Feb 17, 2021

Managers with no medical training or experience: is this the unravelling of aged care services?

Senior man sitting on chair and cross arms
Photo credit: fzantiStock
While this editorial is based on information from sources that are considered reliable, they do not necessarily reflect HelloCare’s views, instead the intent it to highlight topical issues impacting consumers and the sector more broadly. * Warning disturbing content.

Aged care homes are hiring managers with no medical or aged care qualifications or experience, according to the wife of a resident the move is putting the health and safety of residents at risk in the home her husband resides in.

A HelloCare reader reached out to share her story about deplorable management in the aged care home where her husband has lived for the last two and a half years, and the latest development – the appointment of a manager with no medical or aged care experience.

On top of that, the home has appointed 10 managers in the last 18 months.

It was the last straw for Jan**, who is a nurse herself with a long and successful career in the healthcare sector.

“A turnover like that is indicative of major issues,” she told HelloCare – and she has seen these issues play out.

No response to royal commission grilling

The Royal Commission into Aged Care Quality and Safety “took the home to task”, Jan told HelloCare, over its poor clinical governance which they considered to be a “major problem”. 

However, Jan said the home has not implemented any discernible improvements since then. “They don’t seem to have taken the message,” she said, and in fact since then, things have become “much worse”.

“I don’t know if it’s arrogance or stupidity, or both. I know if I’d had such negative feedback at the royal commission, I would do everything possible [to improve].”

“They don’t have the policies, the procedures or the system in place. They don’t have the appropriate staff appointed in relevant roles to provide that support and mentoring that’s needed when new people start.

“The royal commissioners were very clear when they spoke to this organisation about these deficits, so to make a decision to put a non-clinical person into a facility management role is extraordinary.”

“I’m alarmed and I’m afraid”

After a long series of care failures, the last straw came when the home appointed a manager with no medical or aged care experience.

To make matters worse, the home does not employ any senior resident nurses either. The clinical coordinator is a second-year graduate, and most staff are personal care workers new to the industry.

“It’s extraordinary that we can have older people who can have multiple comorbidities in these aged care facilities and you don’t have people who understand those comorbidities or people who understand how to look after the elderly,” Jan said.

“I’m alarmed and I’m afraid for the residents and my husband.”

“It’s really shocking. As a nurse, I can’t believe this is happening in Australia.”

“You have a situation where you don’t have the clinical staff to ensure that the residents are safe, clinically, and you have a manager appointed who has no clinical knowledge.”

Jan believes that if operators employ managers with no health qualifications, they must then have a very strong nursing workforce. “These facilities don’t want to do that because they don’t want to pay for it,” she said.

“I see him screaming”

Jan believes that if she wasn’t a registered nurse, her husband would have died because the care provided at the home is so poor.

He has a terminal illness, but Jan wants him to continue to have as good a quality of life as possible. Cognitively he is the same person, although physically he has serious challenges which the staff do not help with.

Jan provided a harrowing account.

There are no attempts to rehabilitate residents, they are simply in “a holding pattern for death”, she said.

Dehydration has been a recurring problem, both for Jan’s husband and among the other residents. 

“The staff don’t give the residents sufficient fluid and they get delirium,” Jan said. “For those people who don’t have families or know how to advocate, they die prematurely from dehydration. 

“My husband is alive because I have been meeting with these people over and over.”

Jan said she has attended meetings during which the manager was instructing the nurse on clinical practice. “It was totally inappropriate. It’s absolutely dangerous,” she said.

Punished for speaking out

Jan told HelloCare she raised her issues with the Aged Care Quality and Safety Commission and at the royal commission, but the “reprisals” from staff at the home after doing so were “shocking”.

A group of the staff claimed Jan had physically and emotionally “elder abused” her husband when she lifted up his skin to show he was dehydrated. 

“It was the most devastating thing I’ve ever had anyone do to me. I love my husband. We’ve been married for 40 years. He’s a really decent man. And they did this the week before Christmas,” Jan said. 

Jan was forced to hire lawyers, but once police investigated the matter, it was quickly seen there was no substance to the allegation. 

“It’s been the most horrendous journey,” she said.

A cost cutting excercise

Jan believes the reasons aged care homes are not employing skilled and experienced staff is, in this case at least, to cut costs.

While some will argue a good manager does not need to have medical experience, Jan believes that is “a cop out, so they can say ‘these are just their homes, we don’t actually have to give the care’”. 

“People are going to aged care homes in a much more acute state of health… So in fact the skill sets that are required in these aged care facilities have increased,” she noted.

All eyes on the royal commission

Jan lives in a state of sustained trauma and has been diagnosed with traumatic stress syndrome because of her harrowing experiences with her husbands’ aged care home. 

She describes herself as a “very strong person” who is used to coping with stress. She has worked in ICU, open heart surgery and emergency, and through famine, drought and natural disaster.

But she has never before been in a situation of sustained trauma as caused by the experience of having her husband in care.

Rather than stay quiet and powerless, she has decided to speak out.

The royal commission will release its final report and recommendations next week and Jan, as well as others, will be looking closely to see if any recommendations are made about requirements for manager qualifications.

Jan believes that aged care managers should at least have a health, aged care and management qualification, with the appropriate support under them.

What do you think? Should aged care managers have medical or aged care experience?

While HelloCare has chosen not to name the home in question in this article, we have advised Jan of the appropriate channels to seek resolution including the Aged Care Quality and Safety Commission to investigate.

** Not her real name.

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  1. I am now a registered nurse after being a carer at my same work place for 15years. Please don’t put us all under the same umbrella. There are some good nursing homes out there but with all this news about aged care, families only see the worse in nursing homes.At my work place the residents are our family . Some really do care about your family members so please when I say I’m an aged care nurse, don’t think the worst. I really love my job and my residents I treat like their my own family.

  2. The same thing is now happening at glenara lakes Launceston kingsmeadows new facility manager he is all for saving money and not filling shifts his background is hospitality

  3. Jan** this saddens me that I read ‘most’ staff are Personal Care Workers new to the industry…….many aged care workers have years of experience and do mentor and support new staff.

    Jan**what saddens me is that CEO’s order these Aged Care Facilities to operate for profit by cutting costs, putting both residents and care workers at risk.

    Jan**reading this report saddens me that your husband has been in this particular facility for two and half years. Only you have a choice/option to relocate him to another……for the sake of a happier Jan** and husband.

  4. Unfortunately for Aged Care Residents it is pointless complaining to the Aged Care Quality and Safety Commission.
    That is a toothless tiger, poorly lead and constipated by its own paperwork.
    Change will not come until we see effective legal action against the Directors of badly managed Aged Care Service Providers.

    1. Unfortunately I do not think that is correct, many of the newer facility managers for a company I use to work for are from a hospitality background. This is fine if you have an experienced clinical manager not just appointing inexperienced RNs because they cannot find anyone else.

  5. Absolutely they should have medical experience and at the very minimum be a Division 1 nurse with extra training in elderly care management. Atrocious that a home for our elderly should have as manager someone with no medical experience! Totally beyond my comprehension how they can do that!!

  6. I have worked in a facility that had an accountant as Facility Manager.
    Technically, it was a ‘not for profit’.
    But if beds were empty, staff had reduced hours, or if they were casual, they lost shifts.
    I understand all ACF are businesses, but some forget that the residents, and their care is paramount.

    1. I wondered this too, but then thought about it and there are other factors to consider. The article does not say where this facility is located, in more rural areas there are not more options that are close to home for the partner and family members. My mother in law was in hospital in Wagga, NSW and when looking for a nursing home they were told they may have to go to Narrandera, about an hour’s drive away, meaning her husband would not be able to visit daily as his health was also declining. Sometimes it just isn’t an easy fix. 😕

  7. I whole heartedly agree with Jan and am terribly saddened that this is happening. Why are our elderly so undervalued in society, to be allowing this to happen?
    It is criminal…and it all boils down to money!

  8. I agree with Jan that aged care managers should at least have a health, aged care and management qualification, with the appropriate support under them. Under this qualification, the managers already have knowledge or experience, or gained the knowledge and experience through the studies in medical and aged care.

    The health management is very different from others, it is people-centred, compassion motivated management than others, such as managers with hospitality background, which mentioned by May in comment. People living in an aged care who need health care do not like people living in a hotel who do not need health care. Therefore, it’s obviously that a manager from hospitality will focus on the sales not the cares.

  9. Sadly, because some operators think residential aged care is a “home” they think that clinical care is not as important as it once was. Some aged care providers have drastically cut back on Registered Nurses, employing Enrolled Nurses or carers to filll those roles to cut costs. The same applies to management roles.
    A manager should be a Registered Nurse. They have the expertise to ensure resident care across all areas not just clinical. Non medical managers rely on Clinical Coordinators for support but often, these staff are not even available.
    When will people realise that Aged Care is a specialised area that requires well educated and registered staff to ensure appropriate care for the frail aged with multiple comorbidities???

  10. I worked for an Aged Care place for 5 years, I have some stories to tell. I tried to name things which concerned me and reported a night nurse for physical violence to a woman, they claim it was unsubstantiated. This person had been there for years, retired and was welcomed back with open arms and she dictated were she’d work. Staff some called her mum! Investigated 🤔. I ended up being called to office regularly and claims of to many to mention, it broke my heart ethics morals. The story goes on however I have now found an Aged Care Facility that acknowledges my skills, commitment💖

  11. This is a BLOODY DISGRACE . Wasting money on a royal commission is not solving the problem
    it just continues on and and on. Aged Care means just that CARE FOR THE AGED. When are we going to see some meaningful action. OR DOES OUR GOVERNMENT NOT CARE AT ALL.

  12. Yes of course, it doesn’t take a university degree to understand that.
    Its logical!
    How the almighty dollar wins every time!
    How low we have stooped as a society when this is allowed to happen to our elderly. Disgraceful.
    Governments have no backbone today.
    Will anything come out of this Royal Commission.
    Supposedly we are meant to teach our kids consequences, yet in the Aged Care sector this does not apply.

  13. This is a major crisis especially in privately run aged care homes. Managers are simply appointed to run the day-to-day running of these homes; these managers delegate duties to the nurses and carers, and it is of little use bringing loved ones concerns to these ‘managers’ as they have little regard for the residents, there concern is only the financial side of running the homes, and the PR of the home.
    I often used to say to the kinder nurses “I’d love to see how management would cope. maybe they should come out of their office and help you guys at least once a week”.

  14. Aged care managers do not need to be clinicians however they do need solid clinical leadership within their team. One of the outcomes of the RC and the media negativity aganst the backdrop of chronic under funding has been significant shortages of both clinical and non clinical expertise. Those within the industry are run down and fatigued and constantly told they do a disservice or worse to those for whom they provide support and care. Some have given up and left the industry and new comers see the constant criticism and regulatory abuse and decide it’s not for them. The damage is done and I’m not sure the industry will recover although for the sake of those within it – elders and team members alike – I hope it is time to Care about Aged Care.

  15. Yes I too believe all managers should have some form of medical experience. If you manage an aged care home you also manage the staff to care for those aged residents. If you have no knowledge of how to perform care practices how can you ensure your staff are providing the care required. How do you assist the staff to maintain their competencies and keep up skilling them. Protocols should be in place and safety at all times. Standards need to be adhered to at all times. This is the last resting place for these residents also known as human beings so please ensure their safety, dignity and comfort in their remaining times. Have some compassion please.

  16. Yes, Managers shouldn’t have nursing qualifications in aged care. What Jan describes is exactly what happens in the nursing home my mother was in but with rough handling causing constant bruising on my mother’s left leg. This stopped once we complained to the Aged Care Commissioner but happened once more as recently as days before her death 3 days ago. My brother has photos of the physical abuse.

  17. If aged “care” facilities were precisely that, it would stand to reason that in order to provide appropriate care , appropriate qualifications should be mandatory.

    A manager should, at a minimum, have had extensive training in the specific care that elderly or disabled people require. That way, they could have a useful and beneficial conversation with the qualified personnel and staff who work in those facilities. That would be the ideal scenario.

    A manager should not be just a “numbers man” but rather, must have particular qualities which lend themselves to providing the best care and the best ambiance for the residents . THEY PAY FOR THE SERVICE and so they should receive it. Unfortunately, far too many of them do not.

    The good facilities are worth their weight in gold as are the caring and dedicated care workers. I hate hearing that good ones leave because of the appalling state of affairs forcing them to leave because with the departure of every good one, a bad one takes their place.

    Most of the DONs I have come across, and I have come across quite a few, are on power trips and treat the residents as if they are their own personal property to do with as they wish. Families/friends/concerned others are given the short shrift and suffer the consequence as “Jan” above.

    Pay the staff appropriately, employ the right candidates, increase the staff ratios and look upon the residents as human beings to be valued and not just cash cows, paying the wages and fattening the service provider’s bottom line.

  18. There are lots of good facilities out there, with staff who care and nurses who have the knowledge and experience.
    I would have moved my relative out of a home like that, unless there is absolutely nowhere else to go, it saddens me to think that people get away with such abuse. I would not consider it giving up and ignoring the problem, but keep fighting for those who have nowhere else or no one to advocate for them.
    I can only urge anyone looking for a facility to do your homework, visit the facility, talk to staff, residents and relatives before making a decision.

  19. Sorry to hear that this has occured to you and your husband. I am a young aged care facility manager with no clinical experience. I have a medical background B. of Medical Sciences and have works in healthcare sales training Aged Care Staff on personal care items. I always put my residents first before profits as I expect the same level of care for my family. Yes, I come from a sales background having worked in retail and hospitality but I am too a in home carer for my own grandparents, this is what drives me to empower and make a positive change in such an underfunded brittle industry.


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