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Aged Care
Introductory
page Australian
section Nursing home
residents and their relatives
The many extracts on these pages are from
copyright material. They are owned by the reference
given or its owner. They are reproduced here for
educational purposes and to stimulate public debate
about the provision of health and aged care. I
consider this to be "fair use" in the common
interest. They should not be reproduced for
commercial purposes. The material is selective and
I have not included denials and explanations. I am
not claiming that the allegations are true. The
intention is to show the general thrust of
corporate practices as well as the nature and
extent of any allegations made. Any comments made
are based on the belief that there is some
substance at least to so many
allegations.
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This page examines the plight of nursing home
residents and their families in Australia. It gives
a few examples of their difficulties. It does not
offer specific help to those with problems. For
more information and links to resources you should
try the Aged Care Crisis web page. They have had
direct experience of the system.
Nursing home and health care have traditionally been seen as community services provided by a community that cares to individuals who appreciate the efforts made on their behalf. There was a system built on trust and trust worthiness. Those providing care would do their best with the resources available and those receiving it would behave responsibly, pay what they could and be appreciative.
That mythical picture has changed radically with the advent of a market in health and aged care but much of the community, particularly the older community is unaware of this. The adage "buyer beware" has never been so applicable yet all too often the government and not the resident is the buyer. The government is promoting and supporting the companies providing the care and you should not expect much from them. Nursing homes are overcrowded and there is little choice - although government claims the system is based on choice.
Although nursing homes get paid much the same there can be wide differences in the care they provide. Residents and their family's have every right to examine the services they receive critically and act forcefully and confidently when they find problems. This is the only way to ensure that care is adequate.
It's like a lucky dip at life's end for the 27,000 frail and elderly residents in NSW nursing homes. Virtually all nursing home residents pay the same, whether a home is first-class or substandard.
May 1996 Different levels of care for same money
At the Albury and District Private Nursing Home, for example, residents pay the standard 87.5 per cent of their pension - about $26 a day - to live in a bleak home threatened with closure. A short drive away at the Lutheran Aged Care Home, it costs the same amount for five-star accommodation, with private rooms and first-class care.
Good homes have long waiting lists, so even substandard operators get full houses. Private operators must make a profit to survive but churches and charities are free from those pressures.
Five-star Luxury Or Overcrowding - It's A Lucky Dip Sydney Morning Herald May 15, 1996
This is where Aged Care Minister Bronwyn Bishop's father is spending his twilight years - a secluded, well-staffed and popular home in the Sydney suburb of Chatswood.
Mar 2000 Contrasts
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And compared with the Alchea Park Nursing Home in Gladstone, Queensland, named in federal parliament yesterday, the Chatswood home is approaching nirvana.
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A room costs around $700 a month. Some other Sydney homes charge that much for a week's stay. Costs are kept down because the home is owned by the local community and run as a non-profit operation.
Only the best for Bishop's dad The Australian March 8, 2000
QUESTION: Who is more expensive to feed, a prison inmate or a nursing home resident? ANSWER: The prisoner - by $3.10 a day.
Mar 2000 Cost cutting on food
An investigation by The Australian reveals that nursing homes around the country are cutting the cost of feeding their elderly residents to as little as $2.70 per day.
In contrast, the cost of feeding prisoners in jail is as much as $5.80. Further, the nutritional standards of prison food are much higher and much more closely monitored.
A bulk order form obtained by The Australian from one NSW nursing home allows for less than 500g of meat per resident and suggests a diet dominated by frozen foods, including party pies, sausage rolls and chicken nuggets.
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Nursing shortages in some homes mean residents may have meals taken away when half finished or may experience "night starvation" when dinners are served too early.
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Professor Binns, head of Curtin University's school of public health in Western Australia, said numerous studies have shown residents often were not given optimum nutrition, leaving them vulnerable to infections and constipation.
Fed up on $2.70 per day The Australian March 21, 2000
The resident has little leverage to ensure that staffing is adequate and that good care is provided.
As one family member interviewed on Australian Broadcasting Corporation (ABC) radio pointed out, if he complained to the management of nursing home he would have nowhere else to take his elderly relative in need of care. The Productivity Commission recently found an average waiting period of 44 days for access to nursing home beds, with waiting period in Victoria up to seven months.
Feb 2000 No where else to go if you are unhappy
Dilemma for families weighing up the true cost of complaint. The Australian February 26, 2000 (ABIX ABSTRACT)
LILLIAN JETER (Australian elder care advocate with US experience): - - - - - - They care very much for their families and the fear and the intimidation. That the families feel that if they take them out of that facility, where else are they going to put them? So they keep them in the facility - they really are in a catch 22 situation.
Feb 2006 families have no choice
Allegations of abuse at aged care facility Lateline ABC TV February 20, 2006
Because staff are often motivated, overworked and driven by cost conscious management residents are sympathetic to their plight and reluctant to complain. The overworked staff will be penalised if they do. At other times families are worried that if they antagonise staff by complaining the resident will suffer.
But she mentioned a climate of fear among relatives that often stopped them speaking out for fear that their loved ones would suffer retribution from the home's administration.
Feb 2000 Fear of retribution
Angry Families Ask: How Could This Happen? The Age February 26, 2000
Management is often oblivious to the problems under their noses and can blame the relatives or resident for being difficult or having a problem. Some claim they have been bullied or threatened. If the resident is removed from one home a vacancy in another may not be found.
When families have complained and investigation of their complaints has revealed serious problems some homes have elected to go out of business. Others have been forcibly closed by the government. In both cases the residents suffer more because of the closure than if they had remained silent. This is not what they had wanted.
People in their 80s or 90s whose home this has been for years can be forcibly relocated to geographically distant accommodation losing their entire nurse support system. The trauma of Riverside is a constant deterrent to anyone wanting to complain, yet unless families do so there will be little change.
"The relatives don't complain because they feel that it's going to be a Riverside all over again, as in the residents might be moved," she said.
Apr 2000 Fear of another Riverside
Nurse says she was sacked for complaints about nursing home. Australian Associated Press April 20, 2000
My examination of the US and Australian market systems leads me to the following conclusions.
Insufficient and untrained staff are key problems. Prospective residents and their families should obtain staffing information and have the knowledge to assess staffing ratios. They should insist on the disclosure of past as well as present oversight reports. Recurrent offenders are of most concern and the accreditation agency should be forced to supply these on request. Families should see what the company was capable of when no one was watching (i.e. insist on surprise inspection results) not when they had been given time to prepare and not after they had responded to an adverse finding in order to stay in business. Most nursing homes have 3 years without any oversight.
They should examine the track record of the owner in its other homes. It is the owner that allocates funding and dictates policy. The profit focus (not for profit, private for profit or publicly listed for profit status) should be considered and the public statements examined within this context. They should visit the home unanounced and be given access preferably during a meal time to see the quality of food and whether there are staff helping residents to eat. A pervasive smell of urine or faeces is a warning. Facilities for physical exercise and mental stimulation are important.
Relatives are often unaware of the key relationship between bad nursing and the deteriorating condition of the elderly resident. Weight loss, dehydration, pressure sores, contractures, being bedridden, and mental deterioration may be accepted as due to aging rather than to bad nursing, excess sedation, insufficient exercise and a lack of mental stimulation.
Wouldn’t it be useful if homes were required to disclose publicly what they spent on food, nurses and cleaning, as well as their staff/patient/skills ratios? Prospective residents should make a point of asking and comparing.
Note that the not for profit private homes have also been compared poorly with publicly run homes. The following article compares private vs public government run homes. It does not compare not for profit vs for profit homes.
We need to know whether the government homes are giving better care as one might expect from the additional expense, or are they inefficiently wasting the extra money as the marketplace claims. No one seems interested in looking at data to see. Experience from the USA suggests that it might be very challenging to market believers but there are insufficient public facilities in that country to make a valid comparison. It can be done here.
What is missing from the report is the incidence of pressure sores, contractures, weight loss and dehydration. This is the sort of information you require when you select a nursing home and decide whether to go public, not for profit or for profit.
PRIVATE nursing homes cost an average of 14.5 percent less to run than government homes, it has been revealed. A yet-to-be-released report says meal costs average $15.25 a day in publicly run homes and $9.83 a day in private homes. Private homes also employ fewer registered nurses and more unqualified staff than homes run by charities and the government. The Victorian Human Services Department report reflects concerns by nurses and consumers about underfunding by the Federal Government of Australia's 3000 nursing homes.
Apr 2000 Private homes spend less than public homes on care
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The study found:* Government-owned high-care nursing homes used more enrolled or division two nurses than registered nurses compared with private or charitable-sector homes.
* Private and charitable-sector homes used more non medically qualified personal-care assistants than public homes.
* Public homes spent more than twice as much on cleaning as private or charitable homes and 72 percent more on laundry per resident. On average, 30 percent of nursing home spending was on cooking, cleaning, laundry, maintenance and administration. The remaining 70 percent was on direct care of residents. Despite an increase of 42 percent to $3.5 billion in nursing home funding since 1996, the number of nurses employed in the industry has fallen by about 9000.
Private nursing homes spend less Courier Mail April 3, 2000
One can only urge relatives to learn about aging, about good care, about failures in care and about the staffing ratios and training in the home their relative is in. If they really care for the resident then they should visit very frequently and at unexpected times to see what is happening. If all is not well be persistent. If need be become such a nuisance that something is done.
If things are not right take photographs, record or take notes of all interviews and visits. Complain through the complaints mechanism but don’t expect the faults to be there when they visit. If you have hard evidence and photos then you can still force the issue by going public.
You should not expect the complaints agency to tell you want they have found and it may cost you years of angst and expense to even see a censored copy.
KERRY O'BRIEN: - - - - Critics of the current system say there's a lack of protection for whistleblowers who report abuses, and that the whole process of complaints resolution is a bureaucratic farce with little or no transparency. Matt Peacock reports.
Mar 2006 No satisfaction from the complaints mecahism
MATT PEACOCK: In her 25 years as a Wollongong GP, Dr Jean Duncan had never been one to rock the boat. But all that changed when she complained about the way staff in a nursing home were lifting her mother.
DR JEAN DUNCAN: They started using a machine (to lift her mother) which they didn't know how to use and this caused gross trauma and bruising and skin tearing.
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MATT PEACOCK: Dr Duncan (daughter) complained about the injuries, but to no avail.DR JEAN DUNCAN: My mother asked them not to use it. I asked them not to use it. Even members of staff asked management not to use it. But they insisted on using it. That situation went on for a period of 10 days before I was able to have her moved out of that complex. Unfortunately it was just too much trauma and she died.
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MATT PEACOCK: Determined to ensure that other patients didn't suffer, Dr Duncan complained to the Federal Aged Care Complaints Resolution Scheme, which organised a detailed assessment team report, but she was never sent a copy.
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MATT PEACOCK: So began a bureaucratic battle that dragged on for years through no less than seven Government agencies. The nursing home fought Dr Duncan all the way here to the Federal Court to stop her from citing the original assessment of her complaint.
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DR JEAN DUNCAN: This is the detailed assessment team report. It took me nearly three years to get and it cost $93,000. You can see quite a lot of information has been blocked out. That's the sum total of all of that effort.
Elderly abuse prompts Govt measures ABC 7.30 Report MARCH 15, 2006
An opposition politician may take up your problem, especially if there is political mileage for them. Only when you have created a crisis situation will politicians in power express enthusiasm to hear your point of view. Carefully consider what you believe needs to be done and do not allow yourself to be readily persuaded to their position. They became politicians by being good at responding but not doing. Keep pressing them until something effective is done. Addressing the key problems may well be unpalatable for them.
SENATOR SANTO SANTORO: Absolutely, I am very happy - in fact, one of the granddaughters wrote to me today. They want to cooperate with myself personally, they want to cooperate with my office and Department. They will be receiving a letter from me tomorrow saying I am totally available to listen to your story. More importantly, the departmental officers will be available to also listen to your story.
Feb 2006 Response to a media crisis
Aged care debate LATELINE ABC TV February 21, 2006
There are of course many nursing homes that do provide excellent services and others that try very hard in the face of real funding restrictions and an inability to secure staff. Sadly they are caught up in the distrust and suspicion which attention to the welfare of our loved ones indicates we should bring to this new competitive aged care system when we enter it. That is what a market system has done.
Even the best of homes and the most motivated of nurses make mistakes, things go wrong in spite of every effort and elderly residents continue to age and die. In these situations it is gracious and appropriate to recognise this, be forgiving and also constructive in assisting the home to prevent recurrences. A good home will explain what happened openly and honestly. They will tell you what they are doing to prevent it happening again and often involve you in the planning. We all like to feel that our misfortune has at least benefited others and we should give our support.
In my comments here I am influenced by my own experiences in health care and my study of aged care in the USA and Australia.
The difficulty for the resident and the family is knowing when this is an isolated event and when it is a manifestation of a systemic problem. You will have to look around you to see whether there are other problems and speak to others to see if they have had similar experiences.
Management may be totally unaware that they have a problem and you will be most successful if you approach them in a friendly and non-confrontational manner. They may be in denial but should be prepared to listen carefully to your concerns and consider your suggestions for improvement. They should be able to explain what happened openly to your satisfaction and if it is needed initiate changes.
If you feel that you are being fobbed off then you should become more concerned. Consult someone with more experience than you have. Seek managements agreement to have the situation reviewed by someone you know who is knowledgeable and independent. They can hardly object. If you can resolve the issue without acrimony, your relationship and influence within the home will improve and you can contribute further to ensure the residents get better care.
The problem for relatives is that they are in an unfamiliar situation, are anxious, angry and sometimes grieving. In this situation it can be difficult to remain objective and restrain ourselves. Judgement can be clouded. We need to reflect before acting and have a friend who is able to stand outside our involvement and advise.
In the USA many of the cases of elder abuse have been exposed by relatives who have hidden video cameras in residents rooms. The success of this strategy has resulted in strong pressure for video surveillance in nursing homes. "Grannycams" have become a political issue with reform groups pressing for the right to put video cameras in rooms so that relatives can check on care.
These US community groups have also targeted companies with a poor track record. They have persuaded and assisted relatives in taking companies to court and securing massive damages. This has been the only community strategy which has had any real impact. The worst corporate chains have been driven out of those states where legislation by friendly politicians has not limited the amount of damages disgusted juries can award.
I stress that this is not what I am advocating but I suspect that this is the way we will have to go if we wish to restrain marketplace excesses. We cannot depend on the market or on government.
What we need is to abandon a system which exerts such strong pressure towards dysfunction; one which then pretends to contain that dysfunction through ineffective industry friendly government controlled structures.
We need something new in which the pressures are towards care and community and in which regulation is integral, unobtrusive and seldom has to penalise. But please tread carefully. Replacing one ideologically driven system of reform with another set of wildly enthusiastic reformers who believe their simple formulas will work is likely to create another set of problems to which they will be blind. We need to move carefully and systematically, something which politicians looking for "reform agendas" which will win votes are particularly poor at.
Relatives of residents who have been victims of the system have led the way in forming advocacy groups. They have documented the plight of residents and the difficulties faced by relatives far better than I could. They express the emotional impact of what has happened from the heart of real experience.
The Aged Care Crisis Group in Australia have a web site which is one of the best. You should consult that. There are also extracts illustrating the plight and difficulties of residents and their relatives on many of the pages on this web site. (eg. see Riverside)
A few recent startling examples give the flavour of the problems for residents and for their families.
TONY JONES: Now back to our top story. Lateline's revelations last night about the rape and indecent assault of four elderly women in a Mt Eliza nursing home in Victoria have sparked calls for state and federal governments to introduce mandatory reporting for elder abuse. In a moment we'll hear from the Victorian and federal ministers responsible for aged care. But first we hear from family members about how difficult it was to find out what happened to their grandmother and how they felt bullied by nursing home staff. Margot O'Neill has the story.
Feb 2006 Intimidation
MARGOT O'NEILL: The intimidation started with a manager who met them on the first day they took their grandmother to the George Vale Nursing Home, says Gail Chilianis.
GAIL CHILIANIS, GRANDDAUGHTER: I said, "Well, could we have a look?" And she said, "No. No, there's no way you can go in there."
MARGOT O'NEILL: Within the first year, many of their gran's best clothes had disappeared and her wheelchair had been broken, but when their father complained...
GAIL CHILIANIS: The woman came up to him, the facility manager, and said, "If you don't like it, you know what you can do with your mother-in-law."
MARGOT O'NEILL: Even after their gran was allegedly raped, Deb Chapman says the nursing home manager was hostile when asked to provide better care for their gran.
DEB CHAPMAN, GRANDDAUGHTER: Her response was to put us down as though we were having an unreasonable request. When we walked out that day, mum was still sitting next to Gran. This facility manager went and sat on Gran's bed and suggested that I had a problem and that I needed counselling.
MARGOT O'NEILL: And their experience is not unusual. A Senate committee which reported last year heard extensive evidence of retribution and intimidation in aged care facilities around Australia. It called for a national inquiry to determine the size of the problem. But Heila Brooks, the CEO of Ellis Residential Care, which runs the George Vale Nursing Home at Mt Eliza just outside Melbourne, denies that families are intimidated.
Aged care abuse reporting scrutinised Lateline ABC TV February 21, 2006
MARGOT O'NEILL (commentator): But Lateline has confirmed that the Victorian police are investigating new rape allegations against a male carer at another Melbourne aged care facility - allegations first made nine months before police were alerted. The initial allegation came from a 73-year-old woman with dementia in March last year, but instead of immediately contacting her family or the police, Lateline's been told the facility's manager questioned the woman and dismissed her claim. Then late last year, another female resident also made sexual assault claims and the police were finally called.
Feb 2006 Not believing a resident
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Catherine Gladman says her mother made claims of sexual abuse two years ago at a Melbourne aged care facility, but, again, they were dismissed by nursing home management.
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This incident took place at the Millward residential care facility in Doncaster East. Rather than contacting her family or the police, Millward's nursing director forced Catherine's mother, who suffers from a brain injury, to repeat her allegation in front of the male carer she alleged assaulted her.MARILYN BREWWIN, MOTHER: I had to stand up in front of him and he denied it completely, he denied it in front of me and the nurse, the director of nursing in Melbourne said she didn't believe me. It's terrible, it's shocking because I'm not a liar, I'm not a liar at all.
MARGOT O'NEILL: It was six weeks before Catherine found out about her mother's claim. There'd been no medical examination and no contact with the police.
CATHERINE GLADMAN (daughter): I felt that they were trying to cover this up, and they were hoping that no-one would find out. I really got that sense that, I mean, they were pretty cheesed off that we'd found out, and then tried to say, "Well, we've dealt with it. It's not an issue, you shouldn't be involving the police."
More abuse allegations LATELINE ABC TV February 27, 2006
For Updates:- A good way to check for recent developments in aged care is to go to the aged care crisis group's search page and enter the name of the company, nursing home or key words relating to any other matter in the search box. Most significant press reports are flagged there. The aged care crisis web site has recently been restructured and some of the older links used from this site may not work.
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This page created Sept 2006 by
Michael
Wynne
