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.
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.
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.
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,
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
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
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.
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:
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?
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
I gathered these thoughts together the day the Royal Commission into Aged Care Quality and Safety was announced – Sunday 16 September 2018 if my memory serves me well.
This information gathering was in response to the first question of the Prime Minister when making the announcement. The question was around the alleged $1.2 billion cuts to aged care.
Folks, I get it – there have been many cuts from both major sides of our Australian Government over a number of years. And there has been continuing growth in aged care funding based on population related indices etc. But what is galling around these discussions is that the major political parties and the bureaucrats seem unwilling to give simple, transparent responses to questions about these matters.
The recent Federal Senate Community Affairs Committee Hansard from 24 October 2018 make for mind numbing obfuscation around this very issue, with Opposition asking relevant questions, and Government, and Officers, all putting in their opinions, without any direct answer to what should be a simple question. This of course happens regularly at such Committees and is not confined to Aged Care. But this Australian is over it!
Why cannot our elected leaders and paid Officers answer simple questions and be held accountable for the policy and funding interventions they create into valued human service provision? We are projecting tens of thousands shortfall of residential aged care places by 2025 (ref 1) and now some 121,000 not provided with an appropriate level of community care packages short for older Australians already assessed by Government as needing community delivered aged care services. (ref 2).
Of that number, almost 57,000 had no package allocated. A discussion around the residential care funding issues can be found below. Parliamentarians prefer to support their side of the debate, but the Department of Health and Federal Parliamentary Library advice really does paint a helpful and insightful picture into this matter of “funding cuts”.
I shall leave it to you to decide. But if you were to ask me, a return to the residential aged care sector of the $1.2 billion in ACFI funding cuts, along with a requirement for providers to sign off on their direct care staff ratios, would provide, on average, an immediate return to a ratio of 3.2 Hours per Resident per Day (“HRPD”), and begin a move to the 4.3 (or from my research, 4.2) HRPD as soon as possible.
ACFI – December 2015 MYEFO (might be a repeat of the May 2015 budget papers) – https://manad.com.au/aged-care-cut-in-mid-year-economic-and-fiscal-outlook-myefo/ The following is on an Australian Parliamentary Library page and really cannot be disputed. The page is at – https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Librar y/FlagPost/2017/March/Residential_aged_care_funding
ACFI subsidy expenditure has been growing more quickly than expected. The Australian Government believes the unexpected growth in claims cannot be explained by an increase in the frailty of residents, although many in the industry disagree. In order to rein in expenditure, around $1.7 billion in savings over four years were included in the Mid-Year Economic and Fiscal Outlook 2015–16 (MYEFO) and the 2016–17 Budget, to be achieved through changes to ACFI scoring and subsidy indexation. Despite these savings, residential aged care expenditure was still forecast to grow at around 5.1 per cent per annum.” A summary of the impact of these two difficult measures can be found below – https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Librar y/pubs/rp/BudgetReview201617/AgedCare
“Rein in expenditure.” Is that not just a euphemism for a cut to funding?
You decide. Nice chatting!
Ref 1- Aged Care Financing Authority, ‘Sixth report on the Funding and Financing of the Aged Care Sector’ (Aged Care Financing Authority, 2018), 36.
Ref 2 – Department of Health, ‘HOME CARE PACKAGES PROGRAM Data Report 4th Quarter 2017 – 18’ (Department of Health, 2018), Table 7, 11.
I am a person with no clinical or “care” background. But after almost forty years in senior management and executive roles across the spectrum of health and aged care – particularly aged care – I have gathered some insights into the nature of care being provided throughout our care services.
And before I suggest anything more, let me say this – my view is that if the major hospitals around Australia – public and private – were put under the same scrutiny and regulatory framework that residential aged care services are for the quality and accreditation of services that are provided in and through them, we would see hospitals falling into sanctions.
I am of the view that we have an aged care system that is too focused on beating the regulatory compliance framework as opposed to funding and providing appropriate levels of care and support to all clients.
On the one hand I am an incredibly strong advocate of high quality services accompanied with some form of accreditation. On the other hand, I believe we have an aged care accreditation system that we can really ill afford.
It underpins inadequate funding levels that cannot provide enough resources for many providers to meet the expressed needs of care for residents. In the same way, our community aged care system is creaking because we cannot provide enough funding for the community aged care packages assessed by the Australian Government as needed by our citizens.
I hear staff all over Australia clamouring, not always for more wages, but for more pairs of hands to do the work. To do more than the system underpins…To go the extra mile… To sit for a few minutes when that is what the client really wants, and really needs… To spend time hearing what the real story is…
To quote a UK study of its Home Help services from the early 1980s – “Too much Charring and not enough Chatting”.
I could ask the question – Which provides more care, the Chatting or the Charring? Neither is necessarily more correct, but often we cannot even get to the question. The bureaucratisation of aged care is with us and the paperwork must be done at our own peril.
I have colleagues that will not (at this time) support minimum staff ratios. Quite rightly they see them as an un-affordable cost under the current funding methodology. How sad that we do not all see them as providing perhaps the single greatest opportunity right now to see a reduction in abuse, and a reduction in short cuts in care. How sad that we do not see minimum staff ratios as an opportunity to support our staff and see a visual improvement in the increased in quality of care. But implementation of minimum staff ratios will be quite costly.
I am still of the view that in Australia we have one the best aged care systems in the world. But for a range of reasons it is creaking.
Let’s all is to consider how much of a cost is there to stop, take stock, and with the next round of changes, really consider the long term impact of where we are heading and fight more intensely to protect the rights of those who are dependent upon us, the general public, for their livelihoods?
And who knows – the Royal Commission might investigate several inter services aspects around care of our elderly folks? One matter that I have discussed for the past decade is how much more proactive care we can provide in our aged care facilities, that might actually have a positive, beneficial impact on our national health and hospital care services.
In the past twenty years we have missed the opportunity to think outside the square with respect to fixing major State based hospitals. As a “cohort” of patients, frail elderly people are significant and frequent users of hospital services. Perhaps if we reviewed the aged care sector and its inherent possibilities we might find better solutions to our hospital problems.
Chatfield’s cartoon below was first published by me in December 2010 in an article containing many of the words in the commentary above. Not much has changed it seems!
So, what is the elephant in the room with aged care at the moment?
In a report released Friday 17 August 2018 that showed a recent increase in home care funding for elderly care recipients, there was a worrying trend in demand versus ability to provide that needed care.
That is, despite the growth in older people desiring home care services, the number of home care packages assigned (or available) is simply not keeping up with demand.
At 31 March 2018, according to figures only released on 17 August 2018, the queue waiting to receive a package had risen to 108,456 people. That is an increase of 3,854 on those waiting at 31 December 2017. Not only that , but just over half of all those in the queue have been assigned a package at a lower level than their needs require. Remember this is all based on the Australian Government’s own approved needs assessment, and allocation of packages.
Contemporaneously we have demographers projecting the number of residential aged care places required to be built/developed is now at about 75,000 by 2025. That is only eight years away.
The word governance may well have been used by Chaucer in 14th century England, but the phrase ‘corporate governance’ has only been commonly used since the 1980s.
Major corporate failures such as Enron, WorldCom, HIH, the dot.com crisis, the global financial crisis, and the Royal Commissions into institutional abuse of children and the banking sector, have increased governance expectations.
The community requires corporations to improve the way in which corporate governance is practiced.
That is, more is expected from companies behaving as good citizens.
Although not a legal term, ‘corporate governance’ does carry the sense of needing to be defined. It regularly arises in actions or Commissions as something lacking in practice.
Yet the concept of corporate governance has struggled to have a single definition. Early definitions were based around corporate governance being the ‘system by which companies are directed and controlled’ (Cadbury Report, 1992; King, 1994).
The Australian Stock Exchange recently broadened the scope of the concept of corporate governance to ‘the framework of rules, relationships, systems, and processes within and by which authority is exercised and controlled in corporations’.
Similarly, the G20/OECD principles discuss how the monitoring of performance against structure of organisational objectives can deliver better
I have never been a great advocate for regulated minimum staffing ratios, but prefer regulation of the things that are really important around provision of care services to the people, our care recipients. If you like, having enough of the right people at the right time, and not just to fulfil a compliance requirement around the number of pairs of hands.
In completing this Review my own views around staffing, quality of care, industrial considerations and the like have changed – for the better. It remains to be seen if those with the capacity to make an even more profound difference to improve care outcomes for frail, vulnerable, mainly elderly recipients of care – the Australian Government and Parliament – will actually choose to support those whom we serve.
It seems that in Australia rarely a month goes by where the public is not informed of another aged care failing. There is wide spread public perception of a lack of care and low quality of life for residents within the aged care system. The call for greater regulation of minimum staffing standards and additional funds to meet them is prominent but seems to fall on deaf ears of the Australian Government.
Without residential aged care provision, residents would likely be inpatients in State based hospitals at several times the daily cost of care of a residential aged care facility. However, the proportion of funds spent on care and service provision should be acquitted on what really matters – the care of people.