Improvement needed throughout process

Aged care assessments

We had an ACAT done for my father and then when we required additional services. A second service provider called on us and we had to go through everything again, distressing to my father, and the 2 ACAT documents caused confusion.

There should be one document and, if another service provider is brought into the mix, the previous document should be continued with. It would be preferable to deal with one service provider, rather than two. Continue reading

Staff ratios must be priority

Staffing ratios per resident need to be addressed. I am an enrolled nurse in a residential facility and I have just had my job made redundant, along with another EN.

This now means only 1 EN to administer medication, treat wounds and assist health care workers, when needed, to every 30 residents. Continue reading

Litany of issues with aged care ratios

I have a long paper trail of issues dealing with residential aged care and the lack of staff. I have heard recently that the government is asking for ratios to be accounted for in facilities. It is a huge problem, especially in the aged care industry.

The facility that I am dealing with never seems to have enough staff. I am finding that, during the time I spend with my husband at the facility, I am left to do things for him that are the staff’s responsibility. Continue reading

Not what was promised

We received a call from our mother’s aged care facility around breakfast time one Friday that she was on her way to hospital after having breathing difficulties overnight. She passed away late the next day, in early November 2016. The emergency department doctors said the likely cause of her admission to hospital the day prior was “aspiration pneumonia”. (This condition occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs, instead of being swallowed into the oesophagus and stomach.) Continue reading

Residential aged care

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With scandals such as that at a South Australian aged care facility for dementia patients – and more recently at multiple Queensland aged care facilities – where several deaths were caused by improper care, the sector has increasingly been under the spotlight.

The first report notes that five people associated with the now-closed South Australian facility were the subject of adverse findings of maladministration: the nursing director, the service manager, one doctor, a nurse and a health department official.

An official inquiry found there had been failures in clinical governance, incidents of rough handling of patients, excessive use of restraints and a high level of injuries.

Astonishingly, the inquiry found that “senior people, including some ministers and chief executive, who were responsible by virtue of their office for the delivery of care and services to the consumers, should have known what was going on but did not”.

Not all care shortfalls in aged care facilities have fatal outcomes. Nevertheless, many have serious consequences for the residents and their families.

Conversation starter

If you or a loved one has been in an aged care facility – or you have worked in one – we invite you to explore and have Your Say and explore any of the following sub-topics in this section of the website:

Aged care residents’ rights and responsibilities
Medication management
Clinical care
Resident meals (including fluids)
Communication
Companionship
Personal care
Hygiene, sanitation
Personal safety and security
Property loss or damage
Financial abuse
Falls, physical harm, abuse
End-of-life and palliative care
Deaths
Staffing in residential aged care

Staff:resident ratios
→ Training
Off-loading to hospitals

Have your say on aged care-2

Off-loading to hospitals

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One of Brisbane’s major hospitals has drawn attention to the “extraordinary” rate of aged care patients from one northside healthcare facility being ‘dumped’ in the hospital’s emergency department for basic care.

In a recent report in The Australian, three senior medical sources at the hospital note that the admissions were typically for minor catheter and wound management, services for which aged care providers receive federal government funds.

Hospitals have been critical of the growing frequency in the use of the money-saving move that is allegedly becoming part of care homes’ “business model”.

Another report by SBS News Online sees the spotlight shone on private aged care facilities being unwilling to hire more nursing and care staff.

Conversation starter

Have you or your family witnessed such transfers? Did you believe they were necessary? Were you of the understanding that the aged care facility concerned would provide such nursing care on-site? Did you have the reverse experience, i.e., would you have preferred that a transfer to a hospital took place?

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Training

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Aged care workers are the backbone of the sector. Without nurses, personal care workers and other aged care staff, this article notes, Australia’s vulnerable elderly and infirm could flounder.

But ensuring all personnel received sufficient training remains an ideal yet to be reached. Stemming the tide of under-prepared personnel is one aspect being looked at by the sector’s experts.

Recently Professor John Pollaers – who is head of the Aged Care Workforce Strategy Taskforce – spoke at the Quality in Aged Care Conference in Sydney.

Reporting his speech, aged care review website HelloCare said Professor Pollaers told conference attendees that, while people were in this industry “because they care”, the Taskforce would be looking at, among other things, current and future education and training provided to all staff.

Conversation starter

Have you – or someone you care about – seen evidence of the level of training in a residential aged care facility? What was the issue that drew your attention? Was any shortfall raised with the facility’s management? What was the response?

Have your say on aged care-2

 

Staff:resident ratios

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Fewer staff, bigger workloads, time for caring wiped out, sometimes with serious consequences.

There are claims that cuts to qualified staff led to the death of a Queensland woman from septicaemia just two months after her aged care facility failed 15 of 44 industry standards.

As an ABC Online report notes, the centre was found to be lacking in the level of food, fluids and personal care, with not enough “appropriately skilled and qualified staff” and insufficient monitoring and reporting of “clinical incidents”.

It two other reports in the Sunshine Coast Daily another Queensland aged care facility – with a previously unblemished record – that had cut 722 hours from its fortnightly staff roster last year subsequently failed eight of 44 industry standards.

The reported shortfalls, worryingly, were in medication management, clinical care and specialised nursing care needs.

Staff-to-resident ratios in both cases drew the wrath of residents, families and, in the latter case, the district’s federal member.

Conversation starter

Are you satisfied with level and quality of clinical or nursing care provided in your – or your loved one’s – aged care facility? Are there sufficient staff to provide a decent service? What needs to change? Have you been able to raise your concerns with anyone and, if so, what was the response? Did care improve afterwards?

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Staffing in residential aged care

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Stories abound of shrinking staff numbers in Australian residential aged care facilities. Fewer people to take on larger workloads and fewer shifts to go around. It is one of the most contentious aspects evident, right across the residential aged care system.

Sadly, evidently with the blessing of authorities, some providers have opted to reassign certain duties – that previously only a registered nurse could do – to the sector’s newest position, “personal care workers”.

Alarm bells are ringing because these less expensive workers, it is claimed, are being tasked with administering medicines “without proper training”.

Just what it was like working in that environment was explained at a recent aged care forum by a qualified nurse.

In this long read from the Bundaberg NewsMail, which describes her typical work day, this nurse outlines the shortcuts needed to meet productivity expectations as well as the reasons she no longer works in the sector.

Conversation starter

Are you a current or former aged care facility worker? What changes have you seen over the recent past in staffing levels and what has that meant for residents and staff? Did you leave the sector because of staffing level issues or are you considering doing so? Or have you or a loved one seen staffing level changes in your aged care facility?

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Deaths in residential care

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Australia’s aged care facilities are increasingly deadly places for their residents, with falls, choking and suicide the main causes of preventable deaths, according to a recent Monash University study that calls for more effort to be made to reduce risks for elderly Australians.

The researchers last year found up to 3,000 residential aged care home deaths were “premature and preventable”, with falls accounting for the vast majority (82 per cent) of these deaths and medication errors also among the reasons for the loss of life.

The result represented a 400 per cent increase in preventable deaths over the past decade.

This Sydney Morning Herald report looks at the experience of one public health researcher whose mother’s death while an aged care resident highlighted some of the key pitfalls in overstretched nursing homes.

Conversation starter

What experience have you had with someone passing away either in or from an aged care facility? If the death was not from natural causes, what was the reason? Did the person receive appropriate palliative care and medical attention? Were that person’s loved ones cared for appropriately?

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End-of-life and palliative care in residential care

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A blistering Productivity Commission report released in March has found the country’s palliative care services are failing older Australians.

The report noted that tens of thousands of Australians are dying in places that do not reflect their choices or meet their needs.

According to this SBS coverage of the report, the commission has recommended a raft of changes to significantly expand community based palliative care and to improve end-of-life services in residential aged care. It noted that the latter “should be core business for aged care facilities” and that the quality of that care “should align with the quality that available to other Australians”.

In residential aged care facilities, the commission has urged the removal of current restrictions on the duration and availability of palliative care funding.

Conversation starter

What have your experiences been with the provision of end-of-life care or palliative care in an aged care setting? Were you and your family satisfied that all was done to keep your loved one comfortable? Could things have been done differently?

Have your say on aged care-2

Falls, physical harm, abuse in residential care

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A National Ageing Research Institute senior researcher says there is not enough research done in residential aged care to truly understand falls, their causes and to evaluate a range of interventions.

While work progresses on reducing the rate of falls in older people living in the community – from one in three people aged 65 years and over – up to three times as many residents, about half of all in aged care settings, experience falls every year.

Given aged care residents are older, more likely to have cognitive impairment and are frailer than those living in the community, a higher number of falls might be expected.

The extent of injury with falls in aged care is higher and the greatest concern is for those who fall frequently.

With consequences of falls including increased anxiety and fear of falling again, increased functional decline, decreased independence, fractures and death, well-funded, targeted research is needed to develop education programs for staff and residents.

Conversation starter

Have you or a loved one experienced – or have you witnessed – a fall or other harm or abuse in an aged care facility? What was the consequence of this? What had been done to prevent that happening beforehand? What was done afterward to prevent it happening again?

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Financial abuse in residential care

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Last year, in a joint ABC-Fairfax investigation, residents of the multi-billion-dollar retirement village industry described buying into a retirement village – even ones that were linked to aged care facilities – had been an unwanted “financial sinkhole”.

This report looks specifically how one of the nation’s largest aged care providers, Aveo, had been exploiting elderly residents of its villages.

The company’s alarming business practices included safety issues, misleading during its marketing, advertising and property sale and lease processes. The company’s legalistic sales contracts were described by some lawyers as “complex” and “draconian”.

Conversation starter

Have you or a loved one experienced financial abuse by an aged care provider? What happened in this instance? Were you or your family able to negotiate a fairer outcome with the provider? Had any contracts been viewed by an independent lawyer prior to signing? Was the matter reported to any authority? What was the eventual outcome?

Have your say on aged care-2

Property loss or damage

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Theft and property loss can be distressing and even cause financial difficulties for those in residential aged care, yet missing or misplaced clothing, broken treasures, stolen jewellery, broken medical aids that are depended on, money taken – or used inappropriately – are frequently spoken of by residents, families and carers.

Sometimes an external player is responsible, as in this Melbourne story from The Age, but more often the perpetrator works in, resides in or visits the facility where the damage or loss took place.

Conversation starter

Tell us about any experience you, a loved one or someone you have cared for has had with property loss or damage while they were a resident in an aged care facility. Was the item repaired, replaced or found intact? If not, were you or your loved one compensated for the loss or damage? Did the loss or damage happen more than once? What was the resident’s reaction? What steps did the aged care facility take to prevent this happening in future?

Have your say on aged care-2

Personal safety and security

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Families, carers and residents often chose a particular aged care facility because they were assured of the steps it takes to ensure personal safety and security.

Increasingly, though, reports have emerged of insecure facilities, poor background checks and other residents with problematic behaviours.

One NSW centre last year failed a number of the Australian Aged Care Quality Agency’s key benchmarks, including staff working without criminal history checks, residents right to privacy not being respected, under-resourced cleaning and catering teams and repairs not being promptly addressed.

Conversation starter

Have you or a loved one felt that personal safety or security was less than anticipated in an aged care facility? What were your experiences? Was the matter raised with the facility’s management or an external body? If it was a serious incident, were police notified? Was a formal complaint lodged? What was the outcome or consequences?

Have your say on aged care-2

Hygiene, sanitation

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Whether the issue be about showering, toileting, dental care, nail length and cleanliness, management of medical devices such as hearing aids, daily wound care or adequate movement to prevent pressure sores that can eventually be deadly, many families and residents have concerns about how hygiene and sanitation are managed in aged care facilities.

One NSW Central Coast family’s tragic story underscores the consequences of inattention to basic hygiene standards. [Warning: graphic image in this story.]

Conversation starter

Have you or a loved one witnessed hygiene or sanitation issues in an aged care facility? How long was it before a family member of the resident concerned was made aware of the issue? How was the issue brought to the attention of the facility’s staff? What was the response? Did the matter have to be raised on more than one occasion? What were the consequences for the person receiving care? What other impacts were there? Was the situation so severe that the resident was moved to another facility?

Have your say on aged care-2

Personal care

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Staff at a Queensland aged care facility that failed 15 of 44 key quality measures during an unannounced visit by auditors have subsequently admitted that residents were left underfed, unfed, and were sponged instead of being showered because of time constraints.

In a written memo to staff after the audit, the facility’s management instructed staff to attempt to feed residents on three occasions and if those attempts failed, they were to discard the food.

Residents at the facility had also told auditors they were being left on toilets for prolonged periods.

Conversation starter

Do you work in an aged care facility where things are not what they should be? Or are you or a loved one involved with a facility where this is evident? What things could be done differently or better? What do you believe are the factors behind this shortfall? Have those concerns been raised with the facility’s management or an external authority? What was the response?

Have your say on aged care-2

Companionship

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You would think that aged care facilities should be well-placed to tackle social isolation. But three Victorian experts say research has shown seniors living in residential care report feeling lonelier than those who remain in the community.

With social connectedness a key determinant of health, it was alarming to hear the Aged Care Minister Ken Wyatt announce last year that up to 40 per cent of people living in residential aged care were not receiving any visitors at all.

This Australian Ageing Agenda article looks at ways to break the cycle of loneliness and isolation.

Conversation starter

Have you or a loved one had concerns about isolation, loneliness or neglect issues in aged care residents? What actions would you like to see taken?

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Communication

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Lack of communication between staff and with residents and their families and carers is a growing concern. But when communication breaks down to such an extent a resident’s life is put in danger, families and carers find their loved ones can be put in life-threatening situations.

That, sadly, was the case just over a year ago for one Queensland family, who has since spoken publicly about the care shortfalls and communication barriers their mother faced before she died of a preventable infection.

Conversation starter

Have you or your loved one found communication issues have impacted the care received in an aged care facility? What was your experience? Was the aged care facility responsive to your concerns? Was this situation addressed or did it lead to further issues? Did you end up lodging a formal complaint?

Have your say on aged care-2

Resident meals (including fluids)

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The headline said it all: Prisoners fed better than Aussies in aged care homes.

Shocking new data unveiled earlier this year showed Australian aged care facilities spent an average of just $6.08 per resident to provide three meals a day, down by 30 cents per resident per day over the previous year.

By comparison, prisons spent an average of $8.25 per prisoner per day on food and aged care facilities overseas were increasing their spending on food for residents.

Other Australians spend $17.25-$23.60 per person each day on food. It’s no wonder half of our nation’s 64,256 residents in aged care facilities suffer from malnutrition.

Malnutrition is associated with a cascade of adverse outcomes, including increased risk of falls, pressure injuries and hospital admissions. Inevitably, malnutrition leads to poorer resident quality of life and increased healthcare costs.

Conversation starter

Have you or a loved one noticed the decline in the amount and/or quality of food or fluids being served in your aged care facility? How long has any decline been evident? Are supplements and/or food replacements being used instead of real food? Are you – or a family member or friend – routinely bringing food to someone in an aged care facility?

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Clinical care

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Even aged care facilities that meet every accreditation standard can be deficient in providing consistent and timely clinical care.

The experience of one Melbourne woman who spoke to Fairfax Media – whose husband endured two years of questionable care, including being placed in restraints up to 12 hours at a time for months at a stretch for spurious reasons and rarely sleeping in a bed, exacerbating his back pain – underscored how subjective standards often are not enough.

Conversation starter

Have you or your loved one experienced an issue with clinical care in a residential aged care facility? What was the issue and what were its consequences? Who was approached to address this issue? Were you satisfied with the response? What was the eventual outcome?

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Medication management

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Monash University research has found medication errors in aged care facilities are common and their potential to cause harm is high, but that reporting of the serious effects of such errors on residents – such as permanent disability or death – is rare.

The researchers looked at a number of studies from 2000 to 2015 that showed between 16 and 27 per cent of residents had been exposed to one or more medication errors. They also found that errors resulting in serious outcomes were “probably underreported or undetected”.

Conversation starter

Have you or a loved one experienced an issue with how medications were being managed in a residential aged care facility? Did any error occur at the home or at the time of transfer to/from another health facility? Were aged care facility staff made aware of any medication issue? Was a medical practitioner made aware of the issue? Were you satisfied by the response from either by staff or medical professionals? Were there any serious consequences? Was the matter ultimately resolved?

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Aged care residents’ rights and responsibilities

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Just in case you haven’t seen them before, there is a suite of rights and responsibilities for those receiving residential care in an aged care facility that is set out under the federal Aged Care Act 1997 Schedule 1 User Rights Principles 2014.

If you have a concern about these rights or responsibilities, the best agency to address those to is the federal Department of Health’s Ageing and Aged Care. However, if your queries are more about accessing aged care services for older or infirm people, you should visit the My Aged Care website or call 1800 200 422.

If you have experiences that do not meet these rights or responsibilities, please go to the appropriate section of this site to let us know what your experience has been. The site’s sections are listed on the left-hand side of each web page.

Conversation starter

Have these residential aged care rights and responsibilities been spelled out to you or your loved one? Have you ever been witness to one or more breaches of these rights? What additional things could be added to these lists of rights and responsibilities?

Have your say on aged care-2