Apr 30, 2019

Has Quality Declined In Aged Care? Or Have Assessors Just Started To Do Their Job Properly?

The announcement of a Royal Commission came as a relief to many families of residents in care, consumer advocates, and the hardworking and dedicated aged care staff that walk the halls caring for the elderly.

Many felt it was an acknowledgment of the problems they have been dealing with for years, and confirmation the issues are also being faced by many others within the industry.

And while the Prime Minister announcing the Royal Commission definitely raised the collective eyebrow of the Australian public, the damning 4 Corners investigative report that aired footage of elderly people being abused in the confines of their aged care homes – managed to spark outrage.

The public had finally seen something outrageous enough to take an interest in Australian aged care, and even though it may have just been a passing interest, people from all over the country turned to those in positions of power within the industry to air their outrage and vent their frustrations.

Since this occurred close to 8 months ago, there has been a sharp increase in the number of aged care providers that have been sanctioned – but does that mean that things have gotten worse? Or does that mean that the Aged Care Quality and Safety Commission has been forced by public scrutiny to reassess what they deem to be acceptable practices of care?

Peter Vincent, is the Director and Principal Consultant at Aged Care Management Australia and has 25 years of experience working in the aged care industry.

These days, Peter provides advice and works closely with aged care providers that are looking for prepare for announced accreditation checks, and Peter was nice enough to share his thoughts with HelloCare on whether the rise in sanctions means that things have gotten worse, or whether they simply mean that assessors have just gotten tougher.

“I personally don’t believe that aged care has gotten any worse, I think that there have always been problems that haven’t been picked up,” said Peter.

“I’m not talking about issues over elder abuse or anything like that; they are extremely rare, in my role we go into many nursing homes across the country every year and we see firsthand the issues that facilities face, and the issues of abuse are incredibly small, in fact, there are far more staff injured by residents on an annual basis than there are residents injured by staff.”

“When we go into a nursing home we go in and do a gap analysis service where we do a risk assessment across all 44 outcomes – only once in 16 years have i gone into a facility and found absolutely nothing wrong, and we would do 10 or 15 of these a year.”

“Issues have always been the same, and the primary issues that we see are staffing, lack of skills, lack of knowledge, lack of numbers, and a lack of understanding of how to deploy staff and how to use them, and this directly impacts on clinical care which is outcome 2.4, and it also impacts outcome 2.13 which is behavioural management – and a whole raft of the other 44 outcomes.”

Were Quality and Safety Assessments ‘Soft’ In the Past?

A number of industry experts have expressed the view that those involved in the aged care accreditation process in the past had a “don’t ask-don’t tell,” approach to investigating the inner workings of Australian aged care homes.

Dr. Rodney Jilek spoke candidly with HelloCare on this issue a few weeks ago, and his revelations seem to echo the thoughts of Peter Vincent.

“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.”

While Mr. Vincent did not make any claims of the same magnitude, he did, however, provide a few very specific examples to back up his claims.

“I was engaged by the commonwealth standing committee on community affairs to provide independent expert advice into the issues at Oakden, and I read 10 years worth of accreditation and compliance documentation and there were huge mistakes made, huge mistakes. And the agency was embarrassed,” said Peter.

“In South Australia, in 2017, the worst case of non-compliance was found at Westminster Village, which was Uniting Care, Wesley, Port Adelaide, and they failed 32 out of the 44 outcomes, but believe it or not, they happened to pass an accreditation visit only 4 months prior to failing these 32 outcomes. How do you go from full compliance to failing 32 outcomes in only four months time?”

“The exact same thing happened to another organisation that we worked with over Christmas, they passed their accreditation – and then only 4 months later they failed 32 outcomes when the agency came back and did an announced visit due to a complaint. It was the exact same scenario.”

When asked whether or not he thought that these outcomes may simply be the result of the aged care provider being well prepared and perhaps even bringing in additional staff for planned accreditation visits, Mr. Vincent offered this response.

“These things do happen, but when a facility is audited they are required to present their rosters for the 6 months prior to the visit, so the assessors will know if they have been stacking the roster. You would be a very foolish operator to do that sort of thing,” said Peter.

“Having said that though, I think that announced visits where everyone is prepared an everything is squeaky clean is not the right way to go, having unannounced visits is certainly going to catch a lot more facilities out, particularly if they start doing weekend visits and visits outside of normal hours – which I don’t support.”

“You work with a lower level of staff in those times and you simply just don’t have the ability to drop everything and do the type of things that the assessors want you to do. A weekend RN is not going to know how to set up an agency person with visitor access to a computer system, it just makes things harder for both parties and they’re not going to find anything different then they would in normal hours Monday to Friday.”

Unfortunately, in the wake of the notorious Oakden aged care scandal, accompanied by a growing backlog of sanctioned aged care facilities, South Australia has unofficially become the state most synonymous with bad aged care.

This is one of the reasons that South Australia was seen as the place most befitting to host the Royal Commission, and according to Peter, aged care facilities in South Australia are feeling the heat of the spotlight more than anyone else.

“South Australia has fewer beds (per capita) than Victoria and yet we make up 25% of non-compliance sanctions, so South Australia seems to be doing something horribly wrong, but is the new quality and safety commission being far more aggressive in South Australia than they are in the eastern states? Personally, I think they are,” said Peter.

“I deal with the agency on a very regular basis and the department of health, and there has been a significant shift in their attitude towards providers, and particularly those providers with a history of non-compliance and places that have been sanctioned more than once. These places are drawing significantly more attention than they ever have, and quite rightly so.”

“There have always been issues that can be found, but it seems that now they are actually finding them – so if you ask the question: have the Aged Care Quality and Safety Commission become more rigorous in their assessments? The answer is yes – And the reasoning behind that is embarrassment – and because they were hit across the head with a very big stick by the Minister.”

“Anybody that has an unresolved complaint with the ACCC they should expect an unannounced visit, and these visits will be vigorous, which is a good thing.”


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