In the media

Aged Care Crisis: Where is the dignity?

Senator BURSTON (New South Wales) (18:04): I rise to speak on the Aged Care (Single Quality Framework) Reform Bill 2018. The recent debate on euthanasia in this place highlighted the need for an improved aged-care sector in this country. According to the last census, the median age in Australia in 2016 was 38, up from 37 in 2011. According to the Australian Bureau of Statistics, one in six Australians is now aged over 65, compared to one in seven in 2011 and only one in 25 in 1911. In addition, 2.1 per cent of Australians are over the age of 85. That’s 84,000 extra residents aged 85-plus since the last census. There were 3½ thousand people aged over 100.

Everyone knows that our population is ageing, and we need lawmakers to ensure that those looking after our elderly and frail have the legislative framework to provide the best care possible. Anyone who has or has had a loved one in aged care, and any senator in this place who has had dealings with constituents about problems in the aged-care system, knows the system is broken. There isn’t enough time to go through the aged-care scandals throughout New South Wales, but I will highlight just three that occurred less than an hour’s drive away from my electoral office in Lake Macquarie.

In 2016 a woman was found with maggots in her mouth at a Raymond Terrace nursing home the day before she died. A Port Stephens woman, Jayne Carter, raised serious concerns about the standards of aged-care facilities after she was told by staff at the Opal Raymond Terrace Gardens nursing home that they had found maggots in her mother’s mouth.

In 2013 Lateline reported on a 91-year-old grandmother, Paula Javurek, who was in a New South Wales nursing home that was supposed to deliver high-level care. Her daughter, who was a nurse and healthcare lecturer, was horrified when she found her mother with exposed, raw ear cartilage due to a lack of turning and with one of her arms immobilised after staff botched injections. Ms Javurek had survived Nazi concentration camps and was tortured and raped after being captured during the war. Her family told the nursing home only female staff should wash her because of residual trauma from war-time assaults, but the family has since counted 70 times when male carers washed Ms Javurek, who tried to fight them off. According to her daughter, her mother often used to say she would be better off being in a concentration camp than where she was. After finding their grandmother shivering from cold and suffering from undiagnosed pneumonia, Ms Javurek’s family took her home. A week later she died.

In 2011, nurses were sacked from William Cape Gardens nursing home on the Central Coast in New South Wales for depriving a dying man of food and photographing residents genitals in a game called ‘the genital Friday club’. The horrific treatment at William Cape includes claims that three nurses told an elderly woman with dementia that her husband was having an affair with her best friend while she was in care. A whistleblower told TheSunday Telegraph that when food was withheld from an elderly man the nurse allegedly said, ‘He was going to die anyway. This way it would make it easier.’ Staff were forced to sign a confidentiality agreement over the scandal. The whistleblower said ‘the genital Friday club’ had been going on for some months and was known of by quite a few members of staff. A second staff member said at least one nurse took photographs of elderly residents’ private parts on an iPhone and asked colleagues to guess who they belonged to.

These scandals must stop. Pressures in the aged-care sector are skewed towards cost cutting and profit. Too often this is at the expense of care. It seems that any good care is occurring in spite of the system, not because of it. We need an aged-care system where good care is provided because of the system and not in spite of it, and where care is the best that can be provided with the resources available.

A few years ago an independent volunteer consumer based advocacy group, Aged Care Crisis, was formed to provide a consumer voice for aged-care residents and their loved ones. According to Aged Care Crisis, one of the most significant factors in providing quality residential aged care is ensuring that there are sufficient skilled staff on hand to provide that care. Many people who contact Aged Care Crisis are shocked to learn that there are no mandated minimum staff-to-resident ratios in aged-care homes across Australia. The Aged Care Act 1997 has little to say about staffing. In fact, only two lines are allocated to this, the most vital aspect of care provision—that there must be an adequate number of appropriately trained staff.

As a direct consequence of this lack of required standards in staffing, managers who are under pressure to meet their profit targets do so by reducing staff, placing vulnerable residents at risk. Nurses and carers frequently report that they are not able to care for residents properly given the conditions and time constraints imposed upon them. It is clear that providers of aged care genuinely strive to operate with as few staff as possible. Incredibly, Aged Care Crisis also found that in some cases no staff were rostered on for considerable lengths of time.

We have mandated staffing levels in childcare centres, kindergartens, schools and hospitals. They too cater for people with different levels of need in different locations but still manage to set a safe minimum staff-to-client ratio. Aged Care Crisis further stated:

This lack of mandated minimum staff/resident ratios has seen the exodus of experienced nurses from aged-care homes, particularly private-for-profit homes.

Those staff who remain find that they can no longer meet their responsibilities to residents in the available time and that resident care is compromised. Most settings which care for vulnerable individuals—for example, hospitals and childcare centres—operate within mandated staff-to-person ratios. It is intolerable that frail, older people do not have this protection.

It is my understanding that, if you are residing in a nursing home in New Jersey in the United States, the nursing home owners there are required by law to provide you with information on the number of staff involved in direct patient care and to publicly post information that details direct resident care staffing levels within their facilities. They’re also required to report daily staffing levels via a web-based system through their department of health. The law also requires that the department makes this information available to the public on a quarterly basis. Being an informed consumer and armed with this and other publicly available information, family members and residents are better equipped to make informed decisions about the care of their loved ones. There are no such levels of transparency or accountability to allow anyone to do similar here in Australia.

In every hospital coronary care unit or intensive care unit in Australia, staff are required to be specially trained in that area and to ensure that high standards of care are maintained. The same principles should apply in aged care. More specially trained staff are urgently required within the sector. To be effective, this commitment to training must encompass continuing education and ongoing professional development.

I share the Aged Care Crisis’s alarm with the continuing reduction in the numbers of registered nurses who work in aged-care homes. More and more homes now rely on having a registered nurse on call rather than on site. This is despite the fact that the level of care needed by residents is higher than ever before. The ongoing reduction in the numbers of registered nurses has had a significant impact on the quality of care being provided in aged-care homes. This is one reason why residents must be placed in hospital when they require treatment for even minor complaints, and that increases waiting times in hospitals. Age Care Crisis advises that they receive feedback from carers about the increased responsibilities which they are given and for which they may have no or insufficient training.

The government and this parliament need to address the crisis in aged care as a matter of urgency. I will support any bill or amendment that will improve our aged-care sector. However, if I believe it will put further pressure on our system, I will vote against it.