In response to the ABC’s Lateline program’s recent coverage of egregious cases of poor aged care[1], the Department of Health and Ageing’s response that these cases are the exception to the rule reflects the Department’s refusal to take problems in Australia’s nursing homes seriously.
CPSA cannot help but wonder that if these cases of neglect and abuse were taking place in childcare centres, rather than denial, there would be a national emergency.
The Department responded to Lateline saying that it “is very concerned that people who watch your program will think that the neglect shown is the norm – this is not borne out by the evidence.”[2]
What evidence, Department?
The only systematic reporting of life in nursing homes is the three-yearly Aged Care Standards and Accreditation Agency reports, which say nothing about health and welfare outcomes of residents, because they are not actually monitored. Rather, these reports say generic, meaningless statements like “the home has systems to ensure there are appropriately skilled and qualified staff to ensure that services to residents are delivered.”
This explains, in part, why the Accreditation Agency won’t detect if a resident is, for example, malnourished or dehydrated because there is no accreditation check by a qualified health professional to see if that’s the case. The CEO of the Accreditation Agency, Mark Brandon admitted as much in response to concerns by a Community Affairs Legislation Committee about malnutrition in aged care facilities. Mr Brandon stated “No, we do not measure nutrition levels. We look at the standards which we expect will stop malnutrition actually happening.”[3]
In contrast to this expectation, studies have found that 50 per cent of nursing home residents are malnourished.[4]
As the Accreditation Agency does not conduct health checks of residents, gauging their wellbeing falls to interviews with them and their families. On average, the Accreditation Agency interviews 16% of residents and/or their relatives when they visit a nursing home.[5] That leaves, on average, 84% of residents and/or relatives not speaking to an assessor. Is it not possible that poor care experienced by the vast majority of residents who are not interviewed is missed by the Accreditation Agency?
If poor care isn’t picked up by the Accreditation Agency, residents and their families can complain to the Department’s Complaint Scheme. Between September 2011 and July 2012, the Scheme received 4,031 complaints about aged care services. Of these, 124 resulted in the Department engaging in compliance action, issuing either a Notice of Intention to Issue Directions or Directions. That represents just over three per cent of all complaints received.
It appears that compliance action taken by the Department in response to complaints is the exception to the rule and raises questions over the ability of the Department to appropriately investigate complaints about institutions for which it has funding and policy responsibility. It is also, therefore, not surprising that stories like these of serious complaints going unsubstantiated by investigators are common.
More worryingly, the Australian National Audit Office recently found that only one in three residents and one in four family members or friends of residents knew that the Complaints Scheme even existed. The ANAO also found that “fear of adverse treatment by management and / or staff of service providers, and disability, including cognitive impairment” contributed to the low rates of complaints made by care recipients, which comprised only 10.7% of all complaints in 2011/12.[6]
There are many out there not complaining because they fear reprisal, or they do not have the capacity to do so, or because they simply don’t know that they can.
The Aged Care Commissioner is the final port of call for people unsatisfied with the result of the Complaints Scheme’s handling of a complaint. In 2011/12, the Commissioner examined and completed 39 complaints. The Commissioner recommended that almost half (18) of the Complaints Scheme’s original decisions be varied or set aside.[7] The number of complaints going to the Commissioner has dropped, which would be a good thing if it reflected satisfaction with the Scheme, but the Commissioner stated that it is too soon to tell.[8]
The Department claims that “while unfortunate issues will sometimes arise, the vast majority of residents in nursing homes live in safety and security.”
There is nothing to back that claim. An analysis by CPSA of what is on the public record shows that over three hundred nursing homes have been exposed for poor care, failing minimum standards or failing to protect residents from neglect and abuse over the past five years.
Failures in basic care provision as exposed on Lateline, like poor wound management and not feeding people enough are not ‘unfortunate issues’. They can mean the difference between life and death for older, vulnerable people.
And if such failings like malnutrition are ‘unfortunate issues’ why do repeated studies suggest the problem is larger than the Department submits? One in five ACT nursing home residents was recently found to be moderately or severely malnourished.[9]
All the mechanisms the Department has touted as being there to protect residents – the Accreditation Agency, the Complaints Scheme and the Aged Care Commissioner – failed to protect the older people featured in the Lateline stories and countless others over the years.
How many more need to be failed before the Department and its Minister admits that Australia has an aged care crisis on its hands?
[1] ABC (2013) ‘Lateline’ 23 August: http://www.abc.net.au/lateline/content/2013/s3832828.htm
[3] Community Affairs Legislation Committee (2010) ‘Health and Ageing Portfolio’ 2 June, available at: http://bit.ly/179M1xo
[4]Gaskill, D., Black, L.J., Hassall, S., Sanders, F. and Bauer, J. (2008). Malnutrition prevalence and nutrition issues in residential aged care facilities. Australasian Journal of Ageing. 27(4):189-194. & Banks, M., Ash, S., Bauer, J. And Gaskill, D. (2007). Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutrition & Dietetics 64:172-178.
[5] The Aged Care Standards and Accreditation Agency (2012) Annual Report 2011/2012,available at: http://www.accreditation.org.au/about-us/annual-reports/ p.16
[6] Australian National Audit Office (2012) ‘Managing Aged Care Complaints’ Audit Report No. 10, pp. 64-65
[7] The Aged Care Commissioner (2012) Annual Report 2011/12, p.16
[8] Ibid., p.2
[9]Lisa Cox (2013) ‘One in five nursing home residents malnourished, study finds’ The Canberra Times 23 May http://www.canberratimes.com.au/act-news/one-in-five-nursing-home-residents-malnourished-study-finds-20130522-2k1oe.html
Nursing Home Black Box 