Nursing Homes

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GUEST OBSERVATION 
If family members are in a nursing home, it’s difficult to know if they’re getting the care they need. Here are some ways to find out.
If you’ve read the headlines about poor standards in Australia’s nursing homes, it’s only natural to be concerned about your own family or friends in residential aged care.
For instance, there was <a href="https://www.propertyobserver.com.au/https://www.abc.net.au/news/2019-09-12/bupas-aged-care-homes-failing-standards-across-australia/11501050" target="_blank">news in recent weeks</a> that 45 of 72 Bupa nursing homes in Australia had failed to meet all health and safety standards, with 22 putting residents at “serious risk”.
Then there are the <a href="https://www.propertyobserver.com.au/https://www.abc.net.au/news/2019-02-22/first-fortnight-of-hearings-for-royal-commission-wrap-up/10837116" target="_blank">harrowing stories of neglect and abuse</a> coming from the <a href="https://agedcare.royalcommission.gov.au/" target="_blank">Royal Commission into Aged Care Quality and Safety</a>, which is due to release an interim report by the end of October.
So, how do you check if your loved one’s nursing home is really up to scratch? How do you interpret audit reports about residents’ health and safety? And how else could you find out if your mum or dad’s nursing home lives up to the promise of its marketing brochures?
Who keeps an eye on nursing home standards?
Every nursing home in Australia receiving government funding is assessed and accredited by the <a href="https://www.agedcarequality.gov.au" target="_blank">Australian Aged Care Quality and Safety Commission</a>. Assessments are conducted every three years or more often if there are concerns.
Commission staff check if each nursing home meets eight <a href="https://www.agedcarequality.gov.au/sites/default/files/media/Aged%20Care%20Quality%20Standards.pdf" target="_blank">minimum standards</a>. These include whether residents are treated with respect, the nursing home is providing safe and effective clinical care, and staff have adequate qualifications and training to do their jobs.
Commission auditors interview residents, families and staff; observe care; and review the facility’s documentation. Visits can be unannounced to get a better picture of what regular care is like. Auditors then use that information to write a site audit.
It takes about a month after a site audit for the commission to decide on the quality of care. Then there’s up to another month for the audit report to be posted online.
Posting the decision publicly can be delayed further if a nursing home asks for the decision to be reconsidered. We understand this often happens if a home receives a poor report.
What is a bad report?
When a home is judged as not meeting standards, the commission will decide how serious it believes these deficiencies are. In increasing order of seriousness, the report says if a home is:
1. Not meeting standards. Nursing homes can be judged as not meeting one or more of the eight minimum aged care standards. Each standard has three to seven individual requirements. Nursing homes don’t have to meet all the individual requirements to meet the overall standard. The more standards or requirements a nursing home fails to meet, the poorer the care.
2. Serious risk. If a nursing home is given a “serious risk” judgement, the quality of care has placed or may place the safety, health or well-being of a resident at serious risk. An example might be a home not having enough skilled staff, leading to clinical mistakes, such as the wrong medication administered often.
3. Sanctions. Sanctions are imposed on homes when care places an immediate and severe risk to residents’ health, safety or well-being. This might be for multiple organisational problems (such as with clinical care, staffing, wounds not being cared for), leading to multiple poor outcomes (such as assault, avoidable illness, and the dangerous administration of medication). Homes can also be sanctioned if they do not fix continued non-compliance.
Families are notified in writing, and facilities must hold a meeting for residents and families to tell everyone what the problems are and how they will fix them by a certain date.
When a nursing home is sanctioned, it is penalised in several ways, depending on what was poor about the care:
the home is not allowed to receive Commonwealth subsidies for any new resident for a set time (usually six months) and an adviser and/or administrator is appointed to the home to help it comply with its responsibilities and/or the home provides specified training to staff within a set time.
A home’s history of non-compliance, serious risk decisions and sanctions are archived online (see below for details). So it might be worth taking a look when choosing a nursing home, as well as checking on an existing one.
4. Revoking accreditation status. If sanctions are imposed and there is no improvement, the commission can revoke a home’s accreditation status. This means a home cannot take new residents or receive government subsidies. Some of these homes reapply for accreditation, others <a href="https://www.propertyobserver.com.au/https://www.abc.net.au/news/2019-07-11/gold-coast-earle-haven-retirement-village-shuts-homeless/11301050" target="_blank">shut down</a>.
How do I find out? Looking online
The most up-to-date information on nursing homes not meeting standards (non-compliance) and sanctions is through <a href="https://www.myagedcare.gov.au/non-compliance-checker" target="_blank">myagedcare’s non-compliance checker</a>. This allows you to see if an individual home has not met standards, is sanctioned currently or has been in the past. Some archived sanctions on the website go back to 2002.
However, the myagedcare website doesn’t list “serious risk” reports. For those, you have to go to the Aged Care Quality and Safety Commission’s <a href="https://agedcarequality.govcms.gov.au/monthly-register-serious-risk-decisions-residential-services" target="_blank">website</a>.
You can also search the commission’s <a href="https://www.agedcarequality.gov.au/reports" target="_blank">website</a> for audit and consumer experience reports, which provide more detail on the quality of care.
Audit reports can be difficult to understand because their intended audience is aged care professionals, not the general public. Reports before July 2019 are on the 44 old aged care standards. Reports from July 2019 are on the new eight standards.
<a href="https://www.agedcarequality.gov.au/consumers/consumer-experience-reports-residential-aged-care-services" target="_blank">Consumer experience reports</a> show what residents said about their care. That’s from whether staff followed-up when they raised an issue, to what they thought about the food. These reports are easier to follow.
How do I find out? Other ways
It can be hard for family to know if their expectations for care are reasonable, particularly when feelings of sadness and guilt colour those expectations.
So, it can help to consider the aged care standards when making your own decisions about whether the quality of care is good enough.
You can do this by observing what happens day to day. Do residents wait too long for attention, for instance, to be taken to the toilet? Do staff speak respectfully and kindly to residents? Are meals appetising and healthy? What happens when residents are distressed? Is there high staff turnover?
Does the nurse on duty know the detail of your loved one’s clinical needs, for instance, diet, illnesses or medications? Is the manager responsive when you raise issues?
You can also talk to other families about their experiences of care.
What should I do next?
If you find that your loved one’s home doesn’t meet standards or is sanctioned, here’s what to expect.
The commission gives the home a set period of time (usually three or six months) to improve care. Commission staff keep visiting the home until they are confident the home is meeting standards.
You will probably want to visit regularly and keep an even more careful eye on your mum or dad’s care. Speak to the home or commission about any concerns.
You can ask your home’s management:
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<li>
about its plan to improve care
</li>
<li>
about staff changes and staff ratios — staff often leave or are asked to leave when there are sanctions and lots of new and agency staff are a challenge to providing quality care
</li>
<li>
for regular written updates and meetings including actions taken and the outcomes. This could be data on the home’s use of antipsychotic medications, and how often residents have falls, critical incidents or pressure ulcers.
</li>
</ul>
As a resident or nominated family member, you have <a href="https://www.agedcarequality.gov.au/consumers/consumer-rights#single%20charter%20of%20aged%20care%20rights" target="_blank">a right to information and to complain</a> about your loved one’s aged care.
When should I consider switching to another home?
The issue of whether to move a loved one to a new nursing home is a difficult one. It’s a personal decision involving weighing up the negative impacts you think the care is having with your own energy levels, <a href="https://www.myagedcare.gov.au/aged-care-home-accommodation-refunds">funds</a> and whether <a href="https://www.propertyobserver.com.au/https://www.abc.net.au/life/questions-to-ask-when-choosing-an-aged-care-home-for-a-loved-one/10302590">you can find</a> a suitable new home.
Government reforms presume market forces <a href="https://www.smh.com.au/business/the-economy/how-market-forces-have-failed-the-nation-20180918-p504f1" target="_blank">will drive up the quality</a> of aged care. In the meantime, we hope the resources in this article will help you make a more informed decision about your loved one’s care.<img src="https://counter.theconversation.com/content/123449/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Lee-Fay Low, Associate Professor in Ageing and Health, University of Sydney.
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449" target="_blank">original article</a>.
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j.ballantyne1990-6AQqhLzZaK

How to check if your mum or dad’s nursing home is up to scratch: Lee-Fay Low

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GUEST OBSERVATION
Australia’s Aged Care Quality and Safety Commission found 45 of Bupa’s 72 nursing homes failed health and safety standards. In 22 homes the health and safety of residents was deemed at ‘serious risk’.
British health-care conglomerate Bupa runs more nursing homes in Australia than anyone else. We now know its record in meeting basic standards of care is also worse than any other provider.
This is more than a now familiar story of a corporation putting shareholders before customers. It is also about another abysmal design failure in regulation.
Health care is meant to be one of our most regulated sectors. In this case, Bupa’s facilities were inspected and certified by the Aged Care Quality and Safety Commission.
The regulator’s inspectors found <a href="https://www.propertyobserver.com.au/https://www.abc.net.au/news/2019-09-12/bupas-aged-care-homes-failing-standards-across-australia/11501050" target="_blank">45 of Bupa’s 72 nursing homes</a> failed health and safety standards. In 22 homes the health and safety of residents was deemed at “serious risk”. Thirteen homes were “sanctioned” – with government funding being withheld and the homes banned from taking new residents.
Yet none of this appears to have spurred Bupa’s management into action, <a href="https://www.theguardian.com/australia-news/2019/sep/12/something-is-wrong-at-the-top-how-bupas-aged-care-homes-hit-rock-bottom" target="_blank">according to media reports</a>. Flurries of inspection reports and written warnings over months and years only underlined that the regulatory tiger, even if it had teeth, had a very soft bite.
Responsive regulation
We have seen examples of equally insipid regulation in other areas. In the building sector, for example, a range of regulatory flaws including <a href="https://theconversation.com/there-are-lessons-to-be-drawn-from-the-cracks-that-appeared-in-sydneys-opal-tower-but-they-extend-beyond-building-certification-109428" target="_blank">outsourced building certification</a> have led to shoddily built and dangerous apartment construction.
In the financial sector, the banking royal commission castigated the industry regulators – the Australian Securities and Investments Commission and the Australian Prudential Regulatory Authority – for their unwillingness to enforce rules.
“The conduct regulator, ASIC, rarely went to court to seek public denunciation of and punishment for misconduct,” <a href="https://www.smh.com.au/business/banking-and-finance/weak-watchdog-slammed-for-reluctance-on-enforcement-20180927-p506fx" target="_blank">noted royal commissioner</a> Ken Hayne. “The prudential regulator, APRA, never went to court.”
This failure is due to more than individual agency shortcomings. It’s an unintended consequence of the design of “responsive regulation” – the system that has superseded command-and-control regulation over the past three decades.
Responsive regulation was popularised by Australian sociologist John Braithwaite and American law professor Ian Ayres in the early 1990s. It was intended to overcome the pitfalls of the command-and-control model, which involved regulators employing large numbers of inspectors to look for non-compliance.
From about the 1970s it had become increasingly evident this model wasn’t working. It was also very expensive. Consider, for example, the cost of having fire and health and safety inspectors visit every single building site, particularly when most builders were doing the right thing. The cost and intrusiveness of the system fuelled calls to do away with regulation .
Too big to fail
Ayers and Braithwaite saw their model as a way forward. “Responsive regulation is not a clearly defined program or a set of prescriptions concerning the best way to regulate,” <a href="http://johnbraithwaite.com/wp-content/uploads/2016/06/Responsive-Regulation-Transce.pdf" target="_blank">they explained</a>. “On the contrary, the best strategy is shown to depend on context, regulatory culture and history.”
Responsive regulation assumes that in most cases the enterprises being regulated are interested in compliance and will respond to light-touch directives. It assumes that often compliance failures are due to ignorance or inadequate procedures. Its approach is to give parties a chance to amend their ways.
But there’s a potentially huge flaw in the responsive regulation model. What happens when an organisation is so large it is deemed too big to fail, or deems itself so?
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<img src="https://images.theconversation.com/files/292165/original/file-20190912-190050-geqsg1.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="">
How Ian Ayres and John Braithwaite conceived the enforcement pyramid in responsive regulation. The problem now seems to be that regulators want to stop halfway. <a class="source" href="http://johnbraithwaite.com/wp-content/uploads/2016/06/Responsive-Regulation-Transce.pdf" target="_blank">Responsive Regulation: Transcending the Deregulation Debate</a>
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This seems to have been the case with a number of financial companies whose misdeeds were exposed by the banking royal commission. It seems it might have been the case with Bupa.
In such cases, because of the timidity of the regulator or the confidence of the enterprise, the warnings might just go on and on. The company continues to book its profits – which may well eclipse any penalty it might have to pay if crunch time does ever come.
Markets have their limits
This design flaw highlights a more fundamental problem with governments positioning themselves as rule makers and leaving the rest to the “market”.
Markets are designed to facilitate exchange on the basis of profits. The profit motive means market participants look for the lowest-cost option. In aged care this means paying the lowest possible wages, possibly to unqualified staff, and cutting corners to cut costs.
Markets are very useful for increasing individual choices and efficiently allocating resources, but they are not suited to every task. They fail when factors other than profit ought to be considered.
We therefore need to think about the design of regulatory systems more holistically, as part of a broader social process.
The pioneers of responsive regulation certainly understood this. They emphasised flexibility, taking into account context, culture and history.
What those three things now tell us, given widespread regulatory failure across industries, is that government should not resist stepping in to provide important public services where the private sector cannot or will not do so at an acceptable level. Nor should it be afraid to act through empowered regulators, with resources and powers to fulfil their mandates.<img src="https://counter.theconversation.com/content/123442/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;">
Benedict Sheehy, Associate professor, University of Canberra.
This article is republished from <a href="http://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/bupas-nursing-home-scandal-is-more-evidence-of-a-deep-crisis-in-regulation-123442" target="_blank">original article</a>.
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