The Royal Commission.
I do not need to add very much here, the blueprint has been supplied to fix this by the Royal Commission into Aged Care Quality and Safety. Please at least read the Chair’s Preface on Pg 1 and the Table of Contents Pg vii for the 26 Recommendations.
Australia’s Largest Family-Owned Providers.
Also read the Centre for International Corporation Tax Accountability and Research document of May 2019 ‘All in the family: Tax and financial practices of Australia’s largest family-owned aged care companies.’ These six companies operate almost 12,000 beds. It is 35 pages that will change the way you view these providers forever. The wealth they derive from $711 million of Govt funding without reporting back anything, their offshore and trust account tax havens, their contempt of ASIC reporting requirements and the huge level of donations to Govt decision makers like the Liberal National Party in Queensland.
Needless to say, I support its three recommendations.
- All entities receiving over $10 million in annual federal funding, must file full and complete financial statements with ASIC (by the prescribed date annually),
- Immediate formation of a public register of beneficial ownership, including trusts: and
- A minimum tax of 30% on distributions from discretionary trusts and an examination of further trust reforms to bring Australia in line with global standards.
The Federal Govt issues ‘Licences’ for these beds and can quickly specify new reporting requirements linked to them if it has the will.
Enrolled Nurses vs Registered Nurses.
One point the Australian Nursing & Midwifery Federation (ANMF) are pushing is for all aged care providers to have a Registered Nurse on site 24/7. Currently 85% comply in Victoria. Some aged care providers and Govt officials say they cannot find nurses willing to take these remaining 15% of positions on. This is deceptive language.
Many private providers are personal profit driven and only pay the lowest possibly hourly rates for nurses with bare minimum entry level qualifications to be called a ‘Nurse’. They seek Certificate IV Enrolled nurses with medication endorsement and pay the Award rate $24.11 an hour. This type of training can be completed in a few weeks full time for a couple of $ thousand vs a Registers Nurse with a 3 yr. University qualification & huge HECS debt that slowly gets paid off from the higher hourly rate.
The significantly higher qualified RN’s have an Award rate starting at $25.59 an hour but progressing within Level to $30.21, Level 2 to $32.88. Level 3 to $36.38, Level 4 to $42.20, and the rare specialist Level 5 Clinical Specialists working solo $57.25.
This is a contributing factor private aged care providers might not be able to get their desired nursing staff. If they are unwilling to pay the higher Award rate for an RN, and frankly why would an Enrolled nurse take on such significant responsibilities for just $24.11 an hour. They would clinically overseeing drug administration and the specific nursing needs of many, many often very unwell residents alone. This would be especially challenging on night and weekend shifts.
Vocation driven vs Commercial Driven – It’s a Tough Job.
Nurses are passionate people like teachers and child-care workers who signed up to a ‘vocation’ in what is known as the ‘caring industry’. Instead of being able to sit with someone and have a chat about the world and connect as they attend to their clinical needs, they find themselves in a very commercial world. It is driven by profits and speed and lowest margins of actual care in a sometimes ruthless ‘career’.
I personally know of RN’s trained in the former public hospital nursing methods, who worked at privately owned residential aged facilities because they were closer to home. They discovered that the evening shift sole nurse’s true workload to administer it in the Hospital standard, meant they worked 25% longer each shift unpaid, to ensure the resident’s safety. They stayed there only because they wanted to try to improve processes, but only found more intrenched hurdles.
To this day they feel the ‘vocational’ guilty that perhaps they could have done more. What if someone like them was still onboard when COVID-19 hit. Could they have ensured the PCA’s were actually trained to the standard each needed to be, and the daily practices were regimentally adhered to?
Minimum Direct Nursing Contact Hours.
Nursing unions are seeking a blanket minimum 2hr 15min of one-on-one nursing contact per resident per day. The actual resident acuity would better dictate actual need. Some need more, some less, but transparency is vital. Residents are unlikely to complain when their life literally depends on the care provided by those around them, especially one-on-one alone at night. I have actual nurse examples of patient exit interviews in a private hospital being recorded by a nurse onto a tablet, when the patient explains her complaint, the nurse records 10/10 satisfaction.
Current Advertisements for Aged Care Nurses.
See current ads ARCARE example: Sydenham I VIC ENDORSED ENDORSED NURSE – skills & experience. All for a MA000034 Award rate of $24.11 an hour, when teenagers working in cafes get paid more.
Federal Govt Mixed Priorities.
One presenter at the ANMF rally in Geelong on 06/05/2022 said the amount of money theFederal Govt paid out to keep a handful of immigration detained in hotels without appeal for 9 years, would have paid for 14,000 RNs for the same period. Which served our community better? Where is the much-promoted Christianity in our leader? How do fellow parishioners in his broad church feel he represents them?
Food Quality and Variety – Representative of the Community & Residents.
Better and more culturally appropriate and nutritious food is also an issue and my suggestion to address this is detailed in Initiative #2.
Penalties for Criminal Abuse.
Every few months we hear about a sex pest or violent care provider being released from Court. Why are Courts so lenient? I suspect it is because our Laws have not kept up with community expectations and we the community never suspected such things were going on. My suggestion is to amend Laws to mirror the penalties of assaults on Essential Workers. If a Care Provider assaults a resident, immediate prescribed penalties apply. Take a leaf out of the Worksafe Act and record a judgement against the facility owner (the named facility, the CEO and the Owner) and a commensurate penalty, so that they have ‘skin in the game’ and commit to fixing things.
Liability of Facility Owner for Avoidable Failures.
The COVID-19 pandemic was an example of needing to hold the ultimate aged care provider personally responsible. In Geelong we had a one high-cost residential aged care facilities extremely overrepresented in COVID-19 deaths. Almost overnight they were simply Renamed and rebranded to hide the past adverse events.
1,400 residents died in Private aged care facilities in Australia during COVID-19, only 14 in Govt run ones with RN’s 24/7 and a better trained conscientious workforce.
Liability of the Federal Govt for Avoidable Failures.
The Federal Govt should be held accountable for this mismanagement in the same vein as the ill-fated:
– Robodebt (which they have paid out) &
– JobKeeper (where Sole Traders received no support, but big business and Private schools did – like Geelong Grammar where the incumbent Corio member attended receiving $8.3 million in a year it posted a $7.2 million profit).
They relied too heavily on inhuman illogical computer-based service delivery and failed to act to reboot and override when blindingly obvious facts appeared. Examples being Robodebt was trying to chase people that had no bona a fide debt to begin with, and JobKeeper was being paid to very profitable companies unaffected by COVID like Harvey Norman.
e-Training Failures.
Don’t blame the nursing staff but look at the Govt of the day overseeing a training model and sending out the mandate for all to adopt it. Mr. Morrison regularly did his marketing script to tell us every care provider in Govt funded (through to private owners) residential aged care had been trained specifically to handle COVID-19 related matters. Slippery words again. Go to HTTPS:/?www.agedcarequality.gov.au/news-covid-19-e-learning-modules-now-available to see how this e-learning was rolled out.
I have been told this suite of e-learning modules only needed to be ticked off by all workers. Some of the lowest paid & lowest trained workers in the federal system Personal Care Attendants etc., who may of had a poor grasp of the language and techniques, are said to have been assisted by other people to completed the modules. It all looked as if they had completed the training and acquired the knowledge. The under-trained, then continued their work because the owner could not attract anyone else at lower pay rates during the crisis, with unintended dire results.
Oversite of the Training.
The owners of the residential aged care facilities failed to adequately oversee the intended application of the lifesaving training. One wonders if their defence is “I don’t hold a hose – That’s not my job.” But if Worksafe laws are applied as intended, they each have a case to answer for the 1,400 deaths.
Learn From Past Experiences.
We as a community need to recognise openly and honestly what did and did not work during this COVID-19 pandemic, so we are better prepared for the next. Over two years there were multiple occasions where we looked in hindsight and said, “Well that should have been obvious…”, but people wee too busy covering their trail to avoid blame.
Our Sunset Years.
My experience in watching and assisting with the care of my parents and in-laws up until they died of old age taught me the value of what must go on daily in a well-run facility to care for loved ones until the end. All four avoided entering residential aged care. It was a place they never wanted to experience.
After 17 years as an accountant and business manager with the likes of Barwon Health, Geelong Community Health Services, Colac Area Health, Bellarine Community Health & Hesse Rural Hospital and Aged Care as a Board Member, I could see all levels of multiple health provider models. I have my scars, mostly from the 1% at the top mismanaging the 99% below and patient/client outcomes.
It is not just a slogan an ALP of ‘having people at the centre of all care’. It must be the systems and procedures and their applications always empathising the clients’ changing needs, and the increased acuity of people when they come to aged care providers. Many are not entering flash resort like facilities for the over 55’s. However, some marketers are suggesting uninspired demountables pushed shoulder to shoulder beside a busy roadway are ‘Resorts’.
Inequitable Distribution of Bed Licences.
In the Corangamite and Corio electorates there are residential aged care private facilities being build every day. Historically they were co-located near independent living units and public hospitals to allow what was termed ‘ageing in place’ as you moved your way across each. Now many independent living units are integrated into housing subdivisions for easy access by neighbouring family members.
Almost none of the new facilities are North of the Ballarat Road (except 1 built by the multicultural community nearby) because the private sector wants to get its hands on the value of your house as a Bond. Northern Geelong houses are significantly lower valued than many other parts of Geelong, and therefore does not financially support the bed as much. The care facilities may not be located on the Northern side of Geelong, but many of its residents drive South to work as groundskeepers, cleaners and Personal Care Attendant jobs with traditionally lower pays.
Better Facility Models.
A couple of shinny alternative to consider. SIROVILLE in Belmont commenced in the 70’s by the good employees of the CSIRO Wool & Fibre division. It seemed like a reincarnation of a-vision from the 1800’s Austin Home for the Disadvantaged. It is as a cluster of individual units to create its own community on the site of a former orphanage. Check it out. At the same time look at ‘The Paddock’ in Castlemaine where the community have come together to build their own solution without big business slicing big profits from it. (My previous #1 initiative could potentially fund these independently). And a third leading light is the Dementia specific facility at Winchelsea.
Clinical Supports In Your Own Home.
All these new builds miss any level of health connect beyond the RN and telehealth as the 24/7 nurse when you live alone. There is no GP doing rounds as you age and needs increase.
In my own fathers’ case he lived one street away the GP he saw for the balance of his years. He planned sensibly to have a GP much younger than himself to ensure he saw him through. But when the GP’s treatment left him unable to move enough to walk into the Clinic for a consult, the GP declined to do a home visit and said go to the EMD instead. My father dies within a fortnight. I wrote more about this incident in the local press at the time. The following year I lodged a very detailed submission to the Andrews Govt inquiry into assisted dying. In it I made specific suggestions for Health industry wide reform and improvements. I detailed at length (no surprise really) where improvements could be easily found. In reply I received an acknowledgement of my submission. Full stop.
Boredom and Lack of Purpose.
As Paul Hogan says, his mother died of boredom. In talking with a migrant friend of mine last night while sampling a wine he made at home, he said “The day they take me out of my own home into care is the day I start to die.” I believe what we need is more commitment to finding ways to enable people stay in their own house right up to as close to the end as possible. It doesn’t take innovation just imagination and practical solutions which the local ‘community’ can support. More on this in initiative #12 later.
Former physical working and country men are famous for not surviving the first year in residential aged care. They are like worker bees, that just keep going until their wings wear out and they fall to earth, vulnerable. They know that when that day comes, they no longer contribute anything to this world. They are just a barnacle. And as much as they love those around them, they are the drag that is holding them back. As the old poem goes, the walrus said, “The time has come…”
Farmers have spent their whole life deciding when to harvest and when to burn stubble. When to send the sheep to market while still in good conditions without lambing again, and when a suffering animal is best put down – by his own hand. They know what the future holds and don’t intend to pass that burden onto others.
Unfortunately for the women in our community, they on average live a couple more years, but increasingly fall victim to dementia. As much as they intended to never to be a statistic, by the time it reaches them, they are not aware it has overtaken them.
Choosing the Right Aged Care Provider.
All too often the decision to enter residential aged care is thrust upon us quickly following an unexpected event like a hospital admission and the discharging doctors says your parent will not be well enough to go home without 24/7 supports. You have your own work, partner and child rearing commitments already, and where would you turn anyway. All the residential aged care providers present their information a little differently and sometimes in confusing terms.
Where would your parent want to go anyway, especially if all they ever wanted to do was go back to their own home. Where do you find informed, unbiased, up to the minute information. Where is a bed available tomorrow. How do you navigate Bonds and fees and extra charges, quality measures like accreditation, food, nurse qualification, staff to patient ratios, social outings, other resident reviews, Annual Reports, provider profit levels etc. 15yrs ago I scoped an app to deliver such a system but could not find a local aged care provider willing to take it’s development on. Perhaps the time has come for a crowd funded version to be piloted to see if it benefits residents and loved ones.
No time like the Present.
When I was analysing the demographics of Victoria and the greater Geelong region, I discovered a shocking fact. The total of all people 85+yo is only 2% of our population. On average they are women. This Mother’s Day, make a point of seeing your parents especially if they are in retirement, because, odds are, for every one that is 85+ there were 98% that went before them.
Now, re-read the Royal Commission Chair’s Preface poem by Alfred, Lord Tennyson, Ulysses and then focus on the outcome we must have “…and not to yield.”.