Expertise is being gradually eroded in the aged care sector, causing an increase in the number of homes struggling to return from non-compliance and hampering the complex reform work required in the wake of the royal commission.
As reported in last week’s The Saturday Paper, the government is employing private sector consultants to review and advise on aged care, eroding in-depth aged care knowledge within government, even as it works through a period of unprecedented reform.
Several private consultancies have recently been awarded lucrative government contracts. Boston Consulting Group was awarded a $1.1 million contract to examine aged care “provider maturity” and was paid $450,000 to look at “options and findings for enhanced aged care governance”.
Deloitte won a $213,000 contract to come up with a “wage estimation tool” for aged care and was paid $1 million to support the aged care transformation program. The same organisation was paid $526,000 to review that very same aged care reform plan.
The government has also paid PwC $1.8 million to run a pilot costing study of residential aged care.
“This is not new and has been happening for at least two decades,” said Dr Rodney Jilek, managing director Aged Care Consulting and Advisory Services and founder of the innovative Kambera aged care home.
“Even when they do have people with frontline experience, they ignore them in favour of consultants,” he said.
“We continue to see reviews conducted by academics and consultants with no hands-on experience of delivering aged care services, and the policies they put into place only work on paper because they lack real life application,” he said.
Peter Vincent, managing director Aged Care Management Australia, echoed Jilek’s concerns.
“These are people who may have academic qualifications, but they don’t have the combination of academia and practical experience in managing aged care,” he told HelloCare.
Sean Rooney, Leading Age Services Australia CEO, told HelloCare LASA objects to the use of consultants “at the expense of meaningful consultation with the aged care sector” on reform.
Rooney said the Australian Aged Care Collaboration, of which LASA is a part, hopes the implementation of the National Aged Care Advisory Council will “get the reform process on-track.”
The erosion of expertise is also being seen at the operational level, meaning non-compliant homes often struggle to return to compliance when issued with a ‘notice to agree’.
A stipulation of a ‘notice to agree’ is usually the appointment of an advisor, a position once required to be filled by a member of a national Advisory Administrative Panel for which members were carefully vetted and selected for their experience.
But in 2016 this requirement was dropped, and now providers can “appoint anybody they wish to act in the role of advisor,” Vincent said.
Jilek and Vincent both have decades of experience as advisors, returning non-compliant aged care homes to compliance.
Often providers appoint a member of their own staff to the role of advisor to reduce costs and “control” the response to the regulator, Vincent said.
Compliance breaches also no longer trigger a ‘timetable for improvement’ but instead a ‘direction to revise the plan for continuous improvement’, meaning it often takes longer for homes to return to compliance.
Notices to agree were once resolved with 100% effectiveness, according to Vincent, but now the rate is closer to 75% with a quarter going on to remain unresolved.
Advisors are taking 18 months to resolve a six-month sanction at times. The latest Non-Compliance Register lists matters going back to July 2020.
“There is no rush anymore, no incentive to get things fixed when the money just keeps rolling in,” said Jilek.
“The commission is not keeping up with their monitoring of compliance and they’re not issuing the penalties that were previously used to hold providers to account,” Vincent said.
Nursing officers once visited homes prior to assessments to identify risks in advance, therefore avoiding many of the compliance issues we see today from arising in the first place, Vincent told HelloCare.
He would like to see a return of dedicated, experienced assessors consulting in aged care homes prior to assessments and in cases of non-compliance.
“No one likes being punitive, but sometimes if [experienced assessors] were appointed before sanctions were imposed … we could fix problems before the assessors come in.
“That would be a much better approach, but there’s no requirement for providers to do that.”
The erosion of expertise in aged care, whether it be through the hiring of consultants to review reforms, or in the assistance aged care homes receive on the ground to help them return to compliance, ultimately means diminished quality of care.
Who suffers the consequences?
First, the residents, the very people the system was designed for.
Second, the staff, who work in poorly paid and insecure jobs, delivering care the best they can in impossible circumstances – a problem that has been known about for years, but the government has done little to fix.
All arguments have merit and should be considered in a pathway moving forward, however what is missing here is a leadership mentoring plan at the grass roots to executive management to equip aged care leaders in preparedness & resilience to respond to Aged Care law reforms & Quality Principles. Notwithstanding a solid workforce retention plan to include wage reforms.
Totally in agreeance. There is too much money being thrown at these consultancy firms who have no skin in the game or motivation to actually provide the tools to fix the problem
This is infuriating: “We continue to see reviews conducted by academics and consultants with no hands-on experience of delivering aged care services, and the policies they put into place only work on paper because they lack real life application.”
Totally agree. We will never fix residential aged care with a number of different consultants leading the way
This infuriated me .It shows a huge lack of respect to the Aged Care workforce.Staff working in Aged Care and the Unions that represent them know what is needed in the sector to move forward.Staff want to be able to have a day in the future of Aged Care after all we are on the coal face and know what our residents need.