Collection of my Opinion Pieces on aged care 2012-2022

Over the past decade, I have undertaken several research projects on both residential and home aged care.

I have also written 75 opinion pieces, published in The Age, The Guardian, Herald Sun and Michael West. I have also appeared on ABC TV  7.30, Afternoon Briefings Channel 9’s The Today Show and Channel 10’s The Project.

This document contains a collection of my Opinion Pieces, Letters and a summary of my research projects.

Aged care homes with outbreaks

The Covid outbreaks aged care homes Excel spreadsheet contains data obtained from the Department of Health’s Weekly COVID-19 outbreaks in Australian residential aged care facilities.

To explain some background about how this weekly report came about – and why I continue to update Excel spreadsheets that summarise the data.

I began naming aged care homes during Victoria’s outbreak in 2020, when the data was “top secret”.

At a Senate inquiry hearing on August 4, 2020, Dr Brendan Murphy, secretary of the Department of Health, and Senator Richard Colbeck, the Minister for Aged Care at the time, refused to name the aged care homes with outbreaks during Victoria’s second wave. They explained that providers didn’t want to be publicly named because they were worried about “reputational damage”.

In my view, it is not the role of the Department of Health or a Minister to protect aged care homes from reputational damage. So I began preparing a weekly list of the outbreaks in Victorian aged care homes in 2020.

After a month or so weeks of updating my list (mostly from intel from members of my Aged Care Matters Facebook Group), the Department of Health released its first Weekly report on 11 September 2020. At that time, an outbreak was defined as one resident or staff testing positive for Covid.

More recently the Department has listed only the names of aged care homes with two or more Covid cases.

This data has been released every week. However, many people told me they found the reports difficult to understand. So I began presenting the data in a simple Excel spreadsheet. The spreadsheet includes the number of cases (residents and staff) and deaths (residents) in each aged care home.

With the Omicron wave, my spreadsheets have enabled people to track the outbreaks in each aged care home over time. This has been important for families who do not receive timely information from the aged care home.

It also enabled people to observe the increased number of aged care homes with outbreaks.

Date Number aged care homes with Covid outbreak
Dec-03 28
Dec-10 36
Dec-17 54
Dec-24 105
Jan-07 495
Jan-14 1,107
Jan-21 1,198

On 31 December 2022 – when Omicorn was spreading like wildfire in aged care homes – the Department did not release the weekly data. No explanation was given for this failure to keep the public (including families) updated.

The weekly report recommenced on 7 January 2022.

In the sheet titled “7 Jan”, the entries highlighted with yellow indicate the aged care homes homes that went into lockdown because a staff member tested positive (i.e. no residents tested positive). In NSW, for example, about 15 per cent of aged care homes were in lockdown on 7 Jan because a staff member tested positive (i.e. not a resident).
The outbreaks caused by staff bringing Covid into the aged care home were preventable. They could have been avoided with all staff having a rapid antigen testing before their shift. I first wrote about using rapid antigen tests in aged care homes in The Guardian in  December 2020.
While taking a test may be inconvenient and time-consuming, it is infinitely preferable to putting residents and families through the trauma of a lockdown.
I put notes in a column of the January 7 spreadsheet to indicate the aged care homes that had a surge in case numbers. These were the aged care homes that needed to be watched (hoping they didn’t have a further surge in case numbers). However, it was not possible to track these homes because the Department did not release the names of the aged care homes with outbreaks on 14 January.
On Jan 14, the Department indicated in a footnote of the Weekly Report that there were “technical issues”. Rather than delay the release of the report until these “technical issues” were resolved, someone in the Department decided to cut and paste the Appendix from the previous report, perhaps hoping that no one would notice.
I noticed – and I was appalled! No data is better than misleading data.
With poor communication in many aged care homes, families rely on the weekly report (and my spreadsheet) for accurate information. In my 6 years of advocacy, the Department’s decision to release a report with misleading data was the nadir. It made me despair.
The decision to cut and paste the Appendix in 14 Jan’s report is yet another example of the Department of Health’s lack of transparency and accountability.
If we can’t trust the Department to release accurate information, who can we trust?
Over the past few months, I have frequently emailed a list of mistakes in the Department’s weekly report. On 9 January, I emailed:
Hi there

Thanks for releasing the data – I am sure it has been a busy time with so many aged care homes with outbreaks.

I note with confusion that you are now naming some home care providers in your list of aged care homes with outbreaks. Are you able to tell me why?
On 24 Dec, you listed the following home care providers as active outbreaks:
Integratedliving Home Care Packages
Kincare
St Basil’s In Home Care
On 7 Jan, you listed
Calvary Community Care
Care Connect
Five good friends
Anglicare SQ South Coast Region Home Care
Integrated Living Australia
Multicultural Aged Care Services Geelong Inc
Australian Vietnamese Women’s Association
Banyule City Council
Hume  City Council
Northern Health Home Care Packages – Level 4
Wintringham Home Care
The Australian Asian Association of WA Triple A Care
You may also be interested in correcting the entry numbers 115 and 237 in the Appendix.
Also – Bupa Clemton Park is in NSW, not Victoria. Also you may want to correct the spelling.
Also, curious that Wesley House (SA) had 1 resident with an active case on 24th Dec. Yet on 7 Jan, had zero (with zero resolved).

Regards, Sarah

I received no reply to my email.

I no longer trust the accuracy  of the data from the Department of Health. Nonetheless, I continue to update my spreadsheets because families tell me my spreadsheets are helpful.

Updating the current spreadsheet involved adding 703 additional aged care homes with outbreaks. It was a mammoth effort.

I also wrote another email to the Department.

Hi again

Could you please forward this email to whoever is responsible for the weekly updates.

Putting on record (again) my extreme disappointment at DoH’s decision to cut and paste the Appendix from Jan 7 into Jan 14.
I appreciate you had technical issues. However no data is better than misleading data.
Did you consider the families who rely on this information (due to poor communication in many aged care homes)? In my 6 years as a voluntary aged care advocate, it was the nadir.
Having said that, I am pleased that you have corrected some of your earlier mistakes – On 21 Jan, there are no home care services in your list of residential aged care outbreaks. You have also listed Clemton Park (spelt correctly in 21 Jan edition) in NSW, not Victoria. Thank you
The report on 21 January has less mistakes than I have become accustomed to seeing in these weekly reports. However, you have listed Catholic Healthcare St Joseph Aged Care twice with different numbers. Does this aged care home have 3 or 8 residents tested positive?
I also note with surprise that Lark Ellen Aged Care (that had 20 Covid positive residents on 7 January) is not listed. Is the outbreak resolved?
Ditto Blue Cross Elly Kay in Victoria. It had 40 Covid positive residents on 7 January. Yet it is not listed in 21 Jan report. Is the outbreak resolved?
I am also pleasantly surprised that Villa Maria Catholic homes O’Neill Aged Care Residence had 21 residents with Covid on 7 Jan, and zero on 21 Jan. Might be worth checking if this is correct.  Also worth checking Whitlesea Lodge (21 residents with Covid on 7 Jan; zero on Jan 21).
I would welcome another conversation with Cameron, if this is possible

I also used compared the data from 7 January with 21 January to identify 10 aged care homes with largest increase of residents with Covid.

Aged care home Residents +ve on 7 Jan Residents +ve on 21 Jan Resident deaths
Estia Health Kilbride (NSW) 0 119 4
Russian Relief Association of St Sergius of Radonezh (NSW) 6 113 8
Cardinal Stepinac Village (NSW) 16 103 10
Uniting Wesley Gardens Belrose (NSW) 0 88 0
Bossley Parkside Care Community (NSW) 50 86 7
Fronditha Clayton Aged Care Facility (2nd outbreak) (Vic) 0 85 5
Bupa Greenacre (3rd outbreak) (NSW) 44 80 5
Forest Lake Lodge (QLD) 0 77 7
Bupa Clemton Park (2nd Outbreak) (NSW) 33 52 0
Constitution Hill Aged Care (NSW) 22 52 2

 

We need to know the factors that contribute to some homes containing the virus while other homes have had a huge surge. For example, in past fortnight, 105 home had a surge in numbers while 71 had no change in numbers.

Is this due to: Residents not receiving a booster shot? Poor infection control? Unable to access PPE? Inadequate staffing levels/training (e.g. training in how to don and doff PPE)? Poor ventilation?

List aged care with an outbreak of Covid-19

In early August 2020, Victoria had Covid-19 outbreaks raging in over 100 private aged care homes, yet the government refused to tell us which ones.

At a Senate inquiry hearing on August 4, 2020, Dr Brendan Murphy, secretary of the Department of Health, and Senator Richard Colbeck, the Minister for Aged Care, refused to name the aged care homes. They explained that providers didn’t want to be publicly named because they were worried about “reputational damage”.

It is not the role of the Department of Health or the government to protect aged care homes from reputational damage. Imagine the government refusing to tell the public which schools, workplaces, restaurants or child-care centres had Covid outbreaks because of concerns about “reputational damage”.

Using several sources, including a Google map: Covid-19 outbreaks in Australian nursing homes, I identified many of the aged care homes in Victoria that had an outbreak* of Covid-19.  This list was not verified by the government.
(*In aged care homes, and “outbreak is defined as one positive case – either staff or resident).
I am aware many aged care homes did everything within their power to protect residents and staff from Covid-19. In some cases, staff came to work asymptomatic.
Alarmingly, 70 to 80 per cent of healthcare workers infected with COVID-19 during Victoria’s second wave of infections caught the infection at work. This suggests inadequate infection control procedures.

In my view, it was unconscionable for important information about aged care homes to be kept top secret. I shared this list in the interests of transparency. It had nothing to do with “naming, shaming or blaming”.

On 11 September, and after much ado, the government shared data about aged care homes with outbreaks. This data should never have been top secret.

Social Media and Defamation

During the coronavirus lockdown, many of us are spending more time on social media. It is a golden era for lawyers to scroll though Facebook and Twitter looking for even the most mildly offensive comments.

Suing people for making ‘defamatory’ comments on Facebook is becoming an industry. While some lawyers chase car accidents, others chase social media posts. Those of us who are sued are often advised to pay ‘go away money’ rather than go to court. It is difficult therefore to gauge the size of this industry.

Australia’s defamation laws were written long before we all had access to social media. They were written with public figures and newspapers in mind. Defamation was once considered solely the domain of rich public figures. Although public figures continue to sue media organisations, private individuals are increasingly turning to defamation laws as a way of being vindictive.

Using the legal system to protest against offensive comments on social media was never the intention of defamation law. None the less, our defamation laws currently treat a Facebook post that is read by a handful of people the same as if the comments were published in a national newspaper.

Recently, a woman was ordered to pay $35,000 in damages after posting in a neighbourhood Facebook group that a member was “intimidating, bullying and threatening” women in the group. The plaintiff alleged that this Facebook post had “totally damaged” his credibility.

Federal Attorney General Christian Porter has described these types of social media cases as “neighbourhood disputes”: “There’s a balance there to be struck between people having the right to defend their reputation, but not clogging up the courts with stuff where there isn’t any actual, realistic, quantifiable damage to a reputation done simply because something was said in a neighbourhood dispute which was mean-spirited amongst neighbours.”

The regular Twitter “pile ons”, ad hominem tweets and personal attacks that are made on Facebook pages suggest that many people posting comments on social media are unaware of the possibility of being sued for defamation. Even an innocent mistake, like the one I made, can cost a significant amount of money.

I am a public health researcher and aged care advocate. I have published several research reports about aged care and had numerous opinion pieces published about systemic issues within the sector. I also administer the Aged Care Advocacy Facebook Group, which has become a go to page for older people and families wanting advice from other members on how to tackle problems.

In recent years, some people who claim to be aged care advocates have engaged in bullying online behaviour. They use social media in an attempt to destroy the reputations of people working in the aged care sector. Some focus their ad hominem attacks primarily on providers. Others attack anyone working in the aged care sector, including aged care advocates.

Social media has enabled a small group of women to play havoc with many people’s lives. Unfortunately, Facebook turns a blind eye to those whose relentless online abuse has caused depression and other mental health issues, including suicidal ideation.

After I exposed the abusive online behaviour of some of these aged care advocates, I then became their target. The abuse against me began with a silly direct message comparing my meetings with aged care providers to “having lunch with George Pell”. It later escalated to vulgar, bullying and harassing posts. The abuse was relentless, and included a large number of uninvited posts on my personal Facebook page.

My strategy was to ignore, delete, block. However, this was difficult because these people use many different Facebook identities such as Kirri Billi, Netty Elizabeth, Marilyn Munroo and Tess Tickle.

I did not read their posts. Instead, I deleted them and blocked the accounts. I later responded with a Facebook post that was intended to name and shame. In this post, I referred to those who had posted on my personal Facebook page as “trolls”, unaware that one of the identities was the name of a real person.

I was subsequently sued for defamation. The plaintiff claimed $100,000 in damages. While I now appreciate how easy it is to satisfy the legal criteria for defamation in Australia, it remains unclear to me what actual reputational harm my post caused. Did it cause the person to lose respect within her community? Her job? Her income?

Rather than sue for hurt feelings from a Facebook post, a person should be required to show serious harm to warrant defamation action. In the first Twitter defamation case in Australia to proceed to a full trial, a judge found a former student’s posts about a school music teacher were untrue. More recently, a registered nurse sued after Facebook posts falsely claimed malpractice by the nurse and that the nurse was drinking on duty. In both these cases, the social media posts caused serious harm by damaging professional reputations.

The federal Attorney General has indicated an overhaul of defamation law that will require plaintiffs to demonstrate serious harm. Damaging professional reputations is serious; hurt feelings are not. An overhaul of the law would make it more difficult for vindictive “neighbourhood disputes” to go to court.

I did not drag my case though the courts and instead settled the case quickly. There’s no suggestion that the particular lawyer involved in my case scrolled through Facebook for the post, but I was nevertheless left wondering how much the lawyer was paid.

First published in Online Opinion 2 June 2020

 

Do We Need Mandated Staffing Ratios Or Staff Transparency In Aged Care?

22 July 2019

The title of this year’s Victorian Healthcare Week Great Debate was: Do We Need Mandated Staffing Ratios in Aged Care? Are we better off focusing on the quality outcomes for older Australians rather than mandated staffing ratios?

Lisa Giacomelli (Chief Operating Officer YMCA NSW) and I (Director, Aged Care Matters) received an invitation to speak on the opposing team. We were told we had been specially selected based not only on our expertise but also our ability to marry humour with intellect.

Lisa presented a strong case to show that mandating ratios does not guarantee quality.  Lisa used examples from the childcare industry, an industry that has mandated ratios.

“I have worked in the child care industry for nearly a decade. Ratios are mandated there and services are audited and checked by the regulator to ensure they are ‘in ratio’.

“When something occurs in a service when things don’t go to plan, the first question asked is always: ‘Are we in ratio?’ And I can tell you the answer is almost always ‘yes’.

“Being in ratio does not prevent poor practice, it does not prevent care standards being upheld, or staff taking their eye off what they are meant to be doing, or clients acting in a way that wasn’t anticipated, or allergic reactions to medication or accidents, nor does it prevent policies and procedures being breached.

“In fact, ratios can have the opposite effect. The need to be ‘in ratio’ (a golden term in the children’s services industry) causes all kinds of stress for coordinators and directors who spend their time finding staff and managing rosters rather than focussing on quality of care, listening to the voices of children and dynamic educational leadership. It’s hard to be inspiring when you are struggling to ‘stay in ratio’.

“Mandated ratios result in a higher reliance on agency staff which, due to the inconsistent nature of agency staff who do not understand the service or know the children, can create inconsistency of care, lack of commitment to the service and the role and undermine the safety that children feel in a familiar and consistent environment. Agency staff, whilst doing their best, just cannot have the same engagement with service and organisational culture, or with clients than long serving staff can.

“They also create a false sense of security. It is not difficult to envisage services believing that as long as we are ‘in ratio’ we are offering good quality, engaged and inspired care. Management and leadership can take their focus off what staff are doing to focus on how many staff are doing it. Leadership becomes more about rosters and less about staff development, more about regulation and less about client experience, more about ‘not getting caught out’ and less about the very people that aged care services are there to serve. This is the danger of ratios and they can be dangerous.

“If you want to mandate quality care – mandate engagement with clients, families and communities. Ensure that staff culture is positive, resilient and empowering. Train the best and brightest and pay them that way.”

Sarah began by asking the audience to raise their hands if they wanted all older people living in all aged care homes to have the best quality of life possible. As you would expect, there was a sea of raised hands.

“I am a public health researcher and aged care advocate. My research shows there are good aged care homes. However, anybody who has paid even the slightest attention to the Royal Commission on Aged Care Quality and Safety knows that not all aged care homes are good.

“In any profit-based system that relies on government subsidies, like pink batts, private colleges and aged care, there are always some shonky providers. These shonky providers thrive because of systemic and regulatory failures.

“Will the systemic problems in aged care be miraculously fixed by mandating staff ratios? The answer is indisputably ‘No’. A shonky provider will make up the numbers with the cheapest, most unqualified staff possible.

“My colleague has presented a strong case to show you that mandating staff ratios in childcare centres does not guarantee quality. To the opposition, I say: ‘Be careful what you wish for’.

“The opposition has used the same arguments that have been shouted for years. These arguments regularly appear as memes on social media. In response, the peak bodies for providers tweet their own memes. The memes and tweetsgo back and forth but nothing changes.

“It is unusual for an aged care advocate not to support mandating staff ratios. Other aged care advocates get very exasperated with me. They tell me it is simply ‘common sense’ that more staff on duty = better service. This was certainly not the case at my local café last Friday when 2 regular, experienced, competent and cute waiters were sick. They were replaced with 2 agency staff who knew nothing about how the café operated – not even how to use the coffee machine or where to find the tomato sauce. They did not improve the quality of the service. In fact, they reduced it.

“To address the systemic issues in the aged care sector, we desperately need ethical leadership. We need someone with a kind heart and open mind who can see past the vested interests. We need a Nelson Mandela, Jacinda Adhern or Greta Thunberg.

“During the past few years, the usual suspects have shouted for staff ratios. The other usual suspects have shouted for more government money. There has been a lot of noise but no leadership.

“Good leaders bring people with diverse views with them. They build consensus not division.

“So what should an aged care leader do?

“Firstly, they should listen to all key stakeholders – not just those with the loudest voice. They would also listen to staff, families, community members and, most importantly older people themselves. They would then bring all key stakeholders to the negotiating table.

“A good leader would put something achievable on the negotiating table – something that all key stakeholders may agree on. I propose we start with staff transparency.

“Yesterday, Rebekha Sharkie re-introduced her Private Members Bill that requires every aged care home to disclose and publish quarterly staff/resident ratios.

“Shonky providers will lobby against this legislation. However, good aged care homes with high numbers of well-trained staff have nothing to fear from staff transparency.

“When we have accurate staffing data we can perform the research needed to develop evidence based staffing guidelines.

“Rather than Staff Ratios that cause division, Staff Transparency is a much better place to start.”