The following article was written by a person with a loved one in a nursing home. It illustrates the direction that aged care is taking in a competitive 'market' - how residents in many homes are cared for by people whose prime interest is how much money can be squeezed from the care of the residents. It needs no further introduction. For obvious reasons, the name of the author is withheld and forgotten.

Dear Mr Jonah and all those who sail with you,

I have been reading your Annual Report and am saddened.

You speak in glowing terms of the wonderful opportunities for the business and your shareholders going forward with expected growth rates and increasing profits. You speak of EBITDA’s and ACFI’s and EBA’s and NPA’s and LTIFRs’ (1) and all sorts of things many of us have never heard of. You speak of greenfields, brownfields, organic growth, acquisitions and management platforms.  You speak of exciting opportunities in the future and the imminent introduction of the 'Workforce Management System' which will further cut staffing levels and add yet more to the bottom line.

If I were a shareholder in your company, I would be beside myself with glee by now. But wait, there's more.

Drilling into your publication, you talk about introducing all sorts of paid services and other opportunities. You speak of how, with the constant delivery of quality care and a safe environment, you have achieved a 100% accreditation rating and give yourselves a pat on the back for the effort.

Then, there, buried away in the body of the report, under the address from your good self, all alone, as the afterthought it is, stands one tiny paragraph headed Our people, our residents and staff remain our number one priority.  The consistent delivery of high quality care and a safe environment.  They are numero uno, number one in line.

Now, that is where it all gets a bit sad. You see, in my view, you are practicing the Oleander Principle:

The Oleander Principle is the principle of looking good, smelling great and promising the world great things using platitudes, secrecy and showmanship, all the while doing something completely different … 

"The Oleander: The flowers require insect visits to set seed, and seem to be pollinated through a deception mechanism. The showy corolla acts as a potent advertisement to attract pollinators from a distance, but the flowers are nectarless and offer no reward to their visitors."

You see, I know of more than one of the facilities you run and I have a few comments to make about them. You took them over a while back. They were ok, not the best, but ok. However, since you have taken control you have made some changes... for the worse.

You have cut staff numbers to the core. This has a serious impact on the high care residents you claim to care for, your 'number one' priority. Then, if any staff member is not able to work one day, the residents get to sit around in rooms waiting and waiting... and waiting to be got out of bed.   Your policy of not replacing non-attendant staff with an agency person is not so good for residents, but works a treat for profitability - no doubt reflected in the huge savings made in the balance sheets.

Your place used to have some reasonable staff known to the residents - until they were bullied out of it by your shiny new team. At least you are on a par with some other homes in that regard. In fact, you are on a par with a lot of other homes in many ways now that I think of it.

Oh, and the policy that says 'if a resident is not able to be got out of bed then they are confined to their bedroom’ - ensuing a day of drudgery and boredom.  The genius who thought of that needs a pay rise.  I can see how that is appealing and makes for a much quieter atmosphere.

There used to be a bus trip weekly so the residents got to experience and see some of the outside world and perhaps go out for lunch at a bakery by a park or to the hills somewhere. An outing, a little excitement in their otherwise drab week. They had favourite places they used to go. That doesn’t happen any more. It''s more like once in a while. What happened?

The home has a hydrotherapy facility which works, or rather, worked quite well and was a comfort to those in need of some exercise of a gentle nature. Then you took over. Now mysteriously, it doesn’t work anymore. A friend of mine found great relief in that pond as it kept him mobile and gave relief. Never mind.  Unfixable I’ve heard.

The food was never much good, but occasionally it was at least warm. Yes, there was choice as there is now. But it is your choice and not something I would want to eat.  But then I, like you, don’t have to eat there. But that is where choice ended. When it came to the temperature side of things, well, there is no choice. When the fish and chips are soggy or the braise is gluggy and they both taste like they came straight from the fridge every day, it gets a tad disappointing. 

Food is an important marker of the day for residents in aged care and often the only thing some residents have to look forward to. 

I want to commend you on your smartly dressed onsite chef - and the kitchen does look really good. All shiny, well kept and set to impress potential new residents and keep your ratings up. Pity it is just for show.

The thieving and destruction of personal property, precious memorabilia and clothes is carrying on unabated I see. Well done. You are always able to blame someone for that one. You always could. Probably due to wandering residents, agency staff, a passing vagrant, who knows. Why, the long suffering resident could have just chucked them in the bin for all you know, or swallowed their teeth. Could have been anybody couldn’t it? You’re never responsible and you don't seem to care.

Toileting your 'number one' priorities you have down to a fine art. Residents who need to wear incontinence pads are rationed to three a day, yes, just three. They get to sit or lie around in their pee and poo for anything up to eight hours. You try that one!

The incontinence nurse from the company that supplies them, speaks in a manner of almost disbelief and marvels at how effective they are and that it is amazing they will hold four litres (that is one gallon give or take) of urine and ''aren’t these modern materials just so great and because of that they don’t need to be changed very often".  The upshot is that you need less pesky staff to care for your leaky old residents. 

Think of the savings and the benefit to the home and the environment --- and they can supply a nifty little three-pack holder to hang on the wall.  They also come in boxes of 12 or more and are very cost effective at only two dollars each.

Q) How does that help your number one priority? High quality care? Really? 

The upshot is: On top of the extreme discomfort they experience daily due to the stinky solid pads, Urinary Tract Infections (UTI’s) are forced upon the residents whether they want them or not, although I can’t imagine anyone actually wanting one. I don’t know what the rates of UTI’s are in your home, but my understanding is that the industry standard for nursing homes is 50% compared to 10% for the same age group in the wider community. I wonder why that is? But I understand that for you it is part of a cost-savings exercise - wouldn’t want to cut into that multi-million dollar NPAT would you?

Anyway, who cares about the oldies really? It is their problem for getting old and leaky.  And if they get sick, well, they can pay for that themselves and they should be thankful they get treatment within a week - in spite of the recommendation in the GP silver book that treatment begin immediately a clinical diagnosis is made.  Here is the bit lifted from the RACGP Silver Book. You should read it because people at that age really go right off the planet with a UTI:

Urinary tract infections: Assessment

... Common symptoms of a lower urinary tract infection are dysuria, frequency, urgency, nocturia, haematuria, and suprapubic discomfort. Patients with pyelonephritis may have loin pain, fever, nausea, vomiting, diarrhoea and general malaise. Older people may also present with delirium, confusion, falls, immobility or anorexia ..."

... Antibiotic treatment of lower urinary tract infections can be commenced on clinical diagnosis, and reviewed with results of urine culture ..."

Source: Medical care of older persons in residential aged care facilities, RACGP Silver Book, 4th edition, Page 54, Common clinical conditions

I guess that is where the good doctors really come in handy and prescribe those mood controlling drugs in the form of 'anti-depressants'.  Where would you be without them? The industry rate for the prescription of them is 70% - but I guess that can be tweaked. That keeps the priority people quiet and less bothersome doesn’t it? And the best part… the dear old residents (those number ones) pay for that as well. Everyone's a winner here - except for the resident.

Forgive me for feeling a little cynical regarding your tiny mention of the 'number one' priority and the 'high quality care' you claim to deliver. I imagine we have different expectations and ways of assessing and defining exactly what 'high quality' is. A bit like the agency which accredits you. They make an appointment at your convenience so they smell the paint, check the paperwork is up to scratch, admire the carpet, look at the menu and speak to the hand-picked residents you have selected, then stamp your card.

At the end of the day, should anything go awry, you can take comfort in knowing that a plethora of assistance from various 'risk management' and PR consultants than can advise on the cost of cover ups. They can advise on the palms you have to grease, the people you have to suck up to and the talking heads you have to buy or lobby. The people on your other short list of priority people, the real ones, are a different set aren’t they? Then you will sail along in to the sunset all squeaky and clean and looking good as you watch your numbers going up... and up.

I don’t imagine my little note will have any effect on you or your quest for the mighty dollar. From my perspective, it’s all a bit sad really. When I was a kid growing up we had society. We also had economy - but the economy was there to serve society. It was a time when people actually cared about each other, especially the vulnerable. Perhaps my problem is I care too much for the people I know and don't know -- and I should just shove off and leave you to weave your magic over the victims of your tailored neglect and abuse.

I guess economy won and now people are of little or no value at all. A bit like an Oleander bush. Lovely tree and beautiful flowers, but it will poison you if you consume it. Your little business is just another shining example of how, when it comes to a dollar versus humanity, for some, the dollar will always win.

I guess the fact that these people built our economy and suffered all sorts of hardships and even for some of them, risked their lives in war so we could have what we have doesn't mean much to you. I doubt it ever did nor to the people who support you in your quest to become profitable, efficient and successful.

They come to you and others like you now in need of care and security and what do they get? A welcoming smile, a room --- and an acuity rating! And my goodness gracious --- haven’t those ratings become more accurate with your team in charge?

After that it's all down hill.


#3 ACRF staff 2016-04-01 00:17
As a new member of the aged care residential facility work force I am dismayed by so much of what I see day to day. I work in the kitchen, not as a carer, but every member of staff at the facility works incredibly hard every minute of the day. In my role I feel that at least 9 hours work is expected to be completed in 7.3 hours, and I must start early, skip lunch and rush constantly to make it fit. And everyone else is the same. No overtime is paid, regardless of the situation, and inevitably people eventually cut corners rather than work for free. It saddens me deeply that the members of our society who built the foundation on which we all live must suffer the indignity of soiling themselves because there are only enough carers rostered to help them to the toilet one at a time! Compared to some of the horrors I've read about recently the facility I work in is great! But the entire way that the aged care industry operates needs overhauling! Caring for people past their prime should never ever be about profit. It should be about giving them everything they need, when they need it, not when the harried staff can get time between the 40 other residents they're also trying to help!! Honestly, I see pca's doing everything they can for residents but the carer to resident ratio currently is never going to allow them to do better. I find it outrageous that there is no government mandate regarding staff ratio. I want to say a huge thanks to everyone working in this industry who actually cares about the people they work with every day. And I believe the vast majority do care an awful lot. It is not by any means an easy pleasant fantastic job, and the people who choose to do it certainly aren't in it for the benefits. Sites like this and people who care will hopefully bring this issue to light more and eventually bring about some much needed change to this essential service industry.
#2 John Buckley 2015-12-13 18:04
The old dietitian and chef tango. Heard that one before. A bit like saying the dietitian stepped in and they have no choice. I don't know what qualifies a dietitian to write a recipe. Why don't you give them some of your recipes and if need be go show the cook how to cook them or offer to work with the chef to make them tasty. If needs be you could quote item b) of the Care Recipients Rights from the Aged Care Act 1997.
b) to quality care appropriate to his or her needs. PS I can fight a bit.
#1 Pam Brunker 2015-12-12 10:46
I have read "The Oleander Project" with great interest. In some respects I felt relieved that the residence which I selected for my mother did not fit the appalling description where most of the care issues were concerned, but then I reached the section relating to the food and the words sounded so much like the ones I have used when complaining vehemently to the Operations Manager of Head Office of the organisation running the group of centres which include the one where my mother is located.

It seems apparent to me that the quality of the food is the single BIGGEST issue in aged care. My mother never wanted to go to aged care and is constantly berating me to find another option for her, but primarily because she hates the food. The organisation controlling her centre uses a "food model" - as though they were McDonalds - but the McDonald's fare sounds like a way more attractive alternative!! Their meals are designed by a dietician and the chefs? (if one uses the term very loosely) are required to strictly follow the recipes provided by said dietician, which mostly results in low fat meals with artificial sweeteners which none of us who are not "on a diet" would want to eat.

It is time for a revolution in thinking about the reason for the very existence of Aged Care Centres. Their purpose should be to provide a communal environment to enable people who for one reason or another cannot live independently to receive whatever level of care they require in a supported environment at a financially viable price. Many of the residents only require a short amount of assistance on a daily basis and could not possibly afford or need 24/7 caring in their own home. They did not sign up for someone to dictate what sort of food they should eat for their remaining years. Many of them have reached ripe old ages eating very "dietician unfriendly" food and they don't care if their remaining years are long, they just don't want them to SEEM long.

In the future we may reach this fate ourselves and we won't be prepared to accept the current food model (where the chef pre-cooks everything so his day can finish at 2pm), so why not galvanize into action NOW so our loved ones are not forced to accept it today.

I am a novice when it comes to social media, but I AM UP FOR THE FIGHT. If anyone else is prepared to join me in trying to force this revolution then I would welcome your comments.