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Poor quality aged care can still ‘fly below the radar’

Stakeholders say a new review must tackle shortcomings in aged care accreditation that allow poor operators to effectively game the system.

The Commonwealth on Monday announced a review to determine how federal regulators failed to detect the scale of the issues at South Australia’s Oakden facility.

The State Government is closing the facility after the state’s Chief Psychiatrist Dr Aaron Groves delivered a damning review into Oakden, which he said was “like a mental institution from the middle of last century.”

Yet the Federal Government on Monday acknowledged that the federal Department of Health had received complaints about the facility, and both it and the Aged Care Quality Agency had been “working with” the facility’s operators.

“This review will, therefore, consider how the extent of the issues had not become clearer to us,” Minister for Aged Care Ken Wyatt said.

Critics of aged care accreditation have persistently warned the scheme is too focused on demonstrating compliance through paperwork rather than evaluating actual care outcomes. They point to other high profile cases of poor care or neglect at facilities that had passed their accreditation.

Dr Groves said his review heard and saw evidence that the facility “learned how to produce documents and records that accrediting bodies and surveyors wanted to and expected to see… However, it became no better at providing safe or better quality care.”

Similarly, the Productivity Commission’s major review into aged care in 2011 found aged care’s quality framework “is not focused enough on outcomes for care recipients.”

Poor behaviour ‘hidden’ 

Council on the Ageing Australia said that accreditation had undoubtedly improved quality across aged care but there were still serious issues with the scheme.

“Despite the formal accreditation and complaint processes mandated by successive governments, some poor behaviour has continued to fly below the radar, hidden from the accreditation processes,” said the group’s chief executive Ian Yates.

Many of the residents and families who are affected were often not confident enough to complain, he said.

Alzheimer’s Australia said the review was a “matter of urgency.”

The group’s CEO Maree McCabe said that the vast majority of providers met accreditation requirements yet her organisation continues to receive reports from families of poor care, abuse and inappropriate use of restraint.

“We must question if the current standards set the bar high enough,” said Ms McCabe.

COTA called for the review to “consider systemic solutions to systemic problems” and not just evaluate current practice.

“Residents and their families should have the right to move their bed licence to another nursing home at any time, without any barriers,” said Mr Yates.

Details of review

Included in the review’s terms of reference is an examination of why the Commonwealth’s regulatory processes did not adequately identify the failures at the centre prior to 17 March when sanctions were imposed, and what improvements are needed.

It is unclear whether the review will take submissions or hold hearings.

The reviewers, who are to be announced “in coming days”, will have just four months to produce their report for government.

Labor called for the review to be “genuinely independent and open to receive submissions from anyone with an interest in aged care services.”

Veteran aged care researcher Maree Bernoth said it was incumbent on the review to hear from residents and their family members, researchers and clinicians.

“Strategies need to be made available to facilitate input by these groups. Residents and families may be reticent to write a submission as it seems a daunting task. Instead, they should be able to relate their experiences by phone, Skype or whatever medium they feel comfortable with, and in anonymity,” Associate Professor Bernoth told AAA.

Provider peaks Aged & Community Services Australia, Leading Age Services Australia and Catholic Health Australia all said they welcomed the review.

The new review into accreditation comes as the government moves to implement a streamlined quality framework for aged care and amidst the voluntary roll out of quality indicators.

Correction: An earlier version of this article incorrectly stated that the review’s terms of reference had not been released.

Related AAA coverage: Review into aged care accreditation after failure on Oakden

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8 Responses to Poor quality aged care can still ‘fly below the radar’

  1. Drew Dwyer May 3, 2017 at 10:11 am #

    I guess in the end it will be the case that the market will vote with its bed space when it comes to better care for the bucks we spend.

  2. Jean May 3, 2017 at 1:19 pm #

    Many of the assessors I have come across whilst managing aged care homes are far too interested in the crossed T’s and dotted I’s. The current structure invites operators to “game the system” as its a good bet the assessors will have their blinders on the moment they walk through the door. It is almost laughable the lengths some assessors go to to confirm a miniscule error with documentation while missing the larger picture of demonstrated quality care.

  3. Dave May 4, 2017 at 1:07 am #

    The framed accreditation certificate in the foyer is your guarantee of…absolutely nothing.

    Toothless and incompetent, the AACQA has bumbled through similar outrages before…but only when it’s been caught out. If this is what we get from a government agency, imagine how things will be when we sub it out to private auditors.

    Boasting that their efforts have raised standards and are responsible for today’s near perfect pass rate is risible. It often seems the process consists of “Heads: Give ’em three more years…or Tails: Shut ’em down. (The coin toss always comes up ‘heads’)

    Knowing when the auditors are coming makes the entire exercise a farce. Best foot forward, fresh coat of paint, a new umbrella for the courtyard and extra staff on the day. (and save the cold party pies for next weeks dinner)

    Their dearth of clinical expertise permits satisfactory documentation to trump the appalling wound management it describes (Love the new folders and shiny plastic sleeves). Tick sheets have become sacred indicators that prove all is well. And if you do happen to fall short on a few standards, just send us your action plan and you’re good to go.

    Nobody looks under the sheets.

    When did we become so content with mediocrity? Do we all really hate our parents that much?

    Dont expect anything to change under the current Act. It protects providers, cloaks the process in secrecy and offers no recourse for consumers.

    Aged care doesn’t need another review…it needs a good dose of litigation. Just watch how fast things change when money’s at stake.

  4. Erin Sharp May 4, 2017 at 7:32 am #

    Assessors are looking for evidence. And so they should. But lets us all remember Aged care homes are just that HOMES.The homes are not hospitals.
    Making sure bowels are documented is not a normal process for those living at home. Look beyond the minutia and see the holistic environment and outcomes.
    Having managed a residential home I looked forward to support visits and the opportunity to a fresh set of eyes to suggest improvements. Looking for minor documentation errors are not helpful.

  5. Lijo May 5, 2017 at 6:57 am #

    Assessing based on holistic environment and general outcomes is better way of measuring the quality rather than searching individual outcomes.Our aged care system needs more quality indicators to assess for compliance rather than documentation trials.Documentation trials make nurses,carers and managers tied in to computers and folders when this quality time could be spent on individuals requiring specific attention.

  6. Kylie Wise May 5, 2017 at 1:13 pm #

    Given the complex clinical needs of residents these days, it’s naive to persist with the notion that high care facilities are ‘homes’ and not hospitals. If they could still be at home, they would.

    Disregarding their clinical needs only guarantees your residents will end up in hospital. You can’t hide behind the ‘Holistic’ label either; a holistic approach is the sum of its parts (aka, the minutiae).

    The farcical national indicators project contains manipulated data and the AACQA is riddled with flaws. I’m surprised that anyone would be calling for more of the former and seeking advice from the latter.

  7. Pat McGovern May 5, 2017 at 6:28 pm #

    Couldn’t agree more Kylie. Ignoring important aspects of care just because they’re not usual processes at home is reckless and looking to the agency for advice and direction is just plain weird.

    Perhaps if there were more managers who really understood the core purpose of their business we wouldn’t even need the AACQA.

  8. Zac May 6, 2017 at 7:31 am #

    Mrs Mansell-Brown from Bundaberg, just the look on your face in the Weekend Australian shows me that the industry has finally got someone who is willing to put their money where their mouth is, and their head on the block for what is right.

    We should ALL be standing behind you!!!!

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