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Too many one-offs

Whenever a negative story is reported about aged care, peak bodies representing the providers claim this negative story is a “one-off incident”. John Kelly’s response to my recent opinion piece is one such example (Letters, 5/6). The federal government’s recent Future of Australia’s aged care sector workforce (2016) received 73 submissions from staff and relatives who are extremely concerned about standards of care in aged care homes. It is clear from these submissions that many aged care homes employ an inadequate number of staff. In some instances, there is only one registered nurse on duty in an aged care home with 150 or more residents. In some cases, relatives feed, shower and dress residents because staff are too busy. When the call bell is used to get assistance to walk a resident to the toilet, no staff may be available. How many “one-off incidents” are required to indicate systemic failure?

Sarah Russell, Northcote

Time to listen

The arrogance of the letter by John Kelly (CEO, Aged and Community Services Australia) is symptomatic of much that is seriously wrong with the aged care sector.  Residents are starting to be heard – and what they say about standards in many so-called “care” premises is deeply unsettling. Australia may be a good place in which to to get sick – can it be said that it’s a good place to get old?

John Simpson, Melbourne

Optimising aged care funding

Religious, community-based and charitable organisations were once the main providers of residential aged care in Australia. Families could feel reasonably secure that while standards of care would vary, aged care facilities were not motivated by profit. During the past decade, privately owned aged care facilities have grown at twice the rate of those in the non-profit sector. Publicly listed companies are now the fastest growing owners of aged care facilities.

Earlier this year, Bentleys Chartered Accountants reported that profits in the aged care industry rose significantly. Despite the small sample (only 179 aged care homes), their report estimated that net profits jumped 159% in 2015, from $4.14 to $10.71 per resident per day.

The growth in the aged care industry is underpinned not only by our ageing population but also government subsidies. Major aged-care providers such as BUPA, Japara, Regius and Estia receive substantial government subsidies. Estia, for example, received a 10.9% increase in government subsidies during last financial year.

The changes to Aged Care Funding Instrument (ACFI) announced in the recent budget are intended to help curb a predicted $3.8 billion blowout in government subsidies. The changes will save the government $1.2 billion.

The peak bodies that represent providers of residential aged care – Leading Aged Services Australia (LASA), Aged and Community Services Australia (ACSA) and Aged Care Guild – have described these changes as a “budget cut”. The Aged Care Guild complains that the budget is fuelling uncertainty in the industry and could force a rethink on future investment plans.

In an increasingly competitive environment within the aged care sector, peak bodies for providers have successfully lobbied the government for less regulation. The recent Aged Care Roadmap describes “lighter regulation” and a “consumer driven and market based system”. Paradoxically, the providers of aged care homes lobby simultaneously for a decrease in regulation and an increase in government subsidies.

Government subsidies in aged care often serve the interests of the providers more than residents. When a resident is reclassified as requiring a higher level of care, the provider receives more money from the government. However, staff levels rarely change nor are extra services provided to the resident.

Currently, funding for aged care homes is based on a ‘terminal decline model’ rather than ‘restorative care’.  The provider receives additional subsidies when a resident declines. There is no financial incentive for providers to introduce services such as strength training or lifestyle programs that would improve residents’ quality of life. Instead, a provider is rewarded for promoting dependency rather than encouraging wellness.

Under the current arrangements, the providers do their own assessments for government subsidies. Many providers employ staff purely to complete the ACFI paperwork. The role of these staff is to generate income for the employers rather than provide care to residents. Some providers employ Aged Care Consultants who specialise in “ACFI optimization”. These Aged Care Consultants promote themselves as specialists who help to maximise funding for the aged care home.

It is not only the for-profit organisations that are making massive profits in residential aged care. Mecwacare, for example, is as a not-for-profit organisation that offers residential aged care. According to its Annual Report, it made a net profit of $3.9M for the year ended 30 June 2015. It purchased a new head office and added a further six Aged Care Homes to its portfolio.

For both the for-profit and not-for profit sector, ACFI documentation appears to have become a creative writing exercise. It has been reported that one in eight claims for government subsidies are incorrect. Whether the blowout is due to false claims for subsidies or the increasing number of high care residents in aged care is unclear.

The federal government recently introduced fines to curb a growing trend of incorrect, or deliberately false, claims for subsidies. Whether a fine of merely $10,800 for providers who repeatedly make false claims will act as a deterrent remains to be seen. Money may speak louder than the coroner.

Coronial inquests into separate deaths at two aged care homes, BUPA Kempsey and Arcare Hampstead in Melbourne, exposed inadequate care, mismanagement and cover-ups in response to complaints. Despite this inadequate care, 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. Surely this suggests something is wrong with the accreditation processes.

Following the coronial inquiries, both homes were asked to improve their policies and procedures. However, the Aged Care Quality Agency did not change the accreditation processes. The accreditation and outcome standards remain woefully inadequate.

The Australian Aged Care Quality Agency must review the process of accreditation. The accreditation process should play an important role in monitoring the standards of care in all aged care facilities. Given accreditation enables aged care facilities to receive government subsidies, it should not be a rubber stamp.

Aged care homes requires greater scrutiny, accountability and transparency. We need evidence-based information so that we can have informed discussions about how to provide the best possible care for frail, elderly people who live in aged care homes. We need to feel reassured that government subsidies are being used to improve the quality of life of residents, not the pockets of providers.

Dr Sarah Russell is the Principal Researcher at Research Matters and a former Registered Nurse.

Published in Online Opinion

Aged care: Preventable nursing home deaths surge

The Age
Michael Bachelard
29 May 2017

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.”

Dr Russell said the care assistants in Joan Russell’s home were “extremely busy”, but “the other explanation is that there were a lot of people in Mum’s nursing home for whom English was not their first language.

“It’s a real problem, not just for instructions left on a walker, but for communication at all. I don’t know if the person who left the trolley beside my mother was not able to read the instructions or was too busy and forgot.

“We were great friends, my mother and I … It mattered a lot to me that she had the fall.”

Dr Russell received an apology from the facility.

Read more here

Climate emergency

I acknowledge the Wurunjeri people of the Kulin Nation. I pay my respects to their Elders past, present and emerging. I acknowledge that sovereignty has never been ceded.

Reason Party bases its policies on evidence. When I was a uni student in 1979, I first heard the evidence about climate change. Over the next 40 years, the evidence has become more conclusive and more terrifying. Now we have the IPCC’s systematic review based on 15,000 academic articles. Yet our major parties still don’t use this evidence to make credible policies.

It is not only the coalition to blame for the mess we’re in. Shame on both the ALP and the Greens. Fiona Patten’s favourite saying is the “perfect is the enemy of the good”. A member of the Reason Party would have voted in favour of the ALP’s Carbon Pollution Reduction Scheme in 2009. The policy was far from perfect, but it was a start.

And shame on the ALP. Reason Party would not be flip flopping over Adani. We oppose the development of new coal mines, full stop. And we oppose fracking for onshore gas and building pipelines in the NT because it is not evidence-based policy.

Evidence indicates we must close existing coal-fired plants and transition to renewable energy. This is the only way Australia can reduce our emissions in line with the Paris agreement.

Today the coalition released a policy to help younger Australians buy their first home. There is no point buying a home if we don’t have a planet.

Thank you.

Mother Of All Myths That Only Mums Mother

Looking for the perfect gift for Mother’s Day? Forget the dust buster. It’s a myth buster.

Motherhood is a fertile breeding ground for myths. Take the myth implicit in Bill Heffernan’s recent comments about Julia Gillard: that women who don’t give birth are “barren”. When we put this myth into the myth buster, we find that there are many reasons that women don’t have children. Calling these women “barren” denies the rich and fruitful relationships that many women nurture with children – you don’t need ‘your own kids’ to mother.

When people talk about mothering the way Bill Heffernan does, they perpetuate the myth that motherhood is defined by biology, breast feeding and “buckets of nappies”. This limited definition of motherhood assumes that ‘mothering’ is exclusive to biological mothers. It ignores the fact that women without children can also be good mothers and that there are many ways to mother.

There are many other myths around motherhood that we should feed to the myth-buster. Take these old favourites: “only women who give birth are mothers”; “children can only have one mum”; “there is no substitute for a mother’s love” and, the mother of all myths, “that only biological mothers are ‘real’ mothers”.

When the myth buster does its work we see that lots of women mother children – adoptive mothers, step mothers, social mothers, foster mothers, ‘aunties’, friends, neighbours, nannies, and so do some men. It is simply not true that all this mothering is second best or that these contributions to raising a child are less real or less motherly.

A child can have many mothers. In fact, there are many days when many, many mothers are needed – to get the kids to footy or netball training, to prepare dinner and get to the dentist on time, to make costumes for drama club, to drive kids to music lessons and parties, to take a turn with the wheel-chair, the shopping trolley or the pram, to help with maths homework, to remove nits from hair and dispense first aid to the guinea pig.

From childhood to adulthood, lots of people provide mothering in the form of sex education, learning to drive, mentoring about responsible drinking. They also share tears, reveal secrets and provide hugs and support children through the rites of passage. Yes, it takes a village. The myth that only mothers mother denies the important way that women without children can and do contribute to childrens’ lives.

With so many women mothering, why limit Mother’s Day lunch to only one mum? Every Mother’s Day, a lot of women who mother miss out because the traditional celebration of Mother’s day excludes women without children. This exclusiveness can make Mother’s Day a sad day for some women. However, by expanding our view of mothering, and by moving an apostrophe, we can share the celebration and make it a Mothers’ Day.

By acknowledging that mothering doesn’t just come from mothers, we provide opportunities to welcome more women to Mothers’ Day lunch and, in some families, we might also welcome a man or two to the celebration.

It is not only women who benefit from motherhood myth-busting. There are some children who feel sad on Mother’s Day because it focuses on the notion of ‘real’ mums. Kids who do not know their biological mothers, or cannot be with them, may not feel like joining in. However, if we acknowledge that there are lots of ways to mother and place less emphasis on biological definitions of mothering, we could make the lives of some kids happier. If we expand our rules about who is a mother, we might find that more children can enjoy the Mothers’ Day stall at school.

This Mothers’ Day, lets put all the myths in the myth buster and buy a toaster for Philomena for taking kids to the footy, a perfume gift pack for Auriol for all her school holiday baking, gardening gloves for Tina for telling the kids a bed-time story and chrysanthemums for Julia Gillard for caring about the future of work for kids.

This Mothers’ Day, the myth buster is the perfect gift for people who want to share the ritual of breakfast in bed. Perhaps we should send one to Bill.

The Australian May 11 2007

Behind the numbers

Letter, The Age

The federal government cut payments to aged care by $1.2 billion over four to help curb a predicted blowout in costs. Aged care providers are predictably are up in arms. Unfortunately, government subsidies often serves the interests of the providers more than residents.

Under the current arrangements, the providers do their own assessments of residents. When a resident is reclassified as requiring a higher level of care, the provider receives more money from the federal government. However, staffing levels rarely change nor are extra services provided to the resident. One in eight claims are reportedly incorrect.

The Aged Care Funding Instrument is based on residents’ level of care rather than ‘restorative care’.  There is no financial incentive for providers to introduce services such as strength training or lifestyle programs that would improve residents’ quality of life.

The funding of aged care homes requires greater scrutiny and transparency to ensure the best possible care for frail, elderly people.

Sarah Russell, Northcote