A new independent study by Dr Sarah Russell, of Research Matters, titled ‘Working Well in an Aged Care Home’ asked staff to fill out a survey on what they enjoy about their jobs. Conor Burke reports
Last week, HelloCare invited me to comment on the requirement in the new Aged Care Quality Standards for open disclosure. I suggested all aged care homes and home care providers should be required to report adverse incidents not only to the older person and their family but also on their websites.
I am pleased both Ian Yates (CEO, COTA) and Darren Mathewson (Acting CEO of ACSA) have contested this idea for improving transparency. I always welcome debate. A public debate about transparency in the aged care sector is long overdue.
This is my response.
While some older people are enjoying their wealth – travelling the world, their luggage broadcasting that they are spending their children’s inheritance – others live in aged care homes, with their children keeping their eyes peeled on the ‘Bank of Mum and Dad’.
Recently, a woman contacted me because a 94-year-old woman was resuscitated in an aged care home despite having an advance care plan stipulating Do Not Resuscitate. Rather than die peacefully after breakfast, this woman had a slow and painful death in a hospital palliative care unit.
A confidential internal inquiry into the office of the Aged Care Minister Ken Wyatt was leaked to the media during the recent election campaign. The journalist described the leaker as a “whistle blower.”
Whistle blowers are honourable people who are motivated by altruistic intentions. Anonymous disgruntled staff members who are dissatisfied with the outcome of an internal grievance process are not whistle blowers.
I have never worked in Minister Wyatt’s office so I do not have inside knowledge. However, this leak had all the markings of a political attack.
Our democracy depends on the robust contest of policies. Yet so far the federal election campaign has been dominated by personal insults, pork barrelling and heated discussions about preference deals. I’ve hardly heard a whisper from candidates about their party’s aged care policies.
I am standing as a candidate for Reason Australia in my local electorate (Cooper in inner city Melbourne) so I can put aged care in the election spotlight. Reason brings an evidence-based approach to all its policies, including aged care policies.
Aged care needs evidence-based, not opinion-based, policies. It also needs kindness. Rather than listen to the opinions of the usual suspects who are part of the broken system that has failed older Australians, we need new thinking. To quote Albert Einstein: “We cannot solve our problems with the same thinking we used when we created them”.
Talk given to Leadership team of Care Connect on March 25 2019
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.
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?