Who cares … Arcare?

Who cares … Arcare? Aged care providers still charging for services never provided, regulator hiding

Some aged care providers are a law unto themselves. Although Australian Consumer Law makes it illegal for a business to accept payment for products and services that are not supplied, some aged care businesses wilfully break the law. Residents in these aged care homes are charged for services they do not use.

Residents may be charged for services such as an internet connection, irrespective of whether they use the internet. Teetotallers may also be charged for wine with dinner. Rather than protect residents from this financial abuse, the Minister for Aged Care and the national regulator of aged care services continue to turn a blind eye.

According to legislation, additional services can only be charged if the resident “receives direct benefit or has the capacity to take up or make use of the services”. Aged care providers must not only regularly review a resident’s ability to derive a benefit from the additional care or services but also itemise these additional services in a monthly statement.

When Mr and Mrs Jones entered an Arcare residential facility, the contract included an Additional Services fees of $20 per person per day. So what did this buy them? A choice of menu for lunch and dinner; a selection of wine and beer with dinner; weekly hot cooked breakfast; exclusive use of the private dining room; weekly pre dinner drinks; weekly high tea; daily newspaper in communal areas; wireless internet in your private suite; exercise classes; Foxtel, and local small group outings. Other items listed in the agreement, included, a welcome gift on arrival, exclusive use of private dining room and two meals for family and friends on first day. So residents had to pay for their own welcome gift – seriously?

When Mr and Mrs Jones’ daughter questioned paying an extra $140 each per week, Arcare agreed to reduce the fee to $70 per week, on the condition that Foxtel was removed from each room.  Was Arcare charging her parents $10 per day to access Foxtel?

Each month Arcare provided an invoice. This invoice included ‘daily care fees’, ‘means tested fees’ and ‘additional services’. However, these ‘additional services’ were not itemised – so there was no way of knowing which of these ‘additional services’ Mr or Mrs Jones had used. Did they have wine for dinner or attend an exercise class?

When the daughter realised that Mr and Mrs Jones were not using any of the additional services, she asked to have the fee abolished. However, Arcare refused. So, the daughter made a formal complaint to the aged care regulator – Aged Care Quality and Safety Commission (ACQSC).

Eight months after her initial complaint, and after numerous follow up emails, the daughter was advised that ACQSC had not been able to resolve the complaint.

The daughter did not give up. She contacted ACCC, the Commonwealth Ombudsman and the Office of the Australian Information Commissioner and Older Persons Advocacy Network – all to no avail. She then went back to ACQSC. Surely it was their job to ensure aged care providers acted lawfully.

Her persistence paid off. Fourteen months after her initial complaint, ACQSC issued a ‘Notice of Intention to Give Directions (Notice)’ to Arcare. According to this Notice Arcare:

  • charged an additional services fee for a bundled package but did not provide an itemised cost for each service;
  • had no review process to assess a consumer’s capacity to benefit from the additional services provided; and
  • included care and services in a package of services already required to be provided under the Quality of Care Principles 2014 (e.g. a communal newspaper, a choice of meals at lunch and dinner, exercise classes and bus outings).

In response to the Notice, Arcare proposed a range of actions it would take. However, these actions were not sufficient to address the complaint. So ACQSC issued Directions to Arcare. These Directions outlined the actions Arcare was required to undertake (including necessary timeframes) in order to meet its responsibilities under the Aged Care Act 1997. Arcare was required to:

  • take action to provide an itemised list (including costs) for each element of its bundled package of additional fees;
  • provide accurate information about the availability and access arrangements for the included care and services;
  • only charge for additional care and services where care recipients are able to derive a benefit from them;
  • cease charging for items that should be provided under the Quality of Care Principles 2014; and
  • provide refunds where they have charged additional fees unlawfully.

Arcare challenged the Directions Order in the Federal Court. It soon became clear that ACQSC was no match for Arcare’s lawyers. After a year of legal shenanigans, ACQSC advised the daughter to negotiate directly with Arcare for compensation. However, the daughter was not fighting only for her parents. She was fighting for all Arcare residents who are charged for services they do not use.

Arcare continues to charge additional fees irrespective of whether residents use these services. They also do not provide an itemised list (including costs) for each service (see recent invoice).

Although the aged care regulator is fully aware that Arcare and other aged care providers are not acting in accordance with aged care legislation, ACQSC has washed its hands. ACQSC simply does not have the power to enforce residents’ legal rights. What is the point of the government introducing a new Aged Care Act without a strong regulator with the power to enforce legislation?

In 2018, Regis and Japara were forced to repay residents millions of dollars that had been charged to clients under the guise of an ‘asset refurbishment fee’. The ‘asset refurbishment fee’ that was declared illegal by the Federal Court. It’s well past time for Anika Wells, Minister for Aged Care, to step up and declare it illegal for aged care providers to charge residents for services that they are not receiving in an aged care home.

Falls, Bed Rails & Reality

The following was posted by Tony Northcote, a member of the Aged Care Matters Facebook Group. I am not sure of why Facebook disabled the comments – perhaps due to its length. I have reproduced the post here until Facebook replies to our messages. I have not included the links that Tony supplied.

************

“A recent post concerning falls quickly generated over 130 comments. While I have no doubt the members of this group only have the best intentions, there are obviously some misconceptions about falls and how to deal with them.

Advances in clinical management come from evidence-based information. We wouldn’t expect any less than a thorough examination of any new drug, procedure or practice. Please be careful with anecdotal advice, do your own research and leave emotion at the door.

Apologies in advance for the length of this post…but this is such a big subject and I’ve only scratched the surface

(A special mention to Eddie Uzsakt for collating some of the recent discussion points)

As a clinician and manager for thirty years, here’s what I know to be true: I invite you to consider the following:

Falls

There is only one way to prevent old people falling…invent an anti-gravity device. Until then, gravity will ALWAYS win.

According to the AIHW, falls are Australia’s leading cause of injury hospitalisation and death, representing 43% of injury hospitalisations and 42% of injury deaths. It’s no surprise that the highest risk group is females over the age of 65…and the risk increases exponentially as we get older.

In 2021-22, fall injuries in people 65 and over accounted for 60% of hospitalisations and 94% of deaths. The full data set can be found on AIHW website.

It makes for sobering reading. It shows that falls are an extensive and common problem for the entire population and almost an inevitable consequence of getting old and frail.

Despite the thousands of researchers writing thousands of research papers and developing lots of great preventative strategies, we’re still falling…a lot. When you throw some cognitive impairment, frailty, poor vision, decreased strength and chronic diseases like Parkinson’s or diabetes into the mix, we’re almost guaranteed to hit the deck at some stage.

My point here is that while there are certain interventions that can and should be implemented in residential aged care, none of them are 100% effective….it’s just not possible to prevent every fall.

If your expectations don’t align with this reality, you’re setting yourself up for a fall (Sorry).

Bed Rails

This is not the 1950s…DO NOT use them. Although some people consider they’ve had a win by getting them installed, the numbers don’t lie…they are dangerous. There is a plethora of information available on the dangers of bed rails.

It’s important to note that even when all the known risks have been managed, no institution can guarantee that mattresses won’t be swapped and beds relocated in the normal course of daily operations, so a mattress or bed that may have initially had the correct clearance measurements can easily become a potential injury risk.

Padded or covered bed rails are still dangerous. They isolate the person and will fall from a greater height when they climb over them. And it’s not just the bed rail structure that needs to be considered: is the mattress correctly matched to the bed base? Is there a gap of more than 10cm between the mattress edge and the rails? Have the rails been fitted correctly (you wouldn’t believe how many get installed reversed).

Hospital bed side rails are different. They’re segmented: typically two – three separate sections on each side and they are only a few hundred mm high. You’ll also note they swing out and under the bed, not along the length of the bed.

For the most part, hospitals aren’t very good at caring for people with dementia…they’re ill-equipped in both design and skill when it comes to severe cognitive impairment. Even with nurse /patient ratios as high a 3: 1 in some areas, aged care residents regularly hit the deck during a hospital admission. (Hospitals are also very quick to reach for the Benzos and anti-psychotics when someone doesn’t ‘behave’)

While you might think you’re acting in the person’s best interest when you demand that bed rails are fitted… you really aren’t. I lay the blame squarely on the facility manager and other key staff. They obviously haven’t sat down with you to have a candid discussion or provided the evidence that would at least give you some confidence when deciding not to use bed rails.

Solutions?

Despite the utopian assertion that falls are preventable, they’re not. The current data suggests that only about one third of all falls are linked to potentially preventable factors.

For the cohort we’re all concerned about, falls prevention is a nightmare. Consider just a few of the increased risk factors Mum or Nana are dealing with:

Decreased mobility, balance and dexterity

Failing eyesight and hearing

General physical decline

Cognitive impairment

Arthritis: there goes your flexibility and here comes the pain

Diabetes: complications include blindness and peripheral neuropathy (the inability sense the position of your extremities plays havoc with your proprioception)

Parkinson’s, Stroke and a myriad of other neurological conditions that can impact balance, strength and spatial awareness

Continence issues: when you gotta go…

Polypharmacy: Probably one of the biggest offenders…hands up everyone taking 5 or more regular medications?

The list of potential risk factors is extensive…you can appreciate the challenges.

Here are a few things that can actually make a dent in fall rates.

Strength and balance training: If your facility physio isn’t running daily exercise classes that specifically target these areas, ask them why not….and then lobby the service to implement a suitable program. A month of sit to stand exercises and balance work can yield extraordinary results for almost everyone. (Just being able to get on and off the toilet safely can significantly impact fall rates)

The Environment:

De-clutter the room,

If they use a walking aid, make sure it’s easily accessible,

Good lighting is essential… and always have a night light on

The best room designs will ensure the bathroom is clearly visible from the resident bed.

Make sure the call bell is in reach

Make sure the things they need are close at hand (TV Remote, glasses, water, tissues, etc.)

For the ambulant resident, get rid of the ill-fitting sandals and fluffy slippers and buy some comfortable joggers with non-slip soles

Ensure the bed is always set at the appropriate height when they’re in it.

No floor coverings with swirling or geometric patterns. These affect orientation and spatial awareness in older persons and even more so in those with cognitive impairment.

Regular and individualised toileting schedules

Medication reviews: This is a big one. GPs are good at prescribing but not so hot with de-prescribing. Is the person still on the same dose of blood pressure medication they were taking when they were more active and living at home? I’d wager the answer is yes. This is something that frequently gets missed…a person enters residential care, becomes more sedentary and starts falling down whenever they stand up because their blood pressure is too low. A pharmacist review is a good place to start…then get a geriatrician to look at their entire medication regimen. They should be the one who has the helicopter view of the entire person. Endless trips to specialists and the cumulative tinkering with medications are a recipe for disaster. Frustratingly, the medical profession continues to operate with a silo mentality, so you need someone who knows what they’re doing to take a holistic view. (You can also help by not pressuring the GP to prescribe additional medications for every minor or temporary ailment. You don’t need to treat everything, every time)

.Ditch the sleeping tablets. Mum might be used to taking them every night for past twenty years, but they stopped being effective about two weeks after she started. After a very short period, benzos are essentially useless as sleeping meds but they remain very effective at screwing with alertness and motor coordination.

Try to reduce the need to pee overnight: less chance of falling as they groggily stumble to the loo and a better chance of getting a good night’s sleep.

Ease up on the coffee and tea after 6pm.

If they’re taking diuretic tablets, these should be administered in the morning. If they’re prone to oedema and their legs swell up over the course of the day, make sure they reduce the fluid intake from the late afternoon and put their feet up regularly. (When they finally get into bed at night, reabsorbing all that retained fluid can be the equivalent of downing a few schooners)

Consider the facility’s daily routine. Do the afternoon staff come on duty at 3pm and start putting people to bed? This is an appallingly common practice and effectively sentences some residents to being in bed for 18+ hours every day (No wonder they become restless and try to get up). The very frail should have an afternoon rest and be up for the evening meal…and nobody should be in bed before 7pm unless they specifically request it (and you can’t talk them out of it!) And you can’t just leave someone in a tub chair all day either.

But…

Some people with cognitive impairment will be more challenging. After all, they’ve been used to getting around independently for the past eight or nine decades.

Even the very few useful interventions available are still just reactive. Bed sensors only alarm after someone gets out of bed (Although, they are very effective at generating ‘alarm fatigue’; endless false alarms induce staff complacency “…don’t worry, it’ll just be another false alarm…’’) and most of the sensors on the market are ordinary, at best.

Infrared bed exit sensors can be useful, but you won’t find many places that use them…or if they do, have them set up correctly.

Placing someone in a lo-bed attempts to reverse the circumstances…now gravity is working against the person as they try to stand up and not with them as they fall down. There is some interesting research on the physics of falling and the height /speed /force, etc. that causes injury; ideally, we should aim for a total bed height under 30cm. (including the mattress). Good lo-beds will easily go lower than that.

Use proper crash mats: not the spongy foam units you see in most facilities. The high density foam mats are only a few centimeters thick and you can stand on a chair and drop onto your knees without sustaining any injury (try doing that with your current crash mat…actually, don’t)

The person will probably still roll onto the floor but the chances of serious injury are greatly reduced (but NOT eliminated entirely).

Note: When used for a person who has been assessed as requiring assistance with mobility, has been reviewed by the physio, GP, clinical manager, etc. and discussions held with their representative, Lo-Beds are NOT a form of restraint. Although the commission identified them as a form of restraint in a 2020 regulatory bulletin, this does not accord with the legislated definition: (They do not impede or restrict the free movement of the resident.) A few years back the commission would crucify you for not using low beds…now, their reactive and ham-fisted interpretation of the legislation has them more interested in regulation than preventing head injuries. If your facility manager can coherently present this rationale they’ll easily counter any allegations of noncompliance.

Furphies

‘Dignity of risk’ is getting a quite a flogging of late…it’s almost as popular as ‘open disclosure’. People seem to like using these terms; it gives the impression you know what you’re talking about

With regards to falls, restraint and consent, one can’t just say “dignity of risk” and call it done. It’s way more nuanced because the ethos rarely matches the reality. This topic warrants its own separate discussion, but suffice to say it does not mean we allow people to exercise choice in ALL circumstances. Nor does it give the right to place your relative in jeopardy just because you can. When a service asks you to sign a waiver (most of these are less useful than toilet paper) they’ve already calculated the implications of risk and their obligations as a healthcare provider and concluded it’s easier to transfer the responsibility to someone else….you!

Please be very careful with this stuff. Also, recognise that when we act as someone’s representative, we’re often basing our decisions on their historical preferences; in many instances, those preferences are no longer appropriate.

A Falls Management Plan sounds like a useful document. But in practice 99’9% of them are essentially useless pieces of paper, produced for the sole purpose of appeasing the commission at audit time. Line up all the plans at any facility and you’ll see the same generic ‘intervention strategies’, the same aspirational toileting schedules and the same set of mobility and activity directives that the staff aren’t following. How could they when nobody actually reads these things?

(It never ceases to amaze me that people continue to believe these documents inform the delivery of care. Does anyone seriously believe that all care personnel read the entire thirty+ pages of care plans for every resident at the beginning of every shift?)

Many of the ‘standard’ protocols in aged care serve no valid purpose. The Falls Risk Assessment Tool (FRAT) is a good example: Like most predictive tools, they just give the impression that something is being done. Ask anyone about the care strategy differences for a medium falls risk and a high falls risk: they won’t be able to tell you because there aren’t any. Even more curious is the number of providers who insist that a FRAT is done after every fall. Even for people who are already rated as high risk. This is absurd…there’s no point doing the same risk assessment after the event… And there’s no such thing as an ‘extra-high’ risk category.

Sight charts and monitoring charts: Hourly, half-hourly, 15 minutes…There’s no point. Check them every 5 minutes? They can still fall over right after you’ve checked them. We used to call these “lie to me” charts. Staff will typically batch complete them at the end of the shift. (Having to battle with a dozen or more of these ludicrous documents every shift, I would too).

Anyone trying to sell you this as an effective strategy is either incompetent or trying to hoodwink you.

Finally

While there are some acute medical situations where restraint is a valid intervention, it’s rarely the case in residential care. Keeping a person restrained “for their own good” is problematic. Tying them up or caging them in is a clumsy and primitive approach to a complex problem.

Ultimately, this is an ethical and moral dilemma: do you keep someone ‘safe’ by restraining them and turning their every waking moment into a torment of frustration, confusion and distress…or do you implement the things you can and accept the consequences? Do you want them to live or just exist? Are you looking for quality or quantity? What would your mum have wanted for her final months… drug- addled imprisonment or freedom (and all its associated risks?) I know what my choice would be. I think we sometimes forget that our folks have been through wars, depressions and much greater risks than we’ll ever experience. We can certainly improve on the current standard of care but there is no perfect solution…so please don’t beat yourself up because you’re unable to fix everything.

Falls, Bed Rails & Reality

A recent post concerning falls quickly generated over 130 comments. While I have no doubt the members of this group only have the best intentions, there are obviously some misconceptions about falls and how to deal with them.

Advances in clinical management come from evidence-based information. We wouldn’t expect any less than a thorough examination of any new drug, procedure or practice. Please be careful with anecdotal advice, do your own research and leave emotion at the door.

Apologies in advance for the length of this post…but this is such a big subject and I’ve only scratched the surface

(A special mention to Eddie Uzsakt for collating some of the recent discussion points)

As a clinician and manager for thirty years, here’s what I know to be true: I invite you to consider the following:

Falls

There is only one way to prevent old people falling…invent an anti-gravity device. Until then, gravity will ALWAYS win.

According to the AIHW, falls are Australia’s leading cause of injury hospitalisation and death, representing 43% of injury hospitalisations and 42% of injury deaths. It’s no surprise that the highest risk group is females over the age of 65…and the risk increases exponentially as we get older.

In 2021-22, fall injuries in people 65 and over accounted for 60% of hospitalisations and 94% of deaths. The full data set can be found on AIHW website.

It makes for sobering reading. It shows that falls are an extensive and common problem for the entire population and almost an inevitable consequence of getting old and frail.

Despite the thousands of researchers writing thousands of research papers and developing lots of great preventative strategies, we’re still falling…a lot. When you throw some cognitive impairment, frailty, poor vision, decreased strength and chronic diseases like Parkinson’s or diabetes into the mix, we’re almost guaranteed to hit the deck at some stage.

My point here is that while there are certain interventions that can and should be implemented in residential aged care, none of them are 100% effective….it’s just not possible to prevent every fall.

If your expectations don’t align with this reality, you’re setting yourself up for a fall (Sorry).

Bed Rails

This is not the 1950s…DO NOT use them. Although some people consider they’ve had a win by getting them installed, the numbers don’t lie…they are dangerous. There is a plethora of information available on the dangers of bed rails.

It’s important to note that even when all the known risks have been managed, no institution can guarantee that mattresses won’t be swapped and beds relocated in the normal course of daily operations, so a mattress or bed that may have initially had the correct clearance measurements can easily become a potential injury risk.

Padded or covered bed rails are still dangerous. They isolate the person and will fall from a greater height when they climb over them. And it’s not just the bed rail structure that needs to be considered: is the mattress correctly matched to the bed base? Is there a gap of more than 10cm between the mattress edge and the rails? Have the rails been fitted correctly (you wouldn’t believe how many get installed reversed).

Hospital bed side rails are different. They’re segmented: typically two – three separate sections on each side and they are only a few hundred mm high. You’ll also note they swing out and under the bed, not along the length of the bed.

For the most part, hospitals aren’t very good at caring for people with dementia…they’re ill-equipped in both design and skill when it comes to severe cognitive impairment. Even with nurse /patient ratios as high a 3: 1 in some areas, aged care residents regularly hit the deck during a hospital admission. (Hospitals are also very quick to reach for the Benzos and anti-psychotics when someone doesn’t ‘behave’)

While you might think you’re acting in the person’s best interest when you demand that bed rails are fitted… you really aren’t. I lay the blame squarely on the facility manager and other key staff. They obviously haven’t sat down with you to have a candid discussion or provided the evidence that would at least give you some confidence when deciding not to use bed rails.

Solutions?

Despite the utopian assertion that falls are preventable, they’re not. The current data suggests that only about one third of all falls are linked to potentially preventable factors.

For the cohort we’re all concerned about, falls prevention is a nightmare. Consider just a few of the increased risk factors Mum or Nana are dealing with:

Decreased mobility, balance and dexterity

Failing eyesight and hearing

General physical decline

Cognitive impairment

Arthritis: there goes your flexibility and here comes the pain

Diabetes: complications include blindness and peripheral neuropathy (the inability sense the position of your extremities plays havoc with your proprioception)

Parkinson’s, Stroke and a myriad of other neurological conditions that can impact balance, strength and spatial awareness

Continence issues: when you gotta go…

Polypharmacy: Probably one of the biggest offenders…hands up everyone taking 5 or more regular medications?

The list of potential risk factors is extensive…you can appreciate the challenges.

Here are a few things that can actually make a dent in fall rates.

Strength and balance training: If your facility physio isn’t running daily exercise classes that specifically target these areas, ask them why not….and then lobby the service to implement a suitable program. A month of sit to stand exercises and balance work can yield extraordinary results for almost everyone. (Just being able to get on and off the toilet safely can significantly impact fall rates)

The Environment:

De-clutter the room,

If they use a walking aid, make sure it’s easily accessible,

Good lighting is essential… and always have a night light on

The best room designs will ensure the bathroom is clearly visible from the resident bed.

Make sure the call bell is in reach

Make sure the things they need are close at hand (TV Remote, glasses, water, tissues, etc.)

For the ambulant resident, get rid of the ill-fitting sandals and fluffy slippers and buy some comfortable joggers with non-slip soles

Ensure the bed is always set at the appropriate height when they’re in it.

No floor coverings with swirling or geometric patterns. These affect orientation and spatial awareness in older persons and even more so in those with cognitive impairment.

Regular and individualised toileting schedules

Medication reviews: This is a big one. GPs are good at prescribing but not so hot with de-prescribing. Is the person still on the same dose of blood pressure medication they were taking when they were more active and living at home? I’d wager the answer is yes. This is something that frequently gets missed…a person enters residential care, becomes more sedentary and starts falling down whenever they stand up because their blood pressure is too low. A pharmacist review is a good place to start…then get a geriatrician to look at their entire medication regimen. They should be the one who has the helicopter view of the entire person. Endless trips to specialists and the cumulative tinkering with medications are a recipe for disaster. Frustratingly, the medical profession continues to operate with a silo mentality, so you need someone who knows what they’re doing to take a holistic view. (You can also help by not pressuring the GP to prescribe additional medications for every minor or temporary ailment. You don’t need to treat everything, every time)

.Ditch the sleeping tablets. Mum might be used to taking them every night for past twenty years, but they stopped being effective about two weeks after she started. After a very short period, benzos are essentially useless as sleeping meds but they remain very effective at screwing with alertness and motor coordination.

Try to reduce the need to pee overnight: less chance of falling as they groggily stumble to the loo and a better chance of getting a good night’s sleep.

Ease up on the coffee and tea after 6pm.

If they’re taking diuretic tablets, these should be administered in the morning. If they’re prone to oedema and their legs swell up over the course of the day, make sure they reduce the fluid intake from the late afternoon and put their feet up regularly. (When they finally get into bed at night, reabsorbing all that retained fluid can be the equivalent of downing a few schooners)

Consider the facility’s daily routine. Do the afternoon staff come on duty at 3pm and start putting people to bed? This is an appallingly common practice and effectively sentences some residents to being in bed for 18+ hours every day (No wonder they become restless and try to get up). The very frail should have an afternoon rest and be up for the evening meal…and nobody should be in bed before 7pm unless they specifically request it (and you can’t talk them out of it!) And you can’t just leave someone in a tub chair all day either.

But…

Some people with cognitive impairment will be more challenging. After all, they’ve been used to getting around independently for the past eight or nine decades.

Even the very few useful interventions available are still just reactive. Bed sensors only alarm after someone gets out of bed (Although, they are very effective at generating ‘alarm fatigue’; endless false alarms induce staff complacency “…don’t worry, it’ll just be another false alarm…’’) and most of the sensors on the market are ordinary, at best.

Infrared bed exit sensors can be useful, but you won’t find many places that use them…or if they do, have them set up correctly.

Placing someone in a lo-bed attempts to reverse the circumstances…now gravity is working against the person as they try to stand up and not with them as they fall down. There is some interesting research on the physics of falling and the height /speed /force, etc. that causes injury; ideally, we should aim for a total bed height under 30cm. (including the mattress). Good lo-beds will easily go lower than that.

Use proper crash mats: not the spongy foam units you see in most facilities. The high density foam mats are only a few centimeters thick and you can stand on a chair and drop onto your knees without sustaining any injury (try doing that with your current crash mat…actually, don’t)

The person will probably still roll onto the floor but the chances of serious injury are greatly reduced (but NOT eliminated entirely).

Note: When used for a person who has been assessed as requiring assistance with mobility, has been reviewed by the physio, GP, clinical manager, etc. and discussions held with their representative, Lo-Beds are NOT a form of restraint. Although the commission identified them as a form of restraint in a 2020 regulatory bulletin, this does not accord with the legislated definition: (They do not impede or restrict the free movement of the resident.) A few years back the commission would crucify you for not using low beds…now, their reactive and ham-fisted interpretation of the legislation has them more interested in regulation than preventing head injuries. If your facility manager can coherently present this rationale they’ll easily counter any allegations of noncompliance.

Furphies

‘Dignity of risk’ is getting a quite a flogging of late…it’s almost as popular as ‘open disclosure’. People seem to like using these terms; it gives the impression you know what you’re talking about

With regards to falls, restraint and consent, one can’t just say “dignity of risk” and call it done. It’s way more nuanced because the ethos rarely matches the reality. This topic warrants its own separate discussion, but suffice to say it does not mean we allow people to exercise choice in ALL circumstances. Nor does it give the right to place your relative in jeopardy just because you can. When a service asks you to sign a waiver (most of these are less useful than toilet paper) they’ve already calculated the implications of risk and their obligations as a healthcare provider and concluded it’s easier to transfer the responsibility to someone else….you!

Please be very careful with this stuff. Also, recognise that when we act as someone’s representative, we’re often basing our decisions on their historical preferences; in many instances, those preferences are no longer appropriate.

A Falls Management Plan sounds like a useful document. But in practice 99’9% of them are essentially useless pieces of paper, produced for the sole purpose of appeasing the commission at audit time. Line up all the plans at any facility and you’ll see the same generic ‘intervention strategies’, the same aspirational toileting schedules and the same set of mobility and activity directives that the staff aren’t following. How could they when nobody actually reads these things?

(It never ceases to amaze me that people continue to believe these documents inform the delivery of care. Does anyone seriously believe that all care personnel read the entire thirty+ pages of care plans for every resident at the beginning of every shift?)

Many of the ‘standard’ protocols in aged care serve no valid purpose. The Falls Risk Assessment Tool (FRAT) is a good example: Like most predictive tools, they just give the impression that something is being done. Ask anyone about the care strategy differences for a medium falls risk and a high falls risk: they won’t be able to tell you because there aren’t any. Even more curious is the number of providers who insist that a FRAT is done after every fall. Even for people who are already rated as high risk. This is absurd…there’s no point doing the same risk assessment after the event… And there’s no such thing as an ‘extra-high’ risk category.

Sight charts and monitoring charts: Hourly, half-hourly, 15 minutes…There’s no point. Check them every 5 minutes? They can still fall over right after you’ve checked them. We used to call these “lie to me” charts. Staff will typically batch complete them at the end of the shift. (Having to battle with a dozen or more of these ludicrous documents every shift, I would too).

Anyone trying to sell you this as an effective strategy is either incompetent or trying to hoodwink you.

Finally

While there are some acute medical situations where restraint is a valid intervention, it’s rarely the case in residential care. Keeping a person restrained “for their own good” is problematic. Tying them up or caging them in is a clumsy and primitive approach to a complex problem.

Ultimately, this is an ethical and moral dilemma: do you keep someone ‘safe’ by restraining them and turning their every waking moment into a torment of frustration, confusion and distress…or do you implement the things you can and accept the consequences? Do you want them to live or just exist? Are you looking for quality or quantity? What would your mum have wanted for her final months… drug- addled imprisonment or freedom (and all its associated risks?) I know what my choice would be. I think we sometimes forget that our folks have been through wars, depressions and much greater risks than we’ll ever experience. We can certainly improve on the current standard of care but there is no perfect solution…so please don’t beat yourself up because you’re unable to fix everything.”

A personal story of living well in an aged care home

In 2010, my parents, Joan and Roy Russell, moved into an aged care home together. They chose the aged care home primarily because they could sleep together in the same bed.

After Dad’s death in January 2012, I visited Mum most days until her death in September 2015. I wanted Mum’s quality of life in the aged care home to be as good as it could be. Mum had already lost her husband and most of her independence, and I wanted her to feel valued in her ‘twilight years’.

Mum was happy living in the aged care home. Many staff treated her with kindness, respect and love. She had her favourites – Charlotte, Alex, Argus, Vicky, Kunal and Jenny…

Mum made lifelong friends with several residents – though many of her new friends did not live for long. Her good friend, Trudi, died in 2014. Soon after, so too did Sam, Greg, Heather, Val and Alma.

I visited Mum around lunchtime. I sat at Mum’s dining table with Trudi, Lorraine, Marion and Etta. Mum did not have a large appetite – but she was always given a full portion at lunchtime so that I could eat her leftovers. The food was excellent. The kitchen staff were all very kind to Mum, especially Tony.

Mum established ‘her seat’ in the communal lounge room from where she observed everything with a registered nurse’s eye. She gently rebuked staff who did not treat her respectfully: “Please don’t talk to me as if I am a child” or “My name is Joan, not sweetie”.

Every Tuesday afternoon, Mum, Etta, Marion and I played bridge. Etta was once a State Champion. Although her hearing and eyesight were impaired, Etta could remember every card that had been played. She was a formidable opponent. Unfortunately, Etta hung up her cards after having a fall. Mum and I then started playing bridge on an iPad, though more commonly we did The Age crossword with Lorraine and Kay.

Lorraine and Kay had done The Age crossword for more than 60 years. These women had an excellent knowledge of synonyms. They also easily adapted to the increasing inclusion of short phrases in the crossword. There was laughter when we finally came up with ”trip of a lifetime” for the clue ”most remembered tour”. However, the obscure general knowledge questions often left them bewildered. Rather than complain, these older women would ask me to pull out the gadget in my pocket and ”google” the answers.

Mum looked forward to her monthly trips to her beach house, away from the routines of the aged care home. She came alive sitting on the deck, or in front of the fire, surrounded by people and dogs, chatting and reminiscing. At her beach house, she peeled the potatoes, top and tailed the beans – activities considered ‘too risky’ at the aged care home.

In 2012, a relative approached my brother and me to express her concerns that standards of care had declined since Pam had retired as the manager. Jane was forming a relatives’ group. My brother did not want to get involved, but I did. The grievances mostly related to management, staff morale and standards of care (Russell, 2012). To the owner’s credit, he responded quickly. The manager was replaced and staff morale and standards of care were restored. This incident demonstrated the vital role a manager plays in any aged care home.

After a year or so of visiting the aged care home, I was concerned that the media only reported negative stories about aged care homes. Surely Mum was not living in the only good aged care home in Australia. My plan was to write a positive story about an aged care home (Russell, 2017). However, things changed dramatically during the last month of Mum’s life.

When Mum was dying, I sat at her bedside in the aged care home to protect her from inflexible routines and policies. I ensured she slept as long as she needed, and ate when (and if) she wanted. I had once worked as a critical care nurse – so I knew how to care for a dying woman.

Only a few PCAs had the skills required to care for Mum when she was dying. Michelle and Cheryl provided excellent care. However, some PCAs provided thoughtless task-oriented care. On one occasion, a PCA tried to change Mum’s night incontinence pad when Mum was asleep. I asked her to let Mum sleep. She replied: “It is policy. She must have a day incontinence pad because it is day time.” I questioned this so-called policy, and the PCA replied: “I just work here. I do what I am told.”

Soon after this incident, I received an email from the Manager. She demanded that I leave Mum’s bedside. “I need you to let my staff do their jobs… Interfering with Mum’s care is not helping her. I replied:

I hope you will re-consider your comments in your email and perhaps educate your less experienced staff about working in partnership with family members. Some relatives want to be involved in ‘hands-on’ care, others don’t. I believe this should be our decision, not yours.

I did not have confidence that staff could do their jobs and refused to budge from Mum’s bedside. Mum died peacefully, with a smile on her face. On the morning of her death, she said to me: “Darling, you really do need a hair cut”.

The day after Mum’s death, the aged care home’s GP phoned me to confirm the time of death. Staff had told him she had died at 6.30pm. I told him it was in fact 5.35pm. He also asked me what he should write on her death certificate. After visiting Mum monthly for several years, I expected him to at least know her medical history. I suggested he wrote: “broken heart”, but that is another story.

I doubt I would have become an aged care advocate if the manager had not emailed me a week or so before Mum died. As an aged care advocate, I have heard countless heart-breaking stories about aged care homes from both relatives and residents. These heart-breaking stories inform my opinion pieces. However, I remind myself that these stories are only part of the story.

Solutions to aged care crisis

Talk given to Southern Womens Action Network (Swan) on 20 November

Thank you for the invitation to speak today.

I also pay my respects to Boon Wurrung people of the Kulin Nation, their elders past, present and future. I extend my respect to all Aboriginal and Torres Strait people here on zoom today. The resilience and wisdom of your culture is our nation’s greatest treasure. I wish to acknowledge the respect your culture bestows on your elders. I also wish to acknowledge that sovereignty has never been ceded. It always was, and always will be, Aboriginal land.

The aged care sector is in crisis.

Evidence for this statement is in the 8 volumes of the Final Report of the Royal Commission into Safety and Quality of Aged Care. It’s also evident in the 20 plus inquiries that preceded the RC and the 75 articles I have published.

A year before the RC started, the federal government announced yet another inquiry into aged care. Soon after the announcement, I bumped into Greg Hunt jogging on the Mt Martha boardwalk. I stopped him to ask why we needed yet another inquiry. Surely the government was aware of the systemic problems in the aged care sector. I told him I thought our aged care system was a national disgrace. Greg disagreed, claiming Australia had a “world-class” aged care system. The RC, announced a year a later, certainly proved me right and Minister Hunt wrong.

This morning, I will describe what’s wrong with the aged care system.

But I don’t want to focus on what’s wrong.

I’d prefer to focus on solutions about how to fix the aged care system. The first step is to shift our ageist attitudes.

It was never part of my life plan to be an aged care advocate. I stumbled into aged care advocacy after my parents moved into an aged care home in 2010. With my background as a public health researcher and a registered nurse, I saw the systemic issues in aged care and began publishing my analysis of these issues in the media. I soon developed a reputation as an independent and informed aged care advocate.

It was also not my plan to stand as the Voices Endorsed Independent candidate for Flinders. However, when the Voices candidate pulled out, and members of Voices voted to endorse a candidate, I put my hand up to replace the Aged Care Minister in his seat of Flinders. I did this primarily to help Voices. But I was also motivated by the failure of successive governments to respond meaningfully to the crisis in aged care.

My parents enjoyed living in their aged care home. Most staff treated them with kindness, respect and love. Staff in aged care homes are often hard working, dedicated people doing a very difficult job for not much pay or professional kudos.

My parents chose the aged care home primarily because they could sleep together in the same room. It’s important to stress that “they” chose the aged care home themselves. Unlike many families who are forced to make the decision quickly after an older person has a health crisis (e.g. fall, heart attack), my parents moved into the aged care home when they were both in reasonably good health.

I noted with interest during the Royal Commission that Merle Mitchell, who had once been the president of the Australian Council of Social Service (ACOSS) and was a resident in an aged care home, did not describe her aged care home as “a home”. In contrast, mum and dad called Victoria By The Park their home. This suggests there are huge variations in aged care homes – ranging from the dangerously bad (like the ones we hear about in the media) to the very good (that we hear very little about in the media). My parents were lucky to choose a good aged care home. However, choosing a good aged care home should not rely on luck.

After dad’s death, I began visiting Mum most days for about 3 years until her death in 2015. I had a routine of arriving each day around lunchtime. I would sit at the dining table with Mum’s friends. Mum did not have a large appetite – but she was always given a full portion at lunchtime so that I could eat her leftovers. The food was excellent, certainly much better than I cook.

In the afternoon when Mum’s great grand children visited, we transformed the lounge room into romper room which Mum and the other residents really enjoyed. We had our own ‘Old People’s Home for 4 Year Olds’.

After a year or so of visiting Mum, I became concerned that the media only reported horror stories about aged care. Surely Mum was not living in the only good aged care home in Australia.

I designed an open-ended questionnaire for family and friends, asking them to describe their experiences of the aged care home.

174 people from around Australia completed the questionnaire. However, they mostly described their negative experiences, some that were quite shocking – similar to what we heard during the RC.

I sent my report to Ken Wyatt who at that time was the Minister for Aged Care. I encouraged him and his advisors to read it. It took a few months – and numerous emails and phone calls –  for him to actually read it. I am known for my persistence. When he and his advisor finally read the report, they told me it shocked them.

When politicians visit an aged care home, the manager/owner puts on a lovely afternoon tea, employs extra staff and introduces them to only the happy residents and families.

Soon after Ken read my report, he asked whether I could do similar research for home care. Ken recognised that I am truly independent –unlike COTA, Older People’s Advocacy Network and National Seniors, I do not receive any government money. My aged care advocacy work is all voluntary.

Ken wanted to know older people’s experiences of in home care – from those who receive home care packages and Commonwealth Home Support Program. I wish staff at Morningon Peninsula Shire Council had read this report before they made their decision to transition council’s home care to private providers.

My consumer research on residential and home care should contribute to evidence-based policy. However, there are some barriers. Aged care policy is primarily determined by providers, bureaucrats and politicians – not older people, families and staff.

Before I start talking about solutions, it’s important to talk briefly about the RC. Scott Morrison’s announcement of a royal commission into aged care surprised everyone, including the aged care minister, Ken Wyatt, who, just the week before had told me we did not need one. We had all the evidence we needed. We just needed the political will to act.

The announcement of the RC came on the eve of ABC Four Corners’ special two-part investigation into the failings in aged care. When the RC was announced, I argued in the Guardian that “government by media” had replaced careful consideration of the evidence. I believe the RC into aged care, like the RC into banking, was a strategy for the previous government to continue to kick the can down the road.

Before jumping into yet another expensive royal commission, it would have been prudent for the government to review the numerous inquiries that both LNP and ALP governments had initiated over the past 2 decades. Surely the government didn’t need Four Corners to inform them that the aged care sector is in crisis.

There have been so many inquiries, reviews, consultations, thinktanks and task forces that have provided mounds of evidence of inadequate personal care, negligence, neglect, abuse and assault. These inquiries have resulted in a large number of really good recommendations, most of which have been ignored by successive governments. I predicted the findings of the royal commission would be similarly ignored. And I was proved correct – though my fingers are crossed with our new federal government.

Ken Wyatt invited me to assist with the terms of reference of the royal commission. But in the end, the major failing of the RC was the 2 royal commissioners disagreed. People think I am joking when I say Lynelle Briggs and Tony Pagone should have had counselling – to sort out their differences – before making their recommendations. Their disagreements resulted in the RC recommendations being a total dog’s breakfast.

When Anika Wells, the new ALP aged care minister, said the ALP government would accept ALL the recommendations from the RC, I contacted her to ask which recommendations – Lynelle Briggs or Tony Pagone’s?

It has become increasingly clear that Anika Wells, the Department of Health and providers all support Lynelle Briggs’ recommendations. Her recommendations tinker with the aged care system. Tony Pagone’s recommendations would have genuinely reformed the aged care system. Not surprisingly, I supported Tony Pagone.


Tinkering with the Aged Care system will not fix it. We need an aged care system that positions older people (not providers) front and centre. We desperately need a new aged care system that is focussed on the Human Rights of older Australians not the profits of providers.

I have made a list of 15 suggestions for reforming the aged care system.

A new Aged Care Act that focuses on the human rights of older people

Effective regulation

Accountability and transparency

Financial transparency

Increased staffing levels and skill mix

Improved training of staff

Registration of personal care attendants

Disclosure of performance indicators

Public access of regulator’s reports

Public reporting of complaints including how they were managed and resolved

Banning the use of antipsychotic drugs unless prescribed by a psychiatrist

Mandatory reporting of elder abuse

Home care that prioritises each individual’s need for support

Working with older people and families when designing aged care services

Stopping the unjust detention of residents in aged care homes

I will spend the remainder of my talk speaking briefly to each of these suggestions.

Firstly: We need a new Aged Care Act that focuses on the human rights of older people

The primary cause of the of the systemic failures in the aged care system is John Howard’s 1997 Aged Care Act. This aged care act put providers in the drivers’ seat, not older people.

One of the most common complaints heard during the royal commission is aged care homes do not employ enough staff. The current Aged Care Act (1997) states that providers are required to employ “adequate numbers of appropriately skilled and trained staff”. This lack of clarity enables providers to determine what is an “adequate number” and what is “appropriately skilled”. As a result, private providers have replaced registered nurses with much less skilled staff. And, given staff salaries are the main outgoings for aged-care providers, many providers minimise staff numbers so they can maximise profits.

Thank goodness, a new aged care act is something both Commissioners agreed on. So it was music to my ears when their 1st recommendation was: A new aged care act – to come in no later than July 2023. They also stipulated in 2nd recommendation that this new aged care act should focus on human rights of older people. Yay!

2. Effective regulation

In 2017, the government released the aged care roadmap. The aged care roadmap promotes “lighter regulation” and a “consumer driven and market-based system”. This is intended to increase competition within the aged care sector.

Paradoxically, the providers of aged care services lobby simultaneously for a decrease in regulation and an increase in government subsidies.

Providers believe the government should step back and let the free market operate. But these so-called “consumers” are often frail elderly people some with dementia. How can an elderly person with dementia “drive” the aged care system in a free market?

Furthermore, when the taxpayer is subsidising the care of elderly people, the public’s investment needs to be protected in the form of more regulation, not less.

In my opinion, our new federal government should ditch the Aged Care Roadmap that has driven aged care down the neo-liberal road and over the cliff.

The aged care sector desperately needs a regulator with teeth that ensures providers are accountable.

3. Transparency and accountability

My research on residential aged care and in-home care indicates the public want more transparency in the aged care sector.

Although many people, myself included, believe the care of older people is too important to be left to the free market, our local council clearly supports a consumer driven and market based system, as evidenced by their decision to transfer local council aged care services to 2 large private providers. It was also evident when the Mayor’s justified this decision on ABC radio with Virginia Trioli.

In a free market, so-called “aged care consumers” require access to information to inform their choice of product.

For example, to make an informed decision when choosing an aged care home, “aged care consumers” require information about the home’s standards of care. However, aged care homes are not required to disclose information about their standards of care. How can people make informed decisions when they do not have access to this vital piece of information?

The most common reason providers give for not sharing this information with the public – please don’t faint – this information is “Commercial-in-confidence”.

After lobbying from advocates such as myself, a crossbencher, Rex Patrick, tabled three critical amendments to the Aged Care Legislation Amendment Bill in 2019.

If these amendments had been passed, they would have been a game changer. They would have improved transparency and accountability around finances, staffing ratios and complaints in aged care homes. However, they did not pass, thanks to LNP and Pauline Hanson.

Without financial transparency, the public has no way of knowing how providers spend the government subsidy, which is now a whopping $21 billion each year. Do they spend the subsidy on providing nursing care, meals and activities for residents or on salaries (or sports cars) for their executive team?

The peak bodies representing providers say they welcome transparency. Yet they lobbied against the financial transparency amendment by producing a “red tape” report. This report claimed that sharing financial data with the public leads to excessive costs. This claim is total nonsense given that providers are required to share financial data with the Department of Health.

My next suggestion is an obvious one: Increased staffing levels and skill mix

A key to high quality aged care is a good staff-resident ratio. Without mandated ratios, many aged care homes operate with too few registered nurses and personal care attendants.

My research found that aged care homes with high numbers of well-trained, empathetic staff invariably provide high quality care. The physical environment matters much less than the personal care. Residents’ wellbeing depends on staff having time to deliver genuine person-centred care, irrespective of whether there is a chandelier in the lounge room.

Which brings me to 180 or so Victorian state operated aged care homes. In 2015, the Andrews government introduced nursing staff ratios to public hospitals AND public aged care homes. Although these state operated homes are often in older buildings, they are really well staffed.

During the past 2 years of the pandemic, most residents who died from Covid were in private aged care homes not state operated aged care homes, highlighting the importance of high numbers of well trained staff.

I am a huge fan of these Victorian aged care homes and fully support Kate Lardner’s advocacy for a state operated aged care home in Mornington.

In addition to improving the numbers of staff, we also need to Improve their training

Caring for older people with complex health issues is a demanding job that requires specific expertise. TAFE offers reputable 12 month courses. However, there are also fast-tracked courses (some as short as 6 weeks). These short courses do not equip graduates to work competently with older people.

Registration of personal care attendants

Currently, there is oversight of most health professionals who work in aged care homes. Registered and enrolled nurses, psychologists, social workers etc. must all be registered with respective professional bodies. But personal care attendants are not registered with any professional body. To work in an aged care home or home care, personal care attendants require only a police check.

Currently when personal care attendants are sacked for poor standards of care, they simply get another job in a different aged care home or with a different home care provider.

I witnessed this in Mum’s aged care home when standards of care declined after a new manager started. In addition to the complaints about standards of care, there were also allegations of theft, abuse and negligence against 2 personal care attendants.

During a meeting with residents’ families, we all shared our complaints. Sharing complaints with each other was extremely important. Rather than everyone think their complaint was a “one-off”, it highlighted the fact that there was a serious problem in the aged care home.

So what did we do? Some wanted to go straight to the media but I did not see how this would resolve our problem. I suggested, in the first instance, families documented their grievances. I then wrote a 60-page report.

I met with the owner and gave him the list of the grievances. The first thing he did was to apologise. I could tell that it was a genuine apology. Then to his credit, he responded quickly.

The manager was ‘retired’ (a euphemism for ‘sacked’) and the 2 personal care attendants did not work in the aged care home again. My concern is they went to work in another aged care home.

I am glad one of the recommendations of the Royal Commissioners is to introduce a system of registration for personal care attendants similar to other health care professionals.

I advocated for this recommendation to be introduced immediately. However, the previous government did nothing. Thankfully, our new federal government has promised that personal care attendants will be registered. We now need the slow wheels of bureaucracy to move.

Disclosure of performance indicators

I have tried unsuccessfully to get data on adverse incidents in aged care homes such as the incidence of pressure injuries, dehydration, malnutrition, medication errors and falls. This information is needed not only for researchers such as myself to have an evidence-based discussion about standards of care – but also to help people make informed decisions when choosing an aged care home.

Let’s say a family is looking for an aged care home. After reading glossy brochures, they choose one. 6 months later, their loved one receives the wrong medication and is rushed to hospital. They then find out that there have been several medication errors in that aged care home over the past year. If they had that information BEFORE they chose the aged care home, they would most likely not have chosen it.

Public access of all regulator’s reports

I once asked Ken Wyatt to give public access to all Aged Care Quality and Safety Commission reports on aged care providers.

A Channel 9 Freedom of Information request showed Ken took my idea of the Aged Care Sector Committee. However, the idea was voted against after the CEO COTA (allegedly a consumer organisation) claimed patronisingly that the information in these reports would be “too technical” for the public.  This completely blew my head off.

Public reporting of complaints including how they were managed and resolved

Public reporting of complaints is part of my push for transparency. Although complains are inevitable, it is important to know how complaints are resolved.

Unfortunately, the Aged Care Quality and Safety Commission refuses to share this information.

The question I have been asking for 6 years is: Who decided that information on the safety and wellbeing of residents and recipients of home care must be kept top secret?

The federal government has a long history of being far more concerned about protecting aged care providers – some of whom are multinationals and large superannuation funds – than looking after the interests of those living in residential aged care and receiving home care.

For example, during Victoria’s 2nd lockdown, Richard Colbeck, the Minister for Aged Care, said he would not publicly name the aged care homes with outbreaks of Covid. He said he said he was worried about providers’ “reputational damage”.  So what did I do? I asked members of my Aged Care Matters Facebook group to name aged care homes with outbreaks. I then published the list of 124 names. It is the only time a tweet of mine has gone viral. Soon after this, The Department of Health published the names in a Weekly Report, and continue to do so.

Banning the use of antipsychotic drugs unless prescribed by a psychiatrist

The first national audit of psychiatric medication prevalence in aged care homes found nearly two-thirds of all residents were prescribed psychotropic agents regularly.

The overuse of sedative medication is “chemical restraint.”

This not a new problem. In the past 20 years, there have been several government inquiries into an over-reliance on medication to manage the behaviour of residents. These inquiries recommended educating staff working in aged care homes about alternative ways to manage behavioural problems. The elephant in the room, however, is doctors who prescribe the medication.

There is strong evidence that many psychiatric drugs are not only often ineffective but may also cause older people substantial harm, including falls, pneumonia and sometimes premature death. So why are doctors prescribing these drugs? That’s a rhetorical question – they are being prescribed because there is not enough suitably trained staff employed to manage challenging behaviours.

Mandatory reporting of elder abuse

Financial abuse appears to be the most common form of elder abuse. Research has identified adult children, particularly sons, as the most common perpetrators of financial abuse. The victims are often women over the age of 80.

I have worked hard to ensure red flags of financial elder abuse – e.g. a bank is now required to report when a financial power of attorney makes large withdrawals from an older person’s bank account.

It is worth noting, however, that the research in this area has been undertaken primarily in the community, not aged care homes.

In more recent years, my attention has turned towards elder abuse in aged care homes – where the most common form of abuse is physical and sexual. We now have a Serious Incident Response Scheme – though I had hoped their reporting would be better.

Home care that prioritises each individual’s need for support

Most older people want to stay at home as they age.

In the old days, before My Aged Care, Victoria had one of the best home care systems via Home And Community Care. Local councils employed highly trained, caring and competent staff to provide an invaluable service to older people in our community.

In 2013, The Gillard ALP government introduced the Living Longer Living Better aged care reforms. These reforms were motivated by forecasts of a burgeoning ageing population and concerns – and quite legitimate concerns – about how the government could afford to provide services for older people in years to come.

These bipartisan reforms encouraged private home care aged care providers to enter what government bureaucrats call the “aged care market place”. Soon after these reforms were legislated, the Liberal and National Party won the federal election – and they have forged ahead with gusto to implement the neo-liberal reforms.

The Coalition government was determined to turn the provision of home care services into a competitive market – turning older people into “economic participants”.

Some Councils have rejected transitioning their long standing and long trusted services to a market-based system. These councils appreciated how important their services are to older people in their communities.

My research shows that council aged care workers are valued and sometimes loved by their clients. Older residents and their families appreciate having a highly trained and fairly remunerated Council employee provide aged care services. They can also be assured they are not being ripped off by a private provider that prioritises profits over care.

The most common complaint about corporate home care providers is the high turnover of unqualified, inexperienced, untrained and poorly paid support workers. A high turnover of staff is a recipe for disaster. It results in strangers being sent to work in an older person’s home. Older people simply have to trust that they will be treated with respect and kindness.

The health department has been talking about combing home care packages and Commonwealth Home Support Program since 2018. The new program, to be called the Home Support Program, was due to start next year. However, the Albanese government has delayed the start date until 1 July 2024. In announcing the delay, Anika Wells, the Aged Care Minister, said the government was “taking the time to address the concerns instead of rushing to failure.” As a result, several councils have delayed their decisions about whether to remain a home care provider.

The best way to ensure older people get the residential and home care services they deserve is for governments to work with older people and families when designing aged care services.

The new buzz word is co-design – however, like many bureaucratic buzz words, the word has been adopted but not the practice.

I’ve attended several co-design workshops with KPMG that have been tokenistic consultations. Again, let’s hope the new Labor government does it better.

My final suggestion relates to the pandemic when many aged care providers detained residents in aged care homes

The past 2 years of Covid has been a heartbreaking time for many residents in aged care homes, and their families.

When the pandemic took off in March 2020, all non-essential staff were banned from entering aged care homes. This included family members who regularly cared for their loved ones by helping with feeding, toileting, social support and so on.

Providers claimed a total lockdown was necessary “to save lives”. However, families who were locked out were far more afraid that their loved ones would die of neglect, not Covid.

In their special report, the aged care royal commissioners expressed concern about providers’ decision to keep residents locked in and families locked out. In several aged care homes, residents were confined to their room, some for more than two months. Taking away an older person’s liberty by confining them to their rooms was profoundly damaging to their mental and physical wellbeing. Some legal experts have suggested it may also have been illegal.

The royal commissioners also noted that the reduction in visitors had made it difficult for staff to meet the day-to-day care needs of residents. This admission points to how heavily private providers rely on the family members/friends and volunteers to help with meals, exercise and care for residents.

To conclude:

If the current Labor government genuinely wants to reform the aged care system, the Minister for Aged Care needs to engage recipients of aged care services – both residential and home care – families and staff.

Many years ago, I gave similar advice to the Department of Health. So they organised a “consumer round table” with Ken Wyatt (when he was the Minister for Aged Care). I was invited together with many CEOs of consumer organisations.

After introductions, I realised there was NOT one genuine consumer at the round table. So I said to Ken Wyatt (who was also the Minister for Indigenous Affairs):

“Can you imagine convening a meeting to discuss Indigenous affairs without one First Nations person at the table?”

Unlike many of the CEOs, Ken understood my message.

My message to federal government  and the Department (which is now called Department of Health and Aged Care – thanks to Lynelle Briggs’ tinkering – is to quote Einstein “We cannot solve our problems with the same thinking we used when we created them.”

Thank you.

Does the Albanese government really want to strip older Australians of their rights?

The federal government has recently made numerous, welcome commitments to improve the lives of older people living in residential aged care. Yet there is one glaring problem with the aged care reform bill that recently passed parliament.

Schedule nine of the aged care and other legislation amendment (royal commission response) bill 2022 provides immunity to aged care providers and their staff for some of the most objectionable aspects of aged care – the use of restrictive practices without having obtained lawful consent. 

The Guardian

Let’s restore humanity to aged care

After the heart-breaking revelations of the Aged Care Royal Commission, I hoped stories of neglect and poor treatment of older people were behind us. Not so, thanks to the decision of some local councils to wash their hands of aged care services.

Just this week we have heard that thousands of vulnerable of older people have been left without home care after Mornington Peninsula Shire Council and Boroondara Council outsourced their services to corporate providers.

The Age