How we have failed nursing home residents

In the view of many Australians, the care provided to the residents of nursing homes – my preferred description rather than that of residential aged care facilities – falls well below their expectations of what constitutes reasonable care. The ready support of Change.org petitions citing appalling care bears this out. Further, having spent in excess of 2,000 hours in various nursing homes, I have no hesitation in saying that the life of a typical nursing home resident is decidedly miserable.

One of my key concerns has long been that of the failure of nursing homes to maintain the mobility of residents. This is notwithstanding the fact that one of the 44 so-called Expected Outcomes in the Aged Care Act 1997 (2.14 Mobility, Dexterity and Rehabilitation – Optimum levels of mobility and dexterity are achieved for all residents) specifically refers to the optimization of resident mobility and dexterity. I attribute this dismal state of affairs to 2 issues. Firstly, the wording of the Outcome itself is so brief as to be effectively meaningless for the purposes of transparency, scrutiny and accountability and, secondly, the Aged Care Funding Instrument makes no mention of mobility but instead focuses on pain mitigation initiatives that the Australian Physiotherapy Association has portrayed as being of little benefit toresidents.

The cruel consequences of the of the vague wording of the Expected Outcomes in nursing homes can be illustrated by reference to the care provided to my mother in one of Australia's largest for-profit providers. The facility physiotherapist had quite reasonably assessed her as being at risk of falling whilst using her four wheel pusher and stated that she must, therefore, always be accompanied by a Personal Care Assistant or nurse. The manager of the facility freely acknowledged that optimizing resident mobility and dexterity is a stipulated requirement but said that my mother would only be accompanied for the short walk to and from the dining room and that she would be prohibited from walking at other times during the course of the day. In his mind and that of the senior executives, the Expected Outcomes in regard to mobility and staffing were fully satisfied.

Tragically, the absence of clarity in regard to the mobility of residents is also apparent in the wording of other crucial Outcomes. Phrases such as adequate hydration, sufficient staff and management of continence condemn residents to poor care and widespread neglect. The frequency of urinary tract infections in nursing home residents is testament to the failure to ensure that residents are properly hydrated at all times and that incontinence is managed in a professional manner.

The 2005 Inquiry into Quality and Equity in Aged Care, which was conducted under the auspices of the Senate Standing Committee on Community Affairs, recommended that the Expected Outcomes be re-drafted to provide greater certainty as to what can be expected from nursing home providers. This would facilitate the much needed values of true transparency, scrutiny and accountability. Sadly, Recommendation 14 has not been adopted and has been largely forgotten with the passage of time. A prescriptive approach to the wording of the Aged Care Accreditation Standards and Outcomes would undoubtedly bring about a sea change in residential aged care, albeit one that would be vigorously opposed by the nursing home peak bodies, ACSA, LASA and The Aged Care Guild.

Putting aside the issues of hydration, continence, mobility and staffing, the scope and nature of activities offered in nursing homes is another area that requires urgent attention. My grim observation is that the activities on offer are perfunctory at best and therefore fail to address the many, many hours of mindless boredom and isolation that residents must face daily. Once again, this is a direct result of poor regulation by the Federal Government and of oversight by the senior bureaucrats in the Department of Health.

Ultimately, responsibility for the regulation of the residential aged care sector must, of course, lie with the Federal Government. Whilst it is no doubt true that successive Governments have failed Australians living in nursing homes, one cannot overstate the role that the peak bodies have played in very successfully defending the sector from criticism and of forcefully promoting the interests of providers, which are not necessarily those of the residents.

The strident advocacy of the peak bodies has been such that a paralysis of sorts has occurred in regard to regulation. Well understood and widely known deficiencies in the Aged Care Accreditation Standards and Outcomes and the Aged Care Funding Instrument have not been addressed. Tragically, this has come at the cost of resident care.

With the hoped for support of the Opposition, the minor parties and the cross-benchers, the Federal Government should distance itself from the self-serving advocacy of the peak bodies and craft a regulatory framework that both meets the expectations of Australians for quality care in nursing homes and ensures that Government expenditure is well spent