Accreditation has never been an effective regulator. It has failed in the USA, the UK and Australia.
Accreditation was not designed to be a regulator, was not intended to be a regulator and between 1997 and 2014 the agency insisted it was not a regulator – although everyone else knew it was a central part of the regulation that government and industry boasted of. As the criticisms show accreditation and regulation are incompatible.
In 2003, industry and regulator promised parliament that they would collect objective data about the outcomes of care. They have never done so and we can only guess why! They clearly cannot be trusted to do so. We need to insist on that and ensure that the data is verified.
We can compare Australia with the USA where on average, they provide twice as much care from trained nursing staff and a third more nursing care overall.
In 2016 in Australia, 97.8% passed all accreditation standards.
In the USA they collect data and verify yearly. Only 7% pass every test. Of the 93% who fail at least one assessment, 20% have a serious failing. We do not advocate this intensity but what we do is unacceptably inadequate.
In 2014, the agency's independence was removed and it became part of a government department. An industry heavyweight was put in charge of it. Under the guise of 'red tape reduction', the Abbott/Turnbull government introduced a $6 billion reduction in regulation in Australia.
As a consequence, between 2012 and 2017 the number of visits to nursing homes by the agency fell by 1,725 (30%) from 6,435 to 3,864.
The number of visits by the complaints system started falling after the Walton Review in 2010 from 3197 to in the region of around 100 in 2017 (98%).
Overall, the number of regulatory visits fell by over 50%. With an unregulated and uncontrolled market things rapidly got worse and we now have a Royal Commission.
With fewer visits and less regulation, the number of facilities not meeting all standards each year fell from 7.6% in 2012-13, to 2.5% in 2015-16.
The percentage of facilities being sanctioned fell from 0.94% in 2012-13 (one in a hundred) to 0.19 (I in 500). (from over 20/year to 5/year).
Recently released data shows that in the 5 years 2013 to 2017, seven facilities had their accreditation revoked and 5 were closed (2 were appealing). The minister recently indicated 1 per month has been closed in the last year (ie. 12).
So, those unhappy managers and their advisers are right, the regulatory role has been brought back and yes accreditation is not a regulatory process and does not work when it tries to be.
Both Anderson and the minister have made statements elsewhere which make it clear that this same market model and same regulatory system are to continue. This model spelt out on the Aged Care Roadmap has not worked. As communities we should not allow that to continue.
We need a new model based on care. This model asserts that each one of us and each of our communities is ultimately responsible for our fellows when they are in need. Anyone who provides care does it on our behalf. They are our agents. Our capacity to hold our agents to account has been taken away by the flawed Aged Care Roadmap.
Aged Care Crisis argue that it is time for the management and oversight of aged care to be brought back into local communities where they can work cooperatively with their agents and make sure they are doing what is needed.
It is government's role to support and build community and train its members so that they have the knowledge to work with their agents in providing services to their communities.
Communities need to have a role in deciding who will care for their frail elderly and be able to reject those who fall short. They can make this market work for them and their members. They can change the culture and make nursing homes the sort of places where trained staff want to work because they are appreciated.
It is government's role to create a proper regulator, a policeman that citizens can call on when any of their members are harmed. If accreditation has a role, it is to work with providers and help them to meet each community's expectations. Its utility should be assessed by its performance in transparently securing outcomes.
