Aged Care Crisis wrote to the Minister questioning the astonishing revelations of NO staff rostered to look after resdients in a Queensland home. We asked that if the Minister wasn't prepared to set safe or minimum staffing ratios in aged care, to at least apply transparency about how homes are staffed, especially in some cases where there are none, so that family members are able to make informed decisions about aged care placement for their loved ones.

19 December, 2012

The Hon Mark Butler MP
Minister for Mental Health and Ageing
Suite MG48
Parliament House
Canberra ACT 2600
email: ministerbutler@health.gov.au

Dear Minister Butler,

It has come to our attention that Southport Lodge, an aged-care facility which underwent an audit by the Aged Care Standards and Accreditation Agency in September this year, was found to provide no staff at all to care for its 31 residents between the hours of 8.00 pm and 6.30 am.

As a result, recurring incidents of resident neglect occurred - including absconding, wandering and falls related injuries. This is all the more extraordinary as this audit was a re-accreditation audit - one which is well known by the facility management and planned for weeks, or months, in advance.

Aged Care Crisis has long decried the absence of mandatory staff/resident ratios and skill levels in government-funded aged-care homes. However, we never envisaged that a situation would occur where there was no staff at all on duty for considerable amounts of time.

Because there are no mandated safe staff/resident ratios or skill levels in aged care, frail, older people who reside in our homes are not afforded the protection offered to most, if not all, other vulnerable citizens who receive care.

We ask that, in the absence of such mandated safe resident/staff ratios and skill levels in aged care, facilities should, at the very least, provide information to families, and to the community in general, on the number of staff involved in direct patient care.

This initiative would enable the community to make informed decisions about placement and care of their loved ones.

We also ask that you investigate further this instance of gross neglect of frail older people and provide assurance that such neglect will not occur again.

Residents require care at all hours during the day - to leave them without support and care is a dereliction of duty.

Regards,
Aged Care Crisis Team.

The following letter was sent to the Minister for Mental Health and Ageing in a desperate attempt to find suitable placement for a resident. Names and some information has been changed to protect the family and resident.

At the time of publishing this letter, no response or acknowledgement of the correspondence has yet been received.

Under the recently revised (4th reincarnation) of the Aged Care Complaints Scheme (2011), Aged Care Crisis continue to receive correspondence from concerned family members about their dissatisfaction with the current scheme.
Many complainants struggle with poor communications and management of their complaints by the ACCS.
The whole process for them, then morphs into some inexplicable obstacle course, which then compounds the family's distress in addition to their actual complaints.

The following letters were sent respectively, to the Minister for Mental Health and Ageing, Mark Butler, The Aged Care Commissioner, and the Department of Health and Ageing, by a concerned family member on the 18th August 2012, as a last resort effort to have their concerns addressed after ABC coverage on the 7.30 Report aired regarding rorts in aged care.

The three letters below, illustrate the points Aged Care Crisis highlighted in our submission to the Productivity Commission's Inquiry Caring for Older Australians back in August 2010 (two years ago from the date of this article).

Specifically, the following sections in our submission which illustrate points made in the following three letters are:

1. Government roles and responsibilities; 2. Tranparency, accountability and disclosure; 4. Complaints Investigation Scheme; 12. Ageing in place; 13. ACAT Assessments; and lastly, 13.1 When "high care" really means "low care"?.

On request, we are publishing a consumer based comment responding to the article that was published in the online Australian Ageing Agenda's article Peaks slam Seven's Today Tonight. The publisher was concerned that their voice was not heard (or published), and has requested that Aged Care Crisis publish their commentary responding to the criticism the aged care industry and it's heads have embellished upon negative media coverage of aged care homes in Australia. Thankyou to Australian Ageing Agenda for publishing the comments soon after we highlighted this via Twitter - very much appreciate their quick response:

My feedback is not very positive on the first two nursing homes my mother was in.  Appalling standard of care.

Both accredited. Which I since learnt meant nothing as to the quality of care or had anything to do with resident to staff ratio.

Public relations: when is a crisis not a crisis?

Aged Care Crisis has observed a fairly new and recurring theme in aged care - public relations and crisis management.

The increasing privatisation of aged-care services has created a lucrative new field of endeavour - that of public relations in aged care.

Here the advice provided is not about care but more about peripheral matters such as how to manage publicity when things go wrong. The peak bodies excel at this too.

Aged Care Crisis believes that the best way to mitigate a crisis is to prevent one from occurring in the first place.

It should be obvious that competent aged-care providers don't need external public relations consultants to massage their image as their aged-care provision is based on substance.

Increase staff …

I APPLAUD the move to support the aged to stay in their homes (The Saturday Age, 21/4). However, some of us need 24-hour care for our loved ones. I am disappointed there appears to be no recognition of the fact that in order to have quality of care in nursing homes, there must be a mandated minimum number of staff.

I agree with Bernadette Clohesy that, generally, staff are caring and do what they can, but my experience is that there are too few of them to provide quality and, at times, even basic care. The proposed My Aged Care website will not solve this problem. Even if some nursing homes provide better care than others, we cannot all move our loved ones there, particularly as we want local ones to allow for frequent visiting. All nursing home residents deserve quality care.

Rita Wainrib, Coburg

… and transparency

MINISTER for Ageing Mark Butler says My Aged Care website will include information on a nursing home's staffing and any history of complaints. This could be a profound change in an industry which is secretive considering its heavy reliance on taxpayer funds. Staffing information means little unless it is expressed as a ratio between staff and residents. Staff's skill levels and the dependency levels of residents also need to be transparent. Such disclosure will need to be mandated in the Aged Care Act.

The planned reforms do not address the secrecy of the Accreditation Agency's reports when its staff make unannounced visits to nursing homes. These are apparently ''protected information'' under the Aged Care Act. However, when the homes are told in advance of the visits, the ''Tweedledum and Tweedledee'' reports are made public.

Carol Williams, Elder Care Watch, Blackburn

Such a ratio is not surprising, however, given the paucity of the legislation regarding staffing requirements - approximately 4 lines - in the 379-page Aged Care Act (1997). And although aged care received a brief appearance on the front pages this weekend, the quality of care is unlikely to change dramatically while providers and the Productivity Commission view ratios as unnecessary and a ''blunt instrument''.

This is astounding, given that a recent report commissioned by the Department of Health and Ageing found the system to be lacking with regard to the delivery of high-quality residential care for dementia sufferers, with ''1600 new cases being diagnosed every week and [its prevalence] likely to double over the next 20 years.''

While providers have licence to employ minimal numbers of registered nurses and a majority of minimally trained personal care workers - at such pitiful ratios to residents - it is little wonder that the prospect of entering residential aged care is viewed so negatively.

Glenda Addicott, East Ringwood

I WISH to contradict a Council on the Ageing report that, at 31 meetings held by Minister for Ageing Mark Butler around Australia, ''usually one or two people … expressed concern at having to sell their principal residence (to meet nursing home bonds), but this concern was not generally picked up and supported by the majority of the audience'' (The Saturday Age, 6-7/4).

I attended several meetings. I, and others, were applauded when we expressed opposition to selling homes for any care.

I asked Mr Butler whether he knew of any other health area in the world where mortgaging or selling the home was a prerequisite for receiving care. He did not.

Currently many people have to sell their homes to pay an accommodation bond for low-level care.

The Howard government tried to introduce bonds for high-level care, but was unsuccessful because of public opposition.

There will be disappointment and anger if the Labor government introduces such legislation.

Shirley Bains, Blaxland, NSW
Read more: http://www.theage.com.au/national/letters/call-it-what-it-is-superstition-20120408-1wje5.html

In August 2011, Mark Butler, the Minister for Mental Health and Ageing, announced a program on National Conversations on Health Ageing (forums) to give the community the opportunity to comment on the recently released Productivity Commission Report, Caring for Older Australians.

COTA was awarded a $410,000 by the government to hold these "national conversations" with communities across Australia about aged care reform.

It is unfortunate that they too have omitted to publicise these sessions sufficiently to provide an opportunity for the public to attend. Attendees were required to formally "register" for each event.

ACC suggested to the Minister that in order to give consumers, carers and their families a real opportunity to participate, he should release these details by way of a media release - in the same way that we receive various other statements, speeches, announcements, new appointments, information sessions for aged care providers, etc.

Aged Care Crisis is concerned by COTA's financial dependence on government and its inappropriately cosy relationship with the providers of aged care.

The Victorian branch of COTA receives 86% of its funding from government (COTA Victoria 2011 annual report), which is likely to be representative of other states.  COTA is a member of the National Aged Care Alliance (NACA), a provider dominated body.

The Global Mail in an article titled "LET'S RAISE A TOAST!" AGED CARE LEADERS JOKE ABOUT KEROSENE BATHS" published on 23 February 2012, describe a series of matey bad taste emails between NACA leaders on the 10th anniversary of the Kerosine bath scandal.  This scandal is what prompted the formation of NACA. 

In his email contribution Ian Yates, chief executive of COTA, toasts NACA's success, and boasts about his role in persuading COTA to join NACA and be part of an "important national vehicle for aged care reform".

Like it or not, COTA (Victoria at the very least) is seen to be dependent on government funding for its survival.  Its leaders are proudly working closely with the providers of aged care, linking COTA's success to theirs.

There is a wide perception, fueled by many whistleblowers, that many nursing homes are understaffed and provide substandard care.

The government and the 2011 report by the Productivity Commission Report, Caring for Older Australians are strongly supportive of the industry and its interests. They have have failed to address these issues adequately and COTA has not challenged them.

COTA should not be surprised that consumers as well as the public are now questioning its independence.

They doubt its ability to represent the interests of consumers, especially when these conflict with the financial priorities of providers and the political sensitivities of government.

Did the government really want publicity for independent critics asking difficult questions at its consultations ... or just to claim it had consulted ?

Updated: 28 February 2012

Related articles:

• 23 Feb 2012: "Let's raise a toast!" Aged Care leaders joke about kerosene baths
  (By Sharona Coutts, Joel Tozer, The Global Mail)
  An email exchange started with a questionable joke, but it led to concerns over the independence of some aged-care advocates.
• 22 Feb 2012: How our twilight years are ripe for the picking
  (By Sharona Coutts, Joel Tozer, The Global Mail)
  The government admits aged-care costs have ballooned by nearly $2 billion, but has kept quiet on the real reasons why
• COTA Australia: Consumer Watchdog or Government Lapdog? Media release (CPSA)
• Pensioners warned: "Age Well" campaign = "Lose Your House" campaign Media release (CPSA)
• Beware the Nursing Home Industry's 'Grand Plan' Media release (CPSA)
• Your gift to nursing home barons Media release (CPSA)
• Flog off the family home for a nursing home bed? Over my dead body Media release (CPSA)

Productivity Commission’s Caring For Older Australians: Aged Care Reform? - Or Economic Darwinism?

In its overview, The Productivity Commission states that its “overriding objective is to improve the wellbeing of the community as a whole” while recognising that “aged care is an integral part of the health system”.

But what does the Productivity Commission consider is the ‘community as a whole’ and why, in its next breath, does the Commission proceed to deconstruct (or, as it says, ‘unpackage’) – “an integral part of the health system” into various components (i.e. personal care, health care, accommodation and everyday living) to which it then attempts to justify attributing separate costs, and responsibility for meeting those costs.

Will the Productivity Commission’s next step be to ‘unpackage’ all parts of the health system into components, and can any hospitalised person consequently expect to (for example) provide for their own bedding, meals and toilet paper? Can we similarly expect maternity or IVF patients to be charged on the basis of the actual cost involved, as well as their individual capacity to pay? Would it not be fair for the government to similarly garnishee their homes? And if not, why is it seemingly acceptable to treat disabled older people more harshly than fit and able younger people? Are the proposed aged care reforms not elder abuse or, at best, ageism?

This email was sent by a daughter who is desperately wanting to move her mother to a nursing home that will look after her mother in a caring environment.  It needs no further introduction. For obvious reasons the name of the author is withheld and forgotten.

MARGARET Gray raised a critical question (Letters, 4/6) that has elicited neither further discussion nor answers.

My mother is also in receipt of an aged care at home package. It is generous at approximately $48,000 a year. The family contributes more than that for her care at home, plus hours of unpaid family care.

The package is paid to a service provider company that doles out the services that can be accessed. 

I calculate these services are worth about $25,000 a year.

So where is the remainder of her grant going?

I cannot scrutinise expenditures made on her behalf because the company will not give me a statement of account despite repeated requests.

We are entitled to access the true value of her package.

Forget about transparency and accountability; these aged care grants are clouded by layers of administration, regulation and double-speak.

Fanny Abrahami, Caulfield North

Source: The Age, Letters

LENGTHY waits for emergency hospital care are the result of elders waiting for aged care beds ("Aged care shortage chokes hospitals", The Age, 2/6). Occupancy rates in nursing homes consistently average around 93 per cent. However, tens of thousands of nursing home residents are classified as "low care". Many of these elders might still be in their own homes if it were not for the severe rationing of community aged care packages by successive federal governments.

The demand for packages outstrips supply by 10 to one. It is socially and economically irrational for this rationing to have continued for so long. This year's budget papers acknowledge consumer preference for care at home and the lower costs. Accordingly a marginal shift has been made in favour of subsidies for home care rather than for institutional care.

Unlike high-care residents, low-care residents are required to pay accommodation bonds to nursing home providers.

The question is just whose interests have been served by the rationing of home care?

Carol Williams, Elder Care Watch, Blackburn

Residents subjected to the alleged events which occurred this time in a New South Wales nursing home, which included the horrors of:

• having resident's genitalia photographed for some sick game;
• depriving a dying man of food; and
• taunting a dementia resident;

Sadly, none of these events satisfied the official government requirements of the "compulsory reporting" regime that was introduced in 2007 to purportedly "protect" residents in aged care.  Although in this case the provider optionally contacted the department, there was no requirement to do so. 

"Compulsory reporting" laws were introduced in 2007, as a result of alleged sexual assaults in a Victorian nursing home. 

I have read through this website, and I am amazed at how much work has gone into it. It is very impressive.  

My mother has been in a nursing home for several years and I've observed power being routinely abused by staff where she lives.   I feel there is a game going on.

Accountability is, in my opinion, a vital ingredient when one group of people have power over another group.  Especially when one of the group's is vulnerable physically and emotionally.

I think Government regulators are incapable of implementing a system of justice and empowerment for Nursing Home residents, that's why it isn't happening. Simple observations tell me this. 

SUGGESTION is to put our seniors in jail and the criminals in nursing homes.

This way the seniors would have access to showers, hobbies, free prescriptions, dental and medical treatment and they'd receive money instead of paying it out.

They would have constant video monitoring, so they could be helped instantly if they fell, or needed assistance.

Bedding would be washed twice a week, and all clothing would be ironed and returned to them.

A guard would check on them every 20 minutes, and bring their meals and snacks to their cell.

They would have family visits in a suite built for that purpose.

They would have access to a library, weight room, spiritual counselling, pool, and education.

Simple clothing, shoes, slippers, PJs and legal aid would be free, on request.

Each senior could have a PC, a TV, radio, and daily phone calls.

And the criminals?

Well, they'd get cold food, be left alone and unsupervised, lights off at 8pm and showers once a week.

They'd live in a tiny room for which they would pay $5000 a month with no hope of ever getting out.

The following article has been written by the daughter of a resident who currently resides in a federally funded Australian nursing home. The intent of the article is meant as a warning for baby boomers. The writer offers some tips and hints to consider, as well as a personal perspective based on the resident's experience. It articulates some of the problems faced by consumers of aged care in this country.

The article should be read with this in mind. While we are aware that not all facilities operate like the one described in this article, it is a sad fact that Aged Care Crisis does receive many complaints that uncannily enough, contain similar scenarios.

It needs no further introduction. For obvious reasons the name of the author is withheld and forgotten.

The following letter was sent by a concerned daughter whose mother currently resides in a nursing home, to Minister for Health and Ageing Nicola Roxon, in an effort to raise their concerns about lack of staffing ratios and skilled staff working in aged care, as well as the lack of care. As well as providing a first hand view of these issues, the author has also provided some practical views on resolving those issues:

The current limited system of late release and early removal of adverse reports from the Aged Care Standards and Accreditation Agency website is unsatisfactory. Consumers are entitled to disclosure of all past, as well as present, reports. Information needs to be presented in a digestible format. Frail older people are one of the most vulnerable groups in society and their protection should outweigh all other considerations.

The NSW State Government is transferring the remaining 11 state owned aged care faculties to the private sector.

The Wallsend Aged Care Facility is one of these facilities. Growing community opposition, frustration, and betrayed individuals are protesting their opposition to this mishandled and demeaning privatisation by stealth.

George Vassiliou applied for the EACHD (Extended Aged Care at Home - Dementia) package to help his then 84 year old mum to stay in her own home - but was shocked to find that two thirds of the money was eaten up by overheads. 

After arguing his case for years, George finally won the right to administer the EACHD package for his mother. 

George's mother's health deteriorated some time later and she now requires full time nursing home care. 

The following correspondence was sent to the Ageing Minister, Justine Elliot, in October 2009, regarding the concerns of care for George Vassiliou's mother.  It highlights the difficulties faced with many consumers, wrestling with a less than satisfactory system.

The Minister quoted: "The data speaks for itself. It shows the vast majority of nursing homes are providing a world class service, but there is a small group - 46 nursing homes - that had failed to meet 44 accreditation standard outcomes under the Aged Care Act." The problem here is that there is an inbuilt assumption that says that if homes pass accreditation then they are 'ipso facto' delivering a world class service.

Thank you Linda Sparrow for speaking so very well on behalf of the residents and staff of nursing homes. I work as a registered nurse at weekends (I teach ethics at a University during the week) at a nursing home, this is my seventeenth year in the job. The facility has over 50 high care and approximately 40 low care beds; 15 of the high care beds are for dementia patients. At weekends we have two registered nurses and one enrolled nurse for these 100 residents.

I began my career in 1994 , as an Enrolled Nurse (EN)working in Nursing homes. There were quite alot of us back then, we had no Personal Care Attendants(PCA) and I was one of 15 ENs over seen by 2 supervising Registered Nurses (RN). We heard of places that were utilising untrained staff, they were cheap and basically it gave the organization "flexibility".

The PCA had to do whatever role was required back then. Slowly the PCA role seeped into most areas of aged care but there was still a large Trained staff componant.  But in time, and because PCAs were cheaper and more pliable, there was more and more of them.

Many Aged Care Homes have a range of facilities. These include some form of catering as an alternative (and for visitors to purchase food) and hairdressing. Usually there some craft facilities and social/entertainment areas for guests as well as residents. There may well be others at different homes.

One rare but necessary facility which seems to be missing is a consulting room for medical practioners when they visit patients who are residents of homes. A consulting room would allow privacy, provide more appropriate surroundings and include some relevant equipment.

Where are we headed with this Government?

Aged Care Homes that people entered in good faith assuming that they would be cared for in their old age are now closing in greater numbers than ever before forcing Residents to find other places to live.

I am a Recreation Activity Officer (RAS) at a (large) nursing home. This home has a mixture of hostel and nursing home accommodation. I work two 6.5hr days per week for $17 per hour (care service employee grade 2 + 3% negotiated in an AWA 2007). The management restructured all staff's working weeks to 6.5hr days around 3 yrs ago...