Showing posts with label aged care. Show all posts
Showing posts with label aged care. Show all posts

Tuesday, 2 June 2020

Council managed Clarence Care & Support service capacity and staff moving over to the Wesley Mission


The federal government's National Disability Insurance Scheme 
(NDIS) continues to limit choice for the frail aged, chonically ill or those with disabilities, as yet another another local service agency changes hands.

Clarence Care + Support - accredited for aged care service provision and a registered NDIS service provider - which has been helping people in their homes in the Clarence Valley since the early 1990s is being transferred from Clarence Valley Council management to that of the religious charity, Wesley Mission.

The Daily Examiner, 30 May 2020:

Mr Linsday said the arrival of NDIS made it difficult for CCS to operate under council management. 


“It was also the decline in profit margins for all of the aged care sector, competitor threats including the private sector and the amount of government change that has occurred and those planned to occur,” he said.  
“Council has observed that there has been a growing ­consolidation of organisations since 2014 and with the NDIS and the aged care sector ­becoming more competitive council’s model of delivery was not financially sustainable.” 

The council voted to ­transform the service from a council entity to an outside-council not-for-profit organisation. 

Earlier this month Wesley Mission became the successful tender for CCS. 

However, Mr Lindsay stressed that this change-­over was not a sale of CCS but a transfer of the community care services offered by the service. 

“A key requirement for council in transferring the services to a not-for-profit organisation was that the services provided by CCS would be continued to be provided in the Clarence Valley with as many of the existing CCS staff transferring to the new organisation as possible,” he said.

Wednesday, 12 February 2020

Shorter Residential Aged Care Industry Message in 2020: If you personally pay us more we will treat you better


"If we expect people to pay more [in the future], we have to deliver much better care" [Catholic Health Australia chief executive Pat Garcia quoted in The Sydney Morning Herald, 9 February 2020]

ABC News, 9 February 2020:

Sydney's streets were thick with smoke as the blazes took hold on December 5 last year. 

That may explain why few noticed or cared about the final sitting day in Canberra.

But what happened in the Senate that day shows just how strong the ties that bind the aged care lobby and government really are.

At 9.30 that day, some crucial amendments to aged care legislation were introduced which would force nursing home to reveal how they spent their $20 billion of taxpayer funds each year — specifically, how much went to staff, food and "the amounts paid out to parent bodies".

Unlike hospital and child care centres, aged care facilities can employ as few staff as they like because there are no staff-to-resident ratios in nursing homes.

When it comes to food, a study of 800 nursing homes shows the average spend is just $6 a day.

The Senate vote was taking place just five weeks after 
the scathing interim report from the Royal Commission into Aged Care Quality and Safety.

Among its findings of a "sad and shocking" system which was 
"inhumane, abusive and unjustified", the commissioners also commented on the lack of transparency in aged care, with the numbers of complaints, assaults and staff numbers all kept secret from the public.

"My amendments are all about transparency and accountability — 
and, boy, do we need more of this," said Senator Stirling Griff from Centre Alliance, who proposed the amendments.

When the crucial vote came, Labor, the Greens, Centre Alliance and Jacqui Lambie supported it. But the Government voted against it and, with the help of Pauline Hanson, the reform was defeated.

It might seem an odd choice for Pauline Hanson, who has previously rallied against the aged care sector for "rorting and malpractice", but it shouldn't be surprising that the Government voted it down.

The influence of lobbyists

The aged care industry has been successfully lobbying governments for years. The influence of the industry through government committees, think tanks and policies is well known and is being rightly questioned at the royal commission.

For example, when the Queensland Government proposed laws requiring nursing homes to publish their staff numbers last year, the federal Department of Health sent a six-page document arguing against it, saying it might "confuse or mislead" families and "appears to create a reporting burden on providers with no clear benefits to consumers".

If you think the Federal Government's objections sound a lot like those of the aged care lobby, you wouldn't be wrong.

In fact, the industry group Leading Aged Services Australia (LASA) argued in its own submission that few families would be interested in accessing a website with such information and that the numbers could be used "to push a particular medically based care model (which may be contrary to the preferences of residents)".

That's an argument LASA has been using for years. It's code for arguing against more registered nurses for fear it spoils the "home-like" atmosphere of an aged care facility.

Others might argue that the hundreds of stories told to the royal commission of poor wound care, misdiagnosis and failure to send sick residents to hospital may have something to do with that lack of a "medical model".

Currently there's no requirement, except in Victorian state run facilities, for an RN to be employed at a nursing home.

The aged care lobby doesn't want that to become a national trend.

Why can't we know how many staff there are?'

The industry and Federal Government's opposition to the argument against making the staff numbers public didn't wash with the Queensland Government.

"We report the number of teachers to students in classes, educators to children in child care, why the hell can't we know how many staff there are in aged care facilities?," said Queensland Health Minister Stephen Mills, who successfully passed the legislation and says he will "name and shame" nursing homes which refuse to make staff numbers public.

Prime Minister Scott Morrison will argue that the Government voted against the federal moves for financial transparency because it doesn't want to introduce any major reforms before the final report from the royal commission.

However, that excuse didn't stop the Federal Government from its massive reform of putting the publicly funded Aged Care Assessment system out to tender last year.

The move to privatise it was widely denounced by state ministers (including from the NSW Liberal Government), advocates and the medical profession.

But the aged care lobby groups are big supporters of the change…...

Read the full article here.


The Sydney Morning Herald, 9 February 2020:

...the federal Health Department revealed it was yet to implement key recommendations of the Australian Law Reform Commission's 2017 report on elder abuse. 

Responding to a question taken on notice at a Senate estimates hearing, Health Department bureaucrats this week said a "scoping study" was being done on a register of aged care workers, while "preparatory work" was under way on a serious incident response scheme for assaults in care. 

Labor's aged care spokeswoman, Julie Collins, said older Australians at risk of abuse deserved "immediate action, not years of inaction and delays". 

Official data shows there were 5233 assaults in residential aged care facilities in 2018-19. 

Catholic Health Australia outlined its proposed new means-testing rules in a pre-budget submission to the federal government.

There is a question begging to be answered here. 

If Scott Morrison and his Lib-Nats cronies go down the path of attempting to permanenltly conceal what amounts to institutionalised elder abuse, allows residential aged care providers to further entrench differing levels of care based on an ability of the frail aged to pay and goes ahead with further aged care services privatisation in order to avoid accountability - has Morrison himself calculated just how many elderly Australians will be likely to commit suicide soon after being told they will be entering residential aged care?

Tuesday, 4 February 2020

Regulation, policy oversight and funding of aged care services are predominantly the role of the Australian Government - under three successive Coalition governments needs are not being met


Regulation and policy oversight of aged care services are predominantly the role of the Australian Government. It funds residential aged care, home care and home support, with state, territory and local governments also funding and/or delivering some of these services directly. However, most services are delivered by non-government providers such as private-for-profit, religious and charitable organisations.

Government subsidises a significant portion of the cost of providing aged care, but clients and residents are expected to contribute where they can and may be charged fees and payments by service providers.

In 2018-19 there were est. 3.9 million people 65 years of age or older in the Australian population.

Of these older people:

236, 213 were in permanent residential care;
64,117 had received respite care;
24,137 had received transition care or short-term restorative care;
1,072 national ATSI flexible age care program places were operational;
826,335 were receiving home support; and
131,534 were receiving home care packages. 
[Productivity Commission, REPORT ON GOVERNMENT SERVICES 2020]

That is est. 1.2 million older Australians who are receiving some form of government funded care.

Government recurrent expenditure on aged care services was $20.1 billion in the 2018-19 financial year or $4,874 per older person, with the federal government providing 98.2 per cent of the funding.

That low annual level of expenditure per person may be one of the reasons for this…..

The Sydney Morning Herald, 23 January 2020:

The time it takes for older Australians to enter a nursing home after being assessed as needing residential care has blown out almost 50 per cent in two years, while waiting times for the highest level of home care package are 34 months.

The Productivity Commission reports that the median "elapsed time" between getting approval from an aged care assessment team (ACAT) and going to a nursing home was 152 days in 2018-19. This is up from 121 days in 2017-18 and 105 days in 2016-17.

In New South Wales, the median wait time was 143 days in 2018-19 and 124 days in Victoria. Across Australia, almost 42 per cent of older people entered a nursing home within three months of getting ACAT approval. Almost 60 per cent of people entered a nursing home within nine months.

The Productivity Commission explained the waiting time was influenced by the availability of places as well as an older person's "preference to stay at home for as long as possible". The commission noted people may choose to try to access formal help at home or more family help, instead of taking up a nursing home place.

It said there may also be delays if people sold their family home before going into residential care.

The Productivity Commission's annual report on government services follows the aged care royal commission's recent scathing assessment of the sector. In its interim report, the royal commission slammed the aged care system as "sad and shocking", "diminish[ing] Australia as a nation". It also comes amid pleas from the aged care sector for $1.3 billion in urgent financial assistance to keep nursing homes open around the country.

The Productivity Commission's report, released today, said the median time between ACAT approval and the offer of a home care package ranged from seven months for a level one package, to 34 months for a level four (highest needs) package in 2018-19.

The commission said there was no comparable data on home care package "elapsed times" for previous years, due to a change to the approval process in 2017. Federal government data released before Christmas showed more than 112,000 people were waiting for home care. The royal commission singled out the home care wait list for urgent attention last October, noting "many people die waiting".

According to the Productivity Commission, in 2018, 84.4 per cent of those who received a formal aged care service in the home over the previous six months said they were satisfied with the quality of help they received. This was down from 89.2 per cent in 2015.

The report also found that 34 per cent of people over 65 who live at home and were classified as "in need of assistance" said their needs were not "fully met"…..

Wednesday, 6 November 2019

Many of the cases of deficiencies or outright failings in aged care were known to both the providers concerned and the regulators before coming to public attention. Why has so little been done to address these deficiencies?


Opening page of the Royal Commission interim report on Aged Care in Australia......

Royal Commission into Aged Care Quality and Safety, Interim Report, Volume 1, p.1: 

It’s not easy growing old. We avoid thinking and talking about it. As we age, we progressively shift our focus from work to the other things that give us purpose and joy: our children and grandchildren, our friends, our holidays, our homes and gardens, our local communities, our efforts as volunteers, our passions and hobbies. The Australian community generally accepts that older people have earned the chance to enjoy their later years, after many decades of contribution and hard work. Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people. 

As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities. Sadly, this failure to properly value and engage with older people as equal partners in our future has extended to our apparent indifference towards aged care services. Left out of sight and out of mind, these important services are floundering. They are fragmented, unsupported and underfunded. With some admirable exceptions, they are poorly managed. All too often, they are unsafe and seemingly uncaring. This must change. 

Australia prides itself on being a clever, innovative and caring country. Why, then, has the Royal Commission found these qualities so signally lacking in our aged care system? We have uncovered an aged care system that is characterised by an absence of innovation and by rigid conformity. The system lacks transparency in communication, reporting and accountability. It is not built around the people it is supposed to help and support, but around funding mechanisms, processes and procedures. This, too, must change. 

Our public hearings, roundtable discussions with experts, and community forums have revealed behaviour by aged care service providers that, when brought to public attention, has attracted criticism and, in some cases, condemnation. Many of the cases of deficiencies or outright failings in aged care were known to both the providers concerned and the regulators before coming to public attention. Why has so little been done to address these deficiencies? We are left to conclude that a sector-wide focus on the need to increase funding, a culture of apathy about care essentials, and a lack of curiosity about the potential of aged care to provide restorative and loving care—all of which is underpinned by an ageist mindset— has enabled the aged care system to hide from the spotlight. This must also change. [my yellow highlighting]

Left isolated and powerless in this hidden-from-view system are older people and their families. ‘This is not a life.’ ‘This is not my home.’ ‘Don’t let this happen to anyone else.’ ‘Left in her own faeces, and still no one came.’ ‘Mum doesn’t feel safe.’ 

This cruel and harmful system must be changed. We owe it to our parents, our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more. 

We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them.

Thursday, 24 October 2019

The hidden costs for rural & regional older Australians when accessing Home Care packages


There are a number of people in the Clarence Valley who are hesitant to apply for Home Care packages - often because the houshold budget maths just don't add up when it comes to what is now essentially privatised and very expensive assistance for older people in their own home.

Here is yet another example......

The Daily Examiner, 21 October 2019, p.3:

Clarence Community Transport CEO Warwick Foster said there were misconceptions surrounding how government funding works with Commonwealth Home Support, NDIS and Home Care Package clients.
“People don’t have the correct information about how the system actually works, and that’s understandable because it’s a confusing system,” he said.
Mr Foster said Clarence Community Transport was primarily a home support program, designed to provide subsidised transport to eligible clients.
“When it comes to clients who transition to a Home Care Package, regardless of the level, then they technically become ineligible to access Commonwealth Home Support Programme services,” he said.
“I think where the problem comes in is that there’s not enough education for the clients about what it means when they accept a Home Care Package.
“Unfortunately clients who had been using community transport to get to appointments go from paying one fee then having to pay another fee because we’re no longer able to provide subsidised transport. That’s why it’s such a shock.
“Three days a week we transport clients to Brisbane and the Gold Coast, and to get them up and back for a subsidised client is $80, but that fee goes up to $780 once someone accesses a Home Care Package.
“We get notified by the government, who tell us when a client is in receipt of a Home Care Package, that they’re no longer eligible for CHSP services.”.....
“We’re a not-for-profit but that doesn’t mean we’re here to provide free transport.
“We are required under our contracts to recoup some costs of the transport service from our clients.”

Monday, 26 August 2019

Morrison Government's understanding of human rights and aged care appears flawed


"Restrictive practices can elicit concern for a number of reasons. Fundamentally, they impact on the liberty and dignity of the care recipient. In circumstances where they are not absolutely necessary, their use is likely to sit uncomfortably for many. Their use without lawful consent may infringe the resident’s legal rights and constitute a civil or criminal offence, such as assault or false imprisonment, although there are very few cases in Australia where a criminal or civil complaint has been pursued to challenge the use of a restraint in an aged care setting. Physical and chemical restraint can have significant adverse effects on a resident, both physically and psychologically. There are also fundamental questions about their effectiveness."  [Royal Commission into Aged Care Quality and Safety, Background Paper 4, May 2019]

9 News, 20 August 2019: 

The Commonwealth government recently introduced changes aimed at limiting the use of restraints in residential facilities. 

But experts believe the regulations have created many more problems than they solved. 

They are urging the Commonwealth to scrap the regulations and start again from scratch. 

Queensland's public guardian Natalie Siegel-Brown said the changes placed her agency and the community in a "really compromising" position. 

"Unfortunately in their current form, the principles actually regress the recognition of human rights of people living in aged care, particularly with respect to chemical restraints," she told the committee in Sydney on Tuesday. 

"But the entire suite itself lacks any monitoring, enforcement or oversight in any event, and this can lead to greater problems." 

Colleen Pearce, from the Victorian Office of the Public Advocate, said aspects of the regulations were flawed and ambiguous. 

"We consider the principles are inconsistent with people's human rights (and) would preferably be contained in legislation," 

Dr Pearce told the committee. "(The principles) introduce, in the case of physical restraints, a new flawed and ambiguous substitute decision-making regime, provide virtually no regulation of chemical restraint usage, and lack the safeguards of other restrictive practices regulatory schemes." 

Joseph Ibrahim, the head of the Health Law and Ageing Research Unit at Melbourne's Monash University, described the regulations as stupid. 

"There is no monitoring mechanism, there are no sanctions associated, there is no way of implementing or making sure the law comes into effect," Professor Ibrahim said. 

A group of advocates believe the government should be prohibiting the misuse of restraints and over-medication, rather than regulating them. 

They argue medication should only be used for therapeutic practices and be administered with a patient's free and informed consent. 

The group includes Aged and Disability Advocacy Australia (ADA) and Human Rights Watch, both of which addressed the hearing on Tuesday. 

"Older people in nursing homes are at serious risk of harm if this new aged care regulation is allowed to stand as is," ADA chief executive Geoff Rowe said. 

"Australia's parliament should act urgently to ensure that everyone, including older people, is free from the threat of chemical restraint.".....

The Canberra Times, 21 August 2019:

New rules on the use of restraints in aged care could lead to more elderly residents being sedated, a parliamentary inquiry has heard. 

The regulation is also unenforceable, and does nothing to relief the staffing pressures that have led to the use of restraints, expert witnesses have said..... 

Professor Joe Ibrahim from Monash University's Health Law and Ageing Research Unit said the regulation also did not recognise the pressures within aged care that forced staff to use restraints. 

"Staff restrain residents to get through their day because they don't have enough hands to get through what's needed or they don't have the skills, knowledge, ability to assess why a person has responsive behaviours or unmet needs to address that," Professor Ibrahim said. 

"A law that isn't monitored, has no sanctions, no way of checking, it will drive practice underground." 

Queensland Nurses and Midwives Union professional officer Jamie Shepherd said he knew of a case where one registered nurse had to administer medication to 166 residents on night shift, and management resisted rostering on an enrolled nurse to help until the RN threatened to call an ambulance each night to assist. 

Australian Nursing and Midwifery Federation federal professional officer Julie Reeves said through a recent member survey, she learnt of an aged care home where there were just six staff rostered on overnight to look after 420 residents. 

"We cannot always effectively manage challenging behaviour issues for dementia residents while at the same time caring for others who have very complex health issues. 

We receive little to no support from management when things don't go as planned," she quoted the member as saying. 

Australian Human Rights Commission president, Emeritus Professor Rosalind Croucher said while parts of the regulation had merit, it should not be allowed to proceed unless there was a mechanism for independent oversight. "If it's a choice of it or nothing, nothing might be better than it as it is," Professor Croucher said....

Physical restraining devices currently allowed in Commonwealth-funded aged care facilities are:

Bed rails
Chairs with locked tables
Seat belts other than those used during active transport
Safety vests
Shackles
Manacles
[my yellow highlighting]


Chemical restraint is any medication or chemical substance used for the purpose of affecting a person's behaviour, other than medication prescribed for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition. 

Use of chemical restraint is specifically excluded from assessment in the National Aged Care Mandatory Quality Indicator Program. [See p.15]


BACKGROUND:

 Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019

Monday, 22 July 2019

What many frail aged Australians can expect if they enter a nursing home - maggots, rotten food and a starvation diet


ABC News, 16 July 2019:


PHOTO: Pictures supplied to ABC investigations as part of a crowdsourcing project on food in aged care. (Supplied)

..Cutting corners


Earlier, a roundtable of three chefs with almost 100 years of experience in a range of aged care services and kitchens between them suggested an answer to why food standards were so poor.

The commission heard the quality of aged care menus — described by one panellist as "the one thing [residents] get to look forward to" — came down to what the facility paid per resident.

For $16 a day, the residents of the unnamed facility Lindy Twyford manages were served salt-and-pepper squid, fillet mignon, and occasional portions of frozen but high-quality produce.

At the other end of the spectrum, a home spending $7 would rely on secondary cuts of meat and mass-ordered vegetables, some of which would be thrown out at the expense of serving sizes.
"You're having to cut corners, you're having to use frozen foods, you're having to use processed foods just to feed residents," chef Nicholas Hall said.
Mr Hall said food costs at some facilities he formerly worked at were inflated by an ordering system beyond supermarket prices, in one instance by as much as 100 per cent.

Chef Timothy Deverell raised concerns about the lack of training to create texture-modified foods, menus that had no input from residents until they complained, and food served on open-air trolleys that was often cold by the time it reached some residents.

Some homes would place food orders using a "restrictive" system in which a drop-down box offered just a handful of options, Mr Hall said.
Facilities would opt for finger food platters because they were "low-risk", cheap, and didn't require a chef.

Some meals would be repeated up to three or four times a week as providers made a bid to reduce costs.
"They're racing to the bottom to see who can feed for the lowest amount of cost," Mr Hall said

Maggots, rotten food


The commission was also told of one "upmarket residential aged care facility" which had a maggot-infested rubbish store between service trolleys and a nearby fridge containing enough rotten food to fill a trailer.

"[I've seen] reusing food that's already been out, served to residents and come back to the kitchen," Mr Deverell said.

"They use that for texture-modified diets."

Mr Hall said food safety audits were too infrequent and services were given advance notice, meaning extra cleaners could be hired to bring facilities up to scratch.

He said nutritionists failed to properly engage with residents and their needs…..

Tuesday, 4 June 2019

The National Disability Insurance Scheme continues a bumbling problem-filled roll out during which its clients suffer


Newcastle Herald Sun, 31 May 2019:

AT least 3000 NDIS recipients from regional NSW and Victoria will have to find new care providers after mutual company Australian Unity decided to cut back on disability services to concentrate on aged care in Sydney.

Australian Unity confirmed the decision after concerns were raised with the Newcastle Herald by the Public Service Association.

It did not dispute an assertion by PSA regional organiser Paul James that the decision was a consequence of the financial pressures facing NDIS providers.

The decision comes just three years after Australian Unity bought the NSW Government's Home Care agency in February 2016, picking up 4000 former government employees and 50,000 aged care and disability clients.

Australian Unity said it would "work closely" with the National Disability Insurance Agency (NDIA) to ensure NDIS participants found "another service provider of their choice".

It said 57,000 clients on aged care packages would not be affected. 
It did not expect the NDIS decision to cause job losses but Mr James questioned how this could be.

"Even if they say the majority of their clients are unaffected, there's still 3000 people in regional areas who will have to find new providers," Mr James said.

"The NDIS was originally supposed to be helping people with disabilities into work, but instead it's become an opportunity for the states to ditch their responsibilities for disability services."

Australian Unity said the decision to "scale down" its NDIS services came after a review of its "Home and Disability Services" business - as it renamed the former Home Care agency.

According to the Dept. of Human Services (recently renamed Services Australia) In NSW as of 31 March 2019:

101,963 people have a NDIS service;
4,219 initial plans have been approved; and
34,397 people will be receiving services for the first time.

While according to the National Disability Insurance Scheme (NDIS), 12 April 2019:

There are now 250,000 participants nationwide;
Almost one in three of these participants are receiving disability supports and services for the first time; and
Costs to NDIS clients for individual service delivery have risen between 10.9 per cent and 20.4 per cent from 1 July.

This price rise will include a minimum rise of almost $11 per hour for therapists, and up to a 15.4% price increase to the base limit for attendant care and community participation and appears to be driven by the demands of service providers.

The number of NDIS participants is set to rise to 460,000 at full roll-out in 2020.


Due to the demand for home care packages, for most people, the expected wait time for approved packages is:

www.myagedcare.gov.au

The expected wait time for the level of interim package you agree to receive (while waiting for your approved level to be assigned) is:

www.myagedcare.gov.au
In May 2018 the Commonwealth Ombudsman investigated the National Disability Insurance Agency (NDIA) handling the annual reviews of those already receiving service under a NDIS plan after around one-third of all complaints he received about the scheme related to review issues.

The conclusions drawn was that the NDIS scheme was administratively under-resourced for the rollout task, however there were a number of areas where NDIA could improve its administration of participant-initiated reviews. Otherwise the review process would remain unwieldy, unapproachable and the driver of substantial complaint volumes.

If you are in New South Wales and have a complaint about a support or service you have received under the NDIS, you can contact the NDIS Quality and Safeguards Commission.