Aged care under fire

A shocking Lateline investigation into quality care and staffing concerns in residential aged care has dominated social media, radio and TV broadcasts for the past 24 hours. AAA reports on wide-ranging reaction to the latest media storm.

Families have reported distressing cases of poor treatment and psychological trauma experienced by loved ones in residential aged care.

By Linda Belardi.

Aged care providers and peak bodies have condemned cases of abuse and neglect in residential aged care facilities following a damning investigation by the ABC’s Lateline on Monday night.

The report by Walkley award-winning journalist Margot O’Neill detailed serious allegations of poor treatment, malnutrition and even bullying and intimidation tactics from providers including the threat of defamation when families spoke out.

The program broadcast distressing images of untreated wounds and injuries and aired the personal stories of three families from Victoria and NSW who described traumatic experiences with residential aged care. Their loved ones were reportedly verbally abused, roughly treated and left in pain with undiagnosed or untreated conditions. 

The report pointed to longstanding and familiar problems in aged care – overworked and understaffed facilities, inadequate training and insufficient access to specialist services and proper palliative care.

The story has dominated social media and TV and radio broadcasts over the past 24 hours and has even attracted a call for a Royal Commission inquiry into the treatment of older people in residential aged care.

A facebook page ‘Nursing Homes in Australia – Time for Change’ has also been set up to campaign government for action in light of the media investigation.

Charles Sturt University’s Dr Maree Bernoth, who appeared on the program, said the accreditation and standards system was not working and stories of inappropriate care were becoming more worrying in recent years.

She said that the issue of cattle exports received more public attention and outrage than stories of malnourished and dehydrated residents dying in aged care.

Earlier this year Dr Bernoth published a study, ‘Two dead frankfurts and a blob of sauce’, describing the nutritional neglect in residential aged care. In May, a study by Jane Kellet from the University of Canberra of residential aged care facilities in the ACT identified that one in five residents were moderately or severely malnourished.

Lateline said it has spoken to at least 16 other people with similar stories to those featured in the program and it has received hundreds more emails and phone calls.

Rodney Lewis, a lawyer specialising in elder law told the ABC that it was time for a Royal Commission to investigate the experiences of older Australians in residential aged care facilities across Australia.

He also urged consumers to use consumer claims tribunals as a form of redress for unsatisfactory quality care.

ACSA CEO Adjunct Professor John Kelly expressed his deep concern and apologies to the residents and families involved.

He stressed the need for a substantial injection of funding to deliver high quality care and urged the government to move quickly to introduce its Living Longer, Living Better reforms, cutting the 10-year timeframe by half.

“We need to see appropriate changes over the 3-5 year period rather than the 10 year- period,” Mr Kelly told ABC News 24. 

He also said Australians were faced with a tough discussion about how society would pay for the rising cost of care in the future. 

LASA CEO Patrick Reid said the program had revealed what industry had known for some time, that there is a critical workforce shortage, recruitment and retention is difficult and government funding does not match care needs. 

He said the government’s focus on regulatory compliance rather than quality clinical care had to change. 

Catholic Health Australia CEO, Martin Laverty said all reports of unacceptable care should be investigated thoroughly and the Aged Care Complaints Scheme must be able to sanction providers who fail to deliver acceptable levels of care.

He said the limited choice of aged care places across Australia meant older Australians could not “vote with their feet” and change providers.

He also called on all political parties to commit to improving access for palliative care including implementing the recommendations of the 2012 Senate inquiry into palliative care.

COTA Executive Ian Yates said that while most aged care providers deliver a high level of quality care to residents, there were still unacceptable cases of neglect, malnutrition and abuse.

He called for a zero tolerance approach to any breaches in care and for stronger penalties to be applied to those services that fail to meet their duty of care obligations. 

He also added his voice to calls for a strengthened independent complaints system, which has full power to investigate allegations of neglect or maltreatment in aged care. 

Mr Yates said the recently passed LLLB reforms would initiate some important changes but the sector needed to move to a funding system where consumers hold control of the funds so they could move to a different provider if they were not being treated well.

Consultant Gerontologist Drew Dwyer said that without a solution to the remuneration and working conditions of care workers and the viability of service providers, concerns would remain.

In her first appearance on Lateline as Minister for Ageing, Jacinta Collins said she was very concerned by the reports and acknowledged that workforce and service shortages needed to be corrected.

“We need to grow the system, we need to grow the quality, we need to improve the workforce and that is the plan that went through the Senate a couple of weeks ago.”

Margot O’Neill said Lateline investigations are continuing and further programs will be aired in coming months.

How the ‘Twittersphere’ responded:

@SimonAJohnson Thanks #lateline for this story on Aged Care. Government needs to seriously revisit Aged Care & Hospitals. What r u doing Jacinta Collins?

@senthorun We must urgently address the lack of resourcing and training in some of our aged care centres. 

@Vikkik88 …Of course you need minimum staffing ratios 4 frail/complex care residents in care. A market will minimise care for $ #LateLine

‏@NurseNelleB elder abuse also happens in community but due to no mandatory reporting in hosp & community it goes unnoticed

Tags: elder-abuse, jacinta-collins, lateline, malnutrition, neglect,

13 thoughts on “Aged care under fire

  1. Thanks AAA for this article. I believe that there needs to be a Royal Commission not necessarily in RACF but in the way we treat our ageing population overall ie in RACF, hospitals and community settings.
    Prior to me being a registered nurse, I was a personal care assistant in a RACF and I absolutely loved working there. I also did a student nurse placement in another facility as enjoyed my time their too. Working in these two places made me want to pursue my career in aged care nursing more specifically older persons mental health. When I was working as a PCA in the RACF not only was I there to look after the residents ADLs I was also their advocate and some of the residents had no family so we became their family. When we had to send residents to hospital we would ring everyday to see how they are going…..This is when it goes wrong. Normally the hospital would not tell us any information or had no idea or even could not locate our resident. We had our pastoral carer on return to visiting one of our residents, had their pain relief medication sitting on the bedside table not given to our resident who was in pain. The residents were not being feed and one case was not feed for three days. They developed pressure injuries came back with MRSA, VRE, not showered not shaved and one occasion came back in a taxi wearing nothing but a hospital gown and cannula still instiu. We also had a resident who was mentally unwell so we sent him to hospital in the mental health ward, he was sent back to us the next day. A day later he suicided. Not one of these incidents of neglect by the public hospital system was investigated and the hospital got away with it. And yet they have more resources, better pay and better working conditions then any RACF. There was only the hospital that we could complained to or the HCCC which is useless because it’s like the state investigating the state. I wish we could have reported the incident independently as a form of elder abuse but who would listen to a RACF? That is why I want a clear definition of what elder abuse is and I want mandatory reporting and mandatory training, just like in state hospitals there is mandatory training and reporting of child abuse, the same should be done for elder abuse. At the moment mandatory reporting is only madatory in RACF and it should be happening in hospitals and in the community.

  2. Linda thanks for your article. Lateline, and subsequent reaction just reiterates the importance of the work we do in the recruitment of Executive leaders to the aged care sector here in Australia. It’s why we are doing what we are doing, and have been for 10 years – to make the aged care user experience a residential (and community) care service something that is remarkable, dignified and respectful, something that meets their needs and preferences at their end of life. If you don’t have great leaders, even at the DDON and DON level within your organisations you are in strife.

  3. The recent ABC Lateline story ‘Aged Care Crisis’, whilst clearly highlighting some specific problems, should not be interpreted as being representative of the entire aged care sector. There is an enormous amount of good and dedicated work being carried out every day in most aged care facilities across Australia. This type of negative story does nothing to empower and support the largely underpaid and overworked aged care workforce. Our deepest regrets and empathy go out to the families involved and there is no doubt that the care provided to their loved ones is unacceptable.

    It is often a difficult and traumatic experience when families have to make the tough-love decision to place a loved one into a residential aged care home. This may be made a little easier if appropriate information and support was more readily available to the community and families of ageing Australians. Death and dying are incredibly tough and emotional subjects that require skilled clinical leaders to listen and support, and in many cases educate, families as they experience feelings of loss and grief during the transition of a loved one through the end stages of life. This experience is a truly traumatic event for these families, and fortunately the bad scenarios described in this story are not as common as this story may have us believe.

    The reality is that new aged care reforms that meet the current needs and community expectations are a work in progress. Change is and should be led from the front, where the best knowledge exists. The government need to more proactively engage experts in the sector and the public needs to be prepared for the change and be open to a new social model.

    Whilst exposure of instances of poor care is necessary, we need to ensure that those carers who are doing good work are not tarred with the same brush. Carers are doing the work that most people in our community are either unable or unwilling to do. Yet many families often take out their inner feelings of guilt or remorse on the stressed, underpaid and overworked staff who are providing the care for their frail, vulnerable and elderly family members.

    Australia, it’s time for ACTION not words and pointing the finger of blame. The level of care and services provided to our elder Australians is a direct reflection of the level of respect that they have in our community. All members of society should reflect deeply on how it is that we would want to be treated in their own end of life transition and then be prepared to shoulder the financial burden required to achieve those outcomes now.

    However, it is not only the models of care and the regulatory frameworks that need reform. It is not just a matter of workforce education and development. The community needs to actively participate in determining the social standards of care that should be provided and be prepared to lobby their elected representatives to achieve it. Better collaboration is required between end users and providers, governments and communities. Greater education of the general society is needed so that they are better equipped to cope with an ageing society. But until the major issue of appropriate remuneration and working conditions for care workers and service providers is properly addressed, no-one should hold out any hope for a proper and lasting solution to this ever increasing problem.

    Ageing is an issue that we all confront eventually, the problem is that very few people understand the impacts of ageing, the choices available or the difficult decisions that may need to be made.

  4. It is time to ‘re think’ the monitoring systems we have in place. The Accreditation process has failed to address the issues of quality and skill within the aged care system. If organisations put the financial resources into care that they spend each year on consultants and non productive staff to protect themselves from potential non compliance or from ACFI repayments, then there would be significantly more funding within the industry to support greater education and quality staff at the bed side.
    According to the departments web page there have been some 209 facilities sanctioned for serious and sustained breaches of various outcomes since 1997. There are currently 9 facilities under sanction and a further 15 with serious issues of non compliance. How can we say the system is working.

  5. I agree with Drew
    If the media wish to contribute positively to this debate instead of high lighting the small percentage of negative outcomes which only serves to depress poorly paid aged care workers who are trying to do their best and spread fear amongst a community who may have no alternative but to place their loved one into residential care why do they not high light some of the wonderful things that are happening in aged care.
    I would like to see a responsible investigative journalist attend a comparative analysis of the numbers and daily cost per bed per day which the Government spends on our prisoners and refugees as apposed to the per bed per expenditure on our aged.The maximum funding provided to the provider to support the most highest care resident is $181.21 per day. This is to provide daily care clinical specialist care medications food housekeeping specialist equipment etc A total of $1258 per week less than half of what aged care pays 1 worker to cover 24 hours a day for those 7 days.
    The buck stops with our Government and until they indicate that our aged deserve more than our prisoners or refugees for what they have contributed to our society over decades no reforms can take place.

  6. It all comes back to money how much as a society are we willing to pay. Are the Australian tax payers willing to pay the tax that is nessary to bring RACF’s up to the same staffing level as hospitals? Do RACF need to have the same staff levels as hospitals??
    Anything is possible depends how much the population are willing to pay.
    Open the Aged Care industry to a more user pay formate where the care is the same no matter where you go but the accomodation changes to what you can afford.
    I reckon alot of what is being said is being driven by a greeedy solicitor looking for a new cash cow. Or residents family cannot accept they cannot or won’t care for their own family member.
    The public have three choices pay the higher taxes or pay it them selfs or how about the families doing the right thing and taking care of their own.

  7. its a simple matter of staff ratios…
    each person needs to have the correct mix of actual contact time with staff and that has to be the basis of funding…

    Labor has done nothing to address this issue even though the nursing unions have tried to talk about it with them…

    the Howard government removed any notion of staff ratios and funding – it needs to be the main focus of how money is given out so staffing levels are adequate instead of allowing the institutionalised neglect we have now…

  8. Ratios are a useless and blunt edged instrument. If they worked older people would be well cared for in hospitals with ratios. They are not. I do not think we need another investigation. Call together a round table of experts and the answers are all there. We do need a major public education campaign -similar to bad backs and AIDS – to remove the general stigma related to older people; it does not matter how long a child remains in hospital they are not called bed-blockers! Unless as a society we are prepared to invest in older people then we should not throw stones at one industry. We are all failing – some more than others and elder abuse should never be tolerated. Having MORE staff will not address the problems without investing in great leadership, models of care that take account of the environmental design and staff scope of practice and expectations that staff WiLL be skilled and knowledgeable for their role and will develop.

  9. I am a clinical Nurse with experience working in number of settings both Government and Non Government. There are some wonderful people working in aged care but there are also very many people working in this area who are unknowledgeable, untrained and uncaring too. That is a fact. It may be easier to minimise the issue that to deal with it. It is not isolated, people are right to be afraid. Many elderly have no families to advocate for them and many have no voice to speak for themselves (i.e. Dementia, Parkinsons).

    Many elderly are as vulnerable as infants and should receive the same degree of supervision and care. We urgently need more professionally trained and staff in appropriate numbers to provide adequate care.

  10. I was assaulted by a resident just a few days ago and this has effected my health and i have been quite distraught. This time it was physical assault, usually its verbal abuse.Staffing levels are way below the average in which hospitals run their staff, currently operating at 3/4 and 5 staff per 35 residents. Staff are run down, neglected,often sick, or off on stress leave, due to lack of correct sttaffing, management neglect, and overworked.

    Not another media-fuelled public frenzy! Aged Care is Big Business, huge business and, like every other Big Business it has its share of inefficient, greedy and downright dishonest operator.
    To read CEO’s, Regulatory Bodies and “peak organisations” expressing their shock-horror and offering the same old solutions ranging from Royal Commissions to more regulations and more government funding has an aura of deja-vue about it. Naturally we hear nothing from the “over 65 cohort”. We never do. After all they only represent 14% of the Australian population today. .
    Already the “Aged Care Industry” conducts 15 to 20, two or three day, national conferences each year. The one in Sydney this August will cost each of the 300 plus delegates $1.310 to register. Transport and accommodation will, of course, be extra… One cannot help wondering how many additional staff could be employed for 300 x $1,310?
    Here again, the list of speakers at that Conference reads like the Birthday Honours List… CEO’s and Directors of major providers and, of course, a gaggle of legal advisers. No representatives of Older Persons Groups…… Peter Leith. Heidelberg West.3081.

  12. Perhaps some of these issues can be addressed with news out of Japan recently and I quote this from –

    “The Japanese government is extending financial assistance to companies who can develop low-cost nursing home robots, this as a part of Japan’s push to deal with the issues of having a large population of elderly people and also to help spur economic growth. The government is looking to support the development of robots with limited functions for very specific nursing care tasks, designed to assist elderly people in daily activities, thereby reducing the burden on nursing home workers. ”

    Don’t underestimate the rapid technical advancement of robotics and Information Technology, I predict in another decade or less, this will be more mainstream in other developed industrialised nations such as US, UK, Europe etc..

    It will be profitable after the initial purchase of the equipment to have “workers” you don’t have to pay or complain about working conditions.

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