Aged care homes are places where our most vulnerable older people live. How do we ensure the highest possible standards of care?
Download Report LivingWellAgedCareHome
We hear a lot of heart-breaking stories about neglect and abuse in aged care homes. We hear much less about older people who are living happily.
“The most reliable indication that residents are living well is their demeanour”, says Dr Sarah Russell, a public health researcher and aged care advocate. “Families are reassured when residents are happy, well groomed, pleased to see staff members and call the aged care home their “home”.
Dr Russell collected more than 170 personal stories from relatives who visit an aged care home. Relatives described what was good about the aged care home, and what was not good. They also made suggestions about how to improve the quality of life of residents. These stories provide a rich source of experiences to inform policy.
“The report is unsettling to read in parts, but that is its value and significance”, says Dr Russell. “In a system where policy and practice is dominated by perspectives of providers and professional groups, it is unique to hear the experiences of people who regularly visit an aged care home. These personal stories have the power to influence decision makers.”
Some relatives described older people being happier in an aged care home than when they lived at home alone. They have company, regular meals and an opportunity to be engaged in different activities.
“The key to high quality care in an aged care home is competent caring staff,” says Dr Russell. “Problems occur when there is not enough staff.”
During the past decade there has been a decrease in registered and enrolled nurses working in aged care homes and an increase in personal care attendants.
“There is strong evidence of a correlation between registered nurses and standards of care”, says Dr Russell. “Registered nurses are trained to manage complex health conditions. Having registered nurses on duty not only improves clinical management but also prevent admissions to hospital. This is important for both the resident and the public purse”.
Relatives want the federal government to legislate staff-resident ratios and skill prerequisites in all aged care homes. “There is currently legislation in childcare centres but not aged care homes.”
Relatives claim the care of vulnerable older people should not be left in the hands of providers seeking to maximise profits. They believe effective regulation and increased transparency will help to prevent neglect in aged care homes. “We cannot simply rely on providers doing the right thing.”
This research demonstrates why the federal government must make systemic changes so the community can be reassured that all residents in all aged care homes receive an acceptable standard of care.
Download Report LivingWellAgedCareHome
Aged-care homes require a highly skilled workforce plus robust regulation.
More than 160,000 Australians live in an aged care home. Recent media reports have highlighted inadequate personal care, neglect, abuse and negligence suggesting that the quality of care in some aged care homes is a disgrace.
Dr Sarah Russell appeared on The Project to discuss her mother’s fall in an aged care home. This fall contributed to her mother’s death.
The Age, Michael Bachelard
Sarah Russell’s mother, Joan, died in a nursing home in September 2015. She believes the death was premature.
“When my mother was engaged, she was terrific. When she was alone and not engaged, she’d suffer anxiety … [and] she would get up and walk,” Dr Russell, a public health researcher, said.
Dr Russell gave up work to look after her, but she could not be there at all times, so she attached a note to her mother’s walking frame to warn the personal care assistants at the aged care facility not to leave her walker within reach.
One day, in the dining room after lunch, they did.
“She got up and walked, fell over. She didn’t break her hip, but she did damage her ribs, and six weeks later she was dead. The GP made the connection between the fall and her decline … I think the fall hastened her death.”
Registered and enrolled nurses now account for less than 27% of this workforce, while personal care attendants (PCAs) make up 68%. Much of the hands-on care that registered and enrolled nurses once provided is now being provided by PCAs.
Last month the Courier Mail reported yet another heart breaking story about aged care homes (Aged care nightmare: man’s scrotum ‘left bleeding’, 20th February). Many of us were shocked because we assume elderly Australians receive high quality care in aged care homes.
The Federal Government is promoting its reforms in the aged care sector as supporting a consumer driven and market-based system. However, the “consumers” in aged care homes are often frail, elderly people, many with dementia. How can they demand a high quality service on the free market?
There are around 2,600 aged care homes in Australia. Although some are excellent, many aged care homes operate without enough staff. Managers who are under pressure to meet their profit targets do so by reducing staff, placing vulnerable residents at risk.
Staff in aged care homes are often hard-working, dedicated people doing a very difficult job for not much pay. When an aged-care home has insufficient staff, there may not be time for staff to walk residents to the toilet or even help them out of bed. All too often relatives feed, shower and dress residents because staff are too busy.
A key to quality healthcare is a good staff-patient ratio. However, unlike hospitals, there is no federal legislative requirement for aged-care homes to have mandated staff-to-resident ratios or skill prerequisites. The decision whether to have a registered nurse on duty is at the discretion of the provider.
When registered nurses are on duty in aged care homes, residents have better health outcomes, a higher quality of life and fewer hospital admissions. However, registered nurses now account for less than 27% of this workforce, while personal care attendants make up 68%.
Some personal-care attendants gained their qualification to work in an aged care home after completing a five-week course. It is inconceivable that someone with only five weeks of training is qualified to provide competent care, particularly when there is no registered nurse on duty to supervise them. Is it any wonder relatives’ submissions to recent inquiries into aged care have highlighted inadequate personal care, neglect, and negligence?
Relatives complain because residents’ needs are unmet – when incontinence pads are not changed regularly, when bruises appear or skin tears, and when pressure sores are not treated appropriately, in some cases turning gangrenous. Complaints are also made when residents suffer from malnutrition and/or dehydration and are chemically restrained. The list goes on.
The accreditation process should play an important part in monitoring the standards of care in all aged-care homes, including whether adequate numbers of skilled staff are employed. The current accreditation standards are woefully inadequate.
Coronial inquests into separate deaths at two aged care homes in Melbourne, BUPA Kempsey and Arcare Hampstead, exposed inadequate care. Yet both BUPA Kempsey and Arcare Hampstead were fully accredited by the regulator, the Aged Care Quality Agency, with perfect scores of 100 per cent in all criteria. This suggests something is wrong with the accreditation processes.
Following the coronial inquiries, the Aged Care Quality Agency did not change the accreditation processes. Vague phrases such as “sufficient staff” continue to be used. In some cases, sufficient staff means no registered nurse on duty. It may also mean an inadequate number of personal-care attendants.
When taxpayers are subsidising the care of elderly people, the public’s investment needs to be protected in the form of regulation, mandated staff ratios and a rigorous accreditation system. The care of vulnerable older people is too important to be left to the whims of the free market.
Published in Courier Mail on 27 March 2017
What would make a man eulogise about his dead father at his mother’s funeral and then propose a toast to his “mother and father”?
This eulogy was more than your garden-variety misogyny. It was misogyny on steroids.
Listening to the eulogy, I was transported back to the to the Victorian era. In those days, a wife lost her personal identity when she acquired her husband’s name. A wife became her husband’s property, his chattel.
Victorian marriage and property laws stipulated that a married woman did not have a separate legal existence from her husband. A married woman was a dependent, like an underage child or a slave, and could not own property in her own name or control her own money.
The laws changed over a hundred years ago. Thankfully so too did attitudes towards married women. Older women may be the last bastion of Victorian traditions.
Some older women are treated like an underage child after their husband dies. They are encouraged to appoint a financial power of attorney because older women, particularly those who have not been the family’s breadwinner, are assumed to be incapable of managing their own financial affairs. Not only is this patronising but also it disempowers older women.
The ultimate act of disempowerment is when an older woman is declared legally incapable. According to the Office of the Public Advocate, older women are more likely to be declared legally incapable than older men. This may be due to the fact that women live longer than men. It may also suggest that older men are revered while older women are infantilised.
Once an older woman is declared legally incapable, an enduring power of attorney, both financial and medical, is appointed. The financial powers of attorney take complete control of their mother’s financial affairs. The older woman is then transported back to the Victorian era. She loses control of her own money, just like a young child.
Financial powers of attorney are required to act in the older woman’s best interest. If they don’t, it is financial elder abuse.
There is little reliable data on the extent of financial elder abuse. State Trustees Victoria found that women over the age of 80 are most at risk of financial elder abuse. They found that adult sons were the most common perpetrators of financial elder abuse.
Financial elder abuse may begin with the best intentions – with children acting as their mother’s financial power of attorney thereby managing her finances. This can quickly progress to a sense of entitlement, particularly when adult children have mortgages or debts.
In some families, children are not willing to wait for their inheritance until after their mother dies. They assume what was once ‘Mum and Dad’s money’ is now their money, not their mothers’ money. They may even curtail the amount of money their mother spends.
There have been several high-profile trust fund disputes in which sons have sued their mothers. In one case, a former pupil of a private boys school in Sydney sued his mother after the family estate was left to his mother rather than to him. This “old boy” was castigated by the judge for having a “highly developed and unhealthy sense of entitlement“.
Financial elder abuse is currently not a criminal offence in Australia. It is treated as a private issue, like family violence was treated during the Victorian era – before the work feminists did to make it a public issue. For financial elder abuse to become a criminal offence, attitudes towards older people, particularly older women, need to change.