Rebuilding trust in aged care

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‘How did we get here? How did a nation who protested so vigorously against the cancellation of ANZAC Day marches to honour our Diggers end up putting those Diggers, and others, in the kind of situations described in the recent report of the Royal Commission into Aged Care? How did we lose our way so much that our most vulnerable citizens are not fed properly, not helped to stay clean and dry and comfortable, are restrained physically and chemically, all dignity stripped from them?’

Main image: A close up is seen of the cover of the Australian Royal Commission Report into Aged Care during a press conference at Kirribilli House (Jenny Evans/Getty Images)

The recently released report of the Royal Commission into Aged Care does not hold back in describing a situation that should be abhorrent to us all. As the report notes, ‘substandard care and abuse pervades the Australian aged care system’. The Commission reports on wide ranging abuse in residential aged care, including restrictive practices, complex care needs not met, particularly in the areas of dementia care and palliative care, lack of even the most basic care of showering, cleaning teeth, good food, supportive toileting and meaningful interaction with others. The report comments on the difficulty of discovering the extent of substandard care and uncovering a culture of reluctance to determine quality of care.

It would be easy to blame individual carers or care providers for the individual incidents of abuse and neglect, but that would be a disservice to the many dedicated personal care workers in the aged care industry who deliver whatever care they can as compassionately as possible under impossible circumstances of under-resourcing, understaffing and minimal training. The problems in the industry are systemic in nature and start at high levels — the report identifies the Australian government and its Minister responsible for the aged care portfolio.

Consecutive governments have continued to strip funding from the Aged Care budget, with no recognition of the rising needs of increasing numbers of older old Australians with complex health care needs who need more than the very basic care being funded. Modern medicine has solved so many causes of ill health and early death that significant numbers of people live well into a much older age and can do so with significant co-morbidities which would have killed them in earlier generations, and this has now created unintended consequences for the larger number of frailer, sicker older adults needing specialised care that also requires significant funding.

Underfunding in the aged care sector and a shift in focus from care to profit has contributed to the poor skill mix and understaffing currently experienced in both community and residential aged care. Direct personal care is being provided to older adults with quite often complex health problems by staff with minimal training, working for inadequate wages with insufficient resources to deliver good care. Personal care workers are not trained to assess their clients and will most likely miss early warning signs of significant health issues.

In most aged care environments, there are very few registered nurses supported by not very many enrolled nurses working under the direction of the registered nurse, leaving personal carers with little quality support. Complex health issues related to managing behaviours of concern fall to these undertrained and under-resourced staff and the solution becomes restraint by force, leaving bruising, bleeding and sometimes fractures, or restraint by medication, often of a psychotropic nature. Poor nutrition compounds these problems — increasing the risk of older adults becoming confused, injuries healing slower or not at all, mobility deteriorating and risk of falls increasing, and overall health deteriorating.

 

'These challenges will be tough to meet. Rebuilding the trust of the community in aged care will have to start by listening to what the community says it wants.'

 

The challenges that face the aged care industry are twofold: how to redress the resourcing issue so that older adults receive the compassionate and competent care they deserve, and how to win back the trust of the community that the older adults in their care will not be neglected or abused. The key factors to meet these challenges relate to establishing an appropriate skill mix of workers with the required knowledge base and ability to apply that knowledge and resourcing the staff appropriately and adequately with acknowledgement that one size does not fit all, particularly in relation to quality care for people with dementia and for palliative care. The resourcing will depend on solving the vexed question of funding — who, how, and how much. Solving this question will invariably need to include a recognition by the community that improving care of older adults will come at a cost. And where funding is involved, governance and accountability must be included. The industry needs a robust system of accountability for the money it receives and how it is spent on improving the lives of older adults.

These challenges will be tough to meet. Rebuilding the trust of the community in aged care will have to start by listening to what the community says it wants. It will require honest and open communication, transparent processes and community involvement in the oversight of care provision in the community and in residential aged care. The industry itself will need to be very clear on resourcing and identify the two components of resourcing — what older adults need and cannot be expected to do without, and what would be ‘nice to have’ but not essential. Funding for the first is a social conscience issue and should be available to all via government funding, funding for the second should be by other means.

Related to rebuilding trust will be the requirement to staff the industry appropriately. At minimum, the industry should work towards having more registered nurses directly involved in the daily care provisions of the older adult, more enrolled nurses ‘on the floor’ and increased numbers and qualifications for personal care workers. The industry should start to work towards upskilling its existing workforce with a major education drive and a focus on the most problematic areas.

And in addition, it should immediately increase the qualification requirement for new employees. Ideally every facility and community care provider should have registered nurses with postgraduate qualifications in gerontology or at least have access to one for consultation purposes. Further into the future it would be prudent for the industry to set minimum qualification requirements for managers, care coordinators and direct care providers, with an emphasis on a strong knowledge base of ageing. Related to this, it may also be timely for the industry to develop position descriptions for the various staff that include a measure of aptitude and attitude towards working with older adults to determine suitability for the position.

Funding of the industry will not resolve quickly. As an interim measure it will be necessary to address the most pressing concerns first, by reviewing how current funds are spent and how funds may be redistributed. It appears the most pressing concerns that need immediate attention include nutrition, finding better ways to manage problems than medicating or restraining residents, and trying to improve staffing levels. Long-term, the issue of staff wages will need to be addressed. Pay rates need to be attractive enough that the industry can attract the most suitable people to work in the industry.

There is a long and difficult road ahead of the industry. But one thing is clear, the status quo cannot continue. Our older adults deserve better.

 

 

 

Associate Professor Jenneke Foottit is Senior Lecturer; Deputy Head of School: Nursing, Midwifery and Paramedicine, Australian Catholic University.

Dr Sue Gledhill is Senior Lecturer and Postgraduate Course Coordinator School of Nursing, Midwfiery & Paramedicine, Australian Catholic University.

Main image: A close up is seen of the cover of the Australian Royal Commission Report into Aged Care during a press conference at Kirribilli House (Jenny Evans/Getty Images)

 

Topic tags: Jenneke Foottit and Sue Gledhill, aged care, RC, elder abuse

 

 

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Existing comments

Take aged care out of the private sector and include it under Medicare embracing both free care in lieu of pensions and means tested paid care. We could also perhaps close down the 30 or so Mickey Mouse universities and educational colleges we fund for no other reason than to make money from overseas students many of whom are not tertiary education material.
john frawley | 14 March 2021


There was very little wrong in residential care before 2015 when the government cut funding. You simply cannot deliver diamonds from a tin mine. Saying that, 24% of residents were always satisfied, another 58% were usually satisfied .. 82% of residents were pretty content. Put back the funding, lower the documentation drag and put more staff on the floor caring.
Anton Hutchinson | 17 March 2021


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