Commissioner Lynelle Briggs has foreshadowed the recommendations in the Royal Commission’s Final Report will turn the entire system ‘upside-down’ within five years at the Royal Commission’s 12th community forum in Newcastle.
The final forum for this year, the Commissioner urged the audience to take on the challenge of upending aged care in Australia – even after the Final Report is handed in in November 2020 – and emphasised the importance of CEOs and boards to be engaged in the process.
“We do intend quite significant changes and without the support of the leaders of organisations, they won’t go very far,” she stated. “Everyone has to come together and say we need to fix it.”
The shape of the Newcastle community forum
Held at the Newcastle Exhibition & Conference Centre (pictured above), known as NEX@Wests City, on a warm, sunny day, the turnout was slightly larger than Monday’s forum in Canberra with around 180 people in attendance.
Most were women along with quite a few men, again aged in their 40’s and above though there were some younger faces in the crowd.
Beginning late at 9:35am, the day ran through until 12:20pm with a 20-minute tea break. The mood was more relaxed than Canberra too, with several spontaneous bouts of applause for various speakers and the Commissioner.
Commissioner Briggs was clearly pleased to be in the room, urging attendees to make submissions and put forward their ideas for reforms.
The Commissioner flagged they will be taking a different approach with their engagement in the New Year – an approach we have already begun to see in the formal hearings – with propositions put directly to witnesses at the hearings and in planned workshops.
Commissioner Briggs also again acknowledged Monday’s announcement of a $537 million funding package to respond to the urgent actions outlined in the Royal Commission’s Interim Report.
In reference to the funding for 10,000 home care packages, the Commissioner said: “This is a significant step towards our view that there shouldn’t be a waiting list for home care but there is still some way to go.”
Commissioner Briggs appeared to be happier with the response to her and the late Commissioner Richard Tracey’s calls for younger people in residential care to be moved out and new arrangements for medication management, saying these would result in much tougher restrictions on Risperidone which has “caused so many people such terrible, terrible distress.”
The floor was then handed over to the 21 registered speakers – 15 women and six men – mostly family members, but also an advocate from the Pain Management Society, former RNs, a local lawyer who specialises in health and aged care and a geriatrician.
Like Canberra, there were a number of common themes that were raised by the speakers:
- Greater accountability for care workers and senior management
- Low staffing levels and the need for staffing ratios and better staffing mix
- A lack of access to respite care
- The long waiting times for home care and inflexibility of funding arrangements
- Poor complaints processes and retribution against families
- ‘Profits before people’
Greater accountability for care workers and senior management:
The failure of the system to ensure both staff and CEOs and their boards are accountable for their actions was high on the speakers’ agendas.
One woman said shortly after her married father moved into an aged care facility, the family was told he was in a relationship with one of the staff at the facility. Making a complaint to the facility, the woman was given the option to resign or be terminated by management.
The family then found out she had been given power of attorney and enduring guardianship of their father and had told the facility not to allow any access to the family.
Taking their concerns to the Complaints Commissioner, the woman said the family was told there was nothing they could do to intervene and their father passed away without the family being informed.
Noting the staff member is now working elsewhere in community care, the woman called for a national register for care workers and more accountability for management.
The loudest applause however was reserved for a man caring for his elderly parents who previously worked in aged care senior management ironically.
He argued for a working with vulnerable persons check to ensure aged care staff are fit to care for older people – to rapturous reception.
A local health and aged care lawyer – representing a legal alliance – also argued for a new Aged Care Act to ensure transparency and accountability.
Noting the current one does not include the word ‘regulation’, she said boards and CEOs should be held personally accountable when standards are not met and families should be able to claim compensation (presumably with assistance from lawyers).
Low staffing levels and the need for staffing ratios and better staffing mix:
Understaffing – and the inconsistency of staffing – was a common complaint.
One man, whose wife had been in residential care for 13 years, said when she first moved into care, his wife had two regular carers from Monday to Friday – today, they change on a daily basis.
A number of speakers called for ratios similar to hospitals where there is one nurse for every four or so patients.
One young woman who cared for her elderly grandfather said she had placed him in a local facility for 30 days of respite while she cared for her own newborn. Encouraged by the level of care and staff, the family decided to extend his stay but both the care and number of staff dropped off.
She says the family found out some time later the facility had been undergoing an accreditation audit at the time – and had put more staff on to meet standards.
A local geriatrician with 30-plus years of experience also noted that residential care had originally been set up to care for people unable to live at home, but now caters to people with chronic mental illness, disability, brain injury, substance abuse, palliative care and respite care.
He argued it is impossible for providers to manage this range of people in one facility with one staffing mix and model – to enthusiastic support from the audience.
His solution? Moving to a model led by nurse practitioners to ensure residents receive adequate medical care (another round of applause).
A lack of access to respite care:
A persistent issue at the community forums.
One young man said he and his mother had to battle to access respite care for his grandmother, who has Alzheimer’s Disease, after her carer, his grandfather, fell and broke his hip at home and later died in hospital.
Contacting the national respite service, the grandson said the operator had complained to him about budget cuts and said he could only access respite for his own mother. Calling his local MP for help, they could only provide him with the number for the same respite line and a list of facilities with respite beds in the area – which all turned out to be unavailable (a classic case of ‘bureaucratic spaghetti’).
The man said in the end he took the advice of a friend, an experienced RN, to take his grandmother to the nearest hospital emergency department and threaten to abandon her – a respite bed was then produced within 30 minutes at a facility 10 minutes from his grandmother’s home. Unsurprisingly, he added he should not have been forced to take this step.
The young woman mentioned above also said when she initially applied for respite care for her grandfather, she was told he needed to be on the home care waiting list for over 12 months to be eligible.
The long waiting times for home care and inflexibility of funding arrangements:
The division of home care into four levels – and the amount of funding assigned to each level – was also criticised for failing to meet the needs of older people.
One woman in her sixties, who has cared for her mother since she had a stroke four years ago with her sister, said her mother’s Level 4 package barely covers her needs with almost all of her mother’s Pension spent on physiotherapy.
Poor complaints processes and retribution against families:
The issue of retribution by facility staff and management for making complaints was also raised.
One woman said she had gone to the media about the use of chemical restraints on her mother – only for the CEO of the provider to release a statement detailing her mother’ private information.
The woman added that her further investigation of her mother’s records found a number of allegations of sexual abuse – of which the family was unaware.
‘Profits before people’:
A few speakers pointed towards the profit-driven nature of the system.
One woman said she had met a CEO recently at a luncheon in Sydney who talked about residents having a shelf life and told her that aged care was a lucrative business – she noted the same man also owned a funeral business.
She called for a code of ethics and enforceable operating standards for providers – to a loud round of applause.
Another woman questioned why her mother is not being showered every day or fed suitable meals when she pays for these services, concluding that aged care is all about profits and not the actual care – her call to give residents the quality of life they deserve garnered another loud response from the room.
There were some positive suggestions from the speakers too, including:
- An independent tribunal to hear complaints of substandard care with the power to issue fines, enforce penalties and publicly name facilities;
- Specialist dementia nurses in every facility;
- Hiring a staff member to visit residents at set times on a weekly basis to record and report on any issues;
- A ‘buddy system’ for new aged care residents to help them adjust to residential care;
- A communication board to list useful information about residents for staff; and
- Access to after-hours advice and emergency assistance, additional services including physiotherapy and mental health, and training for carers looking after family members at home.
Commissioner Briggs – “Everyone has to come together and say we need to fix it”
Like Canberra, the Commissioner again had time to spare at the end of the proceedings and highlighted a number of issues for action:
Insufficient home care packages – and if higher-level packages are needed:
Commissioner Briggs stated she knows the family home is where older people want to be.
“The problem is the long waiting list hadn’t gone away and won’t without a large injection of funds into the sector and more providers and people willing to provide services,” she said.
She added they have heard the story nationally about the inadequacy of packages to provide the level of funding needed to provide the care many people need to live at home.
“There is a question about upper package limits and whether it’s sufficient,” she said.
“That’s something we’re definitely thinking about as we go forward.” (does that mean a Level 5 and higher packages are on the cards?)
Access to respite care:
The Commissioner said she had not heard of people needing to be on the home care waiting list for a certain period to access respite – but clearly there is not enough respite available.
“We as a Royal Commission have to think about that,” she said, adding: “It’s particularly important for people with dementia.”
People, not processes, to be the focus of the regulatory system:
An interesting insight into the Commissioner’s thinking.
Commissioner Briggs says the language she has encountered in aged care has posed a number of challenges for her: going to the toilet as ‘toileting’, nursing home as ‘facility’ and person-centred care reduced to PCC.
“These things really worry me because they take out the focus on the person and think about the process,” she remarked.
The Commissioner also noted the Aged Care Act is not really focused on ‘people’, rather on the funding arrangements.
“Care is the business,” she concluded. “It’s clear from where I’m sitting caring for older people should be enshrined in the legislation along with the associated accountabilities.”
Inadequate staffing and shortfalls in wages:
Commissioner Briggs said the Commission has taken note of the disparity in wages between aged care and other sectors which she labelled a real issue when resident acuity is increasing.
“There is insufficient staff to the growth in demand for aged care services,” she said. “We need a sizable growth in the workforce in the field. People are what runs this system and we have got to find a way to look at increasing supply.”
Better complaints handling:
Noting the issues of abuse and neglect raised by the speakers, the Commissioner said providers need to treat complaints as a window into how their services are performing.
“Across aged care, banking and indeed the public service where I used to work, people are reluctant to treat complaints seriously. We need to welcome them as needed to making improvements.”
Commissioner Briggs concluded there needs to be efficient feedback loops for families.
“Families should be able to say there are issues here we need to address without fear of retribution,” she said, adding: “It all comes down to accountability and internal mechanisms.”
“We will look at all of these as part of what we are doing as part of our final recommendations.”
Engagement with senior management in redesigning the system:
The Commissioner however recognised that none of these changes will be possible if the leadership of the sector isn’t engaged with the process.
“What does one do when the management of the facility, of services fails to say this is what we’re thinking of?” she asked rhetorically. “We do intend quite significant changes and without the support of the leaders of organisations, they won’t go very far.”
“We’ve got to look at how we engage with CEO and board levels,” she said firmly. “Everyone has to come together and say we need to fix it.”
Creating ‘joy’ in aged care:
Another look into the Commissioner’s mind. Commissioner Briggs stated it is not fair for older people to have no joy in their lives.
“No one should be prepared to accept less,” she said. “This is just crazy stuff.”
The Commissioner added that they are looking at ways to engage residents with exercise and the local community, but so far, they have had very few suggestions on how that can be achieved.
“I give that challenge to you what would really work to help elderly people to enjoy the last 10 to 15 years of their life – not just people in residential care but at home,” she said.
“You must have ideas around what you think will work.”
In closing, Commissioner Briggs urged the audience to continue to discuss the issues raised by the Royal Commission – even after they submit their Final Report next November.
“It will take three to five years to initiate the changes we’re talking about,” she said. “If we’ve learned one lesson from the banks, it’s that ‘you’ve just got to keep at it’”.
“Think about what you can do.”
A call to action to us all then.