willfully wanted to improve? or was the fact that the Royal Commission was announced one day before the ABC aired its harrowing ‘Who Cares’ investigation on 4 Corners a simple coincidence?

Either way, regardless of whether this was a gesture of taking responsibility or a preemptive strike to deal with criticism, the additional scrutiny being faced by aged care providers is certainly a welcome relief for residents and their families.

“This pressure to do the right thing was caused by the media, and 4 Corners had a lot to do with it,” said Dr.Jilek.

“Constant media pressure over the last few years has the government scrambling. It’s almost like toothpaste has been opened and it’s flowing out of the tube, and it’s going all over the place, and they are madly trying to shove it back into the tube, but its not working, so now, instead of accepting any responsibility, they are trying to change the narrative of the story.”

“The story is not going to be that the regulator was hiding things, it’s now going to be ‘well this is just a bad industry, something happened and now this industry has just magically gone bad somehow- and even though we don’t know how that happened – we can fix it,’ because the government can’t put their hand up and say ‘hey we are actually complicit in this.’

“I worked at the department of health where they used to have meetings called S.P.O.C which stood for Service Providers of Concern, and the facilities and people that we spoke about in those meetings were still being talked about in the same meetings 10 years earlier.”

“Even though things are changing, I just fear for this sector and where it is going, these people have been speaking bullshit for so long, that they actually have started to believe it.”

“Every problem is the fault of someone else, and the Senior Executives that run nursing homes are unafraid of the repercussions of putting profits before people, and the government has made it that way.”

While the talk of changing the culture within the Australian aged care industry is nice to hear, there are a number of examples that honestly make you wonder whether the government wants to make positive changes or simply wants to appear to be making positive changes.

HelloCare reported earlier this year about a number of people who were hired to perform unannounced accreditation inspections who were still working in residential aged care and the conflict of interest that this situation creates, but according to Dr. Jilek, this is not the only way in which the industry is trying to police itself.

“Believe it or not, sanctioned sites are actually allowed to choose their own internal advisors and administrators, you used to have to get someone external to come in and review what you were doing – and you had to do it, but now that is not the case.”

“Bigger organisations have cottoned on to this already, and so they just pull someone up like a facility manager, or a regional manager and they just say – we are under sanction now but you can be the advisor – we will tell you what to do, but you are the advisor.”

“What this means is that the government is letting organisations that have failed to meet minimum standards try to fix things themselves, and you don’t have to have the scrutiny of someone from the outside coming in.”

“The department never used to let a sanctioned organisation get any bigger, but now you have providers that are under sanction being bought and taken over by other bad providers. How the department can approve someone who has failed minimum standards to buy another home, is beyond me.”

Who Should Be Held Accountable For Failed Accreditation?

When Dr. Rodney Jilek first posed the question regarding exactly ‘who should be held accountable for failed accreditation?’ on a LinkedIn post -it did not surprise me to see a small minority of aged care professionals start to pedal the organisational-sounding rhetoric about not focusing on blame, and focusing on finding solutions.

This brand of unaccountable blathering is just the kind of wishy-washy jargon that has allowed poor-quality aged care providers to avoid appropriate scrutiny and continue to dish out poor care to vulnerable people, and one of the reasons that aged care is currently in the state that it’s in.

“The question shouldn’t be about who should take the blame, it’s about professional accountability – people in senior positions need to put their hand up when a facility fails accreditation and say ‘yeah, we messed up, and as the head of an organisation, this should fall on me,’ and there needs to be some real consequences,” said Dr. Jilek

“If I was the CEO of an organisation or I was on your board and I was looking at 35+ unmet quality outcome standards, I would put my hand up and say ‘look, I have failed you, I’m sorry’ and then I would leave, but that doesn’t happen.’”

“In fact, a lot of these places instead choose to put the blame for these sorts of things on the DON (Director of Nursing) but the organization is responsible for putting the Don there, and they are also responsible to monitor what is actually happening.”

“There may be something like basic care issues that you look at and think, ‘what the hell was the DON thinking? But it’s the senior executives that control the money, who also control the staff and dictate the training, and they control the purchasing of equipment.”

“You can’t go in and instantly place the blame Care Manager or the DON because they often don’t have full control of everything and it’s actually much higher up where the accountability needs to sit, and an approved provider is required to provide staff with the resources that they need to meet the standards.”

”These new standards seem to say that accountability sits with the board, but is the department of the agency actually going to take the board to task? Because at the moment they don’t really take anyone to task.”

“A lot of organistaions still have volunteer boards and many have absolutely no idea what they are doing. You’re DON might be earning 120k, regional manager earning 170K, and you have CEOs who are earning well over 200k, and the people this high up -instead of being made accountable – just end up working next door at another facility.”

“When you track their movements from organisation you can actually see the pattern of destruction that they leave behind, and the reason for this is – because the industry at this level targets people who are shrewd business people who can squeeze out the most money, rather than people who are great at providing care outcomes.”

 

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  1. We (Aged Care Crisis) have been tracking this system as outsiders looking in for 20 plus years. Criminologist John Braithwaite was ignored when he identified the problems and described them in his 2007 book “Regulating Aged Care”. For the first time we actually have a courageous person saying the same things from inside the system that have been glaringly obvious from outside for many years. We know which homes Rodney Jilek was referring to because one of us wrote about them 13 years ago and was threatened for doing so!

    Aged Care Crisis were asked to appear before the Royal Commission in Adelaide but when we said these same things in our statement of evidence that invitation was withdrawn.

    We need to remember that governments ensure that Royal Commissions, like other outside reviews are in in safe hands, (for them) and share the same ideas. Both commissioners have a long association with government and its thinking about regulation and unions.

    This commission (like the April 2019 senate report on the effectiveness of regulation) will certainly identify the failures in care and staffing but their instincts will be to support and expand the government’s revised regulatory system and not change it. This is what the senate report recommended and what the Banking Royal Commission did. It is likely that little will change and in time problems will recur.

    To solve these problems, we need to understand the way people think, behave and respond in the sort of system we have. Jilek describes that well. Effective change means changing the system in ways that will change the way people think and behave both in the market and in its regulation.

    In this case real change will mean challenging deeply help beliefs about competitive markets that correct themselves, small government, supportive regulation and the participatory role of society. It will be interesting to see if the commissioners will rise to that challenge and finally take us into the 21st century.

    Will they have the courage to be the first to break ranks, challenge dogma and actually be innovative – something that has been missing from policy for so long only the old remember — or will they find that too challenging?

    1. Of course the people at the top should be held accountable. Making their staff the scapegoats is absolutely despicable and cowardly in my opinion. Having sat through the first three weeks everyday at the Royal Commission in Adelaide,I was totally appalled and gobsmacked by the blase attitude of some of the CEO’s and provider reps. It’s no wonder there’s abuse and neglect happening because it was obvious the important thing was money. So many things collectively will have to change before we are anywhere near a solution to this disgusting attitude of how care should be given to the most vulnerable members of our society,disability included.

  2. Thank you Hello Care for the coverage you give to highlighting the real issues in aged care.
    I think the Royal Commission will have an uphill battle solving aged care industry problems. To start with there will never be enough taxpayer funding to cover the needs of an aging population.
    Also,my experience of accreditation visits to the dementia facility where my wife was a resident, was the director of care was very good at ‘window dressing’ prior to the visit. Also, feedback on quality of care issues from the residents’ family carers was treated as ‘we’ll look into it’.

  3. All CEO’s and Boards should take ultimate responsibility. They all need to get around and understand their operations, not remain office bound relying on written information and conferences.
    This is how it used to be and unfortunately thst has becomeva practice of the past

  4. As they say a fish rots from the head down. It’s the job of those at the top to know exactly what is occurring in the organisation I do not doubt that they know exactly what’s happening if they don’t then shame on them also shame on them as they do know Each level supports those below as to not would admit basic failure of diligence and so on and so forth right to the top

  5. Totally agree with this article. I believe all managers and board members should spend time on the floor working as a career or volunteering so they understand the needs of residents and care staff and ancillary staff. Should eat the residents meals for a week too to see what is wrong or right in their facility. Mind you there are some fabulous facilities who are doing so many things well. Let’s celebrate them.

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