For instance, there was news in 2019 that 45 of 72 Bupa nursing homes in Australia had failed to meet all health and safety standards, with 22 putting residents at “serious risk”.
Then there are the harrowing stories of neglect and abuse coming from the Royal Commission into Aged Care Quality and Safety.
So, how do you check if your loved one’s nursing home is really up to scratch? How do you interpret audit reports about residents’ health and safety? And how else could you find out if your mum or dad’s nursing home lives up to the promise of its marketing brochures?
Every nursing home in Australia receiving government funding is assessed and accredited by the Australian Aged Care Quality and Safety Commission. Assessments are conducted every three years or more often if there are concerns.
Commission staff check if each nursing home meets eight minimum standards. These include whether residents are treated with respect, the nursing home is providing safe and effective clinical care, and staff have adequate qualifications and training to do their jobs.
Commission auditors interview residents, families and staff; observe care; and review the facility’s documentation. Visits can be unannounced to get a better picture of what regular care is like. Auditors then use that information to write a site audit.
It takes about a month after a site audit for the commission to decide on the quality of care. Then there’s up to another month for the audit report to be posted online.
Posting the decision publicly can be delayed further if a nursing home asks for the decision to be reconsidered. We understand this often happens if a home receives a poor report.
When a home is judged as not meeting standards, the commission will decide how serious it believes these deficiencies are. In increasing order of seriousness, the report says if a home is:
1. Not meeting standards. Nursing homes can be judged as not meeting one or more of the eight minimum aged care standards. Each standard has three to seven individual requirements. Nursing homes don’t have to meet all the individual requirements to meet the overall standard. The more standards or requirements a nursing home fails to meet, the poorer the care.
2. Serious risk. If a nursing home is given a “serious risk” judgement, the quality of care has placed or may place the safety, health or wellbeing of a resident at serious risk. An example might be a home not having enough skilled staff, leading to clinical mistakes, such as the wrong medication administered often.
3. Sanctions. Sanctions are imposed on homes when care places an immediate and severe risk to residents’ health, safety or wellbeing. This might be for multiple organisational problems (such as with clinical care, staffing, wounds not being cared for), leading to multiple poor outcomes (such as assault, avoidable illness, and the dangerous administration of medication). Homes can also be sanctioned if they do not fix continued non-compliance.
Families are notified in writing, and facilities must hold a meeting for residents and families to tell everyone what the problems are and how they will fix them by a certain date.
When a nursing home is sanctioned, it is penalised in several ways, depending on what was poor about the care:
A home’s history of non-compliance, serious risk decisions and sanctions are archived online (see below for details). So it might be worth taking a look when choosing a nursing home, as well as checking on an existing one.
4. Revoking accreditation status. If sanctions are imposed and there is no improvement, the commission can revoke a home’s accreditation status. This means a home cannot take new residents or receive government subsidies. Some of these homes reapply for accreditation, others shut down.
The most up-to-date information on nursing homes not meeting standards (non-compliance) and sanctions is through myagedcare’s non-compliance checker. This allows you to see if an individual home has not met standards, is sanctioned currently or has been in the past. Some archived sanctions on the website go back to 2002.
However, the myagedcare website doesn’t list “serious risk” reports. For those, you have to go to the Aged Care Quality and Safety Commission’s website.
You can also search the commission’s website for audit and consumer experience reports, which provide more detail on the quality of care.
Audit reports can be difficult to understand because their intended audience is aged care professionals, not the general public.
Consumer experience reports show what residents said about their care. That’s from whether staff followed-up when they raised an issue, to what they thought about the food. These reports are easier to follow.
It can be hard for family to know if their expectations for care are reasonable, particularly when feelings of sadness and guilt colour those expectations.
So, it can help to consider the aged care standards when making your own decisions about whether the quality of care is good enough.
You can do this by observing what happens day to day. Do residents wait too long for attention, for instance, to be taken to the toilet? Do staff speak respectfully and kindly to residents? Are meals appetising and healthy? What happens when residents are distressed? Is there high staff turnover?
Does the nurse on duty know the detail of your loved one’s clinical needs, for instance, diet, illnesses or medications? Is the manager responsive when you raise issues?
You can also talk to other families about their experiences of care.
If you find that your loved one’s home doesn’t meet standards or is sanctioned, here’s what to expect.
The commission gives the home a set period of time (usually three or six months) to improve care. Commission staff keep visiting the home until they are confident the home is meeting standards.
You will probably want to visit regularly and keep an even more careful eye on your mum or dad’s care. Speak to the home or commission about any concerns.
You can ask your home’s management:
As a resident or nominated family member, you have a right to information and to complain about your loved one’s aged care.
The issue of whether to move a loved one to a new nursing home is a difficult one. It’s a personal decision involving weighing up the negative impacts you think the care is having with your own energy levels, funds and whether you can find a suitable new home.
Government reforms presume market forces will drive up the quality of aged care. In the meantime, we hope the resources in this article will help you make a more informed decision about your loved one’s care.