Last week, the Review of National Aged Care Quality Regulatory Processes Report was released to the public. You can find it here: agedcare.health.gov.au/quality/review-of-national-aged-care-quality-regulatory-processes if you haven't already read it. This review was initiated due to the failures at a South Australian aged care and mental health facility, Oakden, that got a lot of media attention and public interest in how a facility that had been accredited by the Quality Agency could fail so badly and cause so much harm.
Let me say first and foremost - I, too, was absolutely appalled about the Oakden case. Things like that should never happen, and it makes me deeply sad and angry when they do. I will never not be an advocate for clients of human services, including residential aged care residents. My comment here is about our regulatory system and this review.
To make a blunt statement - I am very disappointed in the review report. I find it to be alarmist, unclear, and not objective. There are clear parallels with what has been recommended in the report to the direction that we in the sector know that both the government and the Quality Agency were steering us down anyway (e.g. the way in which facilities are audited, making the quality indicator program mandatory, and publishing the results online using a star rating system). None of this is new.
The review itself was triggered by the events and Oakden. Throughout the report, the authors write that the situation at Oakden (both in the type of service it provided, and its failures) were "not typical" but also "not unique". But they also state (much further down, I might add), that there was limited data to evidence it being not unique, and that what evidence they did have showed that overall, the sector is performing well. We are now faced with a dissonance between the evidence, and the need for making the recommended changes.
I have pages of the report highlighted - it would take me quite a few blog posts to go through each and every thought I had, and where I thought there were gaps. So this is my main comment:
The aged care sector has been going through reform, it seems, almost continually for the past 20 years. Instead of saying what we should do next, perhaps we could ask - why haven't previous reforms worked, and what can we do about ensuring that any further changes will work?
Briefly, I will say that I think we continue to look at the wrong things. It's not just about the quality standards, process, or accreditation. I do think we need to change the standards, because being based on a continuous improvement framework does not work in the sector. Changing them to being outcomes based isn't going to work either - we need to acknowledge that we need two frameworks. One being a safety and compliance framework, including clinical, where we say what facilities must have and must do. The other being outcomes focused, and supporting facilities to begin measuring outcomes.
But more than that - why does the government continue to shy away from addressing the issue of staffing, staff competency, and remuneration? We do not have staff with the skills needed to support the clients that are now in or entering aged care. We also appear to expect every staff member to be experts in dementia and behaviour management, but we are still paying them what we paid them when residents were low care and only needed help having a shower.
I once spent an hour and a half lying on the floor with a man with dementia while he was agitated. I was lucky to have the time to do that, but could staff on a normal day spend that time? Another gentleman with severe behavioural issues needed four staff on him for most of one day while I was visiting, which no facility can do every day. Our funding structure at the moment does not allow facilities to adequately staff for residents that need a high level of support. But these are not the things that the government directly addresses, even though they are mentioned over and over again by the sector - and were mentioned in this review report, although no meaningful recommendations were made.
If you'd like further comment from me on this review report, or on any aged care issue, please contact me at email@example.com
Thanks for reading,
The Quality Nerd loves all things Quality Management and Internal Audit...too much is never enough!