7 October 2014

Open Letter to John Hargreaves on Aged Care

| AllAboutCareCaraHade
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All About Care

Hi John.

I would like to respond to your recent RiotACT article on the quality of services delivered in aged care facilities. As the founder of Canberra-based home and community care agency All About Care, I’m a passionate supporter of the aged care, disability and early childhood sectors.

Our beloved industry is in crisis. This will continue to cost the government and tax payers (let’s not forget the people of the government are also tax payers) money, time and resources to fix. From my own experience, most industry groups feel just as strongly about this issue as you and me.

I often lay awake at night pondering my own future. I’m 43 years old with two amazing daughters who would absolutely do everything they could to assist with my independence as I get older, but I also don’t want to be a burden on them just when their own lives are getting started. And let’s not forget the burden on the people of Australia, how our forefathers must be turning over in their graves!

I’d like to add my personal point of view to some of the points you raised in your article, particularly around lack of standards in aged care facilities and funding.

We’ve come a long way in the last six decades. Prior to 1954, aged care facilities were called ‘asylums’ and relied donations and volunteers to care and advocate for the residents. Then the Federal Government introduced the Aged Care Act which provided subsides for those charities to assist with the development of self-contained accommodations and hostels.

In the 1980s there were four major reviews (which can be googled). In 1995 the Labor government implemented aged care reform—its major objective was to implement of appropriate assessment strategies to improve access, equity and participation right across the sector. They introduced the following policies (I’m still feeling wow, what an impact):

  • Aged care standards and accreditations
  • ACAT
  • Complaints and resolution scheme advocacy
  • Community care packages and extended care packages
  • Accommodation charges and means testing
  • Concessional beds
  • Building certifications
  • Residential classification scale
  • Ageing in place

In addition to those policies, all industries must adhere to the Privacy Act, Freedom Act, Human Rights Act, Archives Act and Crimes Act.

I’m still trying to figure out how our government prioritises funding. My conclusion is that the most important decisions are made during Happy Hour as I can’t fathom how funding ballerinas takes precedence over dementia funding. Where does this happy hour take place? They must be the best mind-altering drinks in town…

The most talked about topic in my industry is its funding model. When cuts occur (as they frequently do), nine times out of ten, they start at the bottom, affecting care staff and other frontline workers. Rarely do they impact the CEO or board.

What most people don’t know is that all aged care facilities’ financial profiles can be found using a simple tool called Google. For example, I was shocked to discover last week that one Canberra facility, who has been cutting corners for four years, earned between $1 million and $5 million last financial year.

It breaks my heart every time I here of an unnatural death in our facilities care. Thank God most of the time residents pass away in their sleep. Most of these deaths are dementia related, but will frequently be reported as suspicious or under investigation, particularly when the death occurs in the early hours between 2am and 5am. It makes you question where the staff were, and what they were doing at the time. But please bear in mind that night duty usually consists of four workers, depending on the ratio of residents to staff. Their main tasks are to perform hourly health and safety checks and four-hourly incontinence checks.

I could debate these issues all day, but I’d rather put my energy into proactively leading the way. A change is on the horizon and it’s time we become united together. If that means moving away from what has always be traditional or historical then I say let’s do it.

So I invite you, Mr Hargreaves (and everyone else who can spare a small amount of time), to give me a call to arrange a meeting over a coffee that isn’t mind altering.

Cara Hade
Principal Owner All About Care

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Fiona_ADACAS4:00 pm 17 Oct 14

Advocacy and aged care.
In your article Mr Hargraeves (http://the-riotact.com/aged-care-facilities/134211) you raise concerns about the quality of care for Canberra’s older people and about advocacy for them.

ADACAS, as you mention in your response to the open letter by Ms Hade, provides individual advocacy to older people and I am writing to respond to your comment that advocacy is lacking. Firstly to clarify your comment that it is a ‘shared system’. Yes, ADACAS provides advocacy to people with disability as well as older people, however this ‘sharing’ enables us to be more effective rather than less so. We provide advocacy funded under a number of separate funding streams, the majority of our funding is for individual work, where an advocate works with a single client to resolve issues they are facing and ensure that their voice is heard in matters that affect them. We support hundreds of people each year through this individual work, and we generally go about that work without seeking to draw media attention to it, because our experience has been that media attention is not always the most effective strategy for getting good outcomes for our vulnerable and frail clients. ADACAS has a team of older persons advocates working quietly but solidly to achieve good outcomes for our clients. The team specialise in working with this group of clients, their work is not harmed in anyway by working alongside a team of disability advocates – indeed the two teams effectively support each other to undertake their work, and as a small/medium sized community organisation we are able to be more efficient with executive and administrative costs than if the two services were completely independent. There is much pressure on small community organisations to amalgamate or perish in these tight economic times and nothing to be gained by hiving off a small separate advocacy service for older people. You can be confident that the funding we get for older persons advocacy is used as efficiently as we possibly can, to provide advocacy to older persons and for nothing else.

ADACAS also contributes to systemic advocacy, broader issues that affect groups of clients rather than individuals. We have taken complaints on behalf of groups of clients to the Aged Care complaints scheme and the Human Rights Commission. We have raised matters with the Aged Care Commissioner, we have contributed to broader policy reform such as the Senate inquiry into Dementia in 2013 and we have raised concerns about aged care reforms as they have developed. We do all that, and a suite of other things, with barely any funding towards systemic work, but we do it because we know that it’s important. Again we don’t seek media attention as we go about it, because we prioritise time spent on client issues over time spent creating a profile. If you’d like to know more about the work of ADACAS I invite you to get in touch with me.

Is there enough funding for advocacy? Is there enough awareness of the right to advocacy? Is there enough awareness of the rights of older people? Do we as a community prevent and respond well to cases of elder abuse? Is the funding model for aged care always working well for the people in care? The answer to all of these questions is no. Should more be done about every one of these issues? Does ADACAS want to be involved in doing more to enable older people to live fully, meaningfully and well? Yes, most certainly.

John Hargreaves Ex MLA6:46 pm 07 Oct 14


Thank you for your open letter. In it you substantiate my concerns about the treatment globally in Oz of people in nursing homes. It would appear that your organisation may be an exception to the rule if what you profess is true. And thank you for that.

My concerns however, go to not only the treatment of our older folks but also the system for handling complaints if they are raised. A look at the complaints system in the federal dept shows a lack of person oriented system for addressing complaints, a lack of system to see if complaints are episodic or systemic and no data at all around comparisons of facilities.

The ROGS data is pathetic. Comparisons between the States and Territories is meaningless in my mind as we are not comparing like fruit to like fruit. Also, the data set in ROGS does not address quality of service and perhaps it should.

I also note that advocacy groups for people wishing to address concerns are lacking in the sector. Usually, the complaints system is a shared one, such as ADACAS, where the NGO addresses disability as well as aged care. And COTA is more concerned with policy and perks than the complaints advocacy.

I will be keen to see what other posters think and may be they will share experiences.

Again, thank you for the letter. You have given much thought to the situation over a long time and are one of the few people I have heard of ding something about it.

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