By Natasha Egan

There should be zero tolerance for the poor care practices depicted in ABC Lateline’s latest story on the aged care sector, says Alzheimer’s Australia CEO Glenn Rees, while provider peak bodies have reiterated the incidences are uncommon in a sector that is chronically under-resourced.

The sixth investigation in 12 months by journalist Margo O’Neil aired on Tuesday evening and featured frontline aged care workers telling their experiences working in the sector.

An over-burdened carer locking dementia patients in their rooms at night, incontinence pad rationing, toileting shortcuts which encouraged residents to urinate and defecate while showering, abusive and poorly-skilled staff, and regulation that promotes box ticking rather than adequate care were key practices and problems highlighted.

Lateline reported that while good care was provided in many facilities it had been given shocking examples of inadequate care in over 100 Australian nursing homes.

Ms O’Neil said aged care workers from around Australia have told Lateline there was just not enough of them to ensure dignified and compassionate care for residents in many nursing homes. 

Zero tolerance

Speaking after Ms O’Neil’s report, Lateline host Emma Alberici asked Mr Rees how widespread these issues were based on the feedback his organisation received following a campaign asking people to share their experiences of poor quality care.

Mr Rees said among the many emails and letters Alzheimer’s Australia received in the last month, some were as disturbing as those aired during the program but added they were not enough to conclude there was systemic failure across the residential aged care system. 

“What we can say and I think your program tonight shows it again, is that in some places there is really very, very poor care being delivered which is quite unacceptable and as an organisation we believe there should be zero tolerance for that,” Mr Rees said.

COTA Australia CE Ian Yates made a similar call for zero tolerance on poor quality care last month following the previous Lateline aged care investigation as did Mr Rees in a speech to the National Press Club earlier on Wednesday. 

Spot checks and the standards and accreditation agency should be identifying inadequate care practices, but they aren’t, Mr Rees said on Wednesday evening.

“We were promised as consumers that the accreditation agency over time would weed out the bad apples in the industry. And, clearly that hasn’t happened.”

Elsewhere in the Lateline interview Mr Rees said while whistleblowing was difficult for staff because their jobs may be at risk, the notion that nurses and carers would lock up people with dementia, with the risk of fire, was beyond imagination.

“[If] you weigh up the cost of 30 or 40 lives in a fire against exposing that kind of risk then I think that short term action has to be taken,” he said.

Action needed

Mr Rees said a preferred approach involved transparency around care outcomes, using quality indicators and involved consumers in monitoring and checking, rather than current monitoring, much of which addressed systems and compliance instead of quality of care. 

He also highlighted that the current accreditation system did not give consumers a sense of which residential care facilities were doing a better job than others because it lacked scaling even though 95 per cent of organisations got accredited.

“You don’t know within that 95 per cent who are very good, who are moderate and who are just doing a reasonable job.”

Mr Rees said he would like to see the quality agency look at this when it comes into being from January next year.

Sector response

In separate statements issued on Wednesday the two provider peaks, Leading Age Services Australia (LASA) and Aged and Community Services Australia (ACSA), again expressed concern over the issues raised but reiterated they were rare occurrences in a sector that was under-funded with critical workforce shortages.

LASA CEO Patrick Reid said the vast majority of facilities were providing excellent services and healthcare with scant and diminishing resources. 

“LASA condemns neglect and abuse of any kind and the 100 examples cited by Lateline comprise less than 3 per cent of total facilities,” Mr Reid said.

“They also operate in the most heavily regulated industry in Australia, with much of the focus on compliance rather than true quality of care which is unproductive and prevents health professionals from delivering clinical care. When nurses spend up to 75 per cent of their time on paperwork, not caring, something has gone awry.”

Government funding does not match the true cost of care needs and it must be addressed in order to start attracting new staff and remunerating them appropriately, Mr Reid said.

ACSA CEO Adj Prof John Kelly said he was concerned that the emphasis in the Lateline programs could lead viewers to incorrectly conclude that the examples of poor care were endemic. 

“I sympathise with the residents and families touched by these incidents, but the public needs to be reassured the great majority of aged care residents and those receiving community care are satisfied with the quality of their care,” Adj Prof Kelly said.

“What we need to acknowledge though is that there is chronic underfunding, a great deal of stress and too much paperwork that takes carers and nurses away from caring from their residents and clients.”

Adj Prof Kelly said there were currently a number of regulations that examined the standards of care provided in Australia’s nursing homes as well as the new My Aged Care website, which contained details of every nursing home in Australia including reports by the Aged Care Standards and Accreditation Agency.

How the ‘Twittersphere’ responded:

‏@SoggyTiri  #Lateline does it again! @margotoneill thanks 4 work’n on this very important story. Quality of Aged Care should interest all of us #auspol

@Kate_Hannon All credit to #lateline for following up on its exclusive of aged care horrors. The dedicated staff are disillusioned & overworked.

‏@nievesmurray #Lateline #agedcare is an election issue. Get with it. We have parents. We have grand parents. And we vote. Ignore #agedcare at your peril.

‏@SimonBanksHB Consumer need better info about performance of aged care facilities not simplistic slogans like “less red tape” @tonyabbottmhr #lateline

‏@murrayn @Lateline #Lateline #agedcare Quality programs to be introduced next year but who will do the caring while staff do the paperwork?

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7 Comments

  1. The dedicated but poorly paid care staff make care happen by default fortuneatly…!!! Quality care cant happen all the time because staff are under skilled and overworked. Care delivered changes each shift depending on who is working, what their skills are an how well they understand English. We are also dealing with family members who expect champagne service on a beer budget. Where can you go with that?

  2. The dedicated but poorly paid care staff make care happen by default fortuneatly…!!! Quality care cant happen all the time because staff are under skilled and overworked. Care delivered changes each shift depending on who is working, what their skills are an how well they understand English. We are also dealing with family members who expect champagne service on a beer budget. Where can you go with that?

  3. I am sorry I missed lateline. I have been nursing for 41 years and 2 years ago I moved over to aged care from acute and I am loving it. But saying that I am astounded at the amount of work involved in aged care that RN’s are expected to do for less than what acute RN’s get. Wages certainly have to change to get skilled staff to move over.It all falls Back on the PRIVATE owners to have more respect for the staff at the facilities who do all the hard work.
    Carers you are truly angels. These facilities would not function without you.

  4. I have beeb iin Aged care for the past 20 years alway updating my qualifications. I recently moved to SA and worked as a carer in an aged care facility and was horrified by the lack of knowledge and skills the nursing and personal carers had. We are intrusted to maintain the residents care as through it was in their own home. People where only showered in the morining ( what happeded to residents choice). Nurses where holding resident down to give injections. In that time I found over 100 medications either left on the table or spat back out in drinks.When I approached the RN and said I was going to complete an incident report she told me it wasn’t my place to do so. Then she threw them down the sink. I was appalled and decided to go back into training student to empower and ensure the correct training was provided.

  5. There are many issues that affect us in aged care. It is not simply skill. No matter how skilled the person is, if you do not have the resources to do your job well you cannot.

    Examples of this are:

    Access to GP’s
    Access to hospital
    Access to services eg dental
    time to spend with people One to one (wellbeing)

    Often I have had to get families to change doctors to ensure the correct treatment for people in residential care. Doctors will not visit or leave us waiting for them to come. Pain relief does not get managed correctly.

    As a last resort I would send people of to hospital only to have to ring the hospital, get an admitting doctors name and then I could call an ambulance. Often the doctor will not accept the person as they do not see it as important nor as a priority. Hospital’s see older people as taking up valuable time in an emergency room. Since when was medical treatment not available to you because you were over 65.

    Why should I have to explain myself to a doctor when a person needs adequate pain relief that cannot be obtained in the aged care facility because GP’s are not available. The GP’s are closing their books to patients.

    In some facilities accreditation does not pick up the abuse of residents or neglect of residents. I have lost my faith in the systems.

    There a far more skilled workers in the sector than you give credit to. We work with limited resources, higher demands, specialist skills but still people say “we are not skilled” we are, we cannot fit the demands of the sector/governments/accreditation in the time frames you give us as well as being under resourced.

    You should look at the times staff attempt to give good care but can’t because there are no resources to give the care, no pain relief written up and it is the weekend or a GP has been coming and we are still waiting, continence pads withheld because they are too expensive, give them less to drink. Staff who advocate and then loose their job. I don’t see this making head lines.

    I love aged care and it is time people looked at the big picture. We are skilled.

  6. l have worked in aged care for more than fifteen years my last seven as an EEN Medication endorsed, carers and all nurses should be paid more as you are looking after the the elderly when they are most vunerable and like the above comment, it really does depend on the staff that are working on that particular shift as to the care the residents get Carers need continuing education,l have seen some terrible things in aged care facilities over the years even to the point that l myself reported the nursing home to the aged care board, nothing of course was done, l have seen a Podiatrist cutting toe nails where the residents eat, when l asked her to move, she asked me why? l then said to her would you cut your toe nails where you eat,she stated that she had always done it their in the lounge area. l have now moved into educating carers as l want to empower them to do the right thing by our elderly.

  7. I often give reference to the people that I educate and mentor, that working in aged care is like an analogy of roses and onions.

    The roses are the gifts we give in the process of care, the funny things we see only as carers in the daily lives and existence of the people we care for, the things we feel and smell and share, the laughs, tears and fears and love and trust we nurture. The process of good care and the results of a respectful death.

    The Onions are the crappy pay and conditions, the abuse we cop and the stress we take , the anger we receive the guilt we carry off the families, the work environment , the bullying and harassment, the over compliance, the death and the dying, and the ugly reality of the care industry.

    It does not matter how many layers you try to remove there is always another one. Each layer makes you cry and each bite reveals another layer.

    I ask the leaders in care to focus on eating the onions, to create an environment that allows the carers to focus on the roses. Managers, leaders and mentors in care should have the experience and skill to deal with the many layers of the onion, and peel them away for the carer so that they may focus on the true nature of care and learn to smell the roses.
    Accreditation and quality control is very important, however we have to start respecting and paying the people who do the work fairly and properly, build healthy workplaces, and focus on providing care.
    All these new groups, bodies and agencies, all pushing their own agendas. The one thing that we should have in common is providing good care.

    you will never stop the residential services, but you can improve them.

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