Oakden Aged Care Review: Govt “relentless” in doing very little

Horrific abuse and neglect at the Oakden aged care facility in Adelaide prompted the Federal Minister for Aged Care to call for a review. On 25 October 2017, the minister released the report of the Review of National Aged Care Quality Regulatory Processes. 

The minister announced the adoption of one of ten recommendations (recommendation #8) of this review in a speech to the National Press Club on the same day. 

"The old process of notifying providers ahead of subsequent re-accreditation reviews will go, replaced by comprehensive unannounced visits conducted over at least two days.

"Our commitment to this will be relentless, on behalf of all senior Australians, who deserve nothing but the best of care".

However, it is already official policy that each nursing home will receive at least one unannounced visit per year. Currently, nursing homes undergo re-accreditation reviews once every three years.

So, what the minister appears to have committed to is increasing at-least-one unannounced visit per year to at-least-one-and-a-third unannounced visit per year.

The question is: If one unannounced visit per year could not prevent the horrific abuse and neglect at Oakden and other nursing homes, how is a one-and-a-third unannounced visit going to prevent it in future?

From our reading of the minister's speech it seems that the minister has committed to practically nothing at all.

Apart from responding to recommendation #8, the minister has failed to respond to any of the other nine recommendations.

Recommendation #1 is for an "Aged Care Quality and Safety Commission to centralise accreditation, compliance and complaints handling". It is anybody's guess how this will improve the quality of care. The functions of accreditation and compliance are already combined. Complaints handling is stand-alone, but combining it with accreditation and compliance arguably is going to make it easier for things to be swept under the carpet.

Recommendations #2 and #3 are for a "centralised database for real-time information sharing" to enable a "National Quality Indicators Program" in which all aged providers must "participate". Neither a database nor an Indicators Program currently exists, and it is obvious why: The quality of care standards are so absolutely vague that a centralised database to capture performance by providers would be like trying to capture air in a fishing net.

Recommendations #2 and #3 would make sense if there were effective quality standards. However, the review makes no recommendations to develop and establish such standards.

Recommendation #4 is for a "star-rated system for public reporting of provider performance". Nice, but individual consumers don't get to award up to five stars. Instead, the new Commission will put lots and lots of information in its "centralised database" and come up with a star-rating.

Recommendation #5 seems to be there to make up the numbers: "the Aged Care Commission will support consumers and their representatives to exercise their rights". Surely, that should go without saying, let alone recommending?

Recommendation #6 is to "enact a serious incident response scheme (SIRS)" operated by the Aged Care Commission to follow up on the already existing mandatory reporting of significant physical and sexual abuse of nursing home residents. The Review must have found no such follow-up exists today. Extraordinary.

Recommendation #7 is about limiting as much as possible "the use of restrictive practices" such as strapping residents to their bed or chair or sedating them. The Aged Care Commission must approve the administration of psychotropic medications. A good recommendation but what it ignores are the woeful staffing levels in nursing homes which are the likely main cause of inappropriate restrictive practices.

Recommendation #9 is about ensuring that "assessment against [quality] Standards is consistent, objective and reflective of current expectations of care". Again, what is not acknowledged is that it is the current Standards themselves which are not-fit-for-purpose through their vagueness.

Recommendation #10 "Enhance complaints handling". Of all the recommendations, this is the one which would seriously drive positive change. When a complaint is investigated seriously, there is a resultant report which should be acted upon. If this happened with every complaint, over time there would be ongoing improvement in the quality of care in Australian nursing homes.