Boards and board members were grilled in the five days of hearings into the leadership and governance of two of SCC (Tas)’s regional Tasmanian facilities: Yaraandoo Hostel and Glenara Lakes, and Bupa had its South Hobart facility – the only Bupa home in the state which was sanctioned in October 2018 for failing to meet 31 of the 44 expected outcomes.

While SCC’s Chairman Ray Groom (an ex-Tasmanian Premier) argued the provider had had a “rigorous” reporting process to the board, the evidence showed a communication gap between the executive and the facility level.

The provider conceded they had still not established a clinical governance committee – one year after sanctions against Yaraandoo.

BUPA came under real fire for its chase for profitability (actually ‘break even’). Senior Counsel Assisting Peter Rozen QC noted Bupa had introduced several strategies aimed at improving its profitability, titled ‘Pathway to Break-even’.

These were:

1. Back to Base – a program to reduce operating costs by reducing clinical care management numbers;
2. The Bupa Model of Care 2 (BMOC2) – which saw the position of a clinical manager discontinued;
3. Project James – a part of BMOC2 that reduced the number of registered nurses and enrolled nurses employed (in the case of Bupa South Hobart, 26 hours); and
4. Save a Shift – where staff who called in sick were not replaced.

Mr Rozen then said: “You will hear that these various cost cutting strategies were devised and driven by the finance and operations department at Bupa’s head office, in part to respond to funding reforms introduced by the Commonwealth Government”.

 “We anticipate that the evidence will be that these strategies were implemented enthusiastically across the Bupa Aged Care business, including at South Hobart.”

The facility’s in-house GP Dr Elizabeth Monks gave evidence she had been raising issues about the impact of substandard care since 2016 – three years before the facility was sanctioned.

The Managing Director of Bupa’s parent company Carolyn Cooper admitted the provider’s governance structures had failed to prevent the home being sanctioned – and until August 2019, its aged care board was made up solely of its own executives.

Mr Rozen found both providers had:

• deficiencies in care caused by insufficient care time
• deficient organisational culture
• insufficient attention to quality and safe clinical care
• poor communications from facilities and a lack of responsiveness to complaints

His conclusion: they had prioritised financial considerations at the expense of care.

Interestingly, a former Nurse Adviser to the facility Tiffany Wiles, revealed care hours increased by 35 hours a day at Bupa South Hobart after the sanctions, but they could not find enough staff to fill roles.

She doesn’t believe the facility ever had a day when all those hours were filled in her three months there.

Is this an insight into the future of residential aged care?

Mr Rozen summarised with the comment that while providers are legally obligated to stay financially viable, it must be remembered that “financial viability is a means to an end in aged care; it is not an end in itself”.

So, boards are ultimately responsible for ensuring that aged care homes operate in a solvent position, but the Royal Commission has identified that boards are also ultimately responsible for the operation of aged care homes even if they don’t have the cash.

A conundrum that future potential board members may not wish to take up.