If amendments had gone through the Senate, they would have been a game changer for the aged care sector. They would have improved transparency and accountability around finances, staffing ratios and complaints in aged care homes.
20 May 2019
A confidential internal inquiry into the office of the Aged Care Minister Ken Wyatt was leaked to the media during the recent election campaign. The journalist described the leaker as a “whistle blower.”
Whistle blowers are honourable people who are motivated by altruistic intentions. Anonymous disgruntled staff members who are dissatisfied with the outcome of an internal grievance process are not whistle blowers.
I have never worked in Minister Wyatt’s office so I do not have inside knowledge. However, this leak had all the markings of a political attack. Normal administrative processes resolved this grievance. That should have been the end of it.
Instead, a confidential document was leaked to the media in the middle of an election campaign. The leakers’ aim was to throw the Aged Care Minister, the first Indigenous frontbencher in federal parliament, and his Senior Advisor under the bus for political purposes.
The leakers went so far as to accuse Minister Wyatt’s Senior Adviser of bullying. The oldest trick in a bully’s handbook is to accuse others of being a bully. Is this yet another case of the pot calling the kettle black?
Recently, false allegations of bullying have been made against many strong, intelligent and forthright women in senior positions. When a male is forthright, he is “assertive”. When a female is forthright, she is “aggressive”. This gendered disparity was ever thus.
I am a researcher who advocates for improving standards of care in residential and in-home care. As such, I have had many meetings with Minister Wyatt and his Senior Advisor. Paula Gelo is one of the more honourable political advisors I have met. She is intelligent and committed to her job.
Minister Wyatt’s Senior Advisor and I often discussed my ideas for improving the aged care sector. She was not only respectful but also provided evidence to support the government’s position. I contested this evidence. Paula welcomed this robust contest of ideas.
Others on the Executive of Aged Care Matters have also challenged both Minister Wyatt and his Senior Advisor. Paul Dwyer (Aged Care Finance Solutions) said:
“I have found both the Minister and his adviser, Ms Gelo, exceptionally devoted to the aged care portfolio. Ms Gelo has been available 24 hours, 7 days a week, in any matters. She has shown me respect and courtesy, both face-to-face and via correspondence.”
In my experience, bullies do not welcome alternate views. Instead, they react aggressively. They see disagreement as combat they must win. They either attack people who disagree with them, or ignore them. Either way, they ruthlessly shut down dialogue. Bullies perceive those who disagree with them as enemies who must be silenced. If the evidence does not fit with their worldview, they will simply ignore the evidence.
A new member of the Aged Care Sector Committee blocked me on Twitter after I questioned the value of the Aged Care Workforce Strategy Taskforce’s report. He refused to engage with my alternate perspective. In contrast, Minister Wyatt and his Senior Advisor always replied promptly to my emails and texts, including when I was critical of the government’s policies. They always picked up the phone when I called to discuss an urgent matter. Most importantly, they always did what they said they would do.
On several occasions, Minister Wyatt took my request for access to data to the Aged Care Sector Committee (ACSC). On each occasion, the ACSC denied the request. For example, when Minister Wyatt requested all reports on spot checks be made available on the My Aged Care website, the committee provided a patronising response about the data being “too technical”. According to notes from meeting on 12 May 2017 (obtained by freedom of information): “Members expressed caution about releasing unpublished reports from the Quality Agency as they believed that these reports were more technical and, without explanation, may not provide useful information for consumers or their families.”
According to the media’s report: “Ms Gelo spent $108,000 on airfares as well as $31,000 in travel allowances in one year.” Why did this spark alarm? Surely Minister Wyatt was entitled to take his Senior Advisor with him when he visits aged care homes around the country.
The Aged Care Minister, Minister Wyatt and his Senior Advisor visited over 130 aged care homes in urban, regional, rural and remote locations. Unlike Minister Ley (the previous Aged Care Minister), Minister Wyatt consulted widely with residents, relatives and staff. Both Minister Wyatt and his Senior Advisor should be praised for this, not criticised.
During her Christmas-New Year holidays in 2017, Minister Wyatt’s Senior Advisor read my research report “Living well in an aged care home”. She told me she welcomed reading relative’s critical feedback. She suggested a qualitative research project with older people who receive in-home care. Paula said it was important for Minister Wyatt and herself to hear genuine first-hand experiences of in-home care.
The Commonwealth Department of Health generally commissions research from consultants working in large organisations such as KPMG and Korn Ferry. I am critical of this research – it is not only extremely expensive but often lacks rigour.
I was excited to have the opportunity to bring some genuine ‘consumer’ voices into the debate about in-home care. However, working with the Commonwealth Department of Health was an eye-opener, to say the least. Without Minister Wyatt and his Senior Advisor’s help, it is most likely my research report “Older people living well with in-home support” would have languished in the bottom of a drawer (with all the other reports that have provided the Department with unwelcomed critical feedback).
Working in a politician’s office is not for the faint hearted. The hours are long and the stress is enormous. Minister Wyatt is fortunate to have employed a Senior Advisor who showed him such loyalty.
A smear campaign in the media will soon be forgotten. Instead, aged care stakeholders will remember Minister Wyatt and his Senior Advisor’s work to improve the quality of life of older people who receive residential and in-home care.
29 April 2019
Our democracy depends on the robust contest of policies. Yet so far the federal election campaign has been dominated by personal insults, pork barrelling and heated discussions about preference deals. I’ve hardly heard a whisper from candidates about their party’s aged care policies.
I am standing as a candidate for Reason Australia in my local electorate (Cooper in inner city Melbourne) so I can put aged care in the election spotlight. Reason brings an evidence-based approach to all its policies, including aged care policies.
Aged care needs evidence-based, not opinion-based, policies. It also needs kindness. Rather than listen to the opinions of the usual suspects who are part of the broken system that has failed older Australians, we need new thinking. To quote Albert Einstein: “We cannot solve our problems with the same thinking we used when we created them”.
Reason Australia’s policies “Respecting older people” are:
- Implement strategies to combat ageism
- Establish a national framework of Healthy Ageing
- Support the aged care diversity framework and action plans to ensure equality in care for elder Australians
- Create age and dementia friendly environments within communities
- Re-write the Aged Care Act 1997 from a human rights perspective
- Transparency about how aged care providers spend government subsidies
- Mandatory reporting of elder abuse
ALP and Greens also released new policies on ageing and aged care. The Liberal Party has not announced any new aged care election policies. Perhaps they consider their track record speaks for itself.
Consistent with LNP’s focus on the ‘top end of town’, the government recently gave $320 million to aged care providers without any obligation that this money will improve services for older people. The Reason Party disagrees with giving providers a one off cash injection without any strings attached. Taxpayers’ moneyshould be used to improve the quality of life of older people not the pockets of providers.
The numerous aged care inquiries, reviews, consultations, think-tanks and task forces over the past decade have resulted in a large number of recommendations. Both LNP and ALP governments have ignored most of these recommendations. In fact, the 2013 aged care reforms that have marketised residential and in-home aged care have bipartisan support. This may explain why ALP is not talking about aged care.
The Greens’ policies on aged care are much more progressive than either mainstream party. The Greens are the only political party to address the low salaries of aged care workers. They also support staff ratios in aged care homes though curiously their policy does not require a registered nurse to be on site 24 hours per day. When there is no registered nurse on site, elderly residents, particularly those who are uncommunicative, do not receive timely treatment when their condition changes. In some cases, this is a form of neglect.
The Greens’ policies include the government spending a further $8.5 billion – $3 billion on aged care homes and $5.5 billion on home care packages. They sensibly include a cap on the percentage of the funding given to service providers that can be used for administration rather than direct resident care.
Although more staff, better pay and releasing more home care packages are important, we do not support the government giving more money to aged care providers until providers are transparent about how they spend this money. There must be transparency about how aged care providers spend government subsidies.
Both the ALP and Greens have policies to address elder abuse. The ALP policy states: “Labor will address the prevalence of elder abuse”. The Greens’ policy on elder abuse is slightly stronger, but not strong enough. The Greens state: “Measures to prevent and respond to elder abuse”. In contrast, Reason’s policy makes it mandatory to report elder abuse.
According to the Aged Care Act (1997), providers must “maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met”. Although 51 ALP candidates support staff ratios in aged care homes, the ALP policy on staffing in aged care homes states: “adequate staffing levels with the appropriate mix of skills”. The ALP policy does not rock the boat.
Reason not only rocks the boat, we tip the boat over. Our policy is a game changer. We don’t tinker with The Act (e.g. mandate ratios), our policy is to re-write the Act from scratch.
Reason Australia envisagesan Aged Care Act that focuses on the human rights of older Australians not the profits of providers. This new Aged Care Act will include transparency about staffing levels/training and data about quality indicators. Every aged care home will be required to publish data on quality indicators such as pressure sores, medication errors, weight loss, falls, infection rates admissions to hospitals. They will also need to disclose complaints and how these complaints were resolved. Finally, the new Aged Care Act will require the registration of all workers.
Reason Australia recognises that current policies on ageing and aged care are underpinned by ageism. To achieve justice for older people, we have inclusive policies to combat ageism, homophobia and racism. Our policies also focus on healthy ageing and age and dementia friendly environments within our communities. If older people choose to live in their own home, a retirement village or an aged care home, they deserve respect, kindness and love.
18 April 2019
How often does an incident in an aged care home escalate because management is afraid of litigation?
When a mistake occurs in a public health service, the person who has been affected and/or their legal representative must be informed about the ‘adverse event’. This is known as ‘open disclosure’.
Open disclosure is defined as “the open communication that takes place between health practitioners and patients after an adverse event”. An open disclosure process includes: An apology or expression of regret; a factual explanation of what occurred; an opportunity for the affected patient to relate their experience; and the steps taken to manage the event and prevent its recurrence.
Legislation mandates open disclosure in all public health services in Australia, though each state has different legislative requirements. In Victoria, for example, the Victorian Charter of Human Rights and Responsibilities Act 2006, requires health care practitioners to discuss an adverse event with the person who has been affected and/or their legal representative.
There are around 2,700 aged care homes in Australia. Only 5 per cent of these are government owned. The other 95 per cent are private or not for profit. Although government owned aged care homes require open disclosure, there is no legislative requirement for open disclosure in private or not for profit aged care homes.
When an adverse event occurs in an aged care home, some managers inform the resident’s legal representative. These managers also respond respectfully and in a timely manner to requests for information about the adverse event. In these cases, the situation rarely escalates.
In contrast, when a manager is not open about an adverse event and does not provide accurate information about what happened, the situation can quickly escalate. With the media’s insatiable appetite for horror stories about aged care homes, these stories often make headline news.
A month ago, a 94-year-old woman was resuscitated in an aged care home despite having an advanced care plan stipulating Do Not Resuscitate. The family watched their mother and grandmother die a slow and seemingly painful death in a hospital palliative care unit, rather than die peacefully after breakfast.
Despite numerous attempts to find out exactly what happened, a month later the daughter still did not know why/how/who resuscitated her mother.
The quest for information began two days after her mother was transferred to hospital. The manager of the aged care home phoned. He said to the daughter: “I heard your mum got resussed on Saturday”. This was the first time the daughter was told her mother had been resuscitated.
How did a woman with an Advanced Care Plan that clearly stated Do Not Resuscitate get resuscitated?
During a time when the daughter should be grieving, she instead tried to get information. Who made the decision to resuscitate her mother? Where was she resuscitated (in the lounge room or in her bedroom)? What did her doctor advise the staff to do? What did the Ambulance Victoria advise over the phone?
She phoned the aged care home’s head office. She left voice messages that were not returned. She sent emails that were not answered. Eventually she spoke with the District Manager who undertook to investigate what happened.
Aged care homes need to prepare themselves for open disclosure. Standard 6 of the new Aged Care Quality Standards states: “Appropriate action is taken in response to complaints and an open disclosure process is used when things go wrong”.
By the time the daughter contacted me, she had heard several different versions of the event. The Manager of the aged care home, the District Manager, the hospital doctors, the aged care home’s progress notes all provide different accounts about what happened that Saturday morning.
The daughter was so frustrated she was ready to tell her story to the media.
Instead, I suggested she lodge a complaint with the Aged Care Quality and Safety Commission and sought advice from Elders Rights Advocacy. I also suggested she requested an urgent face-to-face meeting with the District Manager.
The District Manager agreed to a meeting. She asked an employee of Elders Rights Advocacy to accompany her as a support person. However, this is not a service Elder Rights Advocacy provides after a resident has died.
I contacted the CEO, OPAN to ask where someone in her position should go for help. Although the National Aged Care Advocacy Framework focuses on the older person, the framework has recently been expanded to include families or representatives.
I agreed to be the support person in the meeting with the District Manager. Unfortunately, an hour before it was scheduled, the daughter received a phone call to inform her that the meeting had been cancelled. There were unforeseeable circumstances.
To prevent this escalating, I immediately phoned the aged care company. I left a message explaining the importance of the CEO returning my call. I did not feel confident that he would.
Much to my relief, the CEO phoned back. I told him the daughter simply wanted a factual explanation of what had occurred, a genuine apology and to know what steps have been taken to prevent its recurrence. She wanted ‘open disclosure.’
I arranged a meeting so the daughter could hear the truth about what happened to her mother. A month after her mother was resuscitated in an aged care home, the daughter now has a time-line to show exactly what happened. She also received a heart-felt apology. During the meeting, we discussed ways to prevent a similar tragedy.
This incident demonstrates an urgent need for aged care homes to have policies to ensure residents are not resuscitated against their wishes. Residents and their families are encouraged to make advanced directives to state their wishes for end-of-life medical care. These advanced directives are meaningless unless health care professionals respect an older person’s wishes.
Aged care homes must ensure direct care staff on each shift know which residents are, and are not, for resuscitation. Each handover sheet should identify residents who have documented Do Not Resuscitate in their advance care plan. This is particularly important for agency staff.
I once arrived at an aged care home to find a fire truck, 2 Mobile Intensive Care Unit Ambulances (MICA), a paramedic motorcycle and an ordinary ambulance. All these flashing lights heralded the death of a 94-year-old resident. This may suggest that Ambulance Victoria needs some education when they receive a 000 call from an aged care home.
A doctor once told his colleagues that, when he reached a certain age, he would have “NOT FOR RESUSCITATION” tattooed on his chest. This would undoubtedly guarantee his wishes were respected.
Currently, residents in aged care home must ‘opt out’ of resuscitation. They do this by indicating Not for Resuscitation in their advanced care plan and advanced care directive. It may be better to make cardiopulmonary resuscitation an “opt in” for residents in all aged care homes. Only those residents who choose to be resuscitated will be. Others will be allowed a dignified death.
It is tragic that older people commit suicide (The Age, 17/1). The National Coronial Inquiry Service estimates that two people over the age of 80 are taking their lives every week. The most common method is hanging.
Ian Hickie suggests older people commit suicide because of myths and negative stereotypes about ageing, pain relief, hospitals and how the health system treats elderly people. Are these myths?
Recently, an elderly woman living in an aged care home died in excruciating pain because no one was suitably qualified on the night shift to administer the prescribed morphine. The woman’s daughter was so traumatised she could not remain at her mother’s bedside to hold her hand.
We do not need motherhood statements about healthy ageing. We need political action to ensure older Australians are valued and receive the quality of health care that they deserve.
Sarah Russell, Northcote