richard tracey

‘Shocking tale of neglect’

December 10, 2019 by Avelia Gandarasa 1 Comment

The Aged Care Royal Commission has delivered a scathing indictment of Australia’s aged care system.

“Cruel and harmful”; “unkind and uncaring”; “a sad and shocking system that diminishes Australia as a nation”.

This is what royal commissioners Richard Tracey* and Lynelle Briggs think of Australia’s aged care industry.

Their interim report released on 31 October describes aged care as “a shocking tale  of neglect”.

It calls for a “fundamental overhaul of the design, objectives, regulation and funding of aged care”.

It finds the aged care system “does not deliver uniformly safe and quality care, is unkind and uncaring towards older people and, in too many instances, it neglects them.”

It goes on: “This cruel and harmful system must be changed. We owe it to our parents, our grandparents, our partners, our friends.

“We owe it to strangers. We owe it to future generations. Older people deserve so much more.”

Aged care is “designed around transactions, not relationships or care” and “minimises the voices of people receiving care and their loved ones” the report says.

The workforce is “under-paid, undervalued and insufficiently trained”.

And the system’s regulatory model “does not provide transparency or an incentive to improve”.

The report calls for an immediate funding increase for high-need, in-home care recipients.

It also calls for urgent action on the use of chemical restraints in residential aged care and on getting 6000 young disabled people out of nursing homes as soon as possible.

Extract from the Royal Commission interim report:

“We have heard countless stories about how much people grieve for all they have lost when they arrive in residential care.

“They become ‘just a resident’, just another body to be washed, fed and mobilised, their value defined by the amount of funding they bring with them.

“They become infantilised, lose autonomy, and are prevented from making decisions or doing physical things that were routine when they lived at home, on the grounds that they ‘could hurt themselves’.

“They lose their basic rights to take risks, to choose what to do in their day, to live a life as close as possible to their previous home and community. There is no joy in this.”

*Commissioner Tracey died three weeks before the interim report’s release. He has been replaced by Tony Pagone QC.

Nurses impress at royal commission

June 3, 2019 by Rayan Calimlim

Evidence from nurses was well received at the inquiry into Australia’s aged care system.

A Royal Commissioner has praised three NSWNMA members for their “very constructive” suggestions on how to improve aged care.

Commissioner Richard Tracey spoke at a hearing of the Royal Commission into Aged Care Quality and Safety in Sydney in May.

His remarks followed evidence from a panel of aged care workers made up of two assistants in  nursing, Susan and Sue; a registered nurse referred to only as Elizabeth; and retired diversional therapist Maggie.

Commissioner Tracey said: “We’ve really heard the voice from the coalface this morning – what it’s really like in institutions that care for our elderly and we thank you for that, and for your very constructive suggestions about how aged care in this country can be improved, both as to quality and to safety. We’re very grateful. Thank you for coming.”

Understaffing of nursing homes was a major theme of the panel’s evidence.

Witnesses said understaffing meant there was not enough time to provide care and led to episodes of missed care.

Workers could not provide individual care and were forced to work unpaid overtime in order to complete their tasks.

RATIOS

Commissioner Tracey is one of two commissioners running the inquiry into Australia’s aged care system.

His fellow commissioner, Lynelle Briggs, said the inquiry had heard arguments from the industry that it was “virtually impossible” to specify staffing levels and staffing ratios.

Commissioner Briggs asked: “Do you see a way or a means to increase or think about how staffing levels might be increased in a way that  a government or a provider can  relate to?”

Elizabeth said the nurses’ union had done a lot of research into aged care ratios and recommended a staff mix of 30 per cent RNs, 20 per cent ENs and 50 per cent AiNs, which would provide “reasonable care”.

She said that with current staffing levels, “all you’re basically doing at the moment is warehousing people.”

Accountants did not understand the consequences of insufficient staffing and there was a gap between “people trying to manage the money and the people trying to deliver  the care”.

DEMENTIA

Counsel assisting the com-mission, Paul Bolster, asked if one RN and two AiNs was sufficient to adequately care for 60 residents – half with dementia – on a night shift.

Elizabeth said that was insufficient to take care of bedridden residents who needed to be turned every two hours to avoid bed sores as well as deal with medical problems affecting people with dementia.

“You’re then having to deal with the difficult behaviours that they can sometimes experience such as becoming agitated overnight, wandering, and if somebody falls, you’ve got to be able to assess  them for a fractured neck or femur,” she said.

Mr Bolster asked the AiNs if they had enough time to “do all the things that you need to do in your ordinary shift at work? Does it happen often?”

Sue said she had to stay back most nights in order to finish caring for residents while Susan said she was never able to finish her shifts on time.

“If I’m on a floor with 40 people I don’t have a cleaner, a laundry person, a kitchen staff. I have to do all that, plus answer call buzzers, attend to people that are on the floor, in pain … you can never get it done,” Susan said.

Both AiNs said they were given no extra staffing to deal with residents’ palliative care needs.

Susan said staff needed more training on how to deal with palliative care and current training was “just not good enough.”

SUNDOWNING

The commission heard that residents with dementia often became more confused, restless or insecure late in the afternoon  or early evening – a process known as “sundowning”.

Maggie said diversional therapists were most needed between 4.30pm and 7.30pm to help residents who experience sundowning.

She was asked how managements reacted when she sought to change hours to meet the needs of the people with dementia.

She replied: “To be perfectly honest, management don’t want to know about it. They don’t seem to understand the need for people with dementia requiring the space to walk, yes, just to be themselves, really.”

Sue said her workplace had had a successful trial of afternoon activity officers “but that just faded out and went back to normal 8.30am to 4pm.”

She agreed that this was “a fault in the system”.

Susan said: “We don’t get any help at all, usually, on night shift with problem behaviours.

“Sundowners can happen, as they said, any time but mostly from about 4 o’clock because they’re frightened, they want to look for their family, nothing looks the same, they’re not feeling the same.

“They’re not eating the same, nothing is familiar.”

Asked about chemical restraint, panel members said it should not be acceptable and was used because too few staff were employed.

Elizabeth said instead of employing “specials” to provide one-to-one care, nursing homes resorted to chemical restraint, “because … everyone looks fine, everyone looks, you know, they’re all clean and tidy and they’re not crying out. But they’re not actually getting the care they need and being treated like a person with needs.”

She said: “I can’t think of a time where it (chemical restraint) actually should be happening at all. So then rather than give proper care, you just sedate people so then they’re not annoying you. And it’s just not acceptable.”

More information

To find out more about our Make Ratios Law in Aged Care Now campaign go to www.ratiosforagedcare.com.au.

“No one seems to gives a toss”

June 3, 2019 by Rayan Calimlim

Aged care expert blasts ‘uncaring’ lawmakers and governments that leave residents ‘waiting to die’.

Australia’s aged care system would be a “complete catastrophe” if not for the efforts of nurses, a leading geriatrician has said.

Professor Joseph Ibrahim, a consultant specialist in geriatric medicine and head of the Health Law and Ageing Research Unit at Melbourne’s Monash University, made the comments when giving evidence to the Royal Commission into Aged Care Quality and Safety.

He said aged care workers did not have enough resources to do their jobs properly.

“If it was a group of doctors, the AMA (Australian Medical Association) would be banging on about the need for resources, more pay for doctors, more resources for residents, and the situation is not good enough.

“When the ANMF (Australian Nursing and Midwifery Federation) say the same thing, they’re predominantly met with silence.

“If it wasn’t for the nurses in the aged care system … the whole thing would just be a complete catastrophe.

“If they walk away I’m not quite sure what we would be left with. But things are not good enough and it’s not acceptable the way it is now.”

Commissioner Richard Tracey assured Professor Ibrahim the Commission was “very conscious” of his concerns “and the need to have something done about them.”

Commissioner Tracey asked if current training programs were sufficient to produce “a skilled group of geriatricians who can look after the ageing generation in the decades to come”.

Professor Ibrahim said the training of specialists in geriatric medicine rarely involved any attachments or work in residential aged care.

Nurse practitioners better option than doctors

He said nurse practitioners working in collaboration with a senior medical officer were a better option for residential aged care than doctors.

“A lot of the issues that we currently face require non-pharmacological techniques, particularly for dementia, which would be better applied through nurse practitioners, rather than medical specialists.

“What we need is more cross-training in aged care for the allied health side, speech pathologists, physiotherapists, occupational therapists.

“The people that speak best with the larger part of the workforce would be nurse practitioners who understand the nature of a nurse’s work and how to fit that in. ”

Professor Ibrahim said residential aged care should be a place where older people can enjoy life.

However, residents are left “stateless” in a system that is waiting for them to die, and “no one seems to give a toss”.

He said they are stateless because federal parliament did not care about people in residential aged care and had failed to act despite 20-plus reports on the sector and now a royal commission.

“If they truly care, they would do something, or they would at least say something. They don’t say anything, they don’t act.”

He said aged care residents are citizens of the state “but the state doesn’t provide care because the federal government is supposed to.”

“The federal government doesn’t provide care because the states are supposed to.”

The aged deserve better

Referring to a typical aged care resident, Professor Ibrahim said the result of being stateless was “an 80- to 90-year-old woman who had a hard time, sacrificed her life for the betterment of everyone else and is still doing it, and no one seems to give a toss”.

“If you have to go to residential care, it usually means you’ve survived to 80. You’ve usually  got three to five diseases. You’ve lost your home, you’ve left your family behind.

“You’re coping with having dementia or severe arthritis. You’re coping with having people support you with your day-to-day living and toileting.

“I would have thought at that point in life you deserve to have something decent happen to you, and so I think that residential aged care should have the goal that it’s a place where people can at least enjoy their last few months or years before they die.

“What currently happens is most of us sit around waiting for them to die, and if they die quickly then it’s a good job done.”

He said that approach would not be acceptable in paediatric palliative care “and it’s not acceptable anywhere else”.

He said a death from an injury was a premature death, which meant someone had died before their time.

“If they’re 90 or 95, I don’t care. What I care about is they’ve died before they were supposed to.

“We accept people dying prematurely because we believe they’re old and have no benefit to society, and that’s just wrong.

“In residential care, it seems to me no one has been angry for a long time.

“The product of residential aged care is death, and deaths occur one third every year and so it seems that residential aged care is working well because every year 50,000 people die and that’s what we expect so things are happening smoothly.”

Prof Ibrahim said residential facilities provided a list of activities “from bingo to completing a jigsaw puzzle to book reading to watching the midday news”, but never asked residents, “What do you actually want?” and, “Can we help you achieve that?”

“And we get away with it because the generation that’s in residential care at the moment …. had a hard life, made do, compromised, self-sacrificed and don’t complain.”