Community attitudes to aged care explored

Following In-depth interviews and focus groups, the Royal Commission into Aged Care Quality and Safety has released a report, They look after you, you look after them: Community attitudes to ageing and aged care .

The researchers interviewed a range of focus groups to identify current community attitudes to ageing; community understanding of the aged care system and how individuals were planning for their own older age. Interviews were conducted with both younger and older people, diverse economic groups, Indigenous and culturally diverse groups and younger people with disabilities who already resided in aged care facilities.

Written before the pandemic, the report explores how people view entering an aged care facility, what their expectations were and most relevantly, what were the experiences of actual residents.

Post-Covid, the relatively negative comments of most interviewees about their fear of entering the aged care system, seems justified in light of the relatively high number of deaths in care facilities which appear to reflect the inadequate training and equipment available to care for older people.

The report found that as people became older, they were better informed about the complexities of the aged care system but they remained concerned about the cost and quality of care provided. There was a widespread, strong preference across the different age groups and communities to remain living independently as they age and making use of support to do so.

Most interviewees were critical of aged care facilities and saw them as being run as businesses that prioritised profit over high quality care. The prevalence of religiously affiliated organisations running facilities was seen as effectively limiting their choices, as they did not want to spend their older years living in an institution run by a religious body.

Most people described aged care facilities negatively, saying they were depressing, bleak places that felt clinical and sometimes were overcrowded. Moving to aged care was seen as ‘the beginning of the end’ that precipitated a rapid decline in one’s life expectancy and quality of life.

Specific negative factors mentioned included a lack of meaningful mental stimulation, social isolation and loneliness, poor quality personal care, insufficient staffing levels and staff training, and poor quality nutrition. These factors were interrelated with overstretched staff rushing residents through meals and personal care.

While some interviewees mentioned pleasant high end facilities, others mentioned budget facilities that provided a small per resident food budget, or residents being heavily sedated to reduce staff workload. The effect of having to provide a bond to ensure a place in a facility and the ongoing cost was of great concern to most as was the inadequate regulatory system.

Younger people with physical or mental disabilities living in aged care facilities were particularly critical of the care they received, mentioning issues of cleanliness, personal hygiene, stimulation and respect for residents and appropriate social engagement.

This qualitative research included 274 people from the general community and targeted diversity groups. It was conducted primarily to understand the perspectives of these diversity groups and to complement a national survey for the Royal Commission that has been charged with considering the design of Australia’s future aged care system.

May her death not be in vain

The death of Ann-Marie Smith, who died from serious illnesses that developed while receiving full-time care in her home provided by an employee of a disability care provider is a stark warning to potential users of the home care system.

The 54-year-old Adelaide woman suffered from cerebral palsy and lived alone in Adelaide’s leafy eastern suburbs before dying in what has been described as “disgusting and degrading” conditions.

Ms Smith died in Royal Adelaide Hospital on April 6 from septic shock, multiple organ failures from severe pressure sores, and malnourishment. She had apparently been living and sleeping in the same chair in her lounge room for over a year.

While the carer was sacked by the provider, Integrity Care SA for her “serious and wilful misconduct”, Ms Smith’s death has been declared a major crime.

If your family member died in this situation, do you think simply sacking the employee would be enough? To what extent does the provider carry responsibility for their employee’s conduct?

The ongoing nature of the neglect endured by Ms Smith highlights the need to strengthen the accountability and penalty regulations applying to Commonwealth funded aged care services providers.

Rather belatedly, the federal government has announced that a Serious Incident Response Scheme (SIRS) mandatory reporting framework will be introduced into residential aged care providers from 1 July 2021 which will implement greater reporting of incidents involving residents. Potentially, SIRS may be extended into home and community aged care.

The lack of oversight of both in-home care and residential aged care has been the subject of a number of investigations and reports, with little regulatory action to date.

Under the proposed SIRS framework, care providers will be required to report on a broader range of incidents, including neglect, psychological or emotional abuse and inappropriate physical or chemical restraint. Significantly, it will also lift the current exemption on the reporting of resident on resident incidents, where the perpetrator has an assessed cognitive impairment.

The Aged Care Quality and Safety Commission will receive incident reports and will have enhanced powers to administer the SIRS, including taking regulatory action where needed.
As part of the ongoing feasibility study, funding has been included to investigate the design, implementation and regulation of a worker register for aged care.

A 2019 report done by KPMG, Strengthening protections for older Australians, commissioned by the Department of Health, estimated that there were more than 20,000 unexplained serious injury incidents which were not reported under the current system. Any reform of the current aged care system is seen as increasing the regulatory burden on providers to report and respond to serious incidents with an accompanying increase in staffing of the Commission to deal with reports.

The sooner a mandatory reporting scheme is introduced, more deaths like Ann-Marie Smith’s can be prevented.

Sen R Colbeck media release, https://www.richardcolbeck.com.au/press-releases, 14/06/20
Dept of Health release, https://www.health.gov.au/resources/publications/strengthening-protections-for-older-australians, Feb 2019

Australian women at greater risk during pandemic lockdown

Like the rest of the world, Australia is reporting a greater risk to women and children of experiencing violence during the global health pandemic.

Confirmation of the effect of government-directed restrictions that include stay-at-home orders, physical distancing, working at home and the closure of number of community services, has been explored in the results of two surveys of Queensland domestic violence practitioners.

The surveys were conducted by the Queensland Domestic Violence Services Network over two 10-day periods in April and May 2020 and surveyed the professional views of domestic violence support workers. The surveys found an increase in:
• client numbers;
• the complexity of client needs;
• in reported controlling behaviour and manipulation;
• reported perpetrator anger/violence allegedly due to reduced income or job loss due to COVID-19; and
• additional pressure and stress on practitioners as a result of the transition to remote work and increased service demand as indicated by increased reporting.

These findings were published in a Monash University report Responding to Queensland’s ‘shadow pandemic’ during the period of COVID-19 restrictions and mirror Victorian research published in June 2020. Publication of the report is intended to increase understanding of the impact of the COVID-19 global health pandemic restrictions on women’s experiences of gender-based violence and practitioners’ experiences supporting women.

In April 2020, the United Nations Executive Director of UN Women, Phumzile Mlambo-Ngcuka, labelled violence against women the ‘shadow pandemic’ (UN Women, 2020b), recognising the heightened risk to women and children to all forms of gender-based violence. It has been estimated that for every three months the enforced lockdown restrictions continue, an additional 15 million cases of domestic violence will occur worldwide. One of the ongoing issues is that while the risk to women increases while they are confined to their homes, their access to support is reduced.

Pfitzner, N., Fitz-Gibbon, K., Meyer, S., and True, J. (2020). Responding to Queensland’s ‘shadow pandemic’ during the period of COVID-19 restrictions: practitioner views on the nature of and responses to violence against women. Monash Gender and Family Violence Prevention Centre, Monash University, Victoria, Australia.
file:///I:/Writing/Qld%20Responding%20to%20the%20Shadow%20Pandemic%20Report%2030June20.pdf