|Title||MATTERS OF PUBLIC IMPORTANCE
Howard Government: Aged Care
|Source||House of Reps
|Speaker||Ellis, Annette, MP
|Stage||Howard Government: Aged Care
|Context||Matters of Public Importance
Ms ELLIS (3:29 PM) âIt saddens me to have to open up this matter of public importance on the failure of the government to protect the frail and elderly residents of nursing homes. The kerosene bath scandal which, as we all remember, occurred in 2000 under the Howard government's then Minister for Aged Care, the Hon. Bronwyn Bishop MP, shocked the nation. The appointment of the Hon. Kevin Andrews as Minister for Ageing in 2001 gave the sector and the Australian public some hope that the government would take real action to protect the frail and elderly residents of nursing homes.
Sadly, three years after the kerosene scandal, there are still shocking cases of abuse, negligence and mistreatment in nursing homes. I must add here that there is no doubt at all that the majority of providers do their best to provide good care to their residents. The big question is: do we leave it up to the aged care sector to justify its own delivery of services or do we have a strong and independent quality assurance and accreditation system in place? I will return to this question later on.
Since my appointment as shadow minister for ageing, I have heard constant stories about low quality of care levels in some facilities. Let me give you an example of the latest horror story. The accreditation agency's report, which has not been publicly released, shows horrifying conditions in Tangerine Lodge in Victoria. The most shocking finding in the report, which I have obtained, is that there were no assessments or care plans for two residents who died earlier this year. One of those residents was admitted in December 2002 and was found dead in February this year. I do not know how that person died, but the fact that there was no care plan is very worrying.
The other resident was also admitted in December 2002 and had a high number of falls since admission but no clinical assessments or care plans to guide and alert staff to their high risk of falling. This resident vomited blood on 27 January this year and was seen by a doctor and, two days later, on 29 January at 7.30 in the morning, was found with breathing difficulties and later died at three minutes past one. There is no record that this resident's condition had deterioratedâwhich suggests, sadly, that there was no monitoringânor was there any record that they had seen a doctor on 29 January, the day of death.
The horror report has many other shocking findings. Documents suggest that one resident who was admitted in March this year with a diagnosis of insulin-dependent diabetes, cancer, epilepsy, stroke and anaemia was not assessed by care staff or a doctor to determine their clinical needs. Young boys were reportedly working in the facility as volunteers and had been assisting in nursing care, including continence management of female patients. Residents had unreported bruises, were left in urine soaked sleepwear, were given incorrect doses of medication and were not treated for medical conditions such as diabetes and swallowing disorders. Can you imagine having a swallowing disorder and receiving no medical treatment? It is too frightening to imagine. Other findings include that palliative care was not implemented during the final stages of life, there was a chronic shortage of staff and, due to this, one resident had been left unattended on the toilet for up to half an hour. In all, Tangerine Lodge failed 33 of 44 accreditation standards, and these are just some examples of the report's findings. This report obviously makes me very angry.
Thankfully, the Department of Health and Ageing has placed sanctions on the nursing home. The nursing home must now address these issues in the next three weeks or its accreditation will be revoked. The provider has asked that the accreditation decision be reconsideredâwhich sounds to me pretty hard to believe, but it is true. This is just the latest horror story following numerous cases we have heard throughout this year. Two weeks ago, we heard about the maggots in Collaroy Nursing Home, and now this story. I will not outline all of the other numerous horror stories, as they are all so very upsetting and time does not permit. However, I will mention that there were severe stories in the following facilities, and these are only some: Aminya Village Hostel in South Australia; Girrawheen Court Hostel and Girrawheen Nursing Home, Nunawading Community Hostel and Ripplebrook Village in Victoria.
The Howard government, in my view, has broken its promise to protect our frail and elderly nursing home residents. Families entrust their frail and elderly residents to the care of this government's system. I fear that we will hear more horrifying stories unless Minister Andrews takes immediate action to improve the current inadequate accreditation system. Going on the minister's record in relation to all of the other reforms desperately needed in the age care sector, we should not be holding our breath.
On 12 November 1998, the then Minister for Aged Care, the Hon. Bronwyn Bishop said:
The government has established the Aged Care Standards and Accreditation Agency (the agency) to manage the accreditation of aged care services. The agency will play a leading role in ensuring that residential aged care facilities achieve and maintain high standards of care and accommodation.
As we can see from the shocking examples I have given, the system is failing. In Senate estimates in February this year, we asked the Department of Health and Ageing to tell us how often spot checks had been carried out in various nursing homes which had failed accreditation or for which there had been reports of shocking conditions. The official response from the department was:
The Department and the Agency undertook over 900 spot checks nationally in 2002.
At a departmental briefing, I was told that no further details about spot checks would be available. Why won't Minister Andrews give the public and me this vital information? What is he hiding? The secrecy around this issue suggests to me that those nursing homes and many others may not have had any spot checks since their last accreditation auditâa period which could be up to four years.
Going on the figures from the department, only 30 per cent of 3,000 nursing homes received a spot check last year. To put it another way, two out of every three nursing homes did not receive a spot check or, to put it yet another way, 2,100 nursing homes never got a spot check. Clearly, this regime is not working, and the federal budget did not provide any new funding to the accreditation agency to ensure that more spot checks will be carried out in nursing homes to prevent the kind of abuse and maltreatment we are talking about here today.
If there were any doubts about the failure of the government's accreditation system, then the recent Australian National Audit Office report on the accreditation agency will, unfortunately, put those doubts to rest. The audit report confirms what many in the industry have been saying for years: that the Howard government's accreditation system for residential aged care may not actually improve the quality of care for residents. The Auditor's report concluded that there was no way of knowing whether or not the accreditation system actually improves the quality of care for residents, because the government had not undertaken an evaluation program to determine this vital information. The accreditation system costs the government millions of dollarsâan estimated $11.5 million this financial yearâand service providers are charged a fee for each accreditation review.
It is astonishing that this government would introduce an accreditation system without ever developing an evaluation program to see if it actually achieves its goal of improving the quality of care. However, why should we be surprised? This is the government that introduced its much-touted new approach to aged care back in 1997, when it was claimed in this place:
..the government's commitment to a new era in the provision of residential aged care in this country, based on dignity, comfort and security for all.
At a workshop for the accreditation agency in June of last year, Minister Andrews said:
The care of residents in all aged care homes is the ultimate aim of everybody involved in the aged care sector and I think it is important that we constantly remind ourselves of that. It is not the process which matters as much as the outcomeâand that is the care of the resident. That is always where our focus must be. We must continue to work together so that we can make steady advances in raising the standard of aged care to benefit residents.
I couldn't agree more. There is a promise that we see broken. We now have a complex system that measures process, not outcome.
Let me return to Tangerine Lodge. This is one of the four facilities owned and operated by Marnotta Pty Ltd. At Senate estimates last night, certain points became clear. Firstly, up until December last year, it appears Tangerine Lodge, which was previously called Abalene Private Nursing Home, was operating at an acceptable level. Secondly, in December last year, it changed hands. We understand a new owner or operator or manager took over and there was a turnover of most, or possibly all, staff members. The minister, I note, is shaking his head to that. Well, we were misinformed in Senate estimates last night if he has different information.
When a facility changes hands, the department, under the provisions of the Aged Care Act 1997, carries out a series of checks regarding the new operator, including checks on standards of care and financial viability. We were told in Senate estimates last night that this series of checks did occurâand these checks are listed in great detail in the Age Care Act 1997. They are there for everybody to see what should be done. Between December last and March this year something dramatic must have occurred because, in that three months, Tangerine Lodge went from being an approved provider to an operator of a horror nursing home. This facility, along with three other Marnotta owned facilities, is now in receivership. There are very serious questions to be answered here. How could financial viability change so quickly? How could the level of care drop so dramatically? And what are the mechanisms under the Aged Care Act which enable the department to ensure that, following the sale of a nursing home, the wellbeing of residents is protected? How does the department ensure that the sale of a nursing home does not lead to this sort of outcome?
The latest in this sorry saga is the advertisement which appeared in yesterday's Financial Review in the `Business for Sale' section. There, sadly, amongst the sale of a primary industry warehouse site, tyres and mufflers, and even a vineyard, is the sale advertisement for four aged care facilitiesâall Marnotta owned and currently under receivership: Rosedale Manor, Ripplebrook Village, Villa Lombardia and Tangerine Lodge, all up for sale. What the advertisementâI think, very sadlyâdoes not include is the most important aspect of the sale: the lives, care and wellbeing of at least 145 elderly and frail people who come with these businesses. And let us not forget that one of these nursing homes under receivership, Ripplebrook Village, had taken in former residents of the Riverside Home after the kerosene baths scandal. Ripplebrook failed five of the 44 accreditation standards earlier this year.
The Department of Health and Ageing reportedly gave $65,000 to Ripplebrook Village so that it could accept the kerosene victims who left Riverside. What has happened to that money and why is Ripplebrook now in receivership? Whenever a horror story breaks in the press and whenever I make a public statement about the quality of care in nursing homes, the response from Minister Andrews is usually very quietâin fact, silent.
However, the minister did comment on an ABC radio interview earlier this week on the subject of Tangerine Lodge. He was reported as saying, in effect, that there were only six facilities under sanction at the moment. In other words, maybe he was suggesting that the situation was not all that serious. But the minister, if that is what he meant, is missing the point entirely. It is not just a matter of where the sanctions are, of how many facilities may be affected; it is all about how the system ensures that all residents everywhere are receiving care based on `dignity, comfort and security for all', to quote the government. The aged care sector has lost its confidence in this minister. ANHECA News of April this year said:
This is the Minister for `inactivity'. When it comes to really doing something for the sector the Minister has failed. The aged care sector has been very trusting of this Minister and has extended a very long honeymoon period in the belief he would deliver ... the honeymoon is well and truly over.
Minister, the care of our frail aged and the viability of this sector is in your hands and the hands of the government. The Howard government should start treating older people with the respect they deserve and stop allowing them to be treated and seen as a commodity to be traded.