The Four Corners Story about Abuse & Neglect in aged care, which was run Monday 17^th September & Monday 24^th September on the ABC, demonstrated serious & offensive behavior by some staff in aged care facilities.  The story finished with a comment of “Who Cares”, but it should have said “Who pays”.

I have been in & around Aged Care for the last 19 years and have always told our clients that it is NOT a perfect system. It can’t be, because it is run by humans & humans make mistakes and are fallible. I have seen far more good in aged care than bad and my concern about this story, and other previous stories, is that all the public hears about are the bad stories. I am not defending the bad things that happen in aged care (I want them to come out & the offenders be dealt with severely) I simply believe that there is no balance to what the public hears & what journalists portray, and the industry is not strong enough to stand up for itself. Keep in mind that a journalist will rarely deliver a “good” story. Good stories don’t sell newspapers or encourage viewers to watch television.

One of my clients who was palliative, had no family. One of the registered nurses in the nursing home, came into work on her days off (unpaid) to be with my client to brush her hair & rub hand cream into her hands & just hold her hand until she died so that she had someone with her. This did not get covered by the media, and I have lots of other similar stories, but these stories will never see the light of day in the papers or on the news, they would rather show you the few bad stories than any of the good ones.

Aged care is NOT all bad, not all aged care facilities are bad, not all aged care workers are abusive and not all residents are neglected.

The story commenced with a comment that Four Corners received 4,000 replies, they didn’t say if all those replies were negative. There is currently around 380,000 people in aged care, which means either there was only 1.05% of those in aged care that complained, (implying that 98.95% of residents or their family were happy with their aged care treatment) OR the other 98.95% couldn’t be bothered answering.

There are two aspects of the story, that of abuse & that of neglect. They both should be dealt with separately, because they are different problems and require different fixes.

ABUSE

I was appalled by the abuse of the elderly woman in The Poplars at Epping, it is a beautiful facility where there does not appear to be any neglect of residents, however there was abuse by a particular carer. Abuse stems from the person delivering the care. Abuse probably cannot be eliminated completely, but there can be steps taken to minimise the chance of it happening. Training staff better, stricter recruiting processes, a zero tolerance approach by the organisation employing the staff and communicating the zero tolerance policy & expected standards of behaviour.

Another story focused on what I thought was extremely heavy handling, the staff got away with it, at least they lost jobs which was appropriate.

There was also the footage of a male nurse being very heavy handed with a male resident of a facility, however the other side of that story is that a client of mine took her relative out of that same facility because of the resident who claimed to be abused. The resident was violent himself & had assaulted her relative, other residents as well as staff at that facility. We just didn’t get to see all the video footage of the entire incident. That in no way excuses the nurse for being violent or abusive back. That resident has dementia (therefore he has an excuse for his violence), the nurse has no excuse. The only way to be able to deal with violent aged care residents is to have staff who are trained & prepared to deal with violent residents. Strangely journalists never report the fact that a staff member is attacked & injured in aged care EVERY week.

However, I want to focus on the neglect side of the story.

NEGLECT

The Four Corners Story had families of residents & staff of aged care facilities tell their stories about the lack of care in some facilities & I believe that these problems are easily fixable.

The general theme that kept coming out from the stories were;

• Not enough staff
• Not enough trained staff
• Too many foreign staff (not enough English-speaking staff)
• Inadequate resources
• Not enough registered nurses- mostly unskilled carers
• Poor quality food
• Not spending enough time with residents to feed them
• Not enough time spent delivering care & compassion

The solution is simple- to make the outcomes in aged care better, so that these stories never come out again, is to;

• Employ more staff
• Employ more registered nurses
• Conduct more training with staff
• Recruit staff who have more training
• Employ more Australians or those with a better command of English
• Engage more volunteers to help in aged care
• Spend more money on resources to help deliver care
• Spend more money on chefs & quality ingredients &
• Drive up pay rates to increase supply of highly trained workers

If it is really that simple to solve these problems, then why doesn’t this just happen?

Because it is about money. NOBODY wants to pay, or can afford to pay, for the additional cost involved in meeting these solutions. Aged Care facilities & their staff do the best they can to try to deliver good care, but there is simply not enough money to employ more people or pay for more qualified people. The industry does not deliver high wages & hence it attracts a lot of low paid, unskilled workers, as they are the only ones that will work for that money. Highly qualified staff work in other areas of the health industry.

Why does everyone duck the issue of mandated staff to resident ratios?

Because it will cost more.

More volunteers in aged care could spend the time with residents talking to them, or help feeding them, so they are less lonely, but that won’t cost any more money. There are bound to be thousands of retired people or lonely people who could spend 2 hours a week or so helping in aged care, to do the jobs that don’t require highly skilled nurses.

If the public can’t afford to pay more for aged care, the question is, will the Government be prepared to contribute more? Clearly the answer is NO. Both sides of the political fence have effectively been reducing the amount paid into the aged care sector, although they claim they pay more each year (that is only because more people need aged care every year- as we are an ageing population). The minister for Health & Ageing came out & advised he will “ensure that more money is provided for compliance & quality control” which simply puts more “police on the beat”. That will only highlight the problems caused by lack of funding, it will not solve the problems highlighted. Why doesn’t he say he will put more money into funding aged care so that there can be more staff & qualified nurses? Because the Government don’t want to pay for it either. There is no political will to pay more for aged care. We would rather give money away to other countries than spend more on our own.

The only solution to the current set of problems in aged care is to increase the funding to aged care significantly. If the media was to get on the back of Government, rather than point the finger of blame at aged care facilities & staff, maybe the solution would be closer to becoming reality.

Imagine having an airplane full of 240 passengers heading overseas with only two flight attendants; the passengers would be screaming. If the minister for aviation advised he would ensure that he puts more money into the industry who monitors aviation, it would not solve the problem. It is more money at the grass roots that will deliver the outcome the public expects, i.e. needing more flight attendants. In the aircraft industry they simply charge more- aged care cannot.

Those people who think aged care is a money-making machine (simply because there are big bonds) simply just do not understand the big picture. Yes, some bonds are big and IF they are paid as a Lump sum, the bonds are Government guaranteed & fully refundable, so the real income that the aged care facility makes is bank interest on that money (bank interest rates are historically low currently). So how does a facility pay for the land, pay for the building then maintain that building & the resources needed (e.g. beds, kitchen equipment, laundry equipment, lifters, oxygen tanks etc) when a $550,000 bond will only earn them $37/day interest.

A new facility in Newcastle cost $8M for the land & $35M for the building for 120 residents. This would equate to an interest cost of $44.18/day per resident, whereas their bond of $550K will only earn them $37/day, this does not cover the operating costs.

The day to day running of a facility is not covered by the bond, it is the fees they charge ongoing that covers the day to day costs (food, nurses, carers, cleaners, cooks, catering staff, admin & finance staff, head office costs).

However, an aged care facility CANNOT charge whatever they want their fees are prescribed by the Dept. of Health. They can only charge a Basic Daily Care Fee ($50.66/day), the rest of their income comes from the Government subsidy (which is reduced by the Means Tested Fee- which must be paid by more affluent residents). As the costs of running aged care rises, the fee they charge cannot rise.

Some aged care facilities can charge an Extra Service Fee (if they pay more for an Extra Service licence) & some facilities charge an Additional Services Fee. These facilities do charge more (so they can afford to provide more staff, & better quality services), but not everybody can afford to pay those additional daily fees.

I challenge the minister for Health & Ageing to commit to putting more funding into aged care, & to do some research on what it would cost to pay for a system that can afford enough people to run a nursing home that delivers the quality & standard of care we should expect in a first world country.