Is it time for another over haul of Residential Aged Care and the manner in which standards are assessed?
The Aged Care Act of 1997 has been with us for a decade now. Published reports tell us that the majority of homes would seem to comply with the standards set out in the Act - but the number of exceptions to compliance that the industry is racking up are enough to warrant a rethink by the industry and the regulators.
Alleged breeches of standards such as those we are witnessing right now in Victoria, where five people have died in tragic circumstances, and the allegations of sexual assault in nursing homes in 2006 can sadly be added to the litany of lesser sins committed within the Aged Care sector over recent years.
There must come a time when the government and aged care proprietors accept the fact that the confidence of the community in the Aged Care system has been severely if not irreparably eroded. It may well be time for the aged care industry and the government to seek out a new paradigm for managing the industry.
As of the April 12, no more than six homes across the nation were under sanction, but since 1997 close to 120 homes have been sanctioned for a variety of breeches of the Act. In an earlier On line Opinion article I used those very figures in relation to elder abuse to highlight how far aged care had come over recent years. Yes things have improved and yes things were a lot worse. But things in the business of Aged Care are still not good enough; particularly if you are a resident suffering from indifference and poor management.
There is now and has been for some time wide spread debate about the efficacy of the Aged Care Standards and Accreditation Agency. Reports to date tell us that the Victorian Nursing Home in the eye of the storm at present had been assessed as meeting all the necessary standards. No sanctions were in place. Did standards fall or was the earlier assessment inadequate?
Most of us would have heard more than one anecdotal story of neglect or abuse of residents in nursing homes. There is one website in Australia that presents an up to the minute catalogue of documented criticism from consumers and self professed whistle blowers, critical of the industry at large and the manner in which it is audited. In light of recent events and wide spread criticism, how then is the community to now satisfy itself that their elders are being cared in an appropriate manner?
Aged Care providers too have been critical of the Aged Care Standards and Accreditation Agency but too often that criticism has been muted. If assessed, for example, as having failed to comply in some areas when they feel that the assessment has been unreasonable, many operators have said nothing for fear of retribution and possible sanctions.
Fear of retribution is often quoted by relatives of residents who fail to complain about conditions in some homes. It is sadly ironic that many proprietors harbour similar fears of the regulators themselves.
That fear may well be unfounded but it is a perception among some Residential Aged Care providers and as such forms part of their experience. That perception distorted or otherwise is a determinant in the manner in which they conduct their business. Such a mindset does not foster a system of open and transparent quality assurance or complaints handling.
I must declare an interest here. I have been in the business of managing both acute and aged care facilities for over 20 years. It is in that role I have heard endless complaints from colleagues who felt that Aged Care audits to which they had been subjected were unfair, biased, inconsistent, and could be characterised as an exercise in bullying and harassment. It might be that they mistook thoroughness and rigour for unfair treatment - I do not know. And I would hesitate to even guess at whether they were right or wrong in their assessment. Needless to say a lot of proprietors are dissatisfied with the process.
There are, it seems, three distinct perceptions of the process of auditing Residential Aged Care agencies. One is that they are cursory and inefficient thereby missing any number of problems and shortcomings of the industry. Another is that they are unduly intrusive, subjective and unfair and a third, especially if your agency is assessed as compliant in all areas, is that the process is entirely fair, reasonable and serves the best interests of the resident and the industry.
But unless there can be consensus between Aged Care providers, consumers and their families and the government, that the process by which standards are assessed is fair and reasonable, it has failed its first test. To that end the system continues to fail the resident and needs to be re-examined now.
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