Staff Ratios – Royal Commission Research Paper

I have read with interest late last week the very freshly released Royal Commission research paper (1) into aged care staffing requirements, and the shortfall in funding needed to raise the staffing mix and levels to appropriately care for the average residential aged care service consumer.  

The following excerpt from the recommendations paints a picture of what residents, families, advocates, and indeed some providers have been saying for some time – the level of service provision (staffing) in residential aged care in Australia is substandard.  

My conclusion is that because that level of provision is so strongly associated with the operating funding mechanism, the funding mechanism for care is equally substandard:

“more than half (57.6%) of Australian residents receive care in aged care homes that have unacceptable levels of staffing (1 and 2 stars).

To bring staffing levels up to 3 stars would require an increase of 37.3% more staff hours in those facilities. This translates into an additional of 20% in total care staff hours across Australia.

We have not limited our analysis to determining the additional resources required to bring facilities up to an acceptable level. We have also provided an indication of the additional resource requirements that are required to deliver staffing levels consistent with good practice and best practice care.

For all residents to receive at least 4 stars (what we consider good practice) requires an overall increase of 37.2% in total care staffing while 5 stars (best practice) care would require an overall increase of 49.4% in total care staffing.” (2)

As you are probably well aware, I am the CEO of Braemar Presbyterian Care (“Braemar”). To put our services into perspective, since I joined Braemar in March 2017 we have been increasing hours per resident per day to a level that is close to the current national average as recorded by the StewartBrown benchmarking service (3) reporting.  And, as far as is reasonable, we have been improving our subsidy income to match the staffing.  But that recurrent income is not enough.  

According to this research paper, prepared for the Royal Commission into Aged Care Quality and Safety, less than 3 star level of staffing is unacceptable, while a 4 star staffing is good practice, and 5 star staffing is best practice.  Yet 57.6% of residents receive less than 3 star (unacceptable) staffing and only 1.4% receive best practice staffing.

How is this translated into the care of our elders? 

Continue reading “Staff Ratios – Royal Commission Research Paper”

The Truth Is Out There!

Over the past several years I have written often on how much funding I believe the aged care sector has been short-changed by a range of political and bureaucratic decisions over.  Aged care funding is not adequate to meet the health care needs of Australia’s frail elderly, vulnerable, care recipients.  My comments apply across residential aged care funding and home/community care package funding alike.  You can review some of my previous articles in the footnotes below. [1] [2]

Patricia Sparrow, Chief Executive of the not-profit aged care peak body Aged and Community Services Australia (ACSA), commentating recently on home care packages, lamented the lack of preparedness and capability of our aged care system, saying “Until we see adequate long-term planning for the structural and funding issues, Australia won’t be able to fully address the needs of older Australians”.[3]  Sean Rooney, Chief Executive of Leading Aged Services Australia, similarly recently commented that the “aged care system needs adequate funding to be sustainable and meet the needs of seniors” and called for an additional $3 billion to “improve the viability of the sector”.[4]

Just this week I was briefed about the outcomes of a very recent Faster Horses Inside Aged Care Report (2019) of perceptions around aged care in Australia. I recommend this review to all readers of this blog. Reviewing response from over 1,500 people from a cross section of metropolitan centres, the response to two specific questions piqued my interest.

Only 17% of all respondents felt that the pricing model used by aged care providers is straightforward, and a high 63% of respondents agreed with the statement “There is not enough funding given to the aged care industry”. For respondents who currently have a family member receiving aged care services, the response rate for each question increases to 31% and 71% respectively. It is clear that even among those active in the industry, there is a poor understanding of pricing models, and there is a heightened need for additional funding in the industry.

The truth is out there, speaking loudly!  More funding is required – urgently and significantly – for viability, and to begin to fund an appropriate level and mix of well-trained staff.

Our elected Members and Senators, and career bureaucrats should listen closely.  Australia gets it that the burgeoning wave of frail elderly is going to hungrily devour scarce national fiscal resources.  But having an ineffective aged care system is injurious to these same people.  Let’s actively change the funding system that better reflects our overall capacity to pay from our own resources where we can, to care services that add value and quality to our lives, rather than a system that is building distrust, poor quality, decreased value of older persons’ lives, and, in some cases, harm and injury.

Nice chatting,

Wayne L Belcher


Further Reading:

[1]     http:// https://wlbelcher.com/aged-care-indexation/

[2]     https://wlbelcher.com/aged-care-sector-financial-comparators/

[3]     ACSA, Home Care Funds welcome but won’t dent waiting lists for home care. Aged & Community Services Australia <https://www.acsa.asn.au/Media/2019/Home-Care-Funds-welcome-but-won-t-dent-waiting-lis>.  Accessed 12 September 2019.

[4] Natasha Egan, Provider CEO survey highlights impact of financial pressures. Australian Ageing Agenda <https://www.australianageingagenda.com.au/2019/09/06/provider-ceo-survey-highlights-impact-of-financial-pressures/>.  Accessed 9 September 2019.

Aged Care Indexation

I am going to assume that most people reading this article will be aware that there is currently a Royal Commission reviewing matters of Quality and Safety in Aged Care.  Among other things, that Commission is inquiring into matters where poor and substandard care have been provided to residents in residential aged care and to care recipients in home and community-based care.

Where there have been findings of substandard care, all providers in the aged care sector should stand resolutely with care recipients and be highly critical of the events that took place to permit such poor care being delivered.  However, without wanting to escape from the responsibility of being a provider of aged care I do want to highlight again the dilemma that providers find themselves in desiring to provide the best care that they can.

One of the threads arising through the Royal Commission Hearings, and for some time prior to the Commission commencing has been a call for a higher staff ratio in care services being delivered.  

Continue reading “Aged Care Indexation”

Living with Dignity, Dying in Comfort

Hi Folks,

Braemar Presbyterian Care is offering a free community event for local people of Perth, who are interested in learning more about palliative care.

The team have developed a Living with Dignity, Dying in Comfort information evening, which will take place on 22 May from 5:30PM at Braemar House, located at 10 Windsor Road, East Fremantle.

I spoke recently with our Professional Standards, Quality and Risk Specialist, Bernadette Samura, who has a lot of experience in this area – having previously managed Braemar House.

Bernadette was quick to point out that palliative care is far more than just end-of-life care, and that it is essential to challenge the myths and stigmas around palliative care. ‘We want people to openly discuss it as a normal part of their future planning,’ she told me. It is Braemar’s desire to ensure everyone involved in this quality of life process is very much part of the care and friendship philosophy that can add so much to quality of life.

The evening involves a keynote presentation from Bethesda Hospital’s Clinical Nurse Manager, Ed Gaudion, as well as exhibits showcasing various care approaches. It is a free event, and is open to members of the community, their families with loved ones in care facilities, those planning to relocate to residential aged care, as well as anyone keen to learn more about palliative care.

Hope to see you there,

Wayne.

Note: The Living with Dignity, Dying in Comfort information evening will take place on Wednesday 22 May at Braemar House in East Fremantle, from 5:30-7PM. Coffee and light refreshments will be provided. Anyone interested in attending this session can find out more details by contacting 08 6279 3654

Easter

In Holy Week, the week leading up to Easter, and particularly Resurrection Sunday, there are a number of things that different parts of the Christian faith celebrate.

I am from an evangelical Baptist tradition. Our Services over this important time of the year usually were solely around a reasonably solemn Good Friday morning service and then a celebration service on Easter Sunday morning. Of course the week leading up to Easter we have, among others, such things as Palm Sunday, the remembrance of the raising of Lazarus from death, Jesus cursing the fig tree at Bethany, and Jesus sharing a “Last Supper” with His disciples.

Other than for the Last Supper, until recently I had paid little attention to the events of Easter Thursday evening. Over the past ten years, we became familiar at our local church with a Service of Shadows – a Tenebrae Service – where darkness descends on the congregation following the extinguishment of a number of candles, all set around specific Scripture passages describing Jesus’ final few hours.

Easter Thursday, or Maundy Thursday, has become something special to me. But strangely it is the word “Maundy” that has caused me to rethink. The word has its roots in Latin and comes from the word “mandatum”, from which we get “mandate”. It means “command” or “commandment”.
So, what commandment is this word “maundy” referring to then?

In John’s Gospel we have a few chapters describing the Last Supper and the washing of the disciples’ feet, leading to the crucifixion of and resurrection of Jesus. Indeed, approximately one third of the entire Gospel of John is dedicated to the last two weeks of Jesus’ life, death, and resurrection. But it is in John 13:34-35 that Jesus says “A new commandment I give you: Love one another. As I have loved you so you must love one another. By this all men will know that you are my disciples, if you love one another.”
Three words, a commandment, that would do us, and the entire world well to remember – “Love one another”!

After all, and contrary to popular belief and practice, Easter is not about chocolate and hot cross buns. It is about one sacrifice for the world, given in love. So love one another!

Have a safe and happy Easter. If you are travelling, please remain vigilant. Enjoy your break. If you are working – thank you for your continued service.

If you have the opportunity, why not stop into a church for an Easter Service and join with others as we celebrate this hugely significant time of the year in our faith journey and annual calendar?

And, “Love one another”!

Blessings,

Wayne.

Transparency Matters

Hi folks,

A former Australian of the Year recently said, “The standard you walk by is the standard you accept”. In aged care, we are entrusted to care for and support some of the most vulnerable in our community. It is my belief that in this industry, we must only accept the highest standard.

While I am proud of the quality of care we deliver at Braemar, I am a strong believer in creating an environment that encourages constant improvement. We want to be open and accountable in all we do.

To ensure that everyone associated with our organisation is able to have their voice heard; about any issues that cause them concern; we have introduced a new service called Your Call.

Your Call is an independent, third-party reporting service which allows residents, family members and staff to report any matters of concern in relation to the care and services we provide.

Sometimes, for various reasons, we might feel uncertain or uncomfortable about directly raising an issue or reporting something we have seen.

It is my hope that this new service will provide those living in care, as well as their families, friends and staff, with an environment in which to raise any concern – no matter how big or small.

Reports to Your Call can be made anonymously. Those lodging a report can do so by phone or online – 24 hours a day. All reports are forwarded directly to me for immediate consideration and action.

Contact details for Your Call have been distributed throughout Braemar’s facilities. This has been done via the installation of large posters; while printed information and updates are being made available.

This service is available to all our staff, residents and family members and friends. It is essential that as aged care providers we ensure we are transparent in all we do.

I want to ensure we hear from you if you have any concerns. I am excited to see Braemar lead by example in this area.

Nice chatting,

Wayne.

My 2018 Christmas Message

Christmas Time Thoughts

Many years ago, I spent one Christmas time away from family and stayed with friends in the Great Southern area of Western Australia. Their father had died when they were both quite young. 

View this greeting as a video.

As boys, these brothers became the men in the family and over time built up their farming property to be a successful enterprise.  They were both good, honest, hardworking men, who also were faithful in their Christian belief.

I could certainly talk with them about harvest time, how the wheat, barley,and oats grew, why back then one had to wait until a little later in the morning to start up the header and get out and cut into the crop.  But talking about personal things was difficult for them – they were just quiet guys who had some really good things to say, but just didn’t much like speaking it out.

There is this man talked about in the Bible who really had a huge impact about all we believe and practice at Christmas time, but of whom, from Scripture, we never hear a spoken word.  We hear from Mary, the mother of Jesus, in the first chapter of Luke’s Gospel.  Tradition has called Mary’s Song the Magnificat.  We hear from Elizabeth, the mother of John the Baptist, and (eventually) from Zechariah, John’s father.

But we don’t ever read a recorded word that was spoken by Joseph.  Oh,we read of his at least three dream encounters with an angel, or God Himself –first with a message to take Mary as his wife and raise Jesus as his father;the second to flee from Israel and travel to Egypt – an historic refugee journey – and third; to return to Israel because it was now safe to doso.  Given the cultural and societal significance of all of the above,Joseph was a very courageous man.  The strong silent type if you will.  A lowly carpenter, from one of the lowliest places in the whole of Israel, at that time overrun by the Roman Empire, and “ruled” by a king who was a Roman puppet.  Joseph did not have to do this, but he felt so led by God that he could not avoid the challenge set before him.

Just a day or so ago I read this social media post: “Sometimes God will puta Goliath in your life, for you to find the David within you.”  I am sure that Joseph will have wondered something like “You want me to do what exactly?”,or “Why me?”, but he did.  We just don’t ever hear his thoughts and words expressed.

There are some significant challenges in the year ahead for our aged care work.  The looming Goliath is of course the Royal Commission into AgedCare Quality and Safety.  You may already feel quite uneasy about what that is likely to reveal and how we will get through this.  We will – no matter how much we are required to provide, and even to share with the Australian public – we will get through this.

My concern for each of you though is that even if your voice does not godown in any formal recorded historical moment, if you have any concerns about your wellbeing through this next twelve months, speak up.  We want to also care for you.  If you need at any time to share any concern about our behaviour that is both unbecoming, and contrary to our desire to provide a dignified life to our residents, then please share that with us too, so that we all be a “David” and improve how we provide our services.

Folks, I pray and hope that your 2018 Christmas brings you much joy, peace,and blessing, and that you have at least some time to reflect of the enormity of the coming of Jesus into the world – not to destroy the world, but to saveit!God bless you all – and Happy Christmas!

Aged Care Sector Financial Comparators

These days I only read the newspaper on the weekend.  My favourite is still The Weekend Australian.  It often has thought provoking articles, and occasionally some fodder upon which one can reflect from an aged care sector perspective.

The December 8-9, 2018 edition is just one of those occasions.

On page 2, there is an article bemoaning the recent year upon year increase in private health insurance premium rates.  The article reports that ‘Health Minister Greg Hunt … expected to approve an industry average below 3.95 per cent … the lowest since 2001.’ It also includes commentary about the anticipated significantly lower rate increase out to 2022 promised by the current Federal Opposition.   

According to Australian Prudential Regulation Authority (APRA) figures cited by The Weekend Australian, the industry weighted average premium increases approved by the Minister for Health since 2015 are as follows:

2015: ​​6.18%

2016: ​​5.95%

2017​​: 4.84%

2018​​: 3.95%

2019​: Under​ 3.95%

I understand the impact of high levels of private health insurance premiums, that seem reachable by those who for whatever reason determine them to be affordable.  What is more, in contrast to aged care funding, the payment of insurance premiums does not come from the Government purse, but rather from individuals who have determined their affordability.

I find this article useful, if only because for almost the past twenty years I have been monitoring Health Ministers making similar approvals for health insurance premium increases yet at the same time, as the senior Minister over the aged care portfolio, makingstarkly lower indexation for payments for recipients of care or, more indirectly, to the providers of care to aged care recipients.

The comparison of funding increases made to aged care providers through the various indexations against several alternate indicia is shown below:

The chart above clearly shows that whilst aged care funding indexation has indeed kept fairly much in line with CPI, it has failed to keep close to Work Price Index (“WPI”), Average Weekly Earnings (“AWE”), and the greatest gap is between aged care funding and private health insurance premiums.

I will be among the first to say that additional funds are not always the determinant of better quality.  Yet the absence of an equitable funding methodology in residential aged care since 1997, and growing concern about insufficient supply of places in community based aged care since February 2017, seems obvious.  

Inclusive of some $1.7 billion removed from forward funds in 2015 and 2016, there is a clear pattern of diminishing Government expenditure in aged care over the past twenty years to a point where it is highly unlikely that even courageous and good providers of care will be able to sustain their service provision without a sizeable injection of funding.

It has been just three days since the Federal Standing Committee on Health, Aged Care and Sport recommended support for the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018.

I support the recommendation that aged care providers disclose their staffing ratios. However, it would be unreasonable to expect that providers will be able to achieve a reasonable staff ratio without an immediate and substantial injection of funds – albeit with reporting requirements.

Perhaps the Royal Commission can consider this matter in their review processes into the whole aged care sector quality and safety funding and performance?

Nice chatting

Wayne L Belcher

Bibliography

Alex Grove, Residential aged care funding: recent developments Parliament of Australia

House of Representatives Standing Committee on Health Aged Care and Sport, ‘Advisory Report on the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018’ (Commonwealth of Australia, Canberra), December 2018 

Sean Parnell, ‘Rise in health premiums likely lowest in decades’, The Australian (Sydney, NSW), 8 December 2018