Concerns over focus on ‘safety’ in new aged care standards as facilitating consumer choice often involves a level of risk.
Experts have welcomed the government’s moves towards adopting a more sophisticated quality framework where the monitoring of aged care providers depends on the risk profile of their services and their compliance history.
But they say providers should be assessed on how they improve residents’ quality of life rather than against outdated concepts of “safety”, which could inhibit the personal freedoms of those living in residential care.
The government last week released three options for streamlining the assessment of aged care providers against new draft standards.
To varying degrees each option would see quality assessment take into account an aged care provider’s history, the perceived level of risk in its service and its compliance with quality systems in other areas where it operates, such as disability.
- What are the new options? Read AAA’s backgrounder here
Professor Marita McCabe, director of the Institute for Health & Ageing at the Australian Catholic University, said she welcomed the moves to take a provider’s track record into account.
“It would be sensible to base assessment on previous performance rather than putting everyone through the same process because accreditation is a massive process that holds everything up for organisations while they’re going through it,” Professor McCabe told Australian Ageing Agenda.
However, Professor McCabe said she was concerned about the standard’s numerous references to protecting the “safety” of residents given the push in recent years had been on empowering older people and facilitating individual choices.
Professor McCabe said her concern is that the proposals are “still talking about wrapping consumers in cotton wool and making sure that they are safe.”
This focus on safety was a “bit of a disconnect” with the standards’ other references to much more contemporary concepts such as consumer dignity, autonomy and choice, she said.
“Inherent in consumer choice is the notion that there may well be accidents, because if I say I want to go out and do some gardening or I want to go dancing, then I may stumble or trip. So ‘safety’ in that traditional medical sense may well be compromised,” she said.
For years, aged care providers and consumer groups have criticised the current regulations for taking a paternalistic approach that puts the avoidance of risk ahead of facilitating consumers’ individual preferences and wishes.
Professor McCabe also highlighted that the sector is still largely without agreed and validated assessment tools to measure the more nuanced facets of aged care quality.
“We can easily measure how many infections there have been, how many broken hips, the compliance with medication, but how do you measure dignity, autonomy and choice, and all the other things listed on the standards,” she asked.
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Aged care environments are already risk averse and prohibitively restrictive in respect to individual freedom, autonomy and choice. Perceived safety or risk audits simply reinforce paternalistic attitudes that will further restrict activities and basic human rights. Completely at odds with any notion of person centred or consumer directed care. Risk managent does not equal risk removal nor is it consistent with enhancing physical and psychological wellbeing.
Anybody interested in a human rights approach to this topic can follow the link below;
https://www.humanrights.gov.au/human-rights-approach-ageing-and-health-aged-care-reforms-and-human-rights
I was interested to read the article ‘Wrapping consumers in cotton wool’ but I believe as with everything in this World – moderation is the key. My mother is terminally ill and my father has just been diagnosed with Alzheimers disease. I live some distance from them and cannot just zip down to sort dilemmas. Dad was just returned home from hospital after suffering a TIA. My mum had been catching the bus to and from the hospital (half an hour by car and 3 buses) and she wanted to arrange her own way home via taxi with my father. Community Transport was arranged after my phone call to the ward. As my father had memory loss, he did not remember what he was told about having to use his wheely walker all the time at home and did not know how long he was not allowed to drive. I had to find this out, as a caring and worried daughter. Wrapping in cotton wool is sometimes the ONLY WAY to manage a tricky situation. I have done numerous OH&S courses – safety should be a priority. But equally everyone should be treated as an individual. It is a fine line!
I remember watching a webinar where a young woman with disabilities said how fabulous it was for her to go on a cruise. She met with other young people and they took her ashore for excursions. There was no risk assessment, no meetings they just ‘went for it’. She was so animated talking about it – it sticks in my mind. She was just like the rest of the people on board – having fun and having a life. Seems like such a simple request.
If only we could legislate common sense. When did safety become an ‘outdated’ concept?
Human rights charters and academic deliberations provide little help when cognitive impairment is thrown into the mix. Do granny’s rights trump our duty of care if she wants to walk down the freeway in her nightie at 3am in June?
We’d do well to first sort out that very grey area of capacity before blindly championing individual rights.
The only reason accreditation becomes ‘a massive process that holds everything up for organisations while they’re going through it’ is because they’ve dropped the ball since their last one.
And relying on a providers’ track record is a ludicrous proposal… one that only the aged care industry would consider as a viable option (and possibly greyhound racing).
There’s a reason why every financial instrument warns that past results are not indicative of future performance.
Our money receives more protection than our elderly. Or are we now able to predict the future?