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Buttrose decries aged care standards



 

By Linda Belardi.

Alzheimer’s Australia national president, Ita Buttrose has given a scathing speech to the national press club decrying the quality of residential aged care standards for people with dementia.

In the hour-long address, Buttrose said basic human rights violations and examples of discrimination were occurring every day and the majority of facilities were failing to properly care for people with dementia.

She said nearly one in four residents were chemically restrained often without their consent, and the sector could be open to a class action over the number of deaths in care resulting from the misuse of antipsychotics.

“It is unacceptable that such practices are taking place today in Australia,” she told the national press club last week. She said antipsychotic medication provide a clinical benefit to only one in five people and were associated with an increased risk of falls, stroke and death.

She urged the government to urgently address “long-standing disquiet” about the quality of residential aged care, particularly for those with severe behavioural and psychological symptoms of dementia.

“It is imperative that we have a high quality residential care system that respects the rights of residents. I don’t believe that is the case now,” she told the audience in Canberra.

An example of inadequate standards she said was highlighted in the ABC’s Lateline program earlier this month, which recounted the failure of some aged care managers to appropriately manage violent behaviour and to protect the rights of both carers and the person with dementia.

In consulting with the community, Buttrose said she was also told that within weeks of entering residential care, many carers found that their loved ones had become “unrecognisable, in terms of their physical, mental and emotional welfare.”

Buttrose condemned Australia’s high rate of institutionalisation of older people compared to other OECD countries and called for more people to be supported in the community.

She said more focus was needed to implement additional high care community packages for people who otherwise would have no option but to move into residential care. 

“In spite of decades of rhetoric about increasing choice and community care…Australia continues to lead the way with the numbers of older people living in institutions,” she said.

In 2009, 54 per cent of Australians requiring long-term care received such care in their homes – 10 per cent below the OECD average – and considerably behind countries like Japan (77 per cent), Norway (76 per cent) and Switzerland (71 per cent).

With a mindset locked into “institutional and residential care models of the previous century”, Buttrose said the Australia was failing to empower older people to exercise choice in the services and support they need.

“We need governments to adopt less regulatory approaches and to promote a partnership approach between consumers and providers. We need the community to be less risk adverse in its attitudes to the provision of support and care. And we need service providers who recognise the individual requiring care as an equal partner.”

Rod Hunt, a consultant at Hunt & Fitzgerald and former deputy CEO at St Ann’s Homes in Tasmania, said Buttrose made a serious contribution to the national conversation on aged care, but he questioned the fairness of some of her statements.

“She has implied that the accreditation system doesn’t work or is ineffective. Her allegations about breaches of human rights are of great concern,” he wrote on his blog, ‘ideas in aged and community care’ in response to the address.

He said Buttrose’s speech had rocked some staff and residents in the sector, who felt their work and home had been unfairly criticised. More broadly, it had the potential to reinforce negative public views and to undermine public support for the industry.

“I don’t think that anyone could listen to the Buttrose address without feeling concerned about the quality of our system and the treatment of individuals within it,” he wrote.

However, he said Buttrose gave few details about the basis for statements apart from anecdotal information, and much of what she said did not accord with his experience as an aged care manager and industry association board member.

“If the Buttrose view is correct then as a society we must take swift corrective action. If it is not then the record should be corrected,” said Hunt.

Read the full transcript of Ms Buttrose’s address here

At the national press club address, Ms Buttrose also launched the Alzheimer’s Australia election campaign document, which aims to:

  • Increase the growth of community care high care packages 
  • Expand access to flexible dementia-friendly respite care 
  • Give priority to improving the quality of residential dementia care 
  • Secure the agreement of health ministers to a new national action framework on dementia 
  • Invest $200 million over five years in dementia research.



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0 Responses to Buttrose decries aged care standards

  1. Gp May 1, 2013 at 10:23 am #

    It is about time someone of notablity stood up and brought such issues to the notice of the Australian Public. I work in an age care facility and it is hard work which is so under appreciated, not to mention underpaid. Yes Ita probably insulted a few, but if you work in age care … you know the truth!
    Yes, chemical restraint occurs – but what other options do we have when you have ill equiped, understaff, unsupervised, untrained staff. I am one of 5 staff from a english speaking background who work directly on the floor, in large facility. I started in age care because I truely do care and I want to make a difference, but it so hard, it is a battle which will never be won without more funding and better infrastructure. I ask one question… why is it that nurses in hospitals have a patient ratio of 1 to 5 when in aged care there is no such ratio – 1 RN to 75 residents – unbelievable… A disgrace. Yes – accrediation does not work! Most facilities will make a made dash to put all in order just before inspections are due – just get the paperwork right and all be ok – is the attitude. No one ever checks on what really happens on the floor!Just go and see between the hours of 7 and 11am it is a real eye opener. Wake up Australia your mothers and fathers deserve better – you deserve better – remember you will someday most likely enter age care – time to act is now.

  2. Renee Timmis May 1, 2013 at 10:27 am #

    Rather than decreeing that the Aged Care sector is violating human rights I would prefer to hear constructive criticism of an Aged Care Sector. We have made great improvements since the last century and due to Accreditation the quality of care has greatly improved.There is a partnership between the consumers and providers they are the ones who are demanding better and better from aged care and this will only improve over the future.

  3. Ros Calvert - Dementia Tas May 1, 2013 at 11:21 am #

    Perhaps Ita Buttrose would have been better off “slamming” the Government for their inadequate funding of Aged Care facilities rather than making a huge generalisation about Care facilities that does nothing to improve the stigma around aged care and dementia.
    The majority of the care homes I visit here in Tasmania take Dementia care very seriously and do all they can to provide care under the funding they receive.
    I believe Ita’s comments will be very hurtful to the carers working with people who have dementia and will not alleviate the guilt felt by many family members when a parent needs to access residential care.
    The hours and dollars that are spent by homes in justifying the money they do receive from the Government could be used for dementia care if the Government was more realistic in the way funding was delivered.
    Perhaps a more positive conversation could happen about dementia and the people who live with it every day so we can reduce the stigma and fear, rather than blame and accusations.

  4. John Coxon May 1, 2013 at 12:23 pm #

    Ita’s comments are a tad generalist and it is a pity to see everyone in the sector being tarred with the same brush; however the discussion is useful in sense of the bigger picture. Dementia care will continue to increase in prominence over coming years and it has an emotional pull when commented upon in a public arena. The aged care environment is changing in Australia and boards and management teams may need to ask some tough questions around not only dementia care but all residential care. It may not be sufficient to sit on yesterdays practices and hope they suffice for tomorrow. Aged care providers are facing a more critical audience and when combined with the power of social media, it becomes important to be sure that the care provided not meets legislative requirements but is also appropriate and socially acceptable. It has become increasingly easy for people to voice their concerns in public. In future, bad press may equate to a drop in revenue for providers. Those that plan ahead, challenge the assumptions underpinning care and have in place a process for responding in an appropriate manner – along with good practice of care will be the ones that come out smelling of roses.

  5. Director of Care May 1, 2013 at 12:24 pm #

    It’s a bit like bashing the child who doesn’t perform well at school or gets castigated because they become a delinquent. Hasn’t our society learnt to think more deeply and compassionately about such problems? Ita is no helpful representative for elderly people – she is repeating the ill-informed uneducated scaremongering of the common folk. Generalisations have hurt us enough. And worse still, offering no solutions. Yes, what she put forward occurs in minority and no-one condones it. The Standards Agency and Aged Care Providers work together to maintain standards of care as much as is possible with dwindling pathetic financial support. Of the minority of problems that occur I would say a high proportion are directly attributed to inadequate nursing/care staff numbers to cater for the needs of highly dependent people. We love our work in aged care and take pride in providing dignity, a meaningful life and improved symptom control or rehabilitation to those who have the privilege of old age. Ita, go swing your fists at the Government and insult them on the basis of below par funding support – and then you’re channelling your indignation and anger at the right people who can influence quality of care improvement in Residential Aged Care services.

  6. Marion Maguire May 1, 2013 at 2:12 pm #

    I totally support the comments by the DOC above. Ita has not done those dedicated staff who come to work every day to be pinched, bitten, kicked & punched when we try to cope with aggression related to the unreal world the the person with dementia suffers.Aged care staff do not undertake their work for money but for their care & compassion.
    None of us like to use medication but there are times that the safety of others & staff is a priority. The money ripped out of ACFI in February has done enough damage without future cuts by the Compact. Much deserved wage increases are not being totally funded when adding all the additional requirements that are included in the equation. Blind Freddy can see that increased salary costs result in lesser staffing numbers that ultimately result in staff rushing , consequently increased behaviours.Ita, please attack the root of the problem, adequate funding for residential care

  7. Anonymous May 1, 2013 at 3:39 pm #

    as far as i know aged care nurses and managers do not have prescribing rights. if there are inappropriate instances of chemical restraint how about doctors being held accountable for not being up to date with the quality use of medicines?

  8. W. Taylor May 1, 2013 at 5:41 pm #

    I find Ita’s comments hurtful for all those aged caare staff who do attempt to do the ‘right thing’ by their residents and promote the best quality of life possible. I’m an aged care manager having worked in the industry for over 25 years. I adore working with those very special people with dementia and working out how we can best care for them. I agree it is challenging work, but very rewarding.
    We require staff who are interested in proper behaviour management strategies and willing to take the time (I know we are all busy) to implement the strategies as it is an investment in time and the resident in the long run.
    I know when I started my current position the attitude of some staff was for residents to sit down and be quiet, there was also quite a lot of psychotropic drugs ordered. I can happily say most of the drugs are gone, and only used if absolutely necessary, it has been a challenge to change attitudes and the long term staff are now finding their jobs more rewarding as the residents are interacting more and theirbehaviours better managed.
    I think Ita has created conversation which needs to occur. I don’t agree with today’s society, all aged people with dementia can be cared for at home. Quite often their spouse is also aged with their own health issues and limited family support. People being cared for in the community are often left for long periods of time alone and do not receive the social interaction of RACF.
    Ita’s comments certainly do not assist with the public perception and fear of entering aged care.

  9. Susanne Macri AM May 2, 2013 at 1:28 pm #

    I have the highest regards for Ms Buttrose, but find such broad sweeping statements to be not only ill informed but also damaging for all stakeholders, that is residents & their families, staff and providers of aged care services.
    Such comments should be supported by legitimate and published research, not off the cuff at a Press Club luncheon. There are examples and evidence of excellent care and services for people suffering from dementia (and other residents/clents)in both residential and community care.

  10. Jason Burton May 2, 2013 at 6:46 pm #

    Well said Ita. We need governments and society to wake up to the reality many people living with dementia face every day. Her comments were not to hurt the wonderful staff who are doing their best but to wake up the Australian public to the paradigms of dementia care where it is ok to lock someone away (pwd are the only group of people in the country who are locked up without consent without any legal process!), give them harmful medication that is not on the pbs list for that use and deemed ok to provide basic and min staffing and support to. It is a disgrace and I for one welcome Ita’s address and hope it has some positive outcomes for people living with dementia.

  11. G Gavin May 3, 2013 at 11:40 am #

    I am tired of the ill informed comments that people make about the bad care received by residents of nursing homes. Unless they and Ms Buttrose have worked in these places themselves they are in no position to make comment. Aged care workers are in one of the lowest wage categories. It is hard work and the shift work is demanding. Not all elderly people and younger people with dementia are easy to work with. And it takes a lot out of those who care for them day in and day out. It is mentally and physically exhausting. Before anyone makes judgement they should spend more than just a half hour weekly visit or an annual visit to see how well most of our elderly and younger dementia suffers are cared for. The government needs to put a lot more money into aged care before we will be living in an ideal world.

  12. Drew Dwyer May 3, 2013 at 2:00 pm #

    This is very sad indeed. To see the focus of an issue that should be the responsibility of governemnt and community slammed into the hard work of devoted healthcare workers and providers is shameful. I respect Ita for her achievements, but this braod and miss informed piece of press platforming does nothing to help the aged and frail.I challenge Ita to come and work with me in a dementia specific unit and to roll up her sleeves and committ to the work that is needed. the work that is underpaid, never thanked, and dramatically over opinionated.
    There is much more to this than is being announced and its a shame that prominent Australians are misguided to use their staure in this way.
    keep going all you aged care workers…..I love and respect the work you do and appreciate every ounce of your devotion…..that said on behalf of those than can not…..our dementia sufferes.

  13. Susan Parr May 6, 2013 at 2:19 pm #

    I have been the CEO of St Ann’s Homes Inc for almost 16 years. I have also been lobbying and advocating for improved resources and RECOGNITION for the work that the sector does and the responsibility it has to clients and the community.I am proud of the work that we do. I am proud and gratified by the professional and compassionate effort that is made by our staff.
    I have also been a family member who was so grateful to move my father from a private hospital,where he was referred to as “that joker”, and was viewed as a nuisance and of no further clinical interest because he did not want further treatment, to residential aged care. I was heartened and consoled to see my father enter his new room ,with his personal effects already displayed; to hear him being addressed by name and being asked if he would like a drink or something to eat. To quote him he said “now this is more like it”
    My family and I were treated respectfully and with great compassion. My father lived a further three weeks,with expert medical and clinical care, sensitive personal care and much indulgence of things that he could still enjoy. He was free of pain and indignity, and composed.
    I am deeply saddened by Ita Buttrose’s remarks. If she truly believes what she has said about aged care, why has she taken such an active part in the celebrations of excellence in Aged Care. I was a finalist in a National Award for Excellence in Aged Care in 2011 and I attended the 2012 ceremony where Ita presided.
    As Ita Buttrose is a journalist, I would have expected the professional discipline of sorting facts from anecdotes and for looking substance and ways to address issues instead of sensationalism.

    Oh Ita, how could you??

  14. Shelley May 16, 2013 at 12:20 pm #

    Esteemed Health Professionals state chemical restraints are a human rights violation. The recent Cochrane Review recommends withdrawal of antipsychotics for management of dementia related behaviours. Also, the Liverpool Care Pathway (LCP) – best practice consensus guideline for the ‘dying’ patient – has been used in the Royal Australian College of General Practitioners (RACGP) ‘palliative end stage care’ for Aged Care residents. However, the Australian protocol includes the antipsychotic ‘serenace’ for the management of ‘agitation and restlessness.’ Serenace is not used in the LCP but is used widely in australian nursing homes to manage dementia related ‘agitation’ the drug known to cause significant deterioration in the elderly. This resulting ‘deterioration’ subsequently qualifies aged care residents for the RACGP protocol for ‘palliative end stage’ management. An esteemed UK neurologist has recently stated the LCP is being widely used in the NHS to ‘euthanize’ the elderly with dementia. Ita Buttrose is not the only person who believes it may require a class action to halt this kind of practice in Australia.

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