Feb 15, 2019

Underpaid staff, malnutrition, neglect: This week at the Aged Care Royal Commission

Warning: Graphic content.

Key points to emerge this week at the Aged Care Royal Commission:

  • Aged care staff unpaid by 15 per cent.
  • Australia’s population is ageing, and the number of people living with dementia is rising.
  • Reported cases of abuse in aged care facility are “tip of the iceberg”.
  • People dying while waiting for home care packages to be released.
  • High rates of malnutrition in aged care.
  • Psychotropic medications often used as “first resort”.
  • The Royal Commission heard how severe neglect caused a shocking catheter injury.

When he announced the Royal Commission into Aged Care, the Prime Minister warned Australians to brace themselves for “bruising” revelations. This week, that prediction was realised, and over the following weeks more such revelations are likely to be aired.

We take a look at the key revelations from the Royal Commission this week.

Oakden family open hearings

On Monday, The Spriggs family, which lobbied strongly for answers when a family member was living at Oakden, opened the hearings.

“We need to make sure each and every Australian, where, through no choice of their own, and they are at their most vulnerable, that they are cared for with dignity and respect that they deserve,” said Barbara Spriggs, wife of Robert Spriggs who was a resident at Oakden.

It was poignant to hear from the family who were among the first to call for changes in the aged care industry, which eventually resulted in the Prime Minister calling for a Royal Commission.

Aged care employees underpaid by a factor of 15 per cent

Ian Yates spoke next, providing evidence about ways to improve the quality of care, including raising wages and employment standards.

“The aged care sector overall is underpaid by a factor of at least 15 per cent, that’s a real challenge,” he said.

He said some of the training given to aged care staff was inadequate.

“There are concerns that not all of the courses out there for, say, certificates III and so on are adequate and that there are components of those courses that are frequently absent,” he said.

Mr Yates said the current wait times for home care packages are “unacceptable”.

Australia’s growing dementia population

Justine Boland, Health and Disability Branch Program Manager with the Australian Bureau of Statistics also spoke on Monday.  

She said the percentage of the Australian population aged 85 years and over was expected to more than double by 2066.

She spoke about the high number of carers looking after a loved one at home.

“In that 65 to 74 age range, it looks like it’s approximately 17 and a half per cent of all females in that age range have reported that they’re providing unpaid assistance to a person either with a disability or 15 problems associated with age or with a health condition,” she said.

She said in the next few years, dementia is likely to become the leading cause of death for Australians.

“Dementia is likely to take over and become the leading cause of death for Australians in the 2020s. At the moment it’s become the leading cause for women,” she said.

Aged care workforce is ageing

Louise York, Head of Community Services, Australian Institute of Health and Welfare, said Australia’s aged care workforce is ageing.

“For both residential aged care workers… and home care workers… this is quite an ageing workforce.

“The highest proportions of workers are in the 55 to 64 or 45 to 54 age bracket,” she said.

People dying on waiting lists

Craig Gear, Chief Executive, The Older Persons Advocacy Network, a support group for older people, said there are “potholes” in the Australian aged care system.

He described matters of abuse OPAN had been made aware of.

“It could be psychological. It could be when the person is a recipient of aged care. It might be physical abuse from a family member… Often it’s financial abuse,” he said.

He said OPAN is running educational programs in an attempt to address elder abuse.

Mr Gear said OPAN receives up to 240 calls a week from people concerned about the waiting times to receive home care packages.

“We are having around about 230 to 240 people calling us each week around their concerns, and what they’re telling us is that the wait times are just too 35 long or the level of support that they’re getting is not meeting their needs,” he said.

Outside the Commission, the ABC reported people sometimes die while waiting for their home care package to come through.

“I have heard of a number of cases where people have been waiting on that home care waiting list, for the right level of care, and they have passed away before that care was able to be accessed, which is really distressing,” he said.

Reported assaults only “tip of the iceberg”

Paul Versteege, Policy Coordinator, The Combined Pensioners and Superannuants Association, said the current model to report assaults is flawed because it relies on staff to self report cases.

The reported cases are only “the tip of the iceberg,” he said.

“There was a resident who bashed another resident to death. There are more examples of very violent attacks of residents on residents which makes the – makes facilities very unsafe.

“And as I said, it’s not reported, it’s not recorded, it’s not subject to any – to any sort of administrative record-keeping that can be reported across an industry,” he said.

Mr Versteege also commented on high rates of malnutrition in aged care. He said anecdotally he is told ates are as high as 50 per cent in some aged care facilities.

Psychotropic medications used as a “first resort”

Associate Professor Edward Strivens, President, Australian and New Zealand Society for Geriatric Medicine, said use of psychtopic medications, which include antipsychotics, antidepressants and sedatives, is “an area of key interest to all of us working within the field.

“I think we’ve seen occasions where psychotropics are used inappropriately,” he said.

“Although it’s part of what can be used, I think when we’re talking about behavioural and psychological symptoms of dementia, it’s important to realise that these are often… an expression of unmet need and actually indicative more of cognitive disability rather than necessarily psychosis,” he said.

“If we treated 1,000 people for a few months with antipsychotic medications we would get some improvements, for want of a better term, in some of those target symptoms in around 10 per cent, maybe 12 per cent of those people,” he said.

“However, we would see an excess of 10 extra deaths in those 1,000 people and 16 strokes as well as around 10 to 12 per cent of people taking those medications more likely to fall over.

“So they do work, for want of a better term, however, the side effects will often outweigh the possible benefits,” he said.

“They are a last resort but too often we see them used as a first resort.

“And the use of medication should never be a substitute for good quality care and non-pharmacological management strategies are always and should always be the first step and we shouldn’t be using strong medications as a substitute for care,” Assoc Prof Strivens said.

About 80 per cent of older Australians in residential aged care with dementia are on at least one psychotropic drug, but only up to 10 per cent of those people will benefit, Assoc Prof Strivens said.

“When all you have is a hammer, every problem looks like a nail,” he said.

“I think this is one of the issues with antipsychotics, it far too often becomes the first step to look at, say, managing someone who’s presenting with agitation, sometimes physical outburst, rather than actually looking at the reasons behind this,” he said.

Understanding “life story” key to caring for those living with dementia

Assoc Prof Strivens said looking at a person’s whole “life story” can be the key to helping aged care workers manage behavioural problems, and gave an example.

“I work up in the far north; we’ve got a lot of old bushies up there who are used to getting up very early in the morning.

“I saw a gentleman not that long ago who was a baker and he used to getting up at 2 o’clock every morning. He would continue to get up at 2 o’clock in the morning but within the setting of his residential care facility that was a potential problem to the facility. It wasn’t necessarily a problem to him,” he said.

An unregulated workforce

Professor Deborah Parker, Chair, Ageing Policy Chapter, Australian College of Nursing, said many people working in nursing homes were part of an “unregulated workforce”.

She said the number of registered nurses as a percentage of the whole workforce had declined, despite an increase in acuity of care.

“Currently we have within the workforce within aged care… we know that the number of, or the percentage of, registered nurses has gone down from about 21 per cent in 2003 down to about 14.9 per cent now.”

She said correspondingly, there has been in the “unregulated worker”.

Prof Parker said the Australian College of Nursing is calling for the National Aged Care Quality Indicator Program to be made mandatory. Only about 10 per cent of facilities take part in the program at present she said.

Severe neglect: “catheter tunnelling into penis”

The final speaker on Wednesday was Annie Butler, Federal Secretary, Australian Nursing and Midwifery Federation.

She spoke about the increasing “pressure” with workloads, which was making it difficult to retain aged care staff. She said many ANMF members say staffing levels in aged care facilities are “unsafe” and “untenable”.

She said low pay levels are also a barrier to retaining aged care staff.

Ms Butler said there were no controls in place to ensure that government funds directed to the care of a particular resident were actually spent on a resident.

Ms Butler was asked about a case of severe neglect revealed in a survey by the ANMF.

“I worked as an agency nurse in an aged care facility. The PCAs told me that the gent in such and such room required Panadol routinely at night to sleep. I asked further and was told the gent who was aphasic post CVA, that is, very vulnerable.

“And he had a sore penis. He was grimacing as I approached. I asked if I might look. He nodded. He had a urinary catheter in place. Instead of exiting from the meatus, the glans had a split down the side to the level of the shaft.

“I’m still horrified to this day. The wound was not new. It took time to erode through with pressure from the IDC (indwelling catheter) tunnelling into his penis.

“The GP had not been informed and obviously I faxed them a message there and then for urgent review. A follow-up shift, he was in hospital for an urgent urology review.

“I am blown away the staff did not report the erosion as it was happening, take steps to prevent it. More educated staff had not looked at the source of his pain. He had Panadol every night.”

Hearings will resume on Monday 18 February.

You can read full transcripts of all the hearing here.


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  1. There needs to be a higher educated staff particularly with dementia The skills required foe a dementia pca are subkt being abke to negotiate and know when a resident is pre antecedent.
    Language, comprehension skills and empathy are not good. Likewise there is often little understanding of resident’s anglo background with staff misunderstanding e.g. I woild like my tea. (Dinner) and theybget a cup of tea.


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