Talk given to Leadership team of Care Connect on March 25 2019
I initially chose to publish this article anonymously. When some of the bullies named in the article made threats, including physical intimidation, I suggested Hellocare remove the article from their website until I found time to re-write the article. I am named as the author of the revised article.
Legislation mandates open disclosure in all public health services in Australia. However, there is no legislative requirement for open disclosure in an aged care home.
The media has been reporting story after story of appalling treatment in aged care homes. But aged care is much more than residential care. It also includes home care packages and the Commonwealth Home Support Programme.
Opinion Piece in Michael West
HelloCare 6 December 2018
According to the script of the TV series ‘Yes Minister’, there are two basic rules of government: Never look into anything you don’t have to. And never set up an enquiry unless you know in advance what its findings will be.
During the past decade, there have been many inquiries, reviews, consultations, think tanks and a task force into aged care. These inquiries have resulted in a large number of recommendations, most of which have been ignored by successive governments.
The Aged Care Workforce Strategy Taskforce kicked off in December 2017 with a so-called “Summit”. As an attendee, I was given a lanyard with the slogan: “Think. Collaborate. Innovate”. The slogan, the free hug video and the break out sessions left me feeling discombobulated. However, the lunch was delicious.
With a $2 million dollar budget (courtesy of the Australian tax-payer), I expected the taskforce to answer the million-dollar question: Will standards of care be improved by the government mandating staffing ratios in aged care homes?
Everyone has an “opinion” about staffing ratios. Jane Seaholme’s change.org petition “Mandate aged care staff/resident ratios” has around 300,000 supporters. Staff, relatives, residents, aged care advocates and unions all support staffing ratios in aged care homes. In contrast, those with power – politicians, peak bodies and providers – oppose staffing ratios. They defend their position by citing the 2011 Productivity Commission Report.
To settle the disagreement about the value of ratios in aged care homes, the taskforce needed data about actual staffing levels and quality outcomes in Australian aged care homes. They also needed to compare this data with international data. This would have provided evidence to support or refute the following claim: ‘Aged care homes with a higher staff-to-resident ratio have higher standards of care’.
Several researchers, including those at the Australian Association of Gerontology, encouraged the Chair of the taskforce to undertake a systematic literature review on staffing. A rigorous review of the evidence would have been money well spent. Instead, an annotated bibliography that lacked any critical analysis was commissioned.
Rather than rely on evidence, the taskforce regurgitated industry “opinions” about staffing ratios cited in the Productivity Commission and Tune Reports. Not surprisingly, staffing ratios were once again dismissed.
What was surprising, however, is the Report of the Aged Care Workforce Strategy Taskforce dismissed staffing ratios with only one sentence. “Static models or set staffing ratios will not assist in meeting these expectations or necessarily result in better quality of care outcomes.”
Rather than focus on the evidence, the report provides a transformational ‘Belief Statement’: “We exist to inspire people to want to care, enable people to properly care and enhance life through care. Because how we care for our ageing is a reflection of who we are as a nation.”
This belief statement and the Unifying Vision of Care set the tone for this 40,000-word report. It is overflowing with jargon, modern management language and Don Watson’s so-called weasel words. This made the report difficult to read. The unifying vision of care (see Vision below) appears to follow the amusing instructions of “How to write a manifesto”.
A Unifying Vision of Care (Report of the Aged Care Workforce Strategy Taskforce, P 13)
It is not my intention to be disrespectful, but I needed to use google translator to understand the taskforce’s approach to building the workforce strategy: “The taskforce recognised that the strategy must be disruptive in its thinking, transformational in its approach, pragmatic to implement, and supportive of immediate improvements”. Huh?
I also needed google translator to ‘look forward’: “Looking to the future, the aged care industry requires a coherent strategy and key enabling infrastructure to support the strategic investment, translation and uptake of innovations designed to improve workforce capability, care quality and effectiveness”. Goodness me.
I am also unfamiliar with this lingo: “touchpoints for consumers in their ageing journey”, “a well-supported research translation pipeline” and “the creation of a research translation ecosystem”. Touchpoints, pipelines and ecosystems. What planet are you on?
One thing, however, was clear: the strategy was “developed with the industry, for the industry”. The bias towards an ‘industry-led’ (i.e. not a ‘consumer-led’) strategy was explicit. The aim was “to develop an industry-led strategy focused on the consumer”. Having no union or genuine consumer representation on the taskforce committee was also an ominous sign.
Not surprisingly, given the report’s abstruse language, the taskforce developed complex processes to address staffing issues. The success of these recommendations depends, in part, on a voluntary code of conduct by industry. These codes only apply to those providers who sign up to them. Good luck with that.
Unfortunately google translator did not help me to understand the findings of The Annual Aged Care Survey. I did, however, understand Korn Ferry, a US corporate giant, was commissioned by the taskforce to undertake this staff survey. I certainly wish someone would offer me $90,750 for doing a tick-a-box survey and then running the responses through a statistical computer program.
According to the report: “Korn Ferry knows more about human performance in the workplace than any other organisation.” Apparently “in order to open up career pathways, there are well-established and research-backed corporate methodologies that can be utilised to enable interaction between job families and opportunities to move across job families”.
Without explaining who or what are “job families”, or indeed the “Job Family Framework” methodology, Korn Ferry produced a colourful report – one for all the family. However, the analysis is poorly explained. Even with my expertise as a researcher, I could not make head or tail of it. Who could?
Reading the taskforce report, I was again reminded of the TV series ‘Yes Minister’, specifically one of Sir Humphrey Appleby’s most memorable quotes: “ I do see that there is a real dilemma here. In that, while it has been government policy to regard policy as a responsibility of Ministers and administration as a responsibility of Officials, the questions of administrative policy can cause confusion between the policy of administration and the administration of policy, especially when responsibility for the administration of the policy of administration conflicts, or overlaps with, responsibility for the policy of the administration of policy.”
Like Sir Humphrey Appleby, the taskforce report has a lot of words. But who understands them? And more importantly: who cares?
The Herald Sun Opinion
23 January 2019
The Royal Commission into Aged Care Quality and Safety began last Friday. Scott Morrison announced the Royal Commission on the eve of last year’s ABC Four Corners’ investigation into inadequate personal care, negligence, neglect, abuse and assault in aged care homes.
Before jumping into another expensive royal commission, perhaps Scott Morrison should have reviewed the numerous inquiries, reviews, consultations, think tanks and task forces over the past 10 years. These inquiries provide evidence of appalling standards of care in some aged care homes. They have also resulted in a large number of recommendations, most of which have been ignored by successive governments.
The most dispiriting aspect of all these inquiries is the number of submissions by residents, relatives and staff that have been ignored. Submissions to the recent Review of National Aged Care Quality Regulatory Processes indicated strong support for mandatory staff ratios in aged care homes and for registered nurse to be on duty at all times. However, there was no mention of this in the report.
To prevent poor standards of care in aged care homes, a sufficient number of trained staff must be employed. Although it’s not the only remedy, evidence shows the value of mandating staff ratios in aged care homes.
The government values the safety of children in childcare enough to mandate ratios. The government also values the safety of patients in hospitals enough to mandate ratios. Clearly the government does not value the safety of older people in aged care homes enough to mandate ratios.
The Terms of Reference for the Royal Commission are primarily about the future of aged care. However, if the Royal Commission does not look back, it will not be able to move forward without making the same mistakes. As Albert Einstein said: “We cannot solve our problems with the same thinking we used when we created them”.
To improve standards of care in aged care homes, The Commissioners must review evidence on quality indicators such as pressure sores, medication errors, weight loss, falls, infection rates admissions to hospitals, staffing levels and training in all aged care homes. Currently, these data are not publicly available.
Who decided that data on residents’ safety and wellbeing in aged care homes must be kept top secret? To answer this question, we need to go back more than 20 years when the Aged Care Act 1997 was drafted.
The Aged Care Act 1997 was a turning point for aged care policy in Australia. It encouraged a large increase in private investment. Private equity firms, new foreign investors, and superannuation and property real estate investment trusts entered the residential aged care market. Many of these companies focus on profits rather than standards of care.
The dean and head of the University of South Australia’s law school Wendy Lacey has criticised the Aged Care Act, arguing that there is “a complete absence of any positive and mandatory legal obligation on the part of facilities to take proactive measures to promote mental health and wellbeing of their residents”.
The standards of care in aged care homes are a human rights issue. The only way to ensure higher standards of care is for the government to rewrite the Aged Care Act. The government needs to work not only with aged care providers, but also staff, residents and their families.
We need a new Aged Care Act that focuses on Human Rights of older Australians not the profits of providers. We need a new Aged Care Act to ensure the highest possible standards of care in all aged care homes.
Dr Sarah Russell is the Director of Aged Care Matters