A new independent study by Dr Sarah Russell, of Research Matters, titled ‘Working Well in an Aged Care Home’ asked staff to fill out a survey on what they enjoy about their jobs. Conor Burke reports
If we want to improve the situation for residents, we need more registered nurses in aged care homes. When registered nurses are on duty, residents have better health outcomes, a higher quality of life and fewer hospital admissions.
26 February 2018
A shocking new study reveals aged care home spent an average of $6.08 per resident to provide residents with three meals a day. Michael Gannon, president of the Australian Medical Association, describes this as a “national disgrace”.
In aged care homes, meals are the highlight of a resident’s day. Some aged care homes provide delicious and nutritious meals. Others serve meals that are inedible.
When compared to international food budgets, Australian aged care homes spend 1.4 times less than Canada and 3.8 times less than Norway. When providers skimp on the cost of meals, they are putting residents at risk of malnutrition.
A recent study described at least half the residents in Australian aged care homes as suffering malnutrition. Malnutrition increases risk of falls, pressure injuries and hospital admissions. This not only decreases residents’ quality of life but also increases health care costs.
The importance of older people having a nutritious, well balanced diet is widely acknowledged. Yet it is also important that older people have choice. Recently, a GP told a 94-year-old resident not to eat soft cheeses (her favourite) because it may raise her cholesterol. My mum also loved soft cheeses – and I encouraged her to eat as much as she wanted. Mum had reached an age when she could eat whatever she wanted, irrespective of her cholesterol levels. This included our regular trip to McDonalds for a cheeseburger and a chocolate shake.
In some aged care homes, residents are not given a choice. They are often served meat pies, deep-fried patties and chicken nuggets. Sugary desserts are also common. Given the incidence of diabetes, heart disease and cancer in older people, the high level of sugar and salt in the meals served in some aged care homes is negligent.
Some residents might enjoy helping staff in the kitchen. However, residents are rarely allowed to participate in food preparation. Although older women spent most of their adult lives preparing food for their families, providers claim that food preparation puts residents at risk of injury. Even a simple activity like peeling potatoes is often not allowed because residents (many of whom have peeled potatoes all their adult lives) are at risk of cutting themselves.
Meal times can be chaotic and distressing for those residents who can’t feed themselves. Often their hot meals are served cold. When an aged care home is short staffed, residents may be fed their meals too quickly. This puts residents at risk of choking.
Many aged care homes use outside caterers that deliver meals wrapped in plastic. It is difficult for some older people (e.g. those with arthritis in their hands) to access their meals. Without assistance, these meals may be left untouched. Staff are so busy they may not notice the unwrapped food remains on the meal tray.
There is also concern that residents may not be drinking enough. Mum would be given a full cup of tea and then later a member of staff would take away a full cup of tea. Staff were simply too busy to notice that Mum had eaten the biscuit but not drunk any of the tea.
The Lantern Project fed everyday Australians a typical aged care meal. The food was described as “disgusting”. Some questioned whether it was in fact food. The poor quality of food served in some aged care homes inspired the Maggie Beer Foundation to develop ‘Creating An Appetite For Life’ Education Programs. These programs raise awareness, train staff, managers and chefs to buy and serve fresh produce and make food more palatable.
Residents’ wellbeing depends on aged care homes serving nutritious and delicious meals. Replacing processed food with fresh seasonal produce makes economic sense. Many aged care homes have productive vegetable gardens tended to by those residents with green fingers.
It is beholden on aged care providers to make meal times a happy experience for older Australians living in aged care homes. This will improve the health, happiness and quality of life of residents.
Aged care homes are places where our most vulnerable older people live. How do we ensure the highest possible standards of care?
Published in Courier Mail on 27 March 2017
Last month the Courier Mail reported yet another heart breaking story about aged care homes (Aged care nightmare: man’s scrotum ‘left bleeding’, 20th February). Many of us were shocked because we assume elderly Australians receive high quality care in aged care homes.
The Federal Government is promoting its reforms in the aged care sector as supporting a consumer driven and market-based system. However, the “consumers” in aged care homes are often frail, elderly people, many with dementia. How can they demand a high quality service on the free market?
There are around 2,600 aged care homes in Australia. Although some are excellent, many aged care homes operate without enough staff. Managers who are under pressure to meet their profit targets do so by reducing staff, placing vulnerable residents at risk.
Staff in aged care homes are often hard-working, dedicated people doing a very difficult job for not much pay. When an aged-care home has insufficient staff, there may not be time for staff to walk residents to the toilet or even help them out of bed. All too often relatives feed, shower and dress residents because staff are too busy.
A key to quality healthcare is a good staff-patient ratio. However, unlike hospitals, there is no federal legislative requirement for aged-care homes to have mandated staff-to-resident ratios or skill prerequisites. The decision whether to have a registered nurse on duty is at the discretion of the provider.
When registered nurses are on duty in aged care homes, residents have better health outcomes, a higher quality of life and fewer hospital admissions. However, registered nurses now account for less than 27% of this workforce, while personal care attendants make up 68%.
Some personal-care attendants gained their qualification to work in an aged care home after completing a five-week course. It is inconceivable that someone with only five weeks of training is qualified to provide competent care, particularly when there is no registered nurse on duty to supervise them. Is it any wonder relatives’ submissions to recent inquiries into aged care have highlighted inadequate personal care, neglect, and negligence?
Relatives complain because residents’ needs are unmet – when incontinence pads are not changed regularly, when bruises appear or skin tears, and when pressure sores are not treated appropriately, in some cases turning gangrenous. Complaints are also made when residents suffer from malnutrition and/or dehydration and are chemically restrained. The list goes on.
The accreditation process should play an important part in monitoring the standards of care in all aged-care homes, including whether adequate numbers of skilled staff are employed. The current accreditation standards are woefully inadequate.
Coronial inquests into separate deaths at two aged care homes in Melbourne, BUPA Kempsey and Arcare Hampstead, exposed inadequate care. Yet both BUPA Kempsey and Arcare Hampstead were fully accredited by the regulator, the Aged Care Quality Agency, with perfect scores of 100 per cent in all criteria. This suggests something is wrong with the accreditation processes.
Following the coronial inquiries, the Aged Care Quality Agency did not change the accreditation processes. Vague phrases such as “sufficient staff” continue to be used. In some cases, sufficient staff means no registered nurse on duty. It may also mean an inadequate number of personal-care attendants.
When taxpayers are subsidising the care of elderly people, the public’s investment needs to be protected in the form of regulation, mandated staff ratios and a rigorous accreditation system. The care of vulnerable older people is too important to be left to the whims of the free market.
Published in Courier Mail on 27 March 2017
Sarah Russell’s article (“We’re neglecting our ageing population”, Comment, 18/4) describes many of the serious shortcomings evident to anyone who has experienced the emotional turmoil of placing a loved one into institutional care.
Mecwacare’s Noel Miller Centre in Glen Iris is a case in point. In the high-care facility, significant cutbacks in staff numbers along with general management disengagement from resident service delivery is of great concern to those who visit daily, some twice daily. All too often relatives have to help with tasks from feeding, bathing and room cleaning because staff are too pressed. Management too often does not see what actually occurs in residents’ rooms and common areas – preferring to remain in their offices.
Curiously, Mecwacare, a not-for-profit organisation, recorded a net profit of $3.9 million for the year ended June 30, 2015, and bought a new head office in Malvern and added six aged care homes to its portfolio.
Neither the board nor the executive of Mecwacare has explained why growing the portfolio of buildings and Mecwa facilities should take precedence over the care and welfare of those already living in their facilities – especially in their high-care units.
John Simpson, former resident relative – Mecwacare