Respite in residential care: ‘perfect storm’ for complaints
The growth in the volume and acuity of respite cases in residential aged care is proving challenging for services and has become an area of increased focus for the Aged Care Complaints Scheme, the head of the scheme has told providers.
The growth in the volume and acuity of respite cases in residential aged care is proving challenging for services and has become an area of increased focus for the Aged Care Complaints Scheme, the head of the scheme has told providers.
In a number of recent cases providers had failed to understand or manage the complexity of respite care recipients and this had contributed to adverse outcomes, Bernadette Walker, manager of the scheme within the Department of Social Services, told the Leading Age Services Australia National Congress on Tuesday.
The number of respite admissions to residential aged care increased from 56,000 to 64,000 between 2008-09 and 2012-13, representing a 13 per cent rise. This meant most residential aged care services were likely to see more people receiving respite care, Ms Walker said.
While respite was previously more common for low level care that is no longer the case, with 50 per cent of respite recipients now requiring high level care.
“We all know that from a legislative perspective you have the same duty of care to all your care recipients but we are finding that respite is particularly challenging,” she said.
There were several key challenges with providing respite care, she said.
The care recipient is transitory not permanent; services might question how much effort they put in to assessing the needs of someone who will be with them for a short time, she said.
The care recipient’s regular doctor may not be linked to the aged care facility, or any aged care service. Similarly, staff, the care recipient and their family do not know each other, and Ms Walker said she wondered whether the short-term nature of the stay meant less effort was made in forming relationships.
Compounding this was the fact respite care recipients were becoming more complex and likely to have evolving needs. “Increasing numbers of respite care recipients with increasingly complex needs create a set of circumstances that can create the perfect storm.”
The complaints scheme had taken a sample of 30 complaints involving respite care recipients and identified a number of common factors, including:
- gaps in communication with carer or nominated GP
- issues with developing comprehensive care plan, and
- gaps in record keeping.
Ms Walker noted that the Aged Care Commissioner had recently discussed “the power of an apology” coupled with a positive approach to complaints. “[The commissioner] noted that what appears to be missing in some cases of complaints handling is evidence of acknowledgment and apology… where it has been established that there have been failings in care an apology is important to an individual as receiving an explanation of what occurred.”
The commissioner pointed out a good apology was not an admission of liability, Ms Walker noted.
Ms Walker said that the scheme’s data showed that the average respite recipient received on average 1.4 episodes of respite and the average stay was around 23 days. “The idea that people have multiple and frequent admission to residential respite is not necessarily accurate, there may be some instances but on the whole that is not that case.”
Around half of those who use respite go on to enter permanent care, which is a change from its original intention, she noted.
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An acute National shortage of rehabilitation beds is also driving this increase in residential respite demand- every red light goes off when a patient is readmitted within 14 days of discharge from our hospital system- with 63 days of respite it is an easy choice for discharge planners-unfortunately, these respite options do not include any rehab focus- with the vast majority of respite then turning into an admission.
More ” beds” need to be made available for hospital avoidance/supported discharge if we are to honor clients wishes of returning to the familiarity of home
Mark’s correct, the ‘Friday Granny Dump’ continues unabated as hospitals clear the decks for the weekend…but the problems noted by Ms Walker stem from a much simpler issue.
Yet again, the ignorance of our regulatory bodies is evidenced by their assumption of the root causes.
“Their doctor isn’t linked to the facility” Nope…that’s the case with the majority of admissions.
“More high care admissions” Huh? Isn’t that what we do, provide high level care?
“The staff dont know the resident” (My personal favourite) Is there an optimal time that must elapse befor we’re able to provide professional medical care? If so, then we should all introduce ourselves to the local Emergency Department, go out for drinks and have them over for dinner just in case we ever need ther services. You dont want to arrive at ED as a stranger.
There’s only one reason we’re getting things wrong; poorly skilled care staff.
If your staff cant manage to read (and understand) the hospital discharge letter, if they’re unable to anticipate a resident’s medical needs and then implement the appropriate startegies, if they dont know how to discuss and plan care with residents and familiy members, maybe you should rethink your hiring strategy.
C’mon aged care. Enough with the lame excuses and blame shifting. This ‘dog ate my homework’ mentality continues to make us look stupid…everyone can see it except us.
Get the clinical care right and the rest will follow. Your ocean-view rooms, and executive chefs dont mean a thing if your resident’s crashing and the staff either dont notice or dont know how to respond. And no…calling 000 (because that’s the only skill you can bring to the table) doesn’t count.
Nothing will change until we ditch the low cost, low skill employment model to which aged care slavishly clings.
David, I don’t think the finger pointing and blame shifting can be directed at any one point. Aged Care organisations are doing what they can with little funding, and little support from the Government (both state and federal). The conversation needs to shift away from this if we are ever to create lasting and positive change for our clients.
What I see as how we can help facilitate this change is (yes) better communication. But not only within organisations, but with other organisations AND with the wider community. The staffing issues that lead to mismanagement are fundamentally grounded in how it’s be perceived by the wider community – low skilled and for people at the end of their careers.
If we can get more passionate people involved in this workforce, people who are genuine in their approach to improving the industry AND with the right support for the staff then we will be half way to solving this.
It’s time to stop finger pointing. Aged care has been at the bottom of the too hard basket for too long. It’s about time we start creating a more positive and thought provoking argument.