702 ABC Sydney
E&OE
MOTTRAM:
More shocking stories have emerged in the past week of abuse and neglect in aged care, in particular, The Australian newspaper uncovered cases in one facility in Bundaberg. By 2020, there is expected to be 1.6 million Australians aged over 65 who will require some form of care – how well we deliver that will say a lot about who we are as a nation of course. These are some of the concerns that we’ve been hearing.
LYNDA SALTARELLI:
Have a situation where legislation dictates that there are no mandated staff to resident ratios or skills in aged care, which we believe leaves elderly people very vulnerable and I guess another situation is opening up aged care to market forces, we’ve seen changes to government policy which translates to the primary focus of market listed entities is really profitability.
MOTTRAM:
So that was Linda Saltarelli, she’s from the advocacy group Aged Care in Crisis, how is this being looked at by the current Federal Government? Mitch Fifield is the Assistant Minister for Social Services and joins me this morning. Senator, thanks for your time this morning.
FIFIELD:
Good morning, Linda.
MOTTRAM:
How do your respond, first of all, to what Linda Saltirelli was saying there?
FIFIELD:
Well, I often hear the proposition that there should be ratios, for example, in aged care facilities. The approach that we take and that the Aged Care Quality Agency takes is that the provider should maintain an adequate number of appropriately skilled staff to ensure that the care needs of recipients are being met. Now, what that involves is the Agency independently assessing the mix, the skills mix of the staff that are in a particular facility. Now, there are a range of factors which have to be taken into account. The physical design and layout of the facility, the individual care needs, the resident mix. So ratios, I understand, can look attractive, but the circumstances of individual providers vary extremely widely so I don’t think that there is a single optimum staffing level.
MOTTRAM:
Ok, but you would acknowledge though that we do need to do better at making sure that there are adequate numbers of appropriately qualified staff in facilities?
FIFIELD:
That is one of the 44 outcomes which are required in the accreditation arrangements that the Quality Agency supervise, so that’s critical. But I guess my point is that it’s very blunt for Canberra to legislate what the ideal staff to resident ratios are. There is not a single perfect ratio and as I say, the physical layout, the individual care needs, the resident mix vary greatly so what the Agency look at is what is right for the circumstances of a particular operator.
MOTTRAM:
Are they getting it right?
FIFIELD:
I think on the whole, yes. We’ve got a pretty good aged care system in Australia. There is something in excess of 300,000 aged care residents, there are over 1,200 providers and, on the whole, I think providers do a pretty good job, but we do have to be vigilant. This is a vulnerable component of the population and we’ve got to make sure that we have good safeguards, we have good complaint processes and we have good accreditation arrangements for aged care providers.
MOTTRAM:
Senator Mitch Fifield is here, Federal Assistant Minister for Social Services. Just on mandating numbers, we do it in childcare for example, we legislate staff ratios in childcare centres, why is it different for aged care facilities?
FIFIELD:
And in hospitals, there are, in some jurisdictions, ratios as well. I don’t pretend to be an expert on childcare or acute hospitals, but in relation to aged care facilities, I think that it’s just very blunt to say here is a legislated staff to resident ratio. You can have entirely different staffing needs, depending on the design of a facility, depending on the needs of individuals, so that’s the approach that is taken by the Australian Aged Care Quality Agency.
MOTTRAM:
So there’s no, I mean it might not be a matter of mandating numbers of staff as such, but numbers of hours of care, depending on the type of client, I mean, is it possible to drill down to that level?
FIFIELD:
Well the Quality Agency has a very rigorous accreditation process. There are 44 expected outcomes under four standards. They cover a range of things like information management, human resources management, medication management, specialised nursing care needs, behaviour management and a range of other elements which are very important. So I think it’s much more important to make sure that the Accreditation Agency are looking facility by facility, provider by provider, at what the resident mix is, what the individual care needs are to make sure that the staffing skills mix and the staffing numbers that are in place with that particular facility are the right ones.
MOTTRAM:
Yeah, I mean it does just sound like it could get awfully tied up in bureaucracy because while that’s all happening, we continue to hear a drip drip of stories about abuse and neglect in aged care facilities?
FIFIELD:
Look, I think we’ve got to appreciate that, as I say, aged care providers, on the whole, do a good job, but aged care homes are dynamic operating environments. The care needs of residents change over time. The resident mix can change. There can be turnover in key staff positions. And one of the things the Agency does, is it looks for certain risk indicators, such as change in ownership, change in key personnel, change in information management system, change in resident mix. And where there are those risk indicators, the Agency takes a closer look at providers. And look, mostly, providers manage those risks well. But sometimes they don’t and where they don’t, hopefully, that is identified by the independent audits of the Quality Agency and also the complaints scheme. But I should make very clear, and I think this is an important point for confidence for people, that the Quality Agency conducts about 5,000 visits each year to facilities and about 3,000 of those are unannounced visits.
MOTTRAM:
Well yes, but we hear a lot of stories about unannounced visits, maybe, in theory, but there’s very much knowledge in the system of when visits are coming up. I mean a lot of people tell us that they’re very concerned about this situation overall, abuse and neglect but also sort of lower level inability to deal with one of the most vulnerable sectors of our society. Minister, do you think that anything needs to be done to restore confidence? Will you do anything to restore confidence?
FIFIELD:
Well part of ensuring confidence in the aged care system is ensuring transparency and that’s why, on the website of the Quality Agency, the last full audit report of each aged care provider is there. So people can see in detail the findings of the audit, the number of care plans that the Quality Agency has reviewed, the number of residents who have been interviewed, what the resident satisfaction levels are. I just come back to an earlier point, there are 3,000 unannounced visits a year and they are genuine unannounced visits where the officers of the Agency turn up, knock on the door. No one knows they are coming. There are, obviously, in addition to that, announced visits, when the Agency is looking at the accreditation of a provider. And one of the reasons why they announce those particular visits is to give residents and their families the opportunity to have confidential discussions with the assessors and in fact, each year, there are about 55,000 interviews that the Agency conducts with residents and relatives. It’s important we have the mix of announced visits, unannounced visits, but also transparency.
MOTTRAM:
As you speak I’m getting quite contrary views streaming through on our text [inaudible], this happens every time we talk about this, there seems to be a real air gap, if you like between the sort of confidence that you say we can have in the system and what people are experiencing, but let me just, we’ll run out of time shortly unfortunately, but let me just play this, Sussan Ley, your colleague, the Health Minister says this to me last week.
MINISTER LEY:
It worries me a little when I hear that Ambulances are called because it’s two o’clock in the morning and there is no medical attention to hand and the disruption and disturbance for elderly patients is significant. I also, like everyone with elderly relatives in aged care, want them to be as happy and healthy as they possibly can.
MOTTRAM:
So Sussan Ley is a little worried about that phenomenon. Is that something you’ll take up with her and maybe that’s an area you can act on?
FIFIELD:
Well, it’s the responsibility of each provider to make sure that they take the appropriate action when there are health issues that emerge. And where a provider thinks that the best response in a given circumstance is ambulances then that’s what they do. But certainly, I’ll happily have a chat to Sussan Ley about any particular issues that she may have. But look I want to leave the impression, Linda, that the aged care system, on the whole, is pretty good. Providers, on the whole, do a pretty good job.
MOTTRAM:
As long as you don’t fall through the cracks.
FIFIELD:
That’s not to say that there are not, from time to time, things that should not happen. And we have to have, and do have, good and robust quality mechanisms in place. But I don’t pretend that we’ve reached regulatory Nirvana when it comes to the aged care…
MOTTRAM:
What a notion, regulatory Nirvana…
FIFIELD:
Indeed.
MOTTRAM:
Senator, l’m going to have to let you go there, but thank you very much for your time today.
FIFIELD:
Thank you very much.
MOTTRAM:
Thank you, bye bye. Senator, Mitch Fifield, Federal Assistant Minister for Social Services. I hope you feel assured.