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Royal commission told sector experiences ‘power imbalance’


A “significant” imbalance of power has made residents and home care recipients fearful of making complaints, the royal commission into aged care heard this week.

Ian Yates speaks to media after giving evidence (AAP Image/James Elsby)

Consumer peak body COTA Australia CEO Ian Yates was among the first to present evidence to Royal Commission into Aged Care Quality and Safety which began hearing evidence from witnesses in Adelaide on Monday.

He told the inquiry that residents and their families often feel they are unable to raise complaints with their providers.

“It’s worth noting that there’s a very significant imbalance of power between a resident or a service recipient in high level home care and the provider of that service,” Mr Yates said during questioning by Senior Counsel Assisting Peter Gray.

“They’re in a condition where they feel vulnerable. And where there is absolutely no intention that there might be repercussions from complaining, there will be a natural fear amongst most people about doing that.”

Mr Yates also said access and availability of information about providers and their facilities was among the top priorities of residents and their families when accessing aged care services, but independent information was hard to find.

“When I book a hotel… I can go and read lots of comments on their website about people’s experiences of that. You can’t do that – or very, very rarely with an aged care provider, except selected quotes used for promotional purposes,” he said.

“Not all providers widely advertise how you can make a complaint and don’t necessarily take the time to go through it carefully.

He said COTA is often told that families are asking questions, but not getting responses.

Additional powers for new watchdog

Mr Yates suggests the new independent Aged Care Quality and Safety Commission should be given additional penalty powers, including ban operators from the industry.

“COTA notes that the current suite of penalties (namely a stop on receiving new customers and government funds or revocation of accreditation) does not meet current community expectations for the worst of offences and does not really give the commission an appropriate range of penalties,” he says in his witness statement.

Mr Yates also told the commission there needed to be a focus on employing the right staff into the sector.

“Many of the horror stories that we hear in aged care are committed by people who have qualifications – nursing and other qualifications. I don’t want high ratios of them.

“We have to focus on how we improve the quality of staff, how we make aged care an attractive, desirable career, how we build career pathways into aged care so that people can progress, he said.

Staffing ratios

Paul Versteege

Elsewhere at the inquiry, advocacy group for older Australians Combined Pensioners and Superannuants Association policy manager Paul Versteege said staffing ratios need to be addressed.

“We feel that staffing in residential aged care facilities is inadequate and that is a community feeling that there is not enough staff,” Mr Versteege said.

“A facility can determine by itself how many staff they’re going to put on at any given time and that’s borne out by reports from nurses that they’re sometimes looking after 100 or even more people in a nursing home at night,” he said.

Minimum staffing ratios would be a first step in rectifying this issue, Mr Versteege said.

“We could actually mandate that certain types of care require certain levels and skill mixes of staff to deliver adequate care,” he said.

Improving quality of life

Also in the hearing, Mr Versteege proposed an official visitors’ scheme be implemented to the aged care system to improve the quality of life for residents.

“It would basically introduce people who have a fair idea about aged care and who are able to advocate on behalf of residents.

He said about 40 per cent of residents living in aged care never have any visitors because they are isolated or don’t have anyone to visit them.

“An official visitor scheme would be a godsend for those people,” Mr Versteege said.

To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. We will also be issuing regular Royal Commission Roundup reports which you’ll receive in addition to your weekly e-newsletters.

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8 Responses to Royal commission told sector experiences ‘power imbalance’

  1. Rex Leighton February 15, 2019 at 9:51 am #

    It’s not about power – its about respect and culture and treating people as you would wish to be treated. This starts from the top and a fish rots from its head.

  2. Raad Richards February 15, 2019 at 11:48 am #

    In relation to Mr Versteege’s comments about establishing a Visitor Scheme into residential Aged Care facilities which could add cost to the system, instead have a proper program of Pastoral care provided through trained volunteers coordinated through the aged care organisation, like some of us have put in place for many years and has been very successful to ensure that a holistic person centred care is provided to all residents including those who have no visitors.

    A good Pastoral Care Program is more than just paying a visit to someone. it is about reducing depression, increased cognition, reduced anxiety, reduced loneliness, increased wellbeing and resilience, quality of life, meaning and purpose, dignity.

    these are some of the key outcomes and effective Pastoral and spiritual Care Program would provide residents through a properly trained volunteer based program.

  3. Jane February 16, 2019 at 8:27 pm #

    Staffing ratios are definitely needed in Aged Care. There is no consistency across facilities as to staffing levels. Some facilities have 3 Registered nurses to 101 Residents while others have one Registered nurse to 80 Residents. There needs to be Registered nurses overnight as well in all facilities.

  4. Rose February 18, 2019 at 7:45 pm #

    RNs in aged care do not have salary equality to RNs in acute care.

    1 unexpected event can add much work time over the 8hr shift, only to be told it’s RNs poor time management – so unable to claim for overtime!

  5. Jade February 19, 2019 at 12:14 pm #

    It could be said that, ” the generations past ‘did not want to complain’ and ‘yes the mindset of long term staff or their approach is ‘one of power’. * My point: Aged Care Funding is tied to Government Accreditation (Audits).

    Re: Royal Commission
    New Aged Care Standards July 2019.
    One main concern the is ‘new aged care framework’ is based on government economic policy understandably however, both ‘bio medical model and a psycho-social model’ are needed.
    * My point – ‘Moving house (Many older people have lived in for a long time) is traumatic and it’s reasonable to suggest ‘for anyone’. So add to this the stress, and other complex factors like the grief cycle, Maslow Hierarcy of Needs, and other famly members and/or friends trying to navigate the maze of support services, eligibility, and the whole process is just stress for everyone involved let alone – moving ( So it’s complex).

    In other words, many factors and all situations have diverse unique stages of life, moving house into an aged care facility, diagnosis, end of life stage it’s also reasonable ‘that the possibility exists that older people need psychologist, counsellor, social worker visits (Mental health – well being or the mind / body connection which is well researched and evidenced). However, due to greater ageing populations new ‘so called’ healers or support services are emerging. The possibility exists even powerful enough to have ‘bad publicity shut down on social media sites’.

    For example, Australia authorities, regulator needs to have regulation on the word ‘Medicine’. Evidenced by the recent (general knowledge in public domain) ‘Universal Medicine’ court ruling (See Lismore). If an organization or people / person begin and continue under various other organisation / cafe names to continue in our society / communities views / theories with no ‘evidenced based claims’ – perhaps another Royal Commission is needed into quasi quack ‘healing’ or ‘esoteric doctor like’ practices.

    My point our ageing citizens here and overseas are being shafted by services or ‘healing reality promises’ lacking evidenced based practice (by Academic or Professional Health Science), and a discerning approach is needed by young and old searching for a better reality.

  6. P.J. February 19, 2019 at 3:56 pm #

    Why don’t providers of aged care clarify what happens to govt. fees and personal payments? To those in residence but also anyone receiving care in their own home? Statements do not explain an increase in administration charges with decrease in number of service hours. When I asked why, they were off handed, even rude . I was told it was to cover insurance. An explanation regarding who and what was insured was not forthcoming. A decrease in hours was not explained either. The quality of administration is not as good as it was one year ago. The support workers are excellent considering the pittance they are paid and lack of care for them by providers.

  7. Dave February 19, 2019 at 6:21 pm #

    And so it continues…Providers and Peak body CEOs with no clinical expertise regurgitate their opposition to staffing ratios, while those of us on the floor are left wondering how our sector came to directed by people with no practical experience in providing care.

    Its a tired old act…and it’s time we called them out.

    Surely I’m not the only one scratching my head as Sean Rooney, Ian Yates and Pat Sparrow pontificates on psychotropic drugs, dementia care, staff workloads, resident care and a range of other items they know nothing about?

    Watching the proceedings, I suspect the assisting counsels have got the measure of these self-appointed aged care ‘experts’.

    The hard part will be finding a peak body that isn’t just a front for provider interests

  8. Toni Trent February 20, 2019 at 10:45 am #

    The Dept of Health fund a Community Visitors Scheme operating around Australia. The scheme is a one-on-one befriending program for residents in aged care and those living at home who receive a Home Care package. There is a need for Increased funding and resources for the community organisations auspicing the scheme and access to free local intensive training for volunteers wishing to visit someone with dementia.

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