Commissioner Lynelle Briggs has hinted a star rating system for aged care facilities will be among the issues to be the subject of recommendations in the Royal Commission’s Final Report while addressing 150 people at the Commission’s 11th community forum in Canberra.
The first forum since the release of the Interim Report, the Commissioner – who appeared to have only been alerted to the Prime Minister’s 12:30pm announcement shortly before the start of the 1:30pm forum – also confirmed the Final Report will target CEOs and board directors and their accountability after the recent Hobart hearings on leadership and governance.
“As a leader or company director, you need to understand business you are in and focus on what your business is about as well as making money and managing finances and that something we intend to deal with,” she stated.
The shape of the Canberra community forum
Held on a sunny, humid day in the Grand Ballroom of the QT Canberra (pictured above), it was a smaller turnout than previous forums with a mix of men and women, mostly aged in their 40s, 50, 60s and 70s.
Beginning promptly at 1:30pm, the forum ran from 1:30pm to just before 4:30pm with a 15-minute tea break. The day was somewhat unsettled, perhaps due to the fact there were two other events taking place in the adjoining ballrooms (pictured below) – at one point, the Commissioner told off the audience for talking while speakers were telling their stories.
The Commissioner as usual was in her element and gave a 12-minute welcome that touched on both the recent Interim Report and the PM’s $537 million funding announcement.
Noting the Government had accepted all of the Commissioner’s recommendations around young people with disabilities in residential care, Commissioner Briggs said the effect will be the “ramping up” of the program to see all younger people in residential care removed by 2025.
The Commissioner also listed the other measures announced in the funding including changes to the administration and distribution of Risperidone; $10 million for training staff in dementia; and $25.5 million for pharmacists to improve medication management.
“I’m pretty happy,” she said to a loud round of applause.
The Commissioner also flagged the Commission expects to hold a number of hearings throughout the first half of 2020, adding the Aged Care Royal Commission has had more hearings, forums and meetings than any other Royal Commission.
It was then onto the 21 speakers – 13 women and eight men – some family members but also advocates for veterans, the LGBTI community and CALD Australians; former aged care staff; two doctors; two occupational therapists; and a physiotherapist.
The major themes from the day were:
- The interface between the aged care and health care sectors
- Poor culture and leadership
- Transparency and accountability around aged care quality and costs
- The lack of services and supports for special needs groups
- The abuse of power of attorney by families
- The need for wellness and preventative care
The interface between the aged care and health care sectors:
Considering it is the subject of the upcoming hearings in Canberra in December, it’s perhaps unsurprising that the lack of equitable access to health services for aged care residents was raised by several speakers.
A young emergency room doctor said he sees the ongoing systemic failures and exploitation of aged care residents every day.
He recounted the case of one patient who was brought in after three weeks in a private aged care facility as a dementia resident. On treating the man, the doctor discovered his ‘dementia’ was actually delirium brought on by an acute UTI and pressure wounds on his heels that had led to septicemia – the man later died.
The doctor also noted that in his department, the ratio is four nurses for every doctor compared to residential care where the number can be 10 to 15 times higher – a clear argument for ratios.
Another woman told how her elderly mother, who had been living in respite care for six months, had fractured her ankle at a medical appointment and was left bedridden for six weeks. Unable to access rehabilitation or physiotherapy services, she became incontinent and unable to feed herself and had repeated infections that saw her returned to hospital.
Deciding to take her mother home to care for her, the woman said it was several weeks before she was able to access home-based palliative care – despite having several referrals – as the ‘bureaucratic spaghetti’ saw her slip through the cracks before she died at home.
Poor culture and leadership:
It was clear the recent Hobart hearings on leadership and governance were still in people’s collective memory with several speakers pointing to the impact of poor management decisions and a lack of oversight.
One former RN said she had blown the whistle on substandard care at the facility she worked at, only for the CEO and senior management to ignore her complaints and bully her into leaving. After five years of fighting for compensation, she says she is now on a disability pension and can no longer work – the facility on the other hand recently failed nine of the expected outcomes including eight related to nursing care.
In a statement that was alarmingly similar to that of Bupa South Hobart GP Dr Elizabeth Monks at the Hobart hearings, she asked simply: where can you go if no one listens?
Her husband, a retired search and rescue pilot with experience in management and safety, added none of the issues would have occurred if management had appropriate qualifications and had taken action to address the concerns at the time.
Both supported mandatory incident reporting for providers, a confidential reporting system for whistleblowers and tougher regulations and penalties for non-compliance.
Transparency and accountability around aged care quality and costs:
The lack of information around facilities and their standards of care – and the responsibility of providers – was also a big sticking point with several speakers.
A consumer advocate noted the ACT has at least two facilities that have failed accreditation audits recently but that information is not easy to find. She compared this to the UK where they have a publicly available ratings system that providers must display in their facilities and on their websites.
Interestingly, she also pointed to a website called Patient Opinion – a ‘TripAdvisor’ for doctors – where people can post stories about their experiences as a suggestion.
Another woman, herself a former aged care RN of 30 years, praised the home care staff who care for her 92-year-old father.
She had considerably fewer kind words for his provider (labelling For Profits the Googles, Apples and Amazons of the aged care system), who she criticised for charging overheads and costs four times what staff are paid per hour.
The former RN added she believes ratios should be mandated with penalties for non-compliance.
She also called for fairer pay for staff, saying she believes providers will only improve wages if required to do so.
Her suggestion? A cap on the amount of profits companies can make compared to the wages that staff are paid (I’ll be watching to see if this idea comes up now in the formal hearings).
Perhaps the loudest applause of the day however was reserved for her call for greater transparency around costs – and less profiteering around the costs of services.
The lack of services and supports for special needs groups:
The needs of diverse groups were also touched on by a number of speakers.
One woman advocated for better access to advocacy services for veterans, noting the lack of data (again) around the number of veterans living in residential care and restrictions by MyAgedCare on sharing information with ex-servicemen’s associations means many veterans living in residential care are not receiving their full entitlements.
Another woman said her 58-year-old relative who has schizophrenia and a disability was placed in a secure dementia unit in residential care seven-and-a-half years ago and despite advocacy by the family, they have been unsuccessful in having her moved elsewhere – the facility manager told them they should be grateful she has a room with a view, she said to mutterings from the audience.
The family has also failed to secure a review of the woman’s medication because she was admitted as a palliative care resident.
The Chair of a local peak organisation representing CALD groups also highlighted the need for more funding to roll out the Action Plan developed to help people from CALD backgrounds access aged care services and the need for more face-to-face supports like the aged care navigator currently being trialled.
The abuse of power of attorney by families:
An issue that comes up frequently at the community forums, but has yet to get much of a platform in the formal hearings.
One advocate from the local aged care safety committee spoke on the case of a 93-year-old Sydney war veteran who had been taken from hospital to a remote property south of Canberra by a relative against the wishes of himself and other family members.
The advocate noted that if the RSPCA suspects someone of abusing an animal, they pursue the alleged perpetrator even if the animal has died – but police closed the case against the family members in this example after the elderly veteran passed away.
He recommended an enduring power of attorney database; welfare checks to be done in person; and hospital and aged care staff to be given the power to prevent people from being removed from care.
The need for wellness and preventative care:
A representative from the local physiotherapy association pushed for better access to allied health services and funding for ‘wellness’ in residential care, saying the current ACFI system is not fit for purpose because it funds for massage, but not other evidence-based treatments.
She said her group supports the new AN-ACC funding but says it will not go far enough to allow access to restorative care – despite studies proving their benefits and associated reductions in care costs.
A retired pharmacist also pleaded for an overturning of the two-year cap on medication reviews for aged care residents.
Commissioner Briggs – “we are intent on exposing that issue”
Unlike the previous Launceston forum, the Commissioner (pictured below) had plenty of time to make her points – speaking for almost 15 minutes on the issues raised by the speakers and pointing to a number of problems to be addressed.
The interface between aged care and health care:
Commissioner Briggs said the speakers had summarised well the systemic failures in treatment, communication and care between the two systems.
In particular, the Commissioner dwelt on the loss of rights to health care when someone enters residential care.
“This is a fundamental human right. We are intent on exposing that issue and seeing what we can do,” she stated.
Access to health and palliative care services:
The Commissioner also noted the fact that many of the allied health services delivered in residential care aren’t necessarily evidence-based.
“This is a bit of a problem here,” she said. “We have a lot of demand for allied health to be covered by the Government in aged care and we will be looking at those equity and financing issues.”
“We have to look at ways and means to make sure older people have access to those supports.”
Inappropriate placement in care:
Commissioner Briggs noted that the provision in the Aged Care Act that allows young people to enter residential care was meant to be a compassionate move, but has now become a default provision.
“We are very conscious of that issue,” she said. “That is clearly what the Government has realised given its announcement today.”
Access to aged care for diverse groups:
The Commissioner added it’s also clear that aged care isn’t ‘one size fits all’ and we need a system that is tailored to individual needs and ensures groups such as veterans, the LGBTI community, CALD groups and the Stolen Generation get access to the supports they need.
“Our Final Report will cover this in some detail,” she added.
Leadership and accountability:
Commissioner Briggs reflected on the fact that while speakers had high praise for staff, the facility’s management had come in for criticism for not being focused on providing safety and quality of care.
“This is an important tenet that we also hear in the banking sector,” she remarked.
“The common issue here is that as a leader or company director, you need to understand business you are in and focus on what your business is about as well as making money and managing finances and that something we intend to deal with.” (a line that suggests the recent Hobart case studies are still top of the Commissioner’s mind).
The Commissioner also said the failure to respond to the complaints of residents and staff was a sign of problems within the system.
“We will be looking at that systemic issue and making recommendations in or around that,” she said.
Questions of power of attorney:
Noting the comment that doctors and aged care staff should have the power to report abuse, Commissioner Briggs said they will look into those issues.
The interaction between aged care and disability:
Labeling this an “old tune for us”, the Commissioner said the interface between aged care and disability will be part of next year’s program of hearings.
Costs of care:
The Commissioner also said fees and charges will be up for scrutiny in 2020.
A star rating system for aged care:
“Expect to see something on that from us,” the Commissioner promised.
Staffing ratios and caps on administration costs and provider profits:
Commissioner Briggs added there are also very real issues around access to training education and career development for staff, mandated staff rations and caps on administration costs and profits – but didn’t offer any more detail.
The home care queue:
Knowing the most Australians want to stay at home, the Commissioner stated they are conscious of looking at the design of the system.
Complaints handling processes:
Commissioner Briggs also asked for suggestions around how residents and their families can have their voice more easily heard.
“Any suggestions made around this issue would be very welcome indeed,” she concluded.
The question is now: will the Commissioner be as happy with the Government’s funding announcement once she has read the finer details?
See tomorrow’s newsletter for my thoughts.