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Those of us working in the aged care sector in Australia have recently watched, in horror, as details have emerged from South Australia and Newcastle of shocking incidents and practices in aged care facilities. This has become public news, rightly so, and the government’s response to public outrage is, usually, to launch an inquiry. Which has, of course, happened.
However, the Aged Care Accreditation Standards, and the way in which those standards are assessed, has been under review for some time already. Actually, many years. There was one crack at it a few years ago, which stalled, but when the Quality Agency took over Home Care the move to make a single aged care quality standard was inevitable.
A few weeks ago, the Department of Health released its final consultation on the draft single set of standards and the assessment / review framework. But yet now the Quality Agency faces another inquiry. What no one has answered, yet, is how these two reviews will meet, if in fact they will at all.
But more importantly than that, have we really addressed the issue of aged care quality in Australia? Do we really know what we want to achieve? Do we understand how facilities work, how the staff in those facilities work, and how to balance safety and a person-centred approach?
The Aged Care Accreditation Standards came about because nursing homes were not accountable for providing quality, safe care – it led to poor outcomes for residents, and a workforce that couldn’t sustain itself. The Standards were all about safety, to start with. There were a few nice things in there about meeting the individual’s needs, but essentially, it was about protecting safety, rights, and overall wellbeing. I strongly believe it still achieves this, overall.
The draft single standards want to go in a completely different direction, and focus more on person-centred care. PCC is a model that is very popular in Australia, because it has worked so well overseas. I feel, though, that no one has asked – are our facilities the same as they are overseas? Is our workforce the same?
I would love to say that Australia provides person-centred care. But we don’t. Not yet. We provide very good care; we have wonderful staff, and we have commitment at all levels, from what I’ve seen, to give residents the best quality of life that we can.
But – we are over-regulated, we are not funded adequately (I’ll concede that the government is reviewing the funding model also), and our workplaces are just not yet set up for true person-centred care.
The trouble with aged care quality in Australia is that the support system it needs isn’t there yet. We need to address that first. I believe that quality will remain the same – despite a new model, standards, or inquiries – until we can address the support system first.
There was a bit of a change of pace in a couple of ways for Day 2 of the forum – firstly, there were tables today! Which I thought was excellent and much better than the lecture layout of day one, as it encourages more interaction with other delegates (most of us are there to network so anything that promotes this is a really good idea). Also the theme for today was focused on healthcare in the Asia Pacific.
One thing that I was immediately impressed with from other countries is the collaboration and sharing of health information across a number of services. Australia does not do this, and it is to our detriment. I fear that our regulatory framework and the diversity of existing systems would make information reform near impossible, but the benefits from other countries are demonstrable.
For me, the talk of the day came from Gustav Strandell, a Swede living in Japan, who spoke about global care models. While I have not had the depth of investigating global models as Mr Strandell has, I too believe that no matter where you are in the world, at one point all of our aged care systems looked the same. Some countries moved away from the old medical / institutional model a long time ago; others are still going through that change. But we can’t judge each other – we can only hope and strive to learn from one another.
I do think that as we are all now so connected, that we are all now moving to the same place – one with the client at the centre of care, one that allows dignity of risk, and that values quality of life. It makes me very proud to be part of such a dynamic sector.
We still have a way to go in Australia before we can achieve what other countries have achieved, and vice versa. Let’s look for the best in each other.
I, of course, am passionate about quality standards as a way of ensuring consistent services and promoting good practice. Please contact me for further information on how I can help your organisation develop and implement quality standards and/or management systems to improve your services.
Thanks for reading,
If you follow my Twitter (which I hope you do!), you’ll have seen my tweets yesterday from the conference. In summary, it’s a very, very long day, but the speakers were great and it was very interesting to hear about how aged care works in different countries.
But I’m a Quality Nerd! I’m here to listen, learn, and talk about quality management. Which was exactly the one thing missing from yesterday. Many of the speakers talked about quality – quality of life, quality of services. But no one talked about quality standards. This really surprised me. Towards the end of the day I had the opportunity to ask a question of Sean Rooney, CEO of Leading Age Services Australia (LASA), who was on a panel discussing the future of assisted living and skilled nursing care for Asia Pacific.
Two other members of the same panel spoke about aged care that very heavily aligns to my own values about human services – that is, that above all else, quality of life is what matters; and that our work must come from a place of love. So my question was: have the Australian aged care quality standards failed; have they stifled innovation; and have they stifled love?
Sean Rooney, as I expected, talked about where the standards came from – to implement safe practices – which lead to a bit of a discussion on risk and the dignity of risk. And I believe that has been the big achievement of the Australian framework – I believe that at the time they were implemented, and even today, they do promote safety and better services for aged care clients.
But that leads to the question – why hasn’t Asia (and other parts of the world) got standards? Have they just skipped past safety? How safe are their services in that case, and who decides that? Asia, it seems to me, has moved past standards to where Australia is only just now coming into – quality of life, and true person-centred care.
I could write another whole (several) blog posts about whether or not I think quality of life outcomes and person-centred care will work under the current funding model in Australia (short answer: no). But for now, I’d like to ponder the question – who is asking about safety and risk in aged care services in Asia, and who is deciding what that looks like?
I’d love to hear from you, especially if you are in aged care services in Asia.
Thanks for reading,
The Quality Nerd loves all things Quality Management and Internal Audit...too much is never enough!