Lessons will be learned

The question of whether sprinklers should be mandatory in all NSW aged care facilities and retirement villages has emerged as a major issue after Friday’s nursing home fire at Quakers Hill.

Above: Victor Harcourt from Melbourne legal firm, Russell Kennedy.

By Stephen Easton

Attention has now turned to whether sprinklers should be mandatory in all NSW aged care and retirement living accommodation, in the wake of Friday’s horrific fire at Quakers Hill nursing home, which has now claimed nine lives.

The question may feature prominently in the coronial inquest, and any other review process that seeks to examine the tragedy.

Only two days after the tragic event, NSW Premier Barry O’Farell indicated that regulatory changes would be considered as a result of the fire, and told journalists he had requested a report on police checks for nursing home staff and the physical structure of all nursing homes and retirement villages across the state.

“We will ensure that lessons are learned over this tragedy,” Mr O’Farrell told the media on Sunday. “This is, no matter how tragic, an isolated episode and let’s not damn every nursing home with these sort of episodes.”

Media reports have drawn attention to the fact that fire sprinklers were not fitted to the Quakers Hill nursing home, and various groups have called for them to be made mandatory as they are in Queensland and Victoria. 

The Victorian Government made fire sprinklers mandatory in nursing homes in 2002, after a long-running inquest into a fire at Kew Cottages in 1996, which resulted in the deaths of nine disabled residents.

Aged care specialist lawyer, Victor Harcourt, who acted for the Victorian Government in the 1997 coronial inquest following that tragic fire, said that at the time, State Coroner Graeme Johnstone had strongly recommended making sprinklers mandatory after hearing evidence from fire safety experts.

“Certainly what that [inquest] led to was a massive reform process in Victoria, in relation to fire safety in congregate care facilities,” Mr Harcourt said.

“It led to changes in the building code, changes to regulation of the providers of congregate care – in particular, state funded congregate care facilities.”

The experienced lawyer, principal of Melbourne firm Russell Kennedy, said that he expected the question of whether facilities like Quakers Hill nursing home should have sprinklers to be a major issue examined during the inquest into the fire last Friday.

“I think fire safety experts will say that a properly sprinklered building will result in a much better chance of saving lives, through prevention of deaths from smoke inhalation and burns, and that was one of the significant issues that arose in the Kew Cottages matter,” Mr Harcourt said.

“There is no doubt that unfortunately, major adverse incidents like this are quite often the catalyst for regulatory reform in building and fire safety.”

Mr Harcourt added that although there was some debate about the value of sprinkler systems during the 1997 Kew Cottages inquest, he recalled the State Coroner, Mr Johnstone, had “come down heavily” in favour of making them mandatory.

“There is no doubt sprinklers will save lives,” Mr Johnstone said in his findings.

“[…] When the issue of mandatory requirements for residential sprinkler systems is considered, the elderly, the sick and the disabled are recognised as being in areas of high risk”.

Mr Harcourt said that other coroners had also made similar recommendations about mandating sprinkler systems in such residences over the years.

Industry awaits review

Rod Young, CEO of Aged Care Association Australia (ACAA), told ABC radio yesterday morning that any recommendations from the NSW Government on improving nursing home safety “would be applauded by the industry”.

The chief executive of ACAA NSW, Charles Wurf, said that he would await further advice from the Premier, but agreed that such a review was necessary.

“Aged care is grounded in quality improvement procedures so there must be a review,” Mr Wurf said, adding that any changes made to either the Aged Care Act or building codes “must be done on the basis of considered evidence”, after a coronial inquest and investigations by the police and fire brigade were completed.

Illana Halliday, chief executive of the Aged and Community Services Association of NSW and the ACT, welcomed any review of the aged care sector that looked at workforce issues, and said that she could understand why the premier would seek answers following the tragedy.

“[…] We welcome anything that examines our workforce issues and helps the safety of our residents and staff,” Ms Halliday said. “Having said that, we have very high safety standards, and my understanding is that this building was compliant, which is why it was a successful evacuation.”

“The sector of course has some difficult workforce issues, and we do screen all newcomers to facilities as they start work. I’m not sure what this review could recommend over and above that.

“Given we already have police checks done, I don’t believe that additional reviews of individuals would have eliminated [the alleged perpetrator]. He was a registered nurse who had already passed the safety checks.

“I don’t want to increase the burden [on providers] if there isn’t a reason – we want high quality staff and do everything we can to get them, but there are tragic accidents and often with tragic accidents, you are unable to foresee or prevent them.

“Being deliberately lit, its not like our systems have failed us. This is a person who, allegedly, deliberately caused a tragedy – and revising your standards doesn’t help you get around something like that.

“However, if there is something we can do that we’re not doing, we welcome that recommendation, from either the Premier or the Coroner, and we would look foward to applying it because the industry takes safety very seriously.”

The Premier’s office did not provide a response to questions about the status of the review which Mr O’Farrell requested, but a spokesperson confirmed that the heads of “all relevant NSW Government departments and agencies” attended an urgent meeting yesterday morning in relation to background checks for health workers. 

Tags: acaa, acaa-nsw, acs-nsw-act, barry-ofarrell, coroner, fire, nsw, premier,

5 thoughts on “Lessons will be learned

  1. Nursing home fires are not new, and this one is one of many worldwide that have established a long precedent of inadequate elder care. And still these terrible events occur.

    There are three issues at fault here – the failure of the nursing home operators to install a sprinkler system, given it is entrusted to a duty of care to keep their elder community safe (irrespective of policy); a dubious screening policy that appears to have enabled a registered nurse (with a history) to work in an environment where vulnerability of its community is open to exploitation, and policy/legislation that considers it’s OK to not have a sprinkler system in an environment for people who are at the mercy of others if something terrible happens.

    The results of such decision making are now obvious. Unfortunately this could have been avoided with commonsense.

    I think there needs to be a more rigourous review of staff employment histories and more extensive contact with previous employers. This is an insurance policy that whilst involves more work, may ensure that nurses with bad attitude and unprofessional ethics do not gain employment. Nurses’ employment histories should be centrally logged and available in an Australia-wide database that can be checked and issues listed. Warnings should be posted, if a person has warranted concern. Every employer should be able to input into this system. This way, there would be no fudging by staff, no glossing over problems that remain hidden.

    In theory, companies tick boxes to say they have complied – in practice mistakes are often covered up, bad attitudes ignored, or put down to having a bad day, and financial bottom lines govern most decisions. This needs to change. Every nursing home should have a ‘bill of fare’ posted outside its doors, listing how many people have ulcers and for how long, the nurse to patient ratio, the length of stay of its residents, medication protocols (to avoid polypharmacy), and a listing of how many of its residents fall. This type of transparency is the only way people will be forced to comply to a duty of care, and will give families a good idea of which homes to avoid. It needs to be regularly updated (monthly). Care is much more than plying someone with pills, popping them in a wheel chair and making them endure a life that is at best sedentary. The infantilisation of the elderly is a great Western shame.
    At heart, elderly people are often at the receiving end of terrible treatment.

    Instead of rhetoric, how about palpable change – such as continual monitoring of staff performance, better recording of problems, swifter reaction to issues, better communication, and an ethics of care that is visible, accountable, and actionable. There appears to be a great deal of political manoeuvring to ensure that people accord blame elsewhere.

    Perhaps if we lived in a country where families sued, there might be change of heart and operation.

  2. Ask any agency registered nurse who works night shift at multiple facilities about fire safety and the responsibility of at times 300 residents with 90% agency care staff on shift , unfamiliar with the residents or the buildings and the evacuation plan. Many do not have sprinklers , corridors , and doorways are narrow ,access is difficult to exits and the staffing is sparce. It will be a long recovery for the staff in that facility. But for the Grace of God it could happen to any facility. Police checks are worthless and revenue raising. They are only as good as the day they are issued and they do not reveal personal psychiatric or emotional history.

  3. i will never forgive the ‘ medication endorsed PSA for ramming sedation into my semi concious fathers mouth while not noticing his feet were jammed in between the footboard and the end of the bed. She refused to withold the medication and said i could complain on Monday if i wanted to
    If you complained you were considered a trouble maker and ‘punished’- ie not contacted when appropriate. I watched him strapped into a wheelchair for hours at a time, and witnessed total incompetence in the use of lifting machines.
    my advice-go into the public system where at least there is transparency and accountability

  4. Blame, Blame, Blame, and more Blame. No one will want to come and work in aged care if this keeps up. I have not heard one peace of Leadership speak and no leaders prepared to. This is the biggest shame of all.

  5. Gee Patrica, you certainly have it in for us RNs working in Aged Care.
    All the ‘checking up’ you propose would reduce RNs in Australia to just one notch above a person just released from years of imprisonment for a felony offence.
    I have actually been subjected to what you propose, and it is enough for me to regularly reconsider my employment options, as I detest the loss of professional status of RNs due to increases in background checking.
    It’s unfortunate, that you do not fully appreciate the effort that is required of becoming an RN. Should an even greater background checking protocol be forced upon RNs in Aged Care, the consequence will be, that many more RNs will simply give up and leave Aged Care.
    At this stage, there is still a great deal of anger and demands for action ( in the wake of this recent tragedy ). Branding all RNs as potential deviants and misfits is not what the Aged Care Industry needs right now.

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