Alarm as Senate inquiry says it cannot be confident that catastrophic failures in Oakden facility not occurring elsewhere in Australia.
Aged care provider and seniors groups have seized on the interim report of the Senate committee investigating aged care accreditation to demand much closer scrutiny of the Aged Care Quality Agency (read more here).
In an interim report issued on Tuesday the committee said it agreed with the findings of the Carnell Paterson review that the issues at Oakden go beyond that facility and a complete overhaul of the quality oversight and regulation framework is needed.
The evidence “makes a compelling argument that the current system is out of date and failing its duty of care to vulnerable older Australians,” it said.
“The committee is not confident that there is not abuse elsewhere that the current compliance system has not identified.”
The committee also moved to extend its inquiry and go beyond its initial scope that limited its investigation to Oakden.
Concerns with Quality Agency
The committee said it was “greatly concerned” by the quality agency’s acknowledgement that “a single visit or accreditation process is sometimes not enough to uncover abusive treatment of residents where a facility seeks to hide that treatment.”
The agency’s ability “to identify where information is being withheld or altered by providers” has also been called into question.
The committee said it was concerned that the review by the Nous Group the agency commissioned last year had not addressed these issues.
Significantly, the committee expressed concern with the agency’s “repeated refusal to take responsibility for what occurred at Oakden, despite renewing the facility’s accreditation even after repeated non-compliance at audits over the course of a decade.”
Consultants who were hired to improve services at Oakden told the committee that they did not understand how the facility was able to pass accreditation audits despite longstanding issues of concern with service delivery.
“The same consultants told the committee of the serious consequences of Quality Agency failures to identify poor service outcomes at Oakden,” the report said.
Australian Ageing Agenda sought comment from the Quality Agency yesterday. A spokesperson referred us to a statement it released on 14 February, which can be read here.
Facility was passing accreditation
Jackie Hanson, CEO of the North Adelaide Local Health Network (NALHN), of which Oakden was part, pointed out that the facility had passed all 44 outcomes and received three-year accreditation as recently as February 2016, and it passed a subsequent unannounced visit in October 2016.
No concerns were raised with NALHN until an audit conducted in March 2017, following the announcement of a review by the state’s Chief Psychiatrists, Ms Hanson told the committee.
The committee found there was evidence that recommendations of the quality agency’s own auditors were not always taken on board by the agency.
It pointed to a December 2007 audit that found 26 of 44 outcomes were not met at Oakden prompting the audit team to recommended the facility not be accredited, yet the agency ultimately granted accreditation. In a letter to NALHN in January 2008 the agency said:
“The assessment team also recommended that the Agency revoke the home’s accreditation… While the home still has non-compliance, the Agency is satisfied that the home is continuing to make improvements to ensure the health, safety and wellbeing of residents.”
Gerontologist Anna Howe told the committee the failure was not in the information gathered during an audit but in the subsequent decision-making within the agency on appropriate follow up.
Dr Howe said:
“Rather than failures to identify poor quality care, the failures are clearly in decision-making by the Agency that over-rode recommendations made by assessors who had visited Oakden, had seen poor care, and had reported on the shortcomings, and done so repeatedly.”
Years of reports go unanswered
The committee’s interim report, released on Tuesday, details a damaging four-page timeline of concerns, reports and complaints about the facility as far back as 1999.
It lays bare dire systemic failures that meant years of reports and complaints were not acted on.
For instance, visitors to the facility from the Community Visitors Scheme had been flagging serious issues with appropriate staffing at the site since 2013.
The CVS annual report in 2014-15 noted key allied health positions, including the facility’s psychologist and social worker, were vacant. In its annual report the following year it noted these positions were still vacant, while its 2016-17 report presented a worsening situation for allied health in the facility.
“At the time of the annual report, the only allied health professional working in Oakden was a part-time dietitian,” the committee heard.
The committee said it was “deeply concerned that warning signs in relation to resident health were not heeded, such as unexplained bruising, medication mismanagement and falls, and that complaints from family members and community advocates were ignored.”
‘Our system did work’ says agency chief
Asked why its audit in March 2016 did not identify the issues at Oakden, the quality agency told the committee that “key information from previous audits was not adequately taken into account in later audits, and that there were improvements to be made in how the agency identifies service risk.”
Agency CEO Nick Ryan said “a culture of cover-up in that facility” meant it took a significant amount of time to uncover the extent of problems.
The agency said it wanted to see aged care accreditation adopt the requirement hospitals have to disclose negative findings from any other scrutiny to their accreditation assessors.
Mr Ryan said the agency had accepted the recommendations from the Nous review it had commissioned, which included using risk-based compliance monitoring and strengthening the capability of auditors.
It had adopted a new computer assisted audit tool, and in future a facility with a history of non-compliance will remain on a “watch list” for monitoring, he said.