Jun 03, 2020

Are unqualified carers administering medication in the community?

When a new carer arrived at Anna’s* front door a few weeks ago to help with the care of her father, the first thing she asked him about was his qualifications.

“I have none,” the carer replied.

Confused for a moment, Anna asked, “Do you mean you have the minimum, just Certificate III?”

“No, I’m training on the job,” he said, adding that due to COVID-19 all training had been moved online.

Incredulous, Anna asked about the carer’s background, thinking perhaps he meant his qualifications had expired.

“I used to work at Woolies”, he said.

“I said, ‘you’re kidding me’,” Anna told HelloCare when we spoke this week. The gentleman had “no experience in the field whatsoever”. He was attending online classes, but was completely unsupervised – no buddy shifts, and no one assessing him. 

“This guy was working at Woolies one day and doing an online course and entering people’s homes the next,” she said.

The gentleman tried to reassure Anna that he was able to call the provider’s office to ask for help if needed, but otherwise he was in the community, performing a range of home care duties including administering medication.

Anna told the gentleman he was not to administer any medication to her father, including medication in Webster packs and liquid Panadol. The carer suggested he could “prompt” her father to take the medication himself.

Horrified, Anna told the gentleman her father is living with advanced dementia and any medication he takes has to be administered to him. 

Anna made it clear to the carer she would administer all medication to her father during his shifts.

Anna contacted the Aged Care Quality and Safety Commission, who suggested she make a complaint and write about her experience to the Royal Commission into Aged Care Quality and Safety. 

An experienced carer herself

Anna understands the rights and responsibilities of aged care consumers and providers. She used to work in aged care herself, and before caring for her father these last three years, she spent 17 years caring for her late husband. Both her husband and her father developed dementia, as well as other serious illnesses.

Anna has a professional set up for her father, with a hospital bed, air pressure mattress, and commode. “I’ve got everything,” she said. “I knew what to get.”

A veteran, Anna’s father is ”blessed” to be entitled to the Department of Veterans Affairs services. 

Anna self-manages his care package because it entitles her to more hours of care; they receive “more bang for their buck”, she said.

Staff must be qualified to do their job

The Department of Health issued a statement to HelloCare, stating that, “Members of the provider’s workforce must have the qualifications and knowledge to effectively perform their roles.”

A statement from Janet Anderson PSM, Aged Care Quality and Safety Commissioner, said in most states and territories some care workers are able to administer medication, and it’s up to the aged care providers to ensure they comply with the relevant laws.

Ms Anderson said all aged care providers, including home care providers, are legally required to comply with the Aged Care Quality Standards, which covers the administration and management of medication.  

Standard 3 (3) (b) requires “effective management of high-impact or high-prevalence risks associated with the care of each consumer. This includes managing medications safely.”

And Standard 8 (3) (e) requires aged care providers to “develop a clinical governance framework”. 

“A provider’s clinical governance framework is expected to refer to policies and protocols to manage the clinical risks associated with medication management,” Ms Anderson’s statement said. 

Aged care providers are also expected to have policies to “monitor” risks related to medication management, including “policies that identify those medicines the service provider does not authorise staff to administer”. 

When assessing aged care providers’ compliance with the Quality Standards, the Commission looks for evidence of “adequate medication administration and management including appropriate identification, handling, timing, and management of medication”.

For more information about home care medication management

Earlier this year, the Commission began the ‘Better Use of Medication in Aged Care Project’ which aims to reduce (and ideally eliminate) the inappropriate use of medicines in aged care settings. Click here to find out more.

The Department’s Guiding principles for medication management in the community’ provides information about the “quality use” of medicines and medication management in aged care the community. 

Further information is also available on the Department’s website to help consumers to understand the medicines they are taking and how to use them correctly. Click here to find out more. 

“I’m peeved off”

Anna said she complained to the regional provider who insisted the carer is in training, and in their view that was adequate. Her complaints to the provider in the past have not been taken seriously, with the provider turning them around to be a negative reflection on her.

Anna said she has strong medication in the house, and it frightens her to think what might have happened if the carer had administered medication and given her father the wrong drug.

“Imagine what would have happened if I hadn’t been here,” she said.

“I’m really peeved off,” she said. “I don’t want him back here, but they say they can’t provide the care without him.”

If you are concerned about an aged care service, you can make a complaint to the Aged Care Quality and Safety Commission through their website or by calling 1800 951 822.

* Name has been changed.

Image: byryo, iStock.

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  1. Seriously?? This is a weird beat up!! So if a GP prescribes a child medication and the pharmacy dispenses it (as occurs with every Webster pack!!) how does a parent give the medication without a Cert 3? Or other training? Just saying the word ‘medication’ does not make it only a task for experts!

    1. I totally agree. I have witnessed people who are qualified to administer medications who have given wrong doses and incorrect meds. If the carer is good at the job then either train them in your protocol for meds dispensed from a Webster pack or be available to administer the meds yourself.

  2. Excellent story Caroline. While the pollies and media circle and beat up residential aged care it’s a reality that there is a lot less oversight in the community and there will be an unprecedented amount of negligence and abuse. Woollies training does not a carer make! Good to see Hellocare dealing with one of the tougher and most pressing issues facing our frail elderly against the trend. Mark Moran

    1. Thanks Mark, it’s lovely to receive your feedback. We will continue to cover these stories, and others, Caroline

  3. I am surprised that, in 17 years as a primary carer, Anna just encountered this problem for the first time. In my 14 years as a primary carer this issue arose on multiple occasions. I certainly had the same cavalier “take it, or leave it” response from providers.

  4. Guiding Principles is a 2012 publication and desperately needs updating. To further complicate matters, each state and territory has its own legislation and regulations regarding poisons and therapeutic goods. There is no decision making in assisting someone with medication….punching out the right number of tablets at the right time of day for the right person and ensuring they take the meds. It’s not like PRN medication where an assessment needs to be made or administering subcutaneous morphine. An informal carer such as spouse or child can assist with medication without training…someone employed to do this for a living should have basic training but doesn’t need a degree in pharmacy for heaven’s sake.

  5. Medication needs to be administered by qualified staff. This is not a weird beat up. When my mother was in a nursing home (which cost about $1200 a week) the PCAs were administering the medications straight out of the Webster pack. They clearly had no idea what they were doing and when I questioned one of them he told me that he was offering the Webster pack to my Mum and my Mum was taking the medication out of the pack. This was rubbish because my mother had moderate to severe Dementia and she could not open a Webster pack or handle tablets because of her arthritis. When my Mum died they gave my Mum the wrong pain medication and she was grinding her teeth in pain. I complained to Aged Care Complaints and they made the facility undertake training in the assessment of pain and pain medication. My mother’s final days in this God forsaken place were painful. Inappropriately administered medication can cause real harm even death. These corporate chain horror shows need to be investigated and shut down. No amount of money can make up for the harm they are causing. Every life has value and every life matters. When we forget this anything goes and we have been silent for too long while this neglect and abuse has been occurring behind closed doors out of the spotlight of iPhone cameras.

  6. I am sorry that Anna had that experience and unfortunately it is not an isolated incident.
    Amanda’s comments reflect the general lack of professionalism in the Aged Care Sector in Australia.
    The worker in question is not the gentleman’s mother. He is being PAID to provide a service and it is reasonable for Anna to expect that he have the skills and knowledge to provide that service safely and effectively especially when that service is intended to support some of the most vulnerable people in our society. If we continue to see the service we provide as per the example of the mother and her child we will continue to witness neglect and abuse of our vulnerable people. Amanda, you could choose to trim and colour your own hair at home without qualifications as a hairdresser. However, if you went to a hairdresser is it reasonable for you to expect the hairdresser you are paying would have the skills and knowledge required to trim and dye your hair safely and effectively? If the person attending to you told you she used to work at Woolies and this was her first day as a hairdresser but it’s fine because she could call someone if she needed help and is doing some online training, would you be happy to pay for her service?
    Every Service Provider (Doctor, Dentist, Masseuse, Teacher, Hospitality etc) has a legal obligation to ensure the service it provides is as agreed upon and that the person providing the service has the skills and knowledge to do so. Why should it be any different when providing a service to support vulnerable people?

  7. There is a difference from being a ‘carer’ or parent who are usually family members and unpaid.An Individual or Lifestyle Worker is employed by an organisation to provide pre-arranged support. They are paid. They MUST NOT administer medications unless they are certified to do so. Even a Cert III will not permit administration of medication. That is another level of study required. This is my understanding of expectations in Tasmania.

  8. All staff involved in either prompting or administering medication to clients should be trained in the
    rights of medication administration. Right patient, Right medication, right dose, right time, right route and write it down. There is a huge difference between a mother giving medication to her child and a care worker administering medication to a client. I’m surprised staff would even want to give medication without some training. The risks are huge if something goes wrong. To all parties, the client, the care worker and of course the organization who thought that this model of care was appropriate.

  9. “Anna self-manages his care package because it entitles her to more hours of care; they receive “more bang for their buck”, she said”

    So if she is self managing the care package, then who was it that hired the inexperienced care worker?

    Anna is responsible for ensuring competency of care workers.

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