The many extracts on these pages are from copyright material. They are owned by the reference given or its owner. They are reproduced here for educational purposes and to stimulate public debate about the provision of health and aged care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes. The material is selective and I have not included denials and explanations. I am not claiming that the allegations are true. The intention is to show the general thrust of corporate practices as well as the nature and extent of any allegations made. Any comments made are based on the belief that there is some substance at least to so many allegations.

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Introductory page
This corporate web site addresses the issues of corporate health care within a broad framework. A web page describing this broad context should be considered as an introduction to each page on the web site. If you have not yet read it then
CLICK HERE to open it in another tab or web page.

Content of this page
The industry friendly accreditation and complaint handling agencies set up by the government in 1997 have failed. This is illustrated by the ongoing problems in care, the recurrent scandals and the increasing seriousness of the problems encountered. This page examines these processes, the reasons why they failed and why the measures to make them effective have not worked and are unlikely to work in the future.

 Australian section   

The Accreditation and Complaint Processes
Australian Nursing Homes



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Overview of page


The chronological story of nursing homes and accreditation practices in Australia is intimately related to the story of government policy over the years. It is told on the government pages. This page more specifically relates to the failure of the accreditation process and the complaints mechanism. It examines the reasons for this. It looks at issues and is not chronological. Because accreditation is such a central part of the story there is some duplication in content and in illustrative extracts between this and the government pages.

It is also an opinion piece rather than a statement of fact and is based on an examination of the US and Australian systems as an outsider and not on any personal experience. There will inevitably be some errors because of this but such an outsiders view can often throw light and raise issues. In some sections the explanations are those made by others. In other sections they are suggestions and ideas of possible or likely explanations rather than assertions.

In 2000 I wrote a series of linked web pages looking at the reasons why regulation and government oversight have failed. More specific pages examined failures in regulation in the USA and Australia. Another page written at this time examined failures in the accreditation process.

This page looks at the failures of the accreditation and complaint handling system in aged care up to 2006.

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Lurking behind the sections on this page is the issue of interpretation - what I have called the divide. The view of those who exercise power and make decisions including politicians, the regulators and the industry is in stark contrast to the views of nursing home advocates, the nurses, the residents who are misused and their relatives.

As in the application of most ideologies it is the former group who are out of touch and who are unable to accept the real life consequences of their policies and practices. They are also unable to form an intelligent analysis of what is going wrong. They nevertheless set the frameworks of understanding (world view) within society. We all experience some emotional instability when we deviate from this.

Activists and families consequently also tend to use these frames of understanding and will squeeze their solutions into them. Although they will be critical of the commercialisation of aged care they seldom openly challenge the marketplace view of the health system, and the applicability of a market in health and aged care. Instead of pressing for real changes to the system they squander their efforts by pressing for greater regulatory vigour and larger penalties.

Accreditation and market forces were used to drive reform of a system which was not working well. This page examines the many reasons for failure including the power structures driving aged care, the lack of insight of decision makers, and the way an industry driven and industry friendly focus has emasculated the structures set in place to protect citizens.

The similarities and differences between surveillance in the USA and Australia are examined and it seems that the Australian system is even more vulnerable than that in the USA.

Conflicts of interest, role conflicts, restrictive legislation, the discouragement of critics, close relationships with industry, excessive political control, an intrusive bureaucracy, revolving doors for staff in the different sectors, under funding of oversight agencies, deteriorating agency staff morale with under staffing, and the abandonment of probity as a key prerequisite are all considered as possible explanations for failure.

It is suggested that an excessive focus on process and the appearance of care has contributed to the failure by shifting the focus in the nursing homes away from actual care and by taking carers away from residents in order to fill in forms.

While transparency was a key concept in the proposed system the pressures within the system have ensured that it has been anything but transparent.

Legislation requiring mediation and preventing prompt investigation rendered the complaints system ineffective. Probably as a consequence staff in the government's complaints unit shrunk from action. They minimised the complaints and labelled the complainant so that they could be discounted.

The accreditation system was ineffective. The pages on this web site contain many accounts of continuing failures in care in the nursing homes..

There was extreme reluctance to accept that the system was not working. When those in authority were forced to confront what was happening they attempted to insulate the events by claiming they were isolated and not representative.

Failures were considered as a failure of individuals or specific organizations. They made every effort to avoid any suggestion that the problems were systemic and integral to the patterns of thinking around which the aged care system was structured. (see response to the rape scandal) Even those exposing the problems and advocating change shied away from this.

The response has been to regulate, to detect and to deal with the offenders while maintaining an industry friendly and consultative system. The minister reiterated his faith in the marketplace as the best way of providing aged care.

In this Australia follows the USA. I have suggested than this will do no more than hide the rot in the system by reducing the visible manifestations.

I found it interesting to review some of the correspondence between myself and the aged care minister's department in early 1999. In this I referred to many of the issues that have subsequently been shown to be so important in the failure of the government’s nursing home and regulatory policy. I commented on the impact of these policies on staff motivation and so on care.

At the time I was objecting to the plans of the US giant Sun Healthcare to enter Australian aged care but that is not the interest now as it was discredited, entered bankruptcy and never did so. The interest is the claims made 7 years ago by the department to the effectiveness of the accreditation and complaints system and my responses to those claims. In retrospect I think I was correct.

 Click here to read the correspondence


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Politicians and industry advocates have insisted that the accreditation system is working, that standards are being improved and that the exposures of multiple instances of failed care are a measure of this success. They have claimed that the instances of neglect, elder abuse and rape are isolated exceptions rather than pointers to serious systemic problems and a deep malaise across the sector.

The nurses, patient advocacy groups and whistle blowers take a very different view and see the system as broken and residents as at high risk. Experience in other health and aged care sectors suggests that these groups perceptions are much more likely to be accurate. Evidence supports them.

I find it worrying that in their eagerness to address the issues advocates have concentrated on more effective oversight processes including complaints mechanisms, frequent spot checks and mandatory reporting of abuse. The focus has been on tightening (patching) a fundamentally flawed system at the expense of the fundamental changes the system needs.

It is not clear to me whether advocates are practising the art of the possible at this time or whether they really believe that a market based aged care system is acceptable and will give the best outcomes. My argument is that it is not acceptable and is most unlikely to serve us well.

I do not think that there can any longer be any serious doubt that the malaise in the system is widespread and that the accreditation system has failed. The glaring examples are pointers to problems across much of the sector. These are concentrated in but not isolated to those sectors which have adopted a strong market focus.

The continued frequent exposure of poor homes shows no signs of abating 8 years after the accreditation system was introduced. There has been a deterioration in the type of scandals. Resident neglect, due to staffing and management deficiencies, in the early years has grown to rape and sexual abuse in 2006 - tragic offences which were not promptly reported. This must reflect a dramatic deterioration in the quality and morale of staff.

Other pages examine the manner in which the aged care marketplace was imposed in Australia and the failures in government when introducing this into nursing homes. This page suggests reasons for the failure of the accreditation and complaints processes.

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Suggested factors in the failure of oversight

The failures in the aged care system are multifactorial and different weights are given by people with different perspectives. My argument is that the most important of these is the decision to turn aged care into a competitive marketplace, to drive for profit companies into the sector and to allow them to create the ethos and ambience in the sector.

I argue that real change and a functioning health and aged care system cannot be developed while the sector is dominated by market system thinking and market processes. The two approaches are fundamentally contradictory.

This analysis concentrates on those factors related to the competitive market.

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Power and Influence

The overall reason for failure of oversight processes in both the USA and Australia has been the disproportionate power and influence of the marketplace when contrasted with that of the regulating agencies and of residents.

The world view of the competitive for profit marketplace is all embracing and self evident for many in society. When it is challenged true believers respond with ridicule and anger.

Accreditation and oversight on the other hand are subjective and uncertain with many ifs and buts. It is more difficult to be certain. In a court of law the certainties of the market are easier to press. Sanctions may be challenged and overturned by the courts.

Convinced of the validity of their perspective corporations challenge aggressively and not infrequently overturn adverse findings. They have access to the best lawyers. Regulators are worn down and become weary. The best and the motivated leave. Apathy prevails. Staff shortages occur, skills decline and regulation becomes ineffective. Consistency is replaced by differing and sometimes conflicting assessments.

In Australia health care companies which have challenged aggressively include Gribbles, Macquarie Health, and Primary Health. Healthscope is now challenging allegations made in Tasmania. In aged care Primelife has litigated aggressively as has the nursing home company owning the Riverside nursing home, and the owner of Belvedere Park and Kenilworth nursing homes.

Credibility is a powerful shield and regulators are hesitant about taking on the rich, the powerful and the friends of their bosses.

Within the system itself there are a number of other factors which contribute to the emasculation of regulation.

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Lack of insight and understanding

Wishful thinking and misconceptions about the nature of aged care and its needs was widespread and is reflected by the aged care minister's (Bronwyn Bishop) views on staffing of homes and her belief that government policy and accreditation was being successful when it had already clearly failed.

Feb 2000 Is Riverside an aberration or a symptom?

For a large number of the other 135,000 people in nursing homes around Australia, the revelations pose the question, How many Riversides are out there?
All the while Mrs Bishop has trumpeted the triumph of the Government's aged care reforms and the move to better standards in homes these days.
Throwing frail aged to wolves. Daily Telegraph February 28, 2000

Feb 2000 The nurses in the homes knew

The Australian Nursing Federation said the overwhelming evidence of a crisis in residential aged care showed the Government should urgently change the Aged Care Act to restore day-to-day accountability to nursing home proprietors for the provision of quality care.
Nominate Administrator Or Risk Licence, Nursing Home Told Sydney Morning Herald February 28, 2000

Mar 2000 But not the minister

A spokeswoman for Mrs Bishop yesterday hit back at criticisms by the Aged Care Standards and Accreditation Agency's general manager, Mr Tim Burn, who said the accreditation process was drastically behind schedule.

The spokeswoman said that 90per cent of the industry supported the accreditation process and that the other 10 per cent were the "bad apples'' spoiling things for the rest.
New Claims As Aged Care Crisis Widens The Age March 2, 2000

Mar 2000 Minister confident in system

"It's a very, very thorough accreditation system which has never existed before," she (Bishop) said.
Bishop Says System OK. Herald-Sun March 2, 2000

Mar 2000 middle-aged women providing tender, loving care?

According to Clutterbuck (Australian Nurses Federation), there are now "thousands of people working in the sector who have not had the luxury of training". This raises serious questions about the quality of care.

In an interview in the Australian Nursing Homes and Extended Care Association's monthly newsletter last March, Bishop was quoted as saying the only standard of training required in a nursing home was "middle-aged women providing tender, loving care".
Crimes of neglect. The Australian March 4, 2000

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Accreditation, an industry friendly initiative


In the USA accreditation has been an industry activity and for companies a marketing opportunity. As a consequence senior staff from the largest corporations have on occasion been directors and funded the agencies. The 1992 US House of Representatives investigation "Profits of Misery" found that the psychiatric accreditation body was founded by the big companies and had directors from these companies. They failed to carry out inspections or to penalise anyone but accredited all of the psychiatric hospitals exposed in the scandals of the early 1990’s.

The Joint Commission for the Accreditation of Health Care Organisations (JCAHCO) is a highly credible US body which now accredits facilities internationally. It has had many failures, been extensively criticised and been forced to revise its processes on a number of occasions. During the psychiatric scandals most if not all of the National Medical Enterprise hospitals that misused patients for profit were accredited by the JCAHO. The policies and practices were spelled out in hospital practice documents they would have seen. They could not have been ignorant. In the second 2002 scandal involving this same company now renamed Tenet Healthcare many hundreds of cardiac patients were harmed even though JCAHO inspections had detected problems in the hospitals concerned.

There are credible claims that instead of investigating the JCAHO sometimes gave the companies the names of those who had complained so that they could be disciplined. Columbia/HCA hospitals scored highly when other investigations showed that they understaffed and simply did not provide less profitable services.

Over the years staff from the health care business sector in the USA have been appointed to senior JCAHO positions in spite of their close links to large corporations with tarnished histories. Representative Pete Stark has documented the JCAHO’s failings and made attempts to legislate in order to make them serve the community rather than the hospitals who pay them for accreditation.

In spite of its failings and its commercial structure the JCAHCO is promoted by the industry and consequently remains highly credible, is admired throughout the world and is used as a role model.

In the USA industry wanted industry controlled accreditation to become an oversight and regulatory body. Even Ronald Reagan shied away from this. Oversight was left to separate state bodies independent of industry. In Australia the Howard government was not constrained in this way and went all the way with the industry.

Aug 2001 Australia has gone further than the USA

In the United States, as the Reagan administration cut back on welfare it came under enormous pressure from the healthcare industry to deregulate nursing homes by dismantling inspection in favour of implementing accreditation schemes administered by the Joint Commission on Accreditation of Healthcare Organizations. Accreditation would have replaced public inspection with a form of privatised peer review or self regulation. As tempted as the Reagan administration was by deregulation, public outcry ultimately persuaded them that it would be a mistake.
The current Australian government, led by Prime Minister John Howard, is the only example of a simultaneous attempt to cut welfare, encourage rapid growth of private care by large corporate organisations, and deregulate nursing homes.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001

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The Australian aged care accreditation agency was set up as an industry friendly body. Industry input has had a potent influence on its design and its operation. They have been consulted at every point and their acceptance of any changes has been crucial.

Without industry agreement the government would not act and without intense public pressure and adverse publicity the industry would not go along with any restrictions on their freedom to operate as they thought fit.

The response of ministers Bishop and Santoro to the 2000 and 2006 scandals was to seek a probably reluctant industry’s backing for the changes forced on them by the public.

Mar 2000 Bishop turns to the industry

Despite also releasing details of a new industry forum to help the Government develop strategies to improve the quality of care in nursing homes, Mrs Bishop looks set to remain under intense pressure.
New Crisis For Battered Bishop Australian Financial Review March 31, 2000

Mar 2006 Santoro turns to the industry

Senator Santoro said experts from his Aged Care Advisory Committee - largely comprising aged-care providers - were split on the issue of forcing people to report cases of suspected abuse.
Cabinet to consider plan to stamp out elderly abuse Australian Associated Press General News March 14, 2006

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State oversight closed down

State regulators were disbanded after the 1996 federal election. In the USA state regulators have many failings but are separate from accreditation and provide the main and most accurate information about standards and that information is readily accessible. Accreditation information is not relied on by those researching standards of care in the sector.

Aug 2001 Shutting down state oversight

Additionally, then candidate Howard (he became prime minister in 1996) promised that he would shut down the state run standards monitoring process and replace it with an industry controlled accreditation scheme.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001

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Conflicts of interest

The accreditation agency was not set up as a regulatory body but primarily as a body to assist nursing homes to improve standards. There is no problem in a cooperative body assisting nursing homes to improve but it is problematical when that body is also assessing and publishing results into the marketplace. Its positive assessments were used in marketing and this creates a conflict of interest for the agency. It is put under pressure to accredit by its supporters, and is at risk of criticism if it does not.

Oct 2002 Accreditation a PR tool

Manager of Sir James Terrace Retirement Village Brian Amos - one of the villages to recently go through the accreditation process - said his village was now recognised as meeting industry standards.

"From a marketing perspective it's a good PR tool," he said.

"Other villages that are not accredited don't get the prestige and recognition that we get."
Accreditation ensures high quality of care. Sunday Mail October 20, 2002

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Role conflicts

In Australia the agency was also an assessor of standards, the regulatory body, and the body that imposed penalties. Its ability to regulate and impose sanctions was limited among other things by having to refer such decisions to the industry friendly minister and her department who had the final say.

Aug 2001 Primarily a support organisation

She (Agency Spokeswoman) said where a published report indicated an unacceptable, critical or serious risk rating for one or more of the 44 expected accreditation outcomes then the agency continued to work with the service until a satisfactory rating was achieved.

Ms Vesk said the agency was monitoring the progress of implementation of required improvements at all 46 homes (with problems) through a program of support visits, review audits and spot checks.

"Homes that do not implement the required improvements may have their period of accreditation reduced or revoked altogether," she said.
Ratings under review. Herald-Sun August 20, 2001

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Consequence of role conflicts

The contradictory roles imposed on the agency could only reduce effectiveness and compromise objectives. One of the consequences was the failure to utilise the powers the agency had. By 2000, more than 2 years after the system was introduced, it had never carried out a surprise visit because it considered these unfair for the homes, and it had not closed down a single home.

There is no reason to doubt that the minister, her staff and the agency all identified with the industry friendly role. It was there to help the homes attain standards. They were blind to the social dynamics of the system and all parties subjugated the regulatory and oversight role to the role of accreditation facilitator.

Feb 2000 No surprise visits

A part of this better standard is a policy of not imposing on nursing homes by paying unannounced inspection visits. This is despite a promise last August by Mrs Bishop that all of the "tools" at her disposal, including surprise visits, would be used to rid the industry of rogue providers.
Despite this pledge, it was revealed that for the past two years the agency had not carried out a single surprise visit in two years.
Throwing frail aged to wolves. Daily Telegraph February 28, 2000

Mar 2000 Never closed a home

The federal government today admitted it had never used its licensing power to close down substandard nursing homes.
But today she (minister Bishop) said the government was aiming to work with nursing home providers to improve standards, rather than just closing them down.

"There has not been a home closed by deliberate action," she told ABC Radio.
"The whole aim of the reforms is to work with providers who are not meeting the best standards that we want to bring them up to that standard
No nursing homes closed down by government, Bishop admits Australian Associated Press March 2, 2000

May 2000 Agency's justification

But general manager of the accreditation agency, Tim Burns, remained defiant, claiming Mrs Bishop declared in February nursing home spot checks were "a last resort". "The reason we chose not to do them ... we felt very much we need to engage the residents and the staff in the audit process and just to turn up on site and barge into somebody's home was not appropriate," he said.

Mr Burns also said the average notice period of up to seven days before an agency inspection did not allow a home time to cover up significant problems. The agency had conducted more than 1300 prearranged monitoring visits to nursing homes as well as 800 visits to determine a home's accreditation over the past 18 months.

"So I think the spot check is a bit of a sideline in that we have been conducting a huge number of visits but we've been giving an average of seven days' notice," Mr Burns said.
Official blast on aged care Courier Mail May 4, 2000

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Critics and spot checks

This was an industry friendly body and as one article indicated when assessors from the agency said that things were bad then they really were. There were many critics of the accreditation system but they were discounted and ignored.

Mar 2000 The agency doesn't have the power anyway

Reforms to aged care will fail unless Bronwyn Bishop overcomes her reluctance to properly police them.
Who is keeping an eye on our parents?

Not, it seems, the new industry watchdog, the Aged Care Standards Accreditation Agency; not the nurses union; not the Federal Government; and not one of the numerous industry bodies.
The Aged Care Standards Accreditation Agency can recommend a reduction or withdrawal of funding or, in extreme cases, the cancelling of a proprietor's service provider licence. But only the Federal Government has the power to impose such sanctions.
The agency, responsible for overseeing the industry, has attracted criticism for its failure to maintain proper controls through regular monitoring and surprise inspections.
Crimes of neglect. The Australian March 4, 2000

Mar 2000 Sprucing up the homes before a visit

But it is becoming clear that the implementation of the reforms has been flawed. Previously, nursing-home proprietors had to account for every cent given to them in government subsidies for the care of residents and even return the proportion not spent. This was a cumbersome and highly bureaucratic procedure, and was destined to be replaced. But doing away with this so-called acquittal system, as the Howard Government has done, without adequate safeguards or effective complaint mechanisms has put patients at risk.

Now that they are entitled to spend government funds as they wish, a minority of unscrupulous nursing-home proprietors are cost-cutting in crucial areas such as the number of qualified staff, the quality of meals and provisions such as dressings and linen.
Despite claims by the industry to the contrary, unannounced inspections are a crucial weapon in the war against bad-quality care. Nursing-home proprietors know when members of the Aged Care Standards and Accreditation Industry are coming and can make the necessary preparations.

Nurses have told The Australian this week of extra staff suddenly appearing on the roster, of menus being changed from mince to something more nutritious and of outspoken residents being sent on "holiday" to another nursing home during the week of the visit.
We all must nurse some responsibility The Australian March 10, 2000

Mar 2000 If they are found to be bad they are very bad

But frankly, it is the whistleblower nurses and the nursing home ``assessors'' I would pay more attention to. This new monitoring and accreditation system was introduced by the Howard Government in 1997 to please the industry, who loathed the old regime of nitpicking government inspectors. If the new assessors, whose brief is to work co-operatively with proprietors, deem a home ``unacceptable'', or of ``serious risk'', you can believe it.
Be It Ever So Awful: No Place Like Home Sydney Morning Herald March 11, 2000

Nov 2003 Six weeks notice of inspection

Mr Thomson (union spokesman) said nursing homes were given about six weeks notice before an inspection, allowing them to clean up before inspectors arrived.
Dirty secrets of millionaire's nursing home Daily Telegraph November 3, 2003

Mar 2004 Still sprucing up the homes in preparation

Aged-care staff claim some homes are bringing in more workers and improving standards ahead of inspections only to revert to poor conditions.
Enraged aged-care staff have told the Herald Sun the accreditation system is a farce, with homes hurriedly employing extra staff, changing menus and improving cleaning standards before inspections.
Nursing homes in jeopardy Herald-Sun March 12, 2004

Sep 2004 A nurses allegations

Mrs Horniak was a night supervisor (who resigned from Tricare in disgust) responsible for four personal carers and 70 beds. Accreditation teams inspected the home to test standards, but administrators used the advance notice to create the illusion of quality care.

But when the accreditation team left, it was back to normal.

The home replaced the experienced workers with cheaper agency workers without benefits, she said.
Money matters more, says carer The Courier-Mail September 1, 2004 (NOTE ALL ALLEGATIONS STRENUOUSLY DENIED)

Sep 2004 Carefully planned deception and dishonesty

UNETHICAL Queensland nursing homes were easily rorting a system designed to monitor standards of aged care, whistleblower staff and former accreditors claim.

Nurses at several Queensland homes have told The Courier-Mail that supervisors asked them to change records and claim training they never received to fool teams working for The Aged Care Standards and Accreditation Agency.
To beat the system, extra equipment and staff are added before visits and supervisors coach staff on answers, and roster off staff that might give negative answers.
One former nursing home care worker, who asked not be identified for fear of being blacklisted by employers, said The Courier-Mail's story only touched the tip of corruption within the aged care sector.

During the accreditation of her home, 10 extra staff were rostered, with extra cleaning duties. Menus were changed and residents received extra baths to impress family members, he said.

But after accreditation, residents were sometimes left in their beds for two weeks at a time, resident belongings were stolen, and staff ignored the buzzers of residents they didn't like.

The nurse, who formerly worked in a NSW prison, said she saw better care for prisoners.
Care system easily rorted The Courier Mail September 2, 2004

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Restrictive legislation

The accreditation body like the complaints mechanism was effectively nobbled as a regulatory body by its supportive brief and its regulations.

Aug 2001 Friendly assessments

Additionally, there is no credible hierarchy of sanctions. An effective regulatory regime requires the capacity to move up a pyramid of enforcement sanctions. Draconian sanctions, such as the revocation of a licence, are so hard to impose in practice that they are rarely used. More graduated sanctions that reflect the severity of a problem are needed. For example, suspending government payments for new residents until a problem is solved can be used before suspending payments for all residents.
In October 1999, the Aged Care Standards and Accreditation Agency quoted the director of nursing in a private home in its newsletter as saying of her accreditation visit: "They gave a lot of positive feedback to the staff [and] they did not make excessive demands!"
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001

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Appeal system helps the owners

As indicated this system was set up to help the providers and protect their rights. The rights of the individual operator rather than their probity or the welfare of the residents were protected by the law.

As I have indicated elsewhere there is a divide in perceptions between the aggressive entrepreneurs who seek to exploit a market and those who provide and receive care. The system also selects for the often charismatic but unrealistically self confident so that they are unwilling to acknowledge any failings in their homes and respond aggressively to criticism.

As in the USA these groups challenge the sanctions aggressively through the appeals process. The judiciary is familiar with marketplace perceptions, rather than the complexities of the health and aged care environment. As the owners are plausible in this environment they frequently succeed in overturning sanctions on appeal. This is depressing and demoralising for the regulators and seriously impinges on their willingness to sanction other homes and so protect residents.

A good example of this is Graeme Menere whose companies aggressively and successfully appealed the sanctions imposed on the Kenilworth and Belvedere Park nursing homes through the courts in 2000 and 2001. It was only when the law was changed that he was prevented from managing these homes.

Marnotta was almost successful in appealing the closure of the dangerously substandard Tangerine Lodge in 2003.

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Funding and policy critics

Criticism was not encouraged and Non Government Organisations (NGO) that received government money and criticised its policies had to worry about their funding.

Aug 2001 Silencing critics

Once in government, he (Prime Minister Howard) also ended public funding of the Australian Pensioners' and Superannuants' Federation, which had been the leading advocacy group for improving standards in nursing homes, and cut funding to other nongovernmental organisations in the belief that this would silence criticism of the accreditation scheme.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001


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Voluntary codes of conduct

Pensioners input into the Minister’s industry consultation process after the Riverside scandal had little chance of being accepted by the market or the minister. Instead the industry came up with a voluntary code of conduct requiring staff to report the abuse of the elderly. Six years later staff were looking the other way while their colleagues raped and sexually abused 90 year old ladies.

Apr 2000 Problems a direct result of government policy

"Accountability for the care of residents has been reduced to an almost non-existent level,'' the APSF's (Australian Pensioners' and Superannuants' Federation) president, Ms Edith Morgan, said yesterday.

"There are basically no strings attached to their $3.5 billion annual taxpayer funding, or on the contributions that the Government requires from residents' pockets,'' she said.

The superannuants group said that while the system was definitely in need of reform, many of the problems being experienced were a direct result of the Federal Government's moves to deregulate the industry.

The action plan, to be presented to the new aged-care industry forum which is expected to meet in the next two weeks, also includes calls for penalties for proprietors who provide sub-standard care, legislative changes to require adequate and appropriate nursing staff, and greater availability of information on the standard of care provided.
Pensioner Plan Advocates Suing Australian Financial Review April 4, 2000

Oct 2000 A voluntary code of conduct

Nursing home staff would have to promptly report adverse events such as falls, injuries, drug mix-ups and significant weight loss suffered by frail elderly residents under a new draft code of conduct developed for the industry.
The key points of the proposed code of conduct and ethical practice aim to dampen some of the other main concerns of nurses, relatives and others over nursing home care. Some nurses in the industry alleged they had been warned not to complain to health authorities about care standards after the scandal erupted.
The Australian Nursing Federation's Victorian branch assistant secretary, Hannah Sellers, said an industry code of conduct was an excellent idea but she queried what impact it would have if it was not backed up by law. It would also need to win the support of key players in the industry, such as provider groups, nurses' groups and others, she said.

"It's not necessarily going to improve those elements of the industry that need to be improved because the honest brokers, the reputable providers, will already be providing acceptable standards of care,'' she said.
The draft code was developed after Aged Care Minister Bronwyn Bishop set up a forum of industry representatives about seven months ago.
Aged Care Industry Moves To Protect Frail The Age October 17, 2000

Nov 2000 Voluntary code not effective - a poor substitute for action

General practitioners also went on the attack over aged care today, saying that a voluntary code of practice for nursing homes was not effective.

Royal Australian College of General Practitioners (RACGP) president Paul Hemming said the code was a poor substitute for decisive action.
Dr Hemming said independent watchdogs backed up by financial penalties were needed and that role would most effectively be undertaken by GPs.
Aged care department contradicts minister Australian Associated Press November 22, 2000

Aug 2001 Bishop praises industry

The new voluntary code aims to protect the rights of nursing home residents and improve nursing home standards. Under the code, nursing home staff would be encouraged to report any failures in care standards, such as medication mix-ups or significant weight-loss among residents.
"This commitment to ethics is a world first, to have the industry be prepared to come in and support ethical behavior not just legal behavior,'' she (Bishop) said. The code's release comes just days after two suburban Melbourne nursing homes drew criticism for care standards.
Bishop Releases Code For Aged Care Standards The Age August 14, 2001

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The dilemma in closing down homes

The government’s right to take over a nursing home and to bring in its own administrators and staff to protect the residents was compromised by excessive industry friendliness.

Industry involvement in the policies had ensured that regulations protected the operators commercial rights rather than the wellbeing of the residents. The owner could for example choose the new administrator for their sanctioned homes when this was a requirement.

There was no effective means of mitigating the severe trauma to residents when homes were forcibly closed because it was unsafe for them to operate. The government had provided no other options.

As a consequence some critics pressed for homes to be closed. Others wanted the state to take over and run the homes until new owners were found.

Jul 2000 Bad homes still operating

Six Victorian nursing homes are still operating despite being censured by the Federal Government for posing an ``immediate and severe risk'' to the safety, health or wellbeing of their elderly residents.
Residents `at Risk' In Six Nursing Homes The Age July 29, 2000

Jul 2000 Don't close homes, fix them

"We do not want to see them closed," Senator Lees told reporters in Melbourne.

"What we should be seeing from this government is a flying squad, a pool of qualified people who can simply move in and take over."

Senator Lees said she wanted to see administrators employed until such time as the nursing homes were back providing adequate care to residents.
Don't close homes, fix them - Senator Lees Australian Associated Press July 29, 2000

Aug 2000 Sanctions failing

"The sanctions are failing, poor providers are not being forced to improve their standards or being driven from the industry," Senator Evans said.
Home funds cut off Herald-Sun August 21, 2000

Sep 2000 Another patch to the system

The "relief teams" would take over day-to-day running of the facility in an effort to keep it as a going concern and minimise disruption or the need to move residents to new facilities, it said.
Substandard nursing homes to be taken over under new plans Australian Associated Press September 16, 2000

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Government bodies left out in the cold

Even the bodies set up by the government to assist the minister in addressing problems were sidelined and ignored. It should not escape our notice that the two who spoke out and are quoted in the article have a background in the not for profit sector. In the political climate of the time they would be less credible.

Apr 2000 Government appointed expert committees ignored

AGED-CARE experts appointed by the Federal Government to deal with badly managed nursing homes have been ignored by Aged Care Minister Bronwyn Bishop for the past 18 months. Her own department described the role of the eight regional committees as providing "expert analysis and advice" on how to improve or penalise homes which habitually failed to meet standards.

But she has never used these committees to investigate any complaints or allegations of mismanagement.

The chairman of the South Australian committee, Alan Beaton, last night said he had not heard from the department since his appointment two years ago.

He had tried to contact the department by phone and fax three times but had not received an answer.

"There's been no contact of any description, whether written or verbal," said Mr Beaton, who is also chairman of Clayton Church Homes.
Under the Aged Care Act principles, the Residential Care Standards Review Committees were created to investigate unsatisfactory homes and advise on whether sanctions are necessary.

But they have not been used despite the Department of Health and Aged Care applying sanctions on 16 homes since the start of 1999.
The chairman of the New South Wales committee Noel Howard, who ran nursing home operator Illawarra Retirement Trust for 30 years, was appalled by the situation.

"The whole thing is extraordinary, to make an appointment under legislation for a two-year period and then just leave me sitting here," Mr Howard said.

"I keep ringing the department and saying, `what's happening?' "

He has been told it is up to Mrs Bishop to decide whether to use the committees.

Mr Beaton said the SA committee had never met.

"If something happened in this state that required intervention by this committee, it would be literally an impossible task because we have not been formed and we've never been briefed on what to do," he said.
Bishop ignored us, say experts on aged Adelaide Advertiser April 6, 2000

Apr 2000 Bishop had promised to use them

The committees are created under the Aged Care Act principles with powers to investigate bad homes and advise on whether sanctions are needed.
This is despite a pledge in Parliament in August by Mrs Bishop to use all the tools available to her, including spot checks, to get rid of rogue providers.

Mr (Noel) Howard accused Mrs Bishop of ignoring her own laws and risking the safety of nursing home residents.
Homes advisers ignored Herald-Sun April 10, 2000

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Agency overruling accreditation staff

A consistent complaint throughout the accreditaton story, particularly after the failures at Riverside, is that nursing homes with serious problems are treated leniently. It takes many months or years before a home which is a recurrent offender is forced to sell or closed down.

Of particular concern were decisions taken by the agency’s management and/or the health department to overrule both the assessments and the advice of the staff doing the assessments when they advised that a home be sanctioned or closed. This was still happening in 2006. Little wonder the assessors lost heart and enthusiasm.

That residents would suffer if the homes were closed was a convenient justification. It was however no excuse for not setting up an industry unfriendly process to intervene and install government appointed administrators to run the homes until new owners were found.

As the pages describing the governments role in Australian aged care show the accreditation system has failed on multiple occasions and has continued to fail after attempts to patch the glaring problems.

Homes where there was extreme tardiness in acting or where the assessors findings were overruled include.

Homes operated by Milstern, a company owned by the ministers friend. Other homes included Riverside, Belvedere Park and Kenilworth, Tangerine Lodge and Ripplebrook, Emerald Glades, Templestowe Private Nursing Home, St Catherine's Nursing Home, and Albury and District Private Nursing Home.

Jul 2001 Assessors overruled

The nursing home accreditation process in NSW is under scrutiny after a second recommendation that a home lose its accreditation was overturned.
It follows the recent recommendation to revoke the accreditation of Sydney's Yagoona Nursing Home, which was later overturned.
The (Albury) home was found to be not complying with State nursing home regulations, Health Department infection control policies, Quality of Care principles, WorkCover requirements, State poison regulations and the Aged Care Act.

Despite the bad report, the agency's NSW manager, Mr Rod Bushrod, overturned a recommendation that the home's accreditation be revoked.
Reprieve For Second Aged Care Home Sydney Morning Herald July 4. 2001

Jan 2006 Another assessment overturned

The home (Bartonvale Nursing Home) has kept its accreditation despite a recommendation by the assessment team to revoke it.
Opposition aged care spokeswoman Jan McLucas said she was concerned the facility failed so badly after passing compliance checks earlier in the year.

She questioned whether unannounced spot checks were occurring. "This is exactly what the spot check system was set up for - to ensure that confidence in the provision is maintained," Ms McLucas said.
Residents ignored, left in soiled beds The Advertiser January 7, 2006

Mar 2006 And again

The assessment team recommended that the agency revoke the accreditation of the home (Hastings Regional Nursing Home), but instead of closing it down, the Department of Health and Ageing decided to let it operate under sanctions.
Action on abuse of aged The Age March 30, 2006

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Also a community problem

As should now be clear the conflict model of market pressures to dysfunction countered by government regulation and oversight has failed. The socialist government run service model when properly funded seems to provide better or equivalent care at less cost. It has not done well partly because of under funding. It has not provided the extras which a wealthier community desires.

What is also clear is that the community is so distracted by the pressures of their own lives, or diverted by other crises created by government that aged care does not rate highly in their lives. Were this not so the government would have been under greater pressure.

It should be obvious by now that I favour the development and exploration of a community driven and focussed paradigm within which to cautiously develop a new community system for vulnerable services - one in which people can "realise themselves" and act out their lives in a more diverse and humanitarian manner.

It would capitalise on the skills of people whose qualities and expertise are wasted because they are unsuited to the market paradigm and cannot bring themselves to operate in that way.

The difficulty today is that the community is so engulfed in their commercial lives that they have little time for the development of the sort of civil society where such a civilising system could flourish.

Mar 2000 All of our responsibility

THE sad situation at the Riverside Nursing Home highlights shortcomings, not only in the monitoring regime for aged care, but in our determination to meet the needs of older Australians.
Third, we need to re-evaluate funding for aged care and give consideration to returning to a system of funding that ensures adequate levels of trained staff, rather than the proprietors pocketing profits.
Beyond Riverside Herald-Sun March 18, 2000

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Political donations and friendships

The accreditation agency in Australia takes on the role of regulator and penalises offenders. In the USA this is done by state regulators responsible to state politicians but the matters are frequently referred to a federal agency which has the power to review and water down fines. There are consequently two layers of politicians who exert influence.

The leaders of the healthcare corporations in the USA are part of the establishment. They can be politicians or relatives of politicians. Many have friendships with politicians. Most donate generously to political parties. Some US critics see this as the prime reason for the failures in oversight.

Regulators in the USA are appointed by the politicians of the day. Corporate leaders in the nursing home chains indignantly go to their political friends when regulators find them wanting. They accuse the regulator of ineptitude, bias or worse and politicians are persuaded. With their jobs at stake regulators learn to look the other way.

In Australia similar associations are common. Both Doug Moran and Paul Ramsay have had a strong political influence on government policy. Minister for aged care Bronwyn Bishop was accused of using her appointee to the agency to influence accreditation. Concerns were expressed about the leniency displayed to homes run by her friend Millie Phillips.

There is a revolving door between politicians and their staffers, the directors and officers of large companies, and the lobbyists who pressure politicians on their behalf. Companies are wealthy and their public relations exercises have a large impact on the way the public and politicians perceive the situation. The minister for Health Dr Wooldridge is now a director of companies. Macquarie Health, Moran Health Care and Mayne Health are revolving door examples which spring to mind


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Regulators and their political masters

In Australia the accreditation agency was claimed to be an independent organization but some of its officers were appointed from the minister’s close political associates and even her policy adviser, although Bishop eventually decided to make him her chief of staff. It is clear that aged care ministers have imposed their will and their control over the agency. This was particularly evident during Bronwyn Bishop’s tenancy as minister. The favourable treatment afforded the homes owned by a friend, the owner of Milstern, was attributed by some to her influence.

Jun 2001 Allegations of political interference

JOHN Howard was last night under pressure to sack Aged Care Minister Bronwyn Bishop over nursing home-related deaths and a growing crisis of confidence in the industry's inspection system.

The former head of the national nursing home watchdog, Penny Flett, claimed public confidence had been "shattered" in the Aged Care Standard Accreditation Agency because it was unable to do its job independently of government.

"The minister's style is very controlling," Dr Flett said in Perth. "She certainly doesn't step outside the rules and regulations, but the agency is not free to decide how it is going to do things."

Dr Flett's comments came as aged care groups demanded an inquiry into the agency over concerns of political interference.
The independence of the standards agency is under question, following revelations that John Lang, the 1998 campaign manager for the Aged Care Minister, Bronwyn Bishop, is on the board. The former board chair, Dr Penelope Flett, has also said that the agency was gagged by the minister, and was not independent enough. This might explain the defensive, siege mentality reporters have come to expect of the agency.

And this week the Opposition alleged in Parliament that at least one operator, Yagoona's long-time proprietor, Millie Phillips, had received favourable treatment because of her support for the Liberal Party.
Handle With Care Sydney Morning Herald June 23, 2001

Jun 2001 Appointment of Bishop's 1998 Campaign manager

Senator Bishop airily dismissed suggestions of a conflict of interest in her appointment of Mr Lang. "The fact that someone is a friend or a political ally of mine should not disqualify them from playing a national leadership role in raising the standard of care provided for older Australians", she declared severely.
Aged care scandals erupt again The Guardian June 27, 2001

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Sharing Staff

The pool of trained staff of necessity come from the nursing home industry itself and from government departments as these are the people with experience. A revolving door occurs as staff move between government and regulator and between regulator and regulated. (see above extract for appointment of liberal campaign director by Bishop)

Staff who have experience and training as accreditation assessors are a valuable asset for the companies seeking to be accredited and to those seeking to circumvent the process. This is apparent in the US system and is likely in Australia.

Feb 2000 Revolving door between regulator and minister

The spokeswoman confirmed that Mrs Bishop's policy adviser, Stan Piperoglou, had been appointed to the (agency) job in April but Mrs Bishop decided to retain him as adviser and then appoint him as her chief of staff in December.
Kerosene scandal reveals staff crisis in Aged Care Courier Mail February 28, 2000

Feb 2000 This decsion was attacked

Mrs Bishop faced further calls for her resignation following revelations that the man appointed to head the aged care and community services section in Melbourne was taken by Mrs Bishop to become her chief of staff.
No boss for complaints Herald-Sun February 28, 2000

As market thinking and market practices become the norm regulators come to think like the market and adopt market understandings in their decisions. This is particularly well illustrated in Florida (USA) where state regulators condoned and accepted the market justification for simply ejecting frail nursing home residents in need when their funding expired. It required a public outcry and intervention from a federal body before they were charged and penalised. I have already described the Australian accreditation agency’s industry focused approach to spot checks.

A web of friendships and personal contacts develops between the two sides of the oversight process as staff move from one to the other. Loyalties are divided.

Not only can this result in a more friendly and less rigorous oversight process but the nursing homes owned by the largest groups get regular and early warnings of planned visits. Even surprise or random checks are rarely a surprise.

It is clear that some in the agency considered that surprise visits were unfriendly and unfair on the nursing homes. The minister agreed and considered them only a last resort.

What I am saying is that the informal networks of contacts and social networks in the real world we live in works against the effectiveness of formal processes and regulation when there is a lack of congruence. Current thinking ignores these powerful forces and fails to harness them. This is always going to be a problem when the objectives of those working in the system differ from those regulating it.

It is a personal view of mine that the informal structures of friends and contacts in a civil society are far more important in the creation of a successful and functioning society than any amount of regulatory vigour.

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Under Funding of the agency

Any sort of accreditation and oversight costs money and in a marketplace context this turns out to be far more expensive than anticipated. Market theory claims that the market is self correcting. Politicians and the public have little idea of the resources which are needed to control a system which instead of being self correcting is driven in the opposite direction.

Regulatory funding must compete with other government priorities with far more voter appeal. As a consequence under funding is the norm. The costs of funding oversight are seldom included in the total cost of health care when examining different systems.

It is clear from the reports that under funding of the accreditation and complaints systems has been a problem in Australia.

Nursing homes have only been regularly surveyed and accredited every three years which is no more than a token exercise. Homes were warned well in advance. Bigger commercial groups are able to bring in their teams to beef up staffing and processes so that they rarely fail accreditation.

They big companies may in fact all be as exemplary all the time as their records suggest but we don’t know that. My view is that it is unlikely and if it is then it is unlikely to be sustained when financial pressures mount.

Homes where there are serious problems often go for long periods before further inspections occur.

Feb 2000 Agency underfunded

The Federal Opposition spokesman on aged care, Senator Chris Evans, said Government funding cuts had reduced the number of inspection staff and the standards and accreditation agency was 60 to 65 assessors short in Victoria and New South Wales.
Probe Widened Into Aged Care The Age February 28, 2000

Feb 2000 Bishop rejects the agency's claim to under-resourcing

FEDERAL Aged Care Minister Bronwyn Bishop last night defended Howard government aged care reforms, warning the sector would not be getting more funds and the national nursing home watchdog was adequately funded.

Mrs Bishop was responding to claims by the Aged Care Standards Accreditation Agency that it was swamped with work and struggling to carry out accreditations of nursing homes.

Agency general manager Tim Burns claimed the watchdog faced a shortage of assessors in NSW and Victoria.

Mrs Bishop said the industry could forget about the Government boosting funding, as the system was working well despite concerns over the adequacy of subsidies and the state of some nursing homes.
Bishop dismisses demands for funds. The Australian February 28, 2000

Mar 2000 Agency not funded or designed for job

THE (Australian Nurses) federation complains the agency is hopelessly under-resourced for the job. "It's supposed to pick up all the pieces and sort out all the problems, and I don't believe it's designed to do that or has that capacity," says the federation's aged care officer, Jill Clutterbuck.
Crimes of neglect. The Australian March 4, 2000

Mar 2000 Delays in publishing findings and in follow up visits

THE worst nursing home in NSW has not had a follow-up report for almost half a year, despite being rated completely unacceptable.

The Fairlea Nursing Home, at Penshurst, was given an "unacceptable" rating on all criteria used by the Federal Government's new nursing-homes watchdog after an inspection in July last year.

The agency waited until November last year to report the damning results, and no follow-up report has been published since.

With three "unacceptable" ratings, Fairlea found itself holding the dubious honour of being the worst nursing home in the State.
Waiting for action at our worst aged home Sunday Telegraph March 12, 2000

Apr 2000 Calls to fund agency properly

Most groups attending the meeting also want greater funding for the Aged Care Standards and Accreditation Agency to investigate complaints.
Call to act on aged. Herald-Sun April 17, 2000

May 2000 Bishop bows before the pressure to increase funding

NURSING HOMES FUNDING for the nursing home industry watchdog has belatedly been boosted in the wake of the Riverside kerosene bath affair.
Mrs Bishop will also provide extra resources for the Department of Health and Aged Care to expand the investigation of complaints through the Government's Complaints Resolution Scheme.
Funding infusion for aged care watchdog The Australian May 10, 2000

Sep 2000 Agency simply not coping with work load

ONLY one Queensland nursing home had a full inspection by the Federal Government agency responsible for monitoring standards in aged care facilities before July this year. Figures from the web site of the Aged Care Standards and Accreditation Agency show a total of seven homes were inspected in Queensland between last September and June, which represents only 1.4 percent of facilities. Six months after the kerosene bath scandal in a Melbourne nursing home, the figures throw doubt on the Federal Government's ability to ensure reasonable standards of care in the country's aged care facilities. Despite promises to increase full inspections and surprise visits in nursing homes in the wake of the scandal by the Minister for Families and Aged Care, Bronwyn Bishop, monitoring remains sparse. Figures on unannounced inspections can be supplied only by the agency and were not available yesterday.
In New South Wales, only six facilities were visited in the period September to June, five of them in the months following the kerosene baths scandal at the Riverside Nursing Home. In South Australia, a total of three inspections are recorded, or 1 percent of all facilities.
State aged homes miss checks on standards Courier Mail September 16, 2000

Oct 2000 An agency under pressure

Revelations that audits of nine nursing homes had to be done again because the assessors were not registered proved that the accreditation process was under pressure, the federal opposition said today.

Aged Care Minister Bronwyn Bishop told parliament that accreditation audits of the nine homes would be carried out again after it was discovered that the assessors involved were uncertified.
"Despite the government's predictions that only 33 per cent of facilities would gain three-year accreditation, we now find that 97 per cent are being granted this level of accreditation - with just one per cent failing the government's standards."

Every residential aged care service in Australia in receipt of Commonwealth funding must be accredited by January 1, 2001, to continue receiving it.
Aged Care Act breach raises questions about accreditation Australian Associated Press October 10, 2000

Jan 2001 In disarrray

Another Queensland home, the Yumba Binda Aged Persons Hostel at Woorabinda, is also listed as facing sanctions over a risk to residents but the website says it has received the full three-year accreditation. Opposition spokesman Chris Evans said the simultaneous three-year accreditation and sanctioning of Yumba Binda emphasised that the agency's left hand did not know what its right hand was doing. "I do not for the life of me understand how a home could be under sanction for posing a serious risk to residents and, at nearly the same time, receive a three-year accreditation," Senator Evans said.
Aged-care audit net spreads. Courier Mail January 2, 2001

May 2003 Funding and staffing - agency unable to meet its responsibilities

Mr Thomson (Health Services Union of Australia) said budgetary restrictions meant audit teams showed up at nursing homes only once every three years and the heavy use of contractors to perform inspections contributed to huge variations in standards from state to state.
The finding (by the commonwealth Auditor-General) said budget restraints and a focus on regulation had stopped the agency from meeting its responsibility to educate nursing home managers about quality control.
`At-risk' nursing home to stay open. The Australian May 22, 2003

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Staff Morale

In a marketplace oversight bodies are at a distinct disadvantage, particularly when the oversight body is designed to be market friendly and when its processes are tightly regulated so reducing its flexibility. These bodies are too often under funded and under resourced.

What they are asked to do is not possible and if they make a serious attempt to do so powerful figures will attack and discredit them to their political masters.

Oversight agencies usually employ salaried lawyers to prosecute offenders. The big companies in contrast can employ the best legal minds. The oversight bodies are outclassed.

Losing appeals in court cases impacts on the accreditation process, on the careers of those who decided to prosecute and on the funding of the agency. A consequence of this is that larger companies and those who are aggressive litigators are less likely to be found wanting and penalised. It becomes a large and very public legal battle. Many entrepreneurs are supremely self confident and seem unable to recognise or confront their failures. They respond aggressively.

Australian examples include the battles between Mayne Nickless and regulators, Macquarie Health and the tax office, Gribbles and the HIC, and Primary Care and the HIC. In aged care the owners of Riverside, Kenilworth and Belvedere Park Nursing Homes as well as Primelife have resorted to appeals and to the courts.

The consequence of the pressures, the difficulties, the political interference and the legal failures is for regulators to become demoralised and apathetic. This leads to unacceptable variation between accreditation teams. (e.g. see Enhance Aged Care)

They hide their inaction and shield behind process. They use the failure of those who complain, and of other agencies, to use defined processes as justification for their refusal to act.

Staff leave. New staff are difficult to recruit particularly at a senior level. Administration becomes sloppy. Homes get plenty of warning and staff get the job done with a minimum of fuss. As a consequence homes which should not be accredited get full marks from disillusioned staff when others would fail them. There is much to suggest that this has happened in Australia.

Feb 2000 Complaints mechanism under staffed

AGED Care minister Bronwyn Bishop has admitted there is no permanent manager to respond to nursing home complaints in Victoria.

The complaint office has not had a permanent head for almost 18 months.
THE AGENCY monitoring nursing homes, the Aged Care Standards and Accreditation Agency, said it needed 65 more staff to assess nursing homes with only 370 of 3000 homes being assessed so far.
No boss for complaints. Herald-Sun February 28, 2000

Mar 2000 Using process to evade responsibility

A dossier on the New South Wales aged care system detailing two instances of death from morphine overdose was never acted upon because it did not name the sites, Aged Care Minister Bronwyn Bishop said tonight.

The dossier had been compiled by registered nurse Anne Fuller, who sent it to the federal department in June last year, the ABC's 7.30 Report said.

Despite the seriousness of the reports, no one from the departmen rang Ms Fuller, even after the dossier was tabled in federal parliament by the opposition in December, the program revealed.
"A complaint per se could have gone through the (federal department's) complaints mechanism but you do have to name the facility," Mrs Bishop told the program.

Asked why no one in the department rang Ms Fuller, Mrs Bishop replied:

"The important thing was that there wasn't any facility that was identified."
Aged overdose report not acted on in eight months Australian Associated Press March 2, 2000

Jul 2000 Complaints system employees confused

In the wake of the kerosene baths scandal, an investigation by the Commonwealth Ombudsman has found federal public servants running the scheme were confused and did not know how to deal with complaints. There was little guidance as to when they should be referred for further investigation and incidents of assault and harassment were given as examples of "urgent" complaints but not health care matters. The report also found:

  • A lack of information on the complaints scheme for the public and poor staff training.
  • Poor record-keeping of past complaints.
  • A lack of surprise nursing home inspections when serious complaints had been made.
  • A potential lack of impartiality in some areas of the complaints scheme.

The report made 10 recommendations calling on the Department of Health and Aged Care to keep better records of complaints, introduce clearer guidelines and to train staff, all of which the department plans to implement.
Aged care complaint system `deficient' Courier Mail July 25, 2000

Aug 2001 Inspections not rigorous

The biggest worry in Australia is that accreditation teams, which mostly consist of two people, one of whom can be nominated by the facility, are not conducting rigorous inspections before giving facilities a clean bill of health for three years.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001

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A lack of consistency in assessments

A recurrent complaint confirmed by independent reviews was a lack of consistency in the findings of assessors. Some of this can be explained by the fact that the nursing homes vary because they are given the opportunity to spruce up their activities and bring in extra staffing. Additional factors include funding deficiencies, wooly processes to assess, imprecise guidelines, and poor staff morale.

Aged care is the most easily and accurately assessed of all the health related services. Care is very largely depended on adequate staffing levels and when staff levels and skills decline there is an increased incidence of pressure sores, weight loss, dehydration and contractures. Staff numbers, staff training, and each of these complications of staff deficiencies can be quantified and the information collated centrally to give an accurate pointer to homes where problems are likely. Spot checks and savage penalties would soon put an end to forged figures. Clearly there is much more to good aged care than this but given the frequency of these problems this would form a solid starting point on which assessments can be built and then traced back to deficiencies in process.

Oct 2000 Variable findings in same facilities

"Five facilities, which were initially granted three-year accreditation, the highest level possible, have had their accreditation revoked because they failed to meet basic care standards," Senator Evans said.
Aged Care Act breach raises questions about accreditation Australian Associated Press October 10, 2000

Nov 2003 Same home different inspectors

The agency also gave the Albury and District Private Nursing Home the all-clear in January to remain open despite its failure to meet the basic accreditation standards.

But a separate team of inspectors visited the home in July and found a litany of problems.

Management has since been threatened with closure and ordered to clean up its act or lose its accreditation.
The agency has not explained how the first team of inspectors overlooked the conditions or why neglectful homes are repeatedly given accreditation.
Dirty secrets of millionaire's nursing home Daily Telegraph November 3, 2003

Apr 2001 A different result after a spot check

The move to cut back the home's accreditation has heightened suspicions within the industry about the accreditation process which is supposed to guarantee higher standards of care and accommodation in nursing homes.

The spot check on the home was conducted on January and 16 and 17 just three months after the home received accreditation for three years to November 10, 2003.
Nursing Home's Accreditation Cut After Spot Check Sydney Morning Herald April 20, 2001

Jun 2001 Inconsistency of assessors

The inconsistencies of assessors were another serious complaint, as homes within the same organisation, using the same system, received widely different ratings.
Handle With Care Sydney Morning Herald June 23, 2001

Jul 2002 A very different assessment

- - - - the home failed 39 of 44 Federal Government standards (in early 2002)
Deakin federal Liberal MP Phil Barresi said he was concerned that care at the home could deteriorate so quickly.

"In May 2001, the home passed initial accreditation. It also passed a progress review in September 2001, and an occupational health and safety audit in November 2001," he said.
Home cleans up its nursing act. Maroondah Mail July 2, 2002

Mar 2004 Extreme contrast between assessments

There are also concerns about the national system that accredits nursing homes and hostels after a Melbourne home was found to pose a "severe risk" to its residents, just weeks after it passed another audit with flying colours.
Chelsea Private Nursing Home at Edithvale passed an inspection by the Commonwealth's Aged Care Standards and Accreditation Agency in September last year.

On November 7 an elderly resident died after sustaining head injuries in a suspicious incident at the home. Another audit 10 days after the death said there was an "immediate and severe risk to the health, safety and wellbeing of residents".
Health Services Union national secretary Craig Thomson said the extreme contrast between the two reports showed the system was "not tight enough" and too subjective.
Nursing homes in jeopardy Herald-Sun March 12, 2004

Aug 2004 A common problems

Chelsea Private was reassessed in June and passed every one of the 44 standards. But theirs is not an isolated example of such inconsistency. Consider the Vincenpaul Hostel in Melbourne, granted three years' accreditation in November 2002 after passing all 44 standards of care. A year later, following the death of a patient who was given the wrong medication, another inspection team audited the hostel and found it to be in breach of 13 standards, - - - - - .
Another home, Albury Private Nursing Home, in southern NSW, was accredited in January 2003 after passing all 44 standards only to be found six months later to be in breach of nine standards of care.
For the love of Alice; Her family want justice. The Bulletin August 17, 2004

July 2005 Aftter 8 years experience the agency is doing no better

In Woolcock's case, Chelsea Private Nursing Home (see separate web page) had passed a routine inspection one month before her "incident". But two months later, after Woolcock lay dying in a Frankston hospital, the federal health department declared there was a serious risk to the health and safety of residents, and sanctions were imposed. Another inspection was carried out and this time the home failed 19 of the 44 standards. How could so much have changed in two months?
Late justice; A
Senate inquiry into the aged care industry has recommended higher levels of scrutiny The Bulletin July 19, 2005

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An excess of accreditation

One of the reflections that comes from a study of the health and aged care systems is that an excessive emphasis on something other than the actual care given can drive attention and effort away from the intention of the service which in this case is better care. The argument I am making here is speculative but I feel has validity.

Accreditation is based on processes and documentation of those process. Processes and recording of processes increasingly drive the activity in the nursing homes. When the pressures to meet accreditation are strong this diverts attention to these processes and can results in the appearance of care rather than the experience of "care". Staff in Australia complain bitterly about the extensive and time consuming processes they must undertake to be accredited. They indicate that they do not have time for their residents personal needs.

This is a general argument against driving humanitarian services with a primary focus other than real care and caring. Examples are profit (eg the US health system) or surgical turnover and efficiency (eg Bundaberg Scandal in Queensland).

My view is that an excessive emphasis on measured outcomes or the demonstration of outcomes can operate in the same way. When measured outcomes become the object of the exercise and displace care as the primary motive in the system then the values and norms of caring which underpin the sector can be lost.

In accreditation, process and outcomes become substitutes for care which is difficult to measure objectively. It consequently receives less reinforcement. People come to believe that what they are measuring is the same thing. What people do increases in importance at the expense of how they do things as they interact with one another.

This is not to suggest that outcomes should not be measured or are not ultimately important. It is about how outcome measures are presented, understood and handled. It is not a criticism of accreditation or of keeping track but a warning about a lack of balance.

We do need to know when things are going wrong and then find out why. This is not the same thing as process although it may be a process. It is also not a criticism of process which of course is crucial to good care but a criticism of process separated from the caring it aims to improve.

Outcome measures and the monitoring of processes can be pointers to problems. They are not necessarily problems in themselves and they are often not primary objectives.

The argument is that process should be integral to caring and rest lightly. Like the law, the less often oversight processes intrude into caring the more effective they are. Infrequent use reflects a functional and reflective (or civil) community as opposed to an outcome driven, responsive or behaviour driven one.

The frequent failures in accreditation in Australia are a reflection of the sort of system we have set in place and not an indictment of those involved in the process.

Conforming to processes does not mean that good care is given although is does assist in that. If there are frequent failures and care is not provided in spite of processes then this is an indication that the system being audited is defective and/or that accreditation processes have become counterproductive.

What I am suggesting as an outsider looking in is that the focus on accreditation in the Australian aged care system is excessive, and that this is counterproductive. If we had a more sensible system driven by humanitarian motives, and which was not so dependent on the various oversight processes to contain abuse and neglect, then accreditation would be more useful and contribute. We are expecting something from it which it is not capable of delivering. That in itself is demoralising for the staff who do the accrediting.

An excess of process and a need to direct effort to dealing with processes in order to achieve goals can result in the diversion of limited resources away from areas where they are needed more but which are less readily assessed. Staff time is a limited resource.

Apr 2000 Monitoring bad homes cut to divert resources to accrediting others

THE agency responsible for watching bad nursing homes cut back monitoring levels two months before the kerosene baths incident at Riverside Nursing Home.

A leaked document shows the head of the Victorian office of the Aged Care Standards and Accreditation Agency told a meeting of industry members it had reduced activity in this area to focus on nursing home accreditation.
Monitoring cut back Daily Telegraph April 13, 2000

Jul 2002 The problem of too much process

Amaroo Private Nursing Home director of nursing Nusia Krolikowski said there was an "enormous amount" of documentation that was required in relation to accreditation and the level of care needed for each patient "The care staff do feel it," Mrs Krolikowski said. "We try to make it as user friendly as possible" Mrs Krolikowski said the centre had provided in-house training to help improve the efficiency of completing the documents.

An Eildon Nursing Home spokeswoman said there was too much paperwork, ranging from auditing to gaining accreditation, care plans, progress notes, monthly reports and assessments.

"If you didn't do it, you don't get accredited," she said. "We have paid six staff for three hours each to come in and do some auditing. They have no time to do the paperwork (during their shifts)."

Federal Liberal member for Deakin Phil Barresi said the documentation was necessary to ensure a high standard of care in nursing homes.
Home cleans up its nursing act. Maroondah Mail July 2, 2002

Aug 2001 Checking outputs rather than outcomes

Another worry is that accreditation is a manifestation of "the audit society": a triumph of methods from the discipline of accounting over those of other fields that have superior evaluation methods. Auditors tend to check outputs, such as financial or medical records, rather than outcomes, such as health and welfare. Audit is a "ritual of verification" designed to give shareholders "comfort"; audit is actually no more useful in evaluating the quality of investments than it is in assessing the quality of nursing homes.

The first stage of accreditation by the Aged Care Standards and Accreditation Agency shows some elements of an "audit mentality." The first stage is called a "desk audit." The agency's assessors from the private sector can be registered to audit providers by attending a four day course given by organizations like the Australasian Auditing and Certification Services.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001

Aug 2001 Confusing complexity

Funding is only part of the answer. Aged care is an industry enmeshed in red tape. In the office of Mary Barry, chief executive of the Victorian Association of Health and Extended Care, stand four volumes - each 5cm thick - of the aged care legislation. Aged Care Association of Victoria chief executive John Brooks says: "It's incomprehensible. That's why there's such a poor level of understanding of aged care in the community."
Bedridden old lost in care limbo The Australian August 27, 2001

Nov 2002 Paperwork detracts from care

Staff from the Belmore Nursing Home, Chow Cho-Poon Nursing Home at Earlwood, Hume Nursing Home at Greenacre and the Wallgrove Nursing Home at Lakemba will demand A Fair Share For Aged Care by wearing pink outfits.

This is the traditional colour of good health.

Wallgrove Nursing Home's director of nursing, Christine Christie, who has been a nurse for 28 years, said nurses had been lumbered with more paperwork under the accrediation system introduced by the Federal Government in 2000.

She said this was having a negative impact on the amount of time nurses got to spend with patients.

"The critical issues nurses face every day include a chronic nursing shortage, a lack of recognition through fair pay and no time for real nursing," Ms Christie said.

"We have so much paperwork to fill out now.

"We have to write a 12-page plan for each of our residents which reflects the type of care they get but by the time we fill out the reports, we have no time to give them the care described in the plans.

"I love working with the frail and aged and getting the chance to listen and learn from them. But now anyone becoming a frail aged care nurse would become extremely disillusioned because of the amount of paperwork and fleeting amounts of time we actually get to see the residents."
Pink staff sees red. Canterbury Express November 19, 2002

Aug 2004 Obsessed with process

But speak to anyone - whether they are a nursing home owner, a nurse, a doctor, a personal care attendant, or resident's family member - and they will also tell you about a system that post-Riverside and its kerosene baths, has become obsessed with process. They all complain about an inspection system that is drowning in paperwork and, according to staff, comes at the expense of elderly people's care. The nursing home operators won't concede that point, but they do say the need for documentation is costly and often repetitive.

"Riverside created a sea change in how the Aged Care Standards and Accreditation Agency behaved," says Richard Gray from Catholic Health Care Australia, the nation's largest aged-care provider. "It became more policeman-like and needed to be seen to be finding fault."

Or as a veteran aged-care industry insider who is contracted to conduct audits for the agency puts it: "They are very keen on you supplying reports of homes that are done in the correct font and typeface and where all the boxes have been ticked. Whether they are as concerned about the care on the ground is another thing. As long as it looks good on paper, no one can accuse them of not doing their job."
For the love of Alice; Her family want justice. The Bulletin August 17, 2004

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In 1994 I was assured by the federal nursing home licensing authority that the probity of a provider was a key determinant in decisions. Probity is a difficult concept in a competitive marketplace where the right to compete is enshrined. Probity in essence puts the protection of the community ahead of the rights and interests of individuals and it is not necessary for the applicant to have committed any crime.

The privilege of serving the community is granted to those who are seen to have impeccable motives and intentions as well as the necessary skills. Probity and market are consequently poor bedfellows. It is problematic to consider a market listed entity as possessing probity because its primary focus is not the community and its members but profit for impersonal investors. Market listed companies have a fiduciary duty enshrined in law to give their shareholders’ interests priority over those of the community - in other words profit before care. As far as I am aware no company has ever been prosecuted for breaking this law by diverting share holders profits to care. Maybe it will happen!

Legislating for contradictory paradigms creates endless problems in interpretation, particularly when the dominant market paradigm is unsuited to the service to be provided. Probity and market are incompatible bed fellows.

Legislated probityrequirements had been progressively undermined and ignored by state and federal regulators as the health and aged sectors were marketised. Probity as a legislative requirement was removed from the federal nursing home legislation in 1997. As a consequence the burden of proof was moved from the company running the homes to the agency imposing penalties. Owners could aggressively appeal the community’s assessment of a lack of probity through the courts where the probity paradigm was not a legal consideration. Examples where this could have been a factor include the owners of Tangerine Lodge and also of Kenilwoth Nursing Home.

Jul 2000 Challenging the agency

A spokesman for Kenilworth, Graeme Menere, said the home was also challenging the adverse finding against it and seeking damages for ``negligence and defamation''. Pine Crescent Hostel is also seeking legal advice and plans to challenge the penalties.
Residents `at Risk' In Six Nursing Homes The Age July 29, 2000

It required a criminal conviction before a person was barred from management and even this was insufficient grounds for the minister. There was no prohibition on ownership and the indirect control it gave.

Groups which might not have qualified under a strict probity requirement bought nursing homes and were allowed to continue operating them. Examples include Riverside, Saitta and Neviskia, Dampier Bay, Tolega and Karoona, Peninsula Care, CIS Holdings, and McKenzie Aged Care Group.

Also problematic are the family scandal surrounding the Moran group, the primary responsibility to shareholders of DCA and the banks, as well as the strong commercial focus of Milstern’s founder.

Mar 2000 Owner with a criminal conviction

AGED Care Minister Bronwyn Bishop allowed a substandard nursing home to remain open with federal funding although the owner (Graeme Menere) was convicted of a criminal offence.
Despite failing three subsequent inspections, it was given only temporary sanctions, which allowed it to continue operating virtually unaffected.
Mrs Bishop's failure to revoke the approved provider licence from Belvedere Park conflicts with federal aged care laws.

The legislation says the Health and Aged Care Department has to consider whether an applicant for a nursing home licence has a conviction for an indictable offence.
Stalker Allowed To Go On Running Nursing Home Sun Herald March 12, 2000

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A lack of Transparency

The new accreditation and complaints system introduced in 1997 replaced an older one. The results of regulatory inspections in the older system were not published to the public but were available in a library for researchers to peruse.

The new system was to be much more transparent and the results were to be published on the agencies web site. Everything was to be open and transparent. The reality has been anything but.

Mar 2000 Transparency before and after 1997

IT WAS a well-kept secret. Government nursing home inspectors produced detailed reports on every nursing home in the country. And the public had a right to read them.

The Herald stumbled upon these reports four years ago. The then Federal Health and Family Services Department provided us with the most recent reports, and told us to look in the State Library for the rest.
Since the Howard Government began to reform the aged-care system in late 1997, even the savvy have been in the dark about standards at least in NSW.

Although the system promised greater openness a Web site, for example but until the Riverside nursing home scandal blew up, there has been less.

If you had wanted to check out a home in NSW this year, bad luck. The new Aged Care Standards and Accreditation Agency, which now monitors nursing homes, will refer you to its Web site. But until last night NSW was the only State where it was not yet possible to learn if any nursing homes are substandard, or if there are causes for concern.

For the first time the agency has listed on its Web site "review audit'' reports on homes recently inspected in response to complaints, official concern, poor history, or other reasons of "risk management''.
How To Identify The Bad Nursing Homes Sydney Morning Herald March 11, 2000

Only the results of the most recent inspection are available on the web site. There is often a long delay between inspections and the appearance of the report on the web site. Nursing homes, particularly the larger ones move in staff to fix the problems and an early follow up inspection of the home soon replaces the bad one so that bad reports are often out there very briefly. Some bad reports such as the DCA report on their home at Caulfield are missed by the press.

This may act as an incentive to the companies to address the problems but it denies future residents and their families the overall knowledge of a homes track record so that they can make informed decisions.

As far as I am aware the agency does not publish figures showing the long term results of the accreditation of the homes, critical information for detecting recurrent offenders. Nor does it publish analyses of the figures, or provide evidence of the consistency and the effectiveness of its practices. It is left to others to speculate and infer.

The inference from this lack of information is that either the agency’s self assessment is so bad that it will not disclose it or worst still it is so ideologically driven that when it was set up no arrangement was made to collect and collate the information.

In fairness to the agency it does offer to supply assessments from its archive and it did send me the few I asked for. To obtain the many thousands of assessments made over the last several years and personally analyse them is more than I am prepare to do. It would tie me up for a year!

The press reports make a number of other criticisms.

At a critical stage over the period when the Riverside scandal broke the web site was down for a long period of time. An advocacy group rose to the occasion and posted the reports it possessed on its web site including some of the older reports.

This caused angst in the industry and the powers that be were clearly threatened. They mounted an attack on what they called a "rogue" site. They criticised the posting of older reports when new assessments showing compliance and problems corrected - but not yet posted on the agency’s web site. At the same time "legal reasons" were used for refusing to make information available.

Why the nursing homes track records should be hidden from the public whose members had been put at serious risk just because they claim to have patched it up is unclear. If we are to have a market then we need to know what they were capable of when no one was watching - not what they did when their future operations were at stake.

Mar 2001 Web site offline

Mrs Bishop also appeared to cave in to demands for a list of the country's worst 18 nursing homes to be made public, as audit reviews completed by the agency began to reappear on its Web site last night.

The agency's Web site went offline last Friday following revelations of mistreatment at Riverside and an admission from Mrs Bishop that there were 18 more nursing homes around the country in serious breach of industry regulations.

Mrs Bishop yesterday rejected claims that her department was hiding that list, insisting that reports on nursing homes were available on request from the agency.
New inquiry at kero bath nursing home The Australian March 1, 2000

Mar 2000 Legal reasons

It is understood the Aged Care Standards Agency yesterday ruled out releasing details of other facilities seen to be of "serious concern'' for legal reasons.
Bishop Denies Aged-care Crisis Amid Rising Fury Australian Financial Review March 1, 2000

Mar 2000 Web site back on line

The official ratings site of the Aged Care Standards and Accreditation Agency (ACSAA) yesterday began listing recent audit reports from hostels and homes around the country.
No nursing homes closed down by government, Bishop admits Australian Associated Press March 2, 2000

Mar 2000 But only those audits the authorities chose to put on

The latest assessment reports by the Aged Care Standards and Accreditation Agency were still unavailable to the public for 17 of the 21 nursing homes named as substandard by the Herald Sun on Tuesday.
Get tough on rogues, Bishop told Herald-Sun March 3, 2000

Mar 2000 Rogue web site posts audits

A website list (Nancy’s Aged Care Site) rating the standard of more than 200 nursing homes across Australia was unauthorised and defamatory, federal Aged Care Minister Bronwyn Bishop said today.

Set up by a community group called the Residential Care Support Network, Nancy's Aged Care site categorised the standard of 224 nursing homes from commendable to serious risk.
But Ms Bishop dismissed the list as unauthorised and based on information downloaded from old reports on the official website of the Aged Care Standards and Accreditation Agency (ACSAA).

The list besmirched good and decent nursing homes, many of which were operated by religious organisations, she said.

She said 28 homes categorised as not having passed government standards had since met the federal government's standards.
Website list defamatory and unauthorised, says Bishop. Australian Associated Press March 1, 2000

Mar 2000 Bishop attacks rogue web sites

A Web site known as Nancy's Aged Care Site contains all nursing home assessments which had been available on the agency's Web site until late December when the site was shut down for renovations. Mrs Bishop yesterday dismissed Nancy's as a rogue Web site.
Bishop Says System OK. Herald-Sun March 2, 2000

May 2000 Refusing to release information

But when it came to finding out other details about the nursing homes crisis Labor Senators found they had to rely on cross-party support to force public servants to surrender a few answers.

ALP Senators and their colleagues complained bitterly on Tuesday that 95 questions on notice about nursing homes to Aged Care Minister Bronwyn Bishop lodged in February and early May were still unanswered.
Surprise checks on nursing homes Daily Telegraph May 25, 2000

Jul 2000 Release of reports only after the issues went public

However, details of the audits only emerged yesterday following public revelations of conditions in the homes (Parkdale and Willowood).
Unveiled: Nursing Home Filth Sydney Morning Herald July 28, 2000

Jul 2000 Audits published but hidden on obscure web page

Nine homes in NSW and Victoria have been blacklisted as substandard and barred from receiving commonwealth subsidies until they are improved.

A detailed audit of the sanctioned homes was published on an obscure page of the Aged Care Department's website on July 10. The sanctions on the nursing homes range in severity from an insistence that a new administrator be appointed to a suspension of subsidies for 12 months.
Federal Opposition spokesman for aged care Chris Evans said information about the substandard homes should be made available on the Aged Care Standards and Accreditation Agency website.

"The system is failing the public if families can't easily find out information about their loved ones' care facilities," Senator Evans said.
Nursing homes on aged care blacklist. The Australian July 28, 2000

Aug 2001 Reports removed from site when they became inconvenient

The government has maintained the integrity of the old standards monitoring process by continuing to make accreditation reports on nursing homes available to the public. However, when critics complained about the weak enforcement of standards and about nursing homes that were providing poor care the Aged Care Standards and Accreditation Agency removed its accreditation reports from its website so as "not to put undue pressure on homes" (in the words of the minister).

This was another political disaster: a rogue website posted the worst accreditation reports. The secrecy of self regulation, which had led the United States to reject accreditation and self regulation, had become reality in the supposedly superior Australian accreditation system.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001

May 2000 No assessment of the agencies own performance

"While a number of factors and entities contribute to the quality of care provided to residents, the agency does not yet have a way to assess the outcome of its accreditation and monitoring work on the residential aged care industry," the report says.

His comments echo the commonwealth Auditor-General's finding that the Aged Care Standards and Accreditation Agency was unable to assess whether its work improved the quality of life of nursing home residents.
'At-risk' nursing home to stay open. The Australian May 22, 2003

Nov 2003 Weak management systems

"The ANAO also concludes that there are some weaknesses in the agency's management systems, which impact adversely on its management of the accreditation process."
Dirty secrets of millionaire's nursing home Daily Telegraph November 3, 2003

People who have complained and whose complaint has been investigated by the accreditation agency have not been given adequate feedback or access to the findings - even after costly court battles.

Feb 2006 information given only when requested

LILLIAN JETER: The only investigation that I know about, sir, is my personally taking the case file and the allegations from the carers to the Aged Care Accreditation Standards Agency before I left after a meeting with one of their managers, my question was, "What are you going to do now?" They said, "We will act upon this immediately." About two months later, I found out that a spot check was done and then they reported back to me upon my asking them to. I had to go back to them and they reported back to me at that point, later at the end of January, and they said that they did not really find anything untoward at that facility.
Allegations of abuse at aged care facility Lateline ABC TV February 20, 2006

Mar 2006 $93,000 in legal fees to get only some of the report on her complaint

DR JEAN DUNCAN: I was given seven words from the Federal Aged Care Complaints Resolution Scheme, absolutely nothing from the Accreditation Agency, so I didn't know what form the investigation took. I didn't know what the findings were, I didn't know what recommendations had been made, I didn't know what monitoring was going to occur.

MATT PEACOCK: So began a bureaucratic battle that dragged on for years through no less than seven Government agencies. The nursing home fought Dr Duncan all the way here to the Federal Court to stop her from citing the original assessment of her complaint. Along the way, various bodies like the Commonwealth Ombudsman told her that it revealed only minor problems. When she did finally get it, the first person ever to do so, it was a heavily censored version.

DR JEAN DUNCAN: This is the detailed assessment team report. It took me nearly three years to get and it cost $93,000. You can see quite a lot of information has been blocked out. That's the sum total of all of that effort.

MATT PEACOCK: - - - - In the nursing home file it found one note: "Staff rights must come before residents rights", - - - - - - . The team concluded: "Staff appeared unable to provide the level of care required, nor was it clear the facility could accurately assess resident needs.
MATT PEACOCK: But Jean Duncan fears her mother's case is just the tip of an iceberg.

DR JOAN DUNCAN: It's a scandal, a national shame. People are being abused in minor and major ways in our residential facilities across Australia on a daily basis. Since I've been involved in this case and people come to me and tell me of their own personal experiences and following my mother's complaint has literally been like opening a can of worms.
Elderly abuse prompts Govt measures ABC TV
7.30 Report MARCH 15, 2006

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Using accreditation to drive change

Accreditation deadlines

The development of, failures in and attempts to patch the accreditation and complaints mechanisms are part of the story of the government’s role in nursing home care. This section deals only with some aspects of that story.

Prior to 1996 there was a smaller selection of criteria used for oversight and regulation. State bodies were responsible for inspection. I am not sure how accreditation was done and by whom but it does not seem to have been a major component of the oversight process.

After 1996 state regulators were closed down and a separate federal accreditation agency was set up. Oversight was moved from state bodies over whom the industry friendly federal government had little control. It was vested in the federal accreditation agency. Burdensome regulations, staffing requirements and restrictions on the way business used the money it received from government were lifted.

The government set a deadline by which all homes receiving government funding would have to be accredited. As early as 1998 it had a list of substandard homes it was targeting.

The government exerted considerable pressure on homes to reach this goal by 2001 threatening to close homes. In practice it was very reluctant to deny accreditation and to close homes. Most often it gave extensions. The opposition complained about this.

Aug 1998 Policy blamed for shocking care

The Federal Government has a secret list of 41 Victorian nursing homes and hostels which it regards as facilities of concern. Today The Age publishes the most recent list which contains the names of 31 homes. The other 10 are unknown.

Facilities of concern are homes that the Department of Health and Family Services believes are in serious breach of basic care standards.
An attachment to the list says that of the 41 facilities, 13 have been issued with a notice of non-compliance, the final step before sanctions are applied.
``It is outrageous that the minister has not acted immediately. He knows where the homes are but has done nothing. He should get in there and clean this mess up,'' Ms Macklin said. ``Two things have happened since this Government came to power. They took $479million out of aged care and they changed the rules so homes no longer had to employ qualified nurses. The result is shocking care.''
Secret List Of State's Hostels The Age August 26, 1998

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The small nursing home

Money did not go to the smaller homes who needed help to meet accreditation standards. Many were forced to sell so favouring consolidation. Some who had devoted their lives to caring for the frail in the community as best they could in small homes suddenly became pariahs and were forced out of business.

Mar 2000 The plight of some old homes

As a news reporter, I was sent out to another nursing home to talk to the insensitive monsters who ran a home where, among other things, incontinence pads were too small and chemicals were stored in unlabelled sauce bottles.

When I arrived, I was confronted by a director of nursing who said, with tears in her eyes, that she had been at the home for 14 years and that it was owned by a 78-year-old woman who had worked there six days a week for the past 30 years. She said the staff were working hard to address the problems, but the home would most likely not survive.

I believed her, and felt sorry. After years of neglect from regulators, the small home was being asked to meet rigorous standards. The way things had been was clearly nowhere near good enough and you have to wonder how, in good conscience, the situation was allowed to develop.

But it would be wrong to assume that it was caused by malice or laziness or greed. Ignorance and inadequate funding would be a better place to start. You can't meet standards that haven't been set or monitored, with money you don't have.

And in an environment of rampant economic rationalism, even the best people can be persuaded to accept conditions they know in their hearts to be unacceptable. ``We simply can't afford it,'' is hard to argue with.
Of Kerosene Baths And Harsh Truths The Age March 7, 2000

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For profit and not for profit

In the for profit sector it was predominantly the smaller companies and the commercial enterprises in Victoria which were problems. These were groups entering nursing homes as a business, often without any other motivation or without knowledge or skills. The failures have been covered in more detail on pages devoted to the companies. Overall for profit homes had several times the frequency of failures in accreditation.

In the not for profit sector, homes in smaller country towns and ethnic communities did not have the local skills or knowledge to set up the complex accreditation processes. Some peripheral homes run by large church groups also lacked expertise. They needed a lot of assistance. Homes established by immigrant groups had similar difficulties with accreditation.

The larger not for profit groups did not always perform well and some homes had problems. Many of the homes were old and in poor condition. Maintenance and refurbishment may have taken funds from care. The pressure to operate as commercial entities may have had an impact.


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Building standards

Many nursing homes were in converted buildings and others were simply aging. The government specified new standards for the physical environment which were to be met by fixed dates. It was not generous in funding this and the homes had to find most of the money from other sources including from care. This may have contributed to difficulties in meeting accreditation goals. These problems were greater in older established not for profit nursing home owners serving the poor. They had been chronically under funded and many of their older facilities needed extensive upgrading or rebuilding to meet the goals set.

Nursing Home Filth

Within the next nine months, he (CEO of Tricare) said, more homes would be forced to close, with providers unable or unwilling to keep pace with changes set by the new Aged Care Standards and Accreditation Agency, thereby losing their government subsidies.
At the same time as residents were entering nursing homes older and more frail than in the past, the aged population was increasing and the federal Government's accreditation requirements had placed increased pressure on available capital.
Industry fears more Riversides. The Australian March 20, 2000

Mar 2000 Extent of the problem

During monitoring visits to 229 nursing homes between July 1998 and last November, the Aged Care Standards and Accreditation Agency found 83 homes failed to achieve satisfactory standards for buildings and safety systems.
Half the nursing homes inspected pose risk to patients Australian Associated Press March 23, 2000

Mar 2000 Bishop acuses Victorian government of not upgrading homes

A spokeswoman for the Minister for Aged Care, Mrs Bronwyn Bishop, said Victoria had been slow improving the building quality of several nursing homes it owned. About 52 nursing homes across the country were yet to reach building certification standards required under federal law, she said. Thirty-eight of these homes were in Victoria and 17 of them were owned by the Victorian Government, she said.

The deadline for states to meet certification requirements was the end of June, she said.
Nursing Homes Checked The Age March 25, 2000

May 2000 Risk of closing homes - Bishop's attitude to responsibility to residents

Mr Fitzpatrick said six homes in Melbourne would not meet the Federal Government's accreditation standards by this year's December 31 deadline because they would not meet building standards.

He said the department needed to outline its plans clearly to avoid anguish for residents who had to relocate and their families. The government had only offered a ``motherhood'' statement, that they would work with providers to ensure ``minimum disruption''.
She (Bishop) said it was the responsibility of the care provider to find accommodation nearby for their residents if they did not meet accreditation standards.
Call For Plan On Nursing Home Closures The Age May 26, 2000

Nov 2000 Threats of closure in Jan 2001

UP to 50 aged care homes, containing an estimated 2500 beds, face closure in the new year for failing to get federal government accreditation and funding, the Aged Care Department has said.

The homes would close because they had failed to gain certification for building and environmental standards, or accreditation for their level of nursing care.

Aged care providers who fail to get certification and accreditation by December 31 will cease to get bed funding from the Government.
50 aged homes below standard The Australian November 23, 2000

Jan 2001 But the minister ducks and keeps them open

But Health and Aged Care Department secretary Andrew Podger has agreed to let some take another six months to meet standards because of exceptional circumstances.
Nursing home futures in doubt. Herald-Sun January 1, 2001

Jan 2001 There have been benefits

Nearly 200 nursing homes have closed or relocated in the past three years as part of the Federal Government's move to improve aged care standards.
The government also confirmed yesterday that 20 nursing homes, 16 of them in Victoria, were given a six-month lifeline to improve standards to reach accreditation.
The national director of the Council on the Ageing, Denys Correll, said the process had improved the industry. ``It's made facilities far more conscientious in looking at the range of quality issues that they need to.''
Nursing Homes Fail To Make The Grade The Age January 2, 2001

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Fire safety targets

Another of the targets set by government were fire safety standards and once again there were those who ignored the requirements and a government which allowed this.

Feb 2006 Dilemma of 20% of nursing homes not meeting fire standards

ALMOST 25,000 elderly Queenslanders remain at risk in nursing homes that have failed to meet new fire safety standards.

The homes failed their tests although the state received more than $218 million in federal funding two years ago for sprinklers, fire doors and safety equipment.

One in five nursing homes across Australia have not met a two-year deadline to get their buildings up to scratch.
More than 40 per cent of Queensland nursing homes still had not reached fire safety standards introduced in 1999.
In June 2004, after a spate of nursing home blazes, the Federal Government provided a one-off payment of $3500 a resident to meet the fire safety standards.
Newly installed Federal Minister for Ageing Santo Santoro said the fire safety standards were voluntary guidelines and the deadline was also voluntary.

Senator Santoro said if the nursing homes were closed . . . "what do we do with the residents? These people are safe. It's much safer than normal residential homes."

Former ageing minister Julie Bishop said last year that nursing homes would have their accreditation reviewed, with a view to be cancelled, if they failed to meet the fire risk deadline.
Nursing homes fail fire risktest The Courier-Mail February 11, 2006

Apr 2006 In spite of 7 years to upgrade - no sanctions imposed

THOUSANDS of NSW nursing home residents are living in fire traps despite the homes' owners pocketing a share of $513million in taxpayers' money that should have been spent on safety.

In NSW, 156 nursing homes have failed to meet a December 2005 deadline to upgrade safety.

But the Federal Government has applied no sanctions on the homes, despite them being given seven years to do the work and $513million having already been dished out.
Senator McLucas said some nursing home operators had taken the grant, not upgraded, and sold their home to a new owner.
Elderly living in death traps - Nursing home cash not spent Daily Telegraph April 18, 2006

Jun 2006 Six months later 14% still don't comply

It's now six months since the expiry of the Federal Government's deadline for nursing homes to comply with the new standards, and figures show that 14 per cent of homes across Australia still don't comply.
396 Australian nursing homes fail fire safety standards Lack of fire safety still in nursing homes Australian Broadcasting Corporation Transcripts June 6, 2006

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The Complaints Mechanism

Strangled by regulation

Complaint mechanisms have been an ongoing source of complaint in aged care in the USA and the stories of brick walls and inappropriate responses are legion. They did have the legal power to act although this was often very difficult.

In contrast the aged care complaints system in Australia was set up so that it would not work. The mechanism was given no powers. They were not allowed to investigate or prosecute.

As was startlingly revealed in the Riverside scandal the complaints unit was required to mediate between the complainant and the nursing home. A serious complaint did not result in surprise visits. The home was consequently in a position to alter records, develop justifications, hide evidence, deny what happened and put pressure on staff, the resident and the family to drop the matter.

When the ombudsman issued a critical report the minister’s department delayed its release while they tried to have it watered down.

Mar 2000 Many complaints but no action

In the past year the Commonwealth has received more than 4000 complaints from relatives, friends and lobby groups for the old and frail, bemoaning the poor state of aged care facilities. Stories of elderly residents tied in chairs with blankets, fitted with infants' nappies, living in dirty rooms, eating cold meals and suffering untreated infections are more common than anyone wants to believe.

Yet it was not until 57 scabies-ridden patients at Riverside - a home known to the Federal Government and its predecessors for a history of neglect - were forcibly bathed in kerosene, with some consequently suffering burns, that anyone was stirred to action.
Crimes of neglect. The Australian March 4, 2000

Mar 2000 Need to respond when problems reported

"Whilst the Australian Nursing Federation supports the concept of accreditation, there needs to be something in addition to that to ensure these facilities are inspected when there are problems," ANF Victorian branch assistant secretary Hannah Sellars told ABC radio.

She agreed with Mrs Bishop that there were many nursing homes across the country providing an excellent standard of care, but said some service providers were only interested in making a profit.
Six deaths to be investigated at Riverside nursing home Australian Associated Press March 10, 2000

Mar 2000 Complaints get lost in system

These actions should be detected, in theory, through people making complaints and inspections carried out as part of the accreditation process. But, as we have heard in the past week, complaints get lost in the bureaucratic system and unexpected spot checks by authorities are rarely carried out.
We all must nurse some responsibility The Australian March 10, 2000

May 2000 Ombudsman critical of complaints system

THE Commonwealth Ombudsman has attacked the Federal Government's aged care complaints resolution process. A report prepared by the Ombudsman is due to be handed to Aged Care Minister Bronwyn Bishop and the Secretary of the Department of Health and Aged Care Andrew Podger.
Deputy secretary Mary Murnane (the agency) told the hearing (Australian senate) the emphasis was now on officers erring on the side of seriousness when evaluating a complaint. - - - - - - Ms Murnane said. She said she had had many conversations with the Melbourne staff since then to try to understand why they had not recognised the seriousness of the complaints.
Official blast on aged care Courier Mail May 4, 2000

Jul 2000 Ombudsman report delayed by government objections

According to staff in the ombudsman's office, the report's release has been repeatedly delayed because of the department's objections to criticisms made by the ombudsman, Ron McLeod.

He initiated the inquiry last February after receiving complaints about the resolution scheme, including its inordinate slowness.
Ombudsman Muzzled Sun Herald July 23, 2000

May 2000 Failures and delays

A serious flaw has emerged in the Federal Government's response to complaints against residential aged-care facilities after a Senate committee was told of five suspicious deaths at a North Queensland nursing home that were not investigated.

Officials from the Department of Health and Aged Care told the committee that despite complaints being lodged with State bodies about the care provided at Alchera Park Nursing Home, no investigation of the deaths had taken place.
The Senate committee also heard of disturbing delays in the department's response to a complaint that a Victorian nursing home operator was a convicted stalker.

After receiving a complaint in May 1998, the department took 18 months to write to the man in December 1999 to ask whether the allegations were true. Officials yesterday confirmed they had yet to determine the truth of the allegation.
Suspicious Deaths, Stalkers Add To Nursing Home Saga Australian Financial Review May 24, 2000

July 2000 Ombudsman finds complaints simply ignored

So she wrote to the Department of Health and Aged Care and also raised concerns about the home being run by people who had criminal convictions. She felt the Department's Complains Resolution Committee treated the complaint as an academic exercise, so she went to the Ombudsman.

Senior Assistant Ombudsman John Taylor conducted the investigation. He interviewed Mr D, an employee in the nursing home, who complained that residents had to provide their own food, pay for incontinence pads, with inadequate fire safety and disposal of infectious waste.

He told Mr Taylor he'd complained more than once, but the Department's Complaints Resolution Scheme officer failed to contact him.

Another witness, Mr E, who'd worked for the Aged Care Standards Office, said he was aware of other people who'd lodged complaints to the Department about the home, but, quote, nothing had ever been done about it.

John Taylor found widespread problems in the nursing home sector, particularly, he says, with the inadequate Complaints Resolution Scheme.
Damning report on complaints in aged care ABC PM - Transcript July 24, 2000

July 2000 Ombudsman's report finds complaints staff confused

In the wake of the kerosene baths scandal, an investigation by the Commonwealth Ombudsman has found federal public servants running the scheme were confused and did not know how to deal with complaints. There was little guidance as to when they should be referred for further investigation and incidents of assault and harassment were given as examples of "urgent" complaints but not health care matters. The report also found:

  • A lack of information on the complaints scheme for the public and poor staff training.
  • Poor record-keeping of past complaints.
  • A lack of surprise nursing home inspections when serious complaints had been made.
  • A potential lack of impartiality in some areas of the complaints scheme.

The report made 10 recommendations calling on the Department of Health and Aged Care to keep better records of complaints, introduce clearer guidelines and to train staff, all of which the department plans to implement.
Aged care complaint system `deficient' Courier Mail July 25, 2000

July 2000 Complaints simply ignored

The investigation was prompted by repeated calls for help from Ms A, the daughter of an elderly resident - - - - .

After repeatedly appealing for the Complaints Resolution Committee to address her concerns, Ms A removed her mother from the home but continued to call for an investigation into the lack of attention her complaint received.

A Riverside employee, Mr D, told the ombudsman he had complained as early as July 1997 about conditions in the home, where residents were required to supply their own food, pay for their own continence aids, and were threatened by inadequate infectious waste disposal facilities and fire safety precautions.
Damning Verdict On Nursing Homes Sydney Morning Herald July 25, 2000

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Still happening in 2006

Glaring examples of failure in the complaints mechanism have continued to occur into 2006. One of the worst of these was the George Vowel home where relatives complaints had been repeatedly ignored. Even after their mother had been raped the complaints system did not respond with much alacrity.

Feb 2006 Inadequate response to complaints

MARGOT O'NEILL: Gail Chilianis says she also felt the Federal Government's aged care complaints resolution scheme failed to deal with their concerns. Despite writing a letter in early December last year, they have yet to receive a written reply. Instead, they've been telephoned twice.

GAIL CHILIANIS: It was quite dismissive, the conversation. I felt extremely let down and extremely frustrated. Where do we go now?
Aged care abuse reporting scrutinised Lateline ABC TV February 21, 2006

Mar 2006 The 2005 Senate inquiry identified problems but nothing done about them

"One of their (2005 Senate inquiry) strong recommendations was to do something about the complaints system and that seemingly hasn't even been looked at by the Government," Ms Ellis said.
Action on aged care abuse issue demanded Canberra Times March 14, 2006

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Why complaints are resisted

Is it little wonder that those running the complaints service, became disillusioned, apathetic and then fob off those who complained. Their hands were tied by the requirement to mediate rather than investigate. When we consider the response to complaints it is hardly surprising that nursing home staff did not bother to report abuses and that some did not see it as their role to report sexual abuse and rape.

An additional factor is undoubtedly the mindset of the people examining complaints. They are appointed by the government and are drawn from the establishment and business sector. They readily adopt the market position and tend to see those who complain as trouble makers and the ones who have problems or don’t understand.

The way in which this happens in the nursing homes is well illustrated by the account of one of the daughters of a raped woman in the George Vowel home in 2006. The same thing happened to them with the complaints agency. The Ombudsman was also scathing.

July 2000 Agency labelled people as "serial complainants"

The ombudsman's damning report found the department had written off Ms A and another witness as ``serial complainants''. But the ombudsman found both were credible witnesses, and concluded the complaints procedure failed to rectify cases of neglect.
Damning Verdict On Nursing Homes Sydney Morning Herald July 25, 2000

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Reluctance to complain

Residents and family members are sticking their necks out into the unknown and are anxious and unsure of themselves. They are fearful of retribution and are sometimes genuinely angry. They would prefer not to make a fuss but have been met with resistance when they have raised issues with the staff at the home. Some may be less balanced than others yet have genuine complaints.

In other instances the families are aware of the difficulties overworked staff have in understaffed homes have, identify with them and are reluctant to complain. For all these reasons those who complain are vulnerable and at risk when their credibility and objectivity is challenged.

The gut instinct of those dealing with hundreds of complaints, particularly when some have been unfounded, is to label the person complaining as lacking objectivity in some way. This absolves them of the need to act. Anyone who has tried to blow the whistle on an organization will be familiar with this.

There are many examples where the complaints mechanism in Australian aged care has failed.

Mar 2000 Reluctant to complain

Because there is such a shortage of beds residents and families feel they are lucky to have a bed so are reluctant to complain.

Because entry is restricted rooms in nursing homes are as scarce as hens' teeth with waiting time for access averaging more than a month.

Residents or their carers are, therefore, willing to overlook poor standards to ensure that at least they have a room.

Some owners are willing to maintain low standards in the knowledge that they will not be closed because of the absence of alternative facilities.
Quality aged care is a family duty Herald-Sun March 11, 2000

Mar 2000 The dilemma for residents' families

Relatives are wedded to the institution in which they have placed their loved one. They are often loath to see its deficiencies, are fond of kindly staff, and are ignorant of better practice.

It is a case of better the devil you know ... and unless relatives are daily visitors, they may not see the horns at all.
Whenever relatives place their loved ones in an institution, suffering agonies of guilt and grief in the process, experience has shown they will be fiercely loyal to it, denounce the fault-finding experts, the media, and the politicians who take action.

Even a substandard institution becomes a home to the residents, and a move from familiar surroundings is often traumatic. But it can be more traumatic for the relatives. It is hard for relatives to accept that they made a poor choice through desperation, lack of alternatives, or lack of knowledge.
Be It Ever So Awful: No Place Like Home Sydney Morning Herald March 11, 2000

Nov 2003 Residents feel guilty

"Residents feel guilty because they know the pressures the staff are under. There's a culture of excuse created that disguises the true problems," he said.
Dirty secrets of millionaire's nursing home Daily Telegraph November 3, 2003

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Patching the system

In an attempt to address these matters some steps have been taken to patch the system and make it leak less often. In 2000 Senator Bronwyn Bishop set up SWAT teams to go out and investigate when complaints were made. I have not seen any subsequent reports of their activities and given the continued deterioration one wonders if these suffered the same fate as the committees set up to advise on sanctions in 1999 but never used.

The findings of a senate committee in 2005 and the experiences in 2006 show that the patching done over the years had little impact. In 2006 the new minister for aged care instituted a raft of new measures to patch the system - police checks, compulsory reporting, more spot checks and more money thrown at process and oversight rather than care. One wonders if they will be any more effective.

Mar 2000 SWAT teams set up

The Federal Government has moved to stem the politically damaging nursing home scandal after announcing details yesterday of a SWAT team to investigate allegations of residents being maltreated.

The establishment of the special team within the Aged Care Standards and Accreditation Agency to ensure serious issues are followed up was revealed by the Minister for Aged Care, Mrs Bronwyn Bishop, in a speech to a Brisbane conference.
New Crisis For Battered Bishop Australian Financial Review March 31, 2000

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Examples of Failures in care

Numerous examples of failures in care are documented in the agency’s records most of which are no longer available on the agency web site. Press reports at the time give an indication of the findings. Extracts from these press reports are given on the web pages dealing with a selection of the companies. Only a few examples are given here.

Extensive and more detailed information is given on the web pages for the individual companies and other accounts are on the government pages.


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1998 and earlier

I am not suggesting that the situation was good prior to the changes at the end of 1997. The system was chronically under funded, buildings were in disrepair and instances of poor care were probably common. The report below is probably representative.

Aug 1998 Probably many problem homes

Meanwhile, Insight has uncovered that a private nursing home in Camberwell has been under the scrutiny of the Commonwealth Government for more than three years and failed to meet any of the most basic standards of care when it was monitored in February this year.

Princeton Nursing Home, in Bellett Street, Camberwell, had been visited by the Department of Health and Family Services' inspectors on 12 occasions. Financial sanctions were finally imposed on 1 April this year, preventing the home from admitting any new residents, but these expired almost two months ago.

It is believed that Princeton received the most damning standards report ever compiled by the department. It failed to meet any of the 29 expected outcomes.
The quality of life and care of the 30 elderly residents at Princeton Nursing Home was seriously compromised, according to the Government's standards monitors.
He (Princeton owner) said he doubted that his home would meet the new accreditation standards that all homes must comply with by 1 January 2001.
Secret List Of State's Hostels The Age August 26, 1998

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The year 2000

By 2000, three years into the new system, the honeymoon was over. The Riverside scandal energised the nation and made nursing homes newsworthy. Many more reports of problems in other homes were published.

Mar 2000 A multitude of problem homes - Queensland

SEVEN Queensland nursing homes have been rated as unacceptable by the Aged Care Standards and Accreditation Agency. One home, at Woorabinda in the Duaringa shire near Gladstone, was rated worse than Melbourne's Riverside Nursing Home which made national headlines after residents were bathed in kerosene-laced water. The assessment of the 15-bed Yumba Binda Aged Persons Hostel at Woorabinda found staff had not been trained to provide health or personal care. The Aged Care agency's reports from December last year also show standards at Eventide Nursing Home at Brighton in Brisbane's north had not met requirements, but a spokeswoman said they would do so "within the legislative time frame". The agency also named Woodlands Park Hostel in the brisbane suburb of Newmarket which has now undergone extensive renovations.
Aged homes fail the test. Courier Mail March 1, 2000

Mar 2000 Maggots in wound in West Australia

NURSES found nearly 20 maggots in the bandaged foot of a Perth nursing home resident a month before the furore over kerosene baths at a Victorian home.
Nursing sources say the resident had dementia and was not aware of her maggot-infested wound but would have been in great pain.
"What that means is that the wound was left open and unattended and basically flies landed on the wound, were able to sit there for a while and have a nice bit of a meal and lay eggs," Dr Segal said.

"It should never happen."
Maggots Found In Resident's Wound The West Australian March 15, 2000

Mar 2000 Many problems - West Australia

The developments came as an Australian Nursing Federation survey in Western Australia found: complaints of scabies infections on residents being ignored until they became very bad; bed linen only changed when it looked dirty; and residents frequently with skin tears and bruising because of rushed handling.
Aged care wounds reopened The Australian March 16, 2000

Mar 2000 Nearly half of homes had problems

Almost half the nursing homes inspected by a federal government audit team over an 18-month period posed an unacceptable or serious health risk to their patients.

The Australian today said 21 of them posed a serious risk, including chronic understaffing, medicinal shortages, a lack of water and food and poor living standards.
And 67 were deemed to be unacceptable or posing a serious risk to the ability of residents to maintain personal, consumer and legal rights.
Half the nursing homes inspected pose risk to patients Australian Associated Press March 23, 2000

May 2000 Understaffing problems

Other incidents included residents being refused bedpans, being sedated to make caring for them easier and being handled too quickly, causing their skin to be torn or bruised.
Overhaul Urged For Nursing Homes The West Australian May 6, 2000

May 2000 Worse than Changi prison

Labor Senator Chris Schacht told the committee a letter from relatives of one elderly resident who died after suffering gangrene and dehydration in the home described his last days as worse than those he spent as a prisoner of war in Changi.

Senator Schacht said the letter clearly showed some complaints about nursing homes were slipping through the cracks.
Suspicious Deaths, Stalkers Add To Nursing Home Saga Australian Financial Review May 24, 2000

Jul 2000 One company with multiple problem homes - NSW

Departmental reports on the Willowood Quality Care Centre at Chatswood and the Parkdale Nursing Home at Waverley cited a range of faults, included lack of fire and infection control training, patients unable to reach call bells, toilet scourers kept with other cleaning cloths, fecal matter on bathroom walls and floors; incontinent residents kept in bed with no pyjama pants and tops rolled up to armpits.
The Aged Care Standards Agency said the faults listed in the reports impinged on residents' privacy, dignity and basic health care and/or posed a severe risk to residents because of lack of surveillance of residents with dementia who may wander.

The two homes are owned by Columbia Nursing Homes Ptd Ltd, which runs six nursing homes in Sydney.
It has also emerged that a third home owned by the group, the Strathdale Quality Care Centre, was issued with a non-compliance notice on June 28 over problems which were not assessed to represent an immediate and severe risk to residents.
Unveiled: Nursing Home Filth Sydney Morning Herald July 28, 2000

Aug 2000 A hostel in Victoria

An Aged Care Standards and Accreditation Agency inspection last month found staff at the Pine Crescent Hostel in Springvale had no idea how to monitor their insulin treatment.

The agency said one insulin-dependent resident needing blood sugar levels tested twice a day, was recorded as non-insulin dependent and requiring tests only weekly.

"Residents with diabetes are at serious and immediate risk because their specialised nursing care needs are not being identified and met," it said in its report.
Home funds cut off Herald-Sun August 21, 2000

Sep 2000 Understaffing in Queensland

An enrolled nurse at a nursing home on Brisbane's northside told the Industrial Commission this week patients regularly spent hours lying on the floor after falling out of their beds because no nurses work the night shift in the home's hostel section. - - - - - -. The home, which cannot be named because of a suppression order, had not had a surprise inspection in three years and is currently awaiting full accreditation.
State aged homes miss checks on standards Courier Mail September 16, 2000

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2001 to 2003

A stead stream of reports continued to appear indicating that the underlying problems were not resolved. This is also confirmed on the company pages.

Aug 2001 Problems in South Australia

RESIDENTS have suffered unchecked gangrene and been restrained in darkened rooms - but their nursing home has continued operating for months, it has been revealed.

Despite repeated assurances from Aged Care Minister Bronwyn Bishop that she would crack down on substandard homes, the facility is still operating.
BISHOP UNDER FIRE AGAIN Nursing home disgrace Adelaide Advertiser August 10, 2001

Jun 2002 Victoria still the worst

MORE than half the Victorian nursing homes inspected by authorities this year failed to meet Federal Government standards.

Seventeen of the 29 homes and hostels did not comply with all required standards when checked by government inspectors this year, a Herald Sun investigation has found.

More than 600 elderly people live in the 17 homes.

Inspectors found many were left alone all day without proper food or medicine. Some soiled their clothes or beds because staff ignored pleas to help them to the toilet.

Residents in some homes were denied access to doctors and other specialists, records show.

The distressing practices continued despite a government pledge two years ago to clean up nursing homes.
HOMES FAIL Herald-Sun June 24, 2002

May 2003 Union criticises accreditation system

"As well as this (Collaroy Nursing Home) being obviously a house of horror, what it shows ... is that the accreditation system that the government has in place is not about providing the quality care for residents," Mr Thomson (Health Services Union of Australia) said.

"It's about giving a bad operator the chance to cover up their mess and keep on operating."
Fed - Nursing home with maggots and infections remains open. Australian Associated Press General News May 22, 2003

May 2003 Problems in NSW and Auditor General critical of accreditation

A SYDNEY nursing home criticised for failing to control staph infections and scabies outbreaks will be allowed to stay open, while the Auditor-General has questioned whether Canberra's aged care accreditation system does anything to improve standards of residential care for the elderly.
National secretary of the Health Services Union of Australia, Craig Thomson, claimed yesterday the Collaroy home typified the problems of an accreditation system that required no minimum staffing levels to ensure quality of care.
`At-risk' nursing home to stay open. The Australian May 22, 2003

Nov 2003 Problems in NSW - accreditation failure

An investigation by The Daily Telegraph has found that nursing home residents across NSW are being forced to endure appalling treatment because the agency responsible has failed to perform proper checks.
Dirty secrets of millionaire's nursing home Daily Telegraph November 3, 2003

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2004 and 2005

Reports of adverse events continued through 2004 and 2005 culminating in a federal senate investigation.

Mar 2004 A problem hostel in Victoria

A resident was found slumped in a chair and "saturated in urine" at Lionsville Hostel in Essendon in November last year.

Staff at the same home failed to give insulin to a diabetic resident at the right time, and more than 200 medication and treatment errors were recorded for 10 patients in one month.
Nursing homes in jeopardy Herald-Sun March 12, 2004

Aug 2004 Seven years on and 10% of homes still don't meet standards

Even so, as a confidential report by the Department of Health and Ageing obtained by The Bulletin shows, almost 10% of homes inspected between 2001 and the end of last year failed to meet all of the required standards, and 113 around the country failed to reach adequate standards for medication management.
For the love of Alice; Her family want justice. The Bulletin August 17, 2004

Aug 2004 Widespread systemic problems

The Howard Government was under pressure in Parliament today over allegations of widespread systemic problems in aged care.
Labor's aged care spokeswoman, Annette Ellis, asked: "What does the Minister say to the husband of the woman who died so tragically (In
Chelsea private nursing home) because of the failure of the Howard accreditation system?"
In a submission to a Senate inquiry into aged care released today, the Health Services Union says staff shortages are having a major impact on the care of elderly residents.
ALP attacks Govt's aged care system Australian Broadcasting Corporation (ABC) News August 11, 2004

Apr 2005 Scabies in Victoria

AN outbreak of scabies at a Melbourne nursing home has infected as many as half the residents and up to four staff members.

The Lionsville Hostel in Essendon was yesterday battling to control the outbreak, which first emerged more than six months ago but reached crisis point at the weekend.
"This is a health crisis that never should have happened," Victorian Health Services Union officer Pauline Fegan said yesterday.

"Staff have repeatedly raised concerns with management about the scabies outbreak and yet no proper infection control procedures were implemented, allowing a full-scale crisis to develop."
Scabies hits nursing home Herald-Sun April 13, 2005

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The scandal of 2006

The media focus swung sharply back to nursing home care when it was revealed that elderly nursing home residents had been raped or sexually abused in a number of nursing homes across the country. There were reports and studies of elder abuse, particularly sexual abuse. These are addressed on the government page describing the 2006 scandal and the response to it.

Feb 2006 This is after 8 years of accreditation

TONY JONES: - - - - But in general terms, they're talking about a range of abuse, aren't they? I mean, there are things like soiled sheets left for weeks on end, people left without care for very long periods - a whole range of things like that.

LILLIAN JETER: Not only that, Tony. There was also one gentleman who was forced into the shower. He's naked, they're forcing him and taking control of him. There's also faeces that are smeared on the walls of the facility. There's a lot of questionable safety issues with the keys going missing to that facility for a long time. Intimidation, fear, harassment, harassment of the employees. These are carers that are trying to do the right thing for dementia residents.
AGED CARE WORKER: In the kitchen this woman was seated in a chair, walked by with a water bottle and squirted water at this woman.

REPORTER: In her face?

AGED CARE WORKER: On her face, on her body and it happened more than once. I believe it was twice or three times that it has happened. The person that saw it a second time mentioned it to the manager. Nothing was done, there was no reprimand, there was no nothing. And this person that has also seen other instances go on is now afraid to say anything. When she has in the past, our manager currently there just says, "Don't worry about it, it will be fine."
Allegations of abuse at aged care facility Lateline ABC TV February 20, 2006

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Acknowledging that the system has failed

Refuting claims that the system was working

Minister for aged care, Bronwyn Bishop asserted in 2000 that the accreditation and complaints process was working and that the exposure of widespread poor care confirmed this. That this is not so is confirmed by the ongoing and continuous exposure of failures in care and the steady deterioration of the situation to the extent that by 2006 some elderly were raped and staff did nothing about it.

I have no dispute with the claim that well motivated homes, particularly run by motivated communities, may have benefited and improved their care as a result of accreditation. An agency which takes experts out to advise and help struggling homes is likely to benefit them provided the homes are motivated primarily by care rather than process.

What has not happened is any impact on the commercial profit focussed homes. The situation here, and the morale of staff has steadily deteriorated until it culminated in another disastrous crisis in 2006.

But the government were given the message that the system was not working way back in 2001, eighteen months after the Riverside scandal.

Mar 2000 Decline in standards

The exchange came amid accusations of a decline in standards of aged care facilities in the country, with two Melbourne nursing homes in the past week having been shown to have placed their residents at serious risk.
Aged overdose report not acted on in eight months Australian Associated Press March 2, 2000

Jul 2000Process not working

Senator Evans criticised the accreditation process yesterday, saying the sanctions were clearly failing and the standard of care was not being improved.
Nursing homes on aged care blacklist. The Australian July 28, 2000

Jun 2001 Not for profit groups says not working for bad homes

A system that promised so much, and was welcomed by most operators, has left many embittered and calling for reform. Its integrity has been questioned, leading peak bodies in the charitable and for-profit nursing home sectors to call for an independent review separate from the minister's current tightly controlled consultation exercise, called Learning the Lessons of Accreditation.

A recent survey of church and non-profit operators by the Aged Services Association of NSW and the ACT (not for profit industry body) concluded, ``Participants supported the aims of accreditation but described its implementation thus far as counter-productive.'' Staff in many homes worked 16-hour days to meet the December 31, 2000, accreditation deadlines.
However, the focus, teamwork and tremendous application required of staff have probably paid off in improved care for many residents. ``It's a better system than the one we had before,'' said Greg Mundy, chief executive of Aged and Community Services Australia. But some things appear to be just the same. Hard-working staff and proprietors have watched cavalier operators survive in the industry despite their failure to take the standards or deadlines seriously. In some cases, operators reverted to old ways once the assessors had gone, just as in the old days.

``There still exists a high degree of cynicism that accreditation has not effected substantial change in low-quality facilities,'' the NSW survey of senior nursing home managers said.
Handle With Care Sydney Morning Herald June 23, 2001

Aug 2001 Situation getting worse

Other deficiencies in the standards monitoring process, however, worsened after the introduction of accreditation. Spot checks of nursing homes made with out notice, which had been rare, ceased. In response to criticism the minister for aged care introduced some spot checks with notice. Enforcement of regulations, which had been inadequate under the standards monitoring process, has been weakened further. The government withdrew funding from one home out of 3000 in the first three years of accreditation.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001

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Ignoring the problems 2003 to 2005

There was further confirmation of failure in 2003 showing that the changes made to the system after the Riverside scandal in 2000 were simply window dressing. Nothing fundamental had been done. Nothing was done into 2004 and even after a damning senate report in 2005 the government did nothing.

Nov 2003 National Audit office found agency has failed to do its job

A report by the Australian National Audit Office tabled in Parliament found that the agency has failed to do its job since it was set up as an industry watchdog in 1997.
"This agency simply does not work and it's leaving the elderly in an incredibly vulnerable situation," Mr Thomson (Health Services Union of Australia) said. "The odd random check when someone has complained is not good enough."
Dirty secrets of millionaire's nursing home Daily Telegraph November 3, 2003

Oct 2004 Agency unable to do what is required

"They can't do the level of surveillance we should probably require."

She (Chief Executive of the Council of the Ageing Sue Hendy) said nursing homes should not be notified of impending inspections.

"If you are doing something wrong and you are given three days notice you can easily staff up and put on people who are qualified."

"If no-one is coming to look you can cut your costs and have unqualified staff."
Vic: Aged care residents put at risk nursing home sanctioned Australian Associated Press General News October 8, 2004

Oct 2004 Homes dolled up for accreditation - system not working

The nursing home won commonwealth approval in November, passing all of the 47 standards set under the act, but staff allege management fabricated documents to secure accreditation and brought in an infectious-waste disposal system that disappeared immediately it was clear government subsidies would continue.

Critics have been calling for reform of the system following repeated examples of nursing homes being dolled up for inspection, with neglect of residents and staff shortages returning the moment commonwealth funds are guaranteed for the operators.

Facilities are notified before inspections, with no spot checks or return visits in the weeks or months after a home gets the all clear.
"We have been saying all along that with out accompanying regulations, the accreditation system does not ensure continuing care will be given," Ms Brownrigg said.
Warren Hogan, who led the commonwealth review of residential care, noted weaknesses in accreditation and called for the introduction of a star rating system as well as a significant boost in education and training to ensure a skilled workforce.
Funding penalty for nursing home The Australian October 9, 2004

Aug 2004 Accreditation a sham

An investigation by The Bulletin has uncovered widespread allegations that the monitoring and accreditation system of Australian nursing homes is a sham, open to abuse by proprietors who receive up to three months' notice before an inspection.

Staff working in aged-care facilities have described instances of the management at homes falsifying medication and patient records, and temporarily "tarting up" facilities and hiring extra staff for days when inspectors visit sites to determine whether a home will qualify for funding.

One nurse who works in a home in outer Melbourne, and who spoke on the condition of anonymity, told of being directed to "fix" up the documentation in the weeks leading up to accreditation. "We had to backdate care plans, create an activities program [because there wasn't one] on paper at least, so we drew up false rosters and crafts and hobbies that had never happened. They were especially worried about pain management and palliative care because there is virtually none. We had to search through the files to find a patient who had had a 'good death' to illustrate that we practised good palliative care."

A personal care attendant who works in another home, says: "There is extra linen brought in and the kitchen is brought up to scratch [before an inspection]. They pay for staff to stay back and do overtime and it's all a mad panic. When the inspectors are on the floor there are extra staff working."
The overwhelming message from those who work in the aged-care industry is that the monitoring system is being exploited. Witness statements collected by the Health Services Union of Australia, which have been included in its submission to the Senate inquiry, bear a common theme. One of the starkest examples is provided by a personal care attendant who has worked at a Tasmanian nursing home for 14 years.
For the love of Alice; Her family want justice. The Bulletin August 17, 2004

Jul 2005 Huge inconsistency in accreditation - senate findings

The Woolcock reversal comes just weeks after a little publicised bipartisan senate inquiry into Australia's aged-care system brought down its findings. Broadly, some add weight to the Woolcock family's worst fears. The inquiry found what many sectors of the industry have been arguing about for some time: huge inconsistencies in the level of scrutiny applied by the federal government-appointed monitoring teams. - - - - - - but what the senators found in this inquiry are troubling systemic problems. The significance of the findings cannot be overstated.
The senators found that scrutiny of the aged-care industry is "grossly" inadequate with only one in 10 homes spot-checked annually. The inquiry recommended more routine spot checks.
The system will be scrutinised when the coroner begins hearing evidence into Woodcock's death. It will be interesting to see whether anyone will be listening this time.
Late justice; A
Senate inquiry into the aged care industry has recommended higher levels of scrutiny The Bulletin July 19, 2005

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Response to the 2006 scandal

It took another damaging scandal, the sexual abuse or rape of a number of 80 and 90 year olds in homes across the country before the government responded. The government were fortunate in having a far more politically savvy minister in the portfolio. He had no choice but to bow to the demands of advocates and he did so with grace.

After joining the prime minister in denying that the problems were widespread the new minister finally admitted to serious faults in the system. He promised and set out to strengthen surveillance and the powers of the accreditation and complaints systems. He initiated the screening of workers for criminal convictions and brought in compulsory reporting of abuse of the elderly.

All of these measures were directed at building up and spending more on mechanisms for dealing with the adverse consequences of the aged care system. None of them addressed the critical conflicts and the problems in the system itself and in the accreditation system. The response to this crisis is dealt with in more detail on the 2006 government page. Within a short period the minister was once again promoting the merits of the marketplace solution and cooperation with the industry. The lessons had not been learned and it was back to ideology based market formulas.

The draconian measures introduced will in my view have an impact in curtailing some of the more excessive examples of abuse - temporarily at least. It will push the problems out of sight and out of mind. Government, industry and some advocates will hail this as a success and vindication of their approach.

Because it does not actually address the problems it will simply make them less visible. They will continue to fester and overall care will continue to deteriorate. A further scandal in a few years is likely.

Feb 2006 Nursing homes and complaints system both going backwards

TONY JONES: In the course of researching our sexual abuse story, Lateline was also told about serious allegations of mistreatment in another facility, a specialist dementia unit in Victoria. Margot O'Neill interviewed a former carer at the unit, who asked that her identity be protected. Her claims are chilling. They raise questions about systematic management cover ups and bullying, as well as the integrity of the Federal Government's accreditation and complaints system.
Allegations of abuse at aged care facility Lateline ABC TV February 20, 2006

Feb 2006 Minister forced to admit problems but tries to minimise them

SENATOR SANTO SANTORO: Look, my office in Canberra, my Department is on full alert in terms of this particular issue. They have been total by me that we need to be as empathetic, as sympathetic and as action driven as we possibly can.
TONY JONES: It sounds like you're acknowledging that the complaint system is failing and, in particular, has failed these two women.

SENATOR SANTO SANTORO: Look, most of the complaints that are put to the complaints resolution scheme and to the complaints ombudsman or the complaints commissioner are resolved to the satisfaction of the complainants, but there are undoubtedly some cases that fall through the cracks, there are undoubtedly some cases that just don't get resolved as efficiently and to the satisfaction of the people making the complaints.
TONY JONES: Did this one fall through the cracks because we know that even before the dreadful things that happened to their grandmother, the alleged sexual assaults, that they wrote a complaint back if May of last year. Was that responded to appropriately?

SENATOR SANTO SANTORO: Look, I'll answer that question precisely. After the 7:30 Report where I said I wasn't aware of the letter, my Department produced the letter for me at 8:30 this evening. I reviewed that letter and I've come to the conclusion that although that particular letter in May did not refer to the rape complaint, what it did refer to are other aspects of what I would consider as care and service delivery, failure of care and failure of service delivery that should have been looked at far more attentively, far more effectively. I've come to that conclusion by just reviewing over a very short period of time the circumstances and the detail of that letter. So, yes, I think that your assumption there is right, but all of this...

TONY JONES: So the Department failed them at that point?

SENATOR SANTO SANTORO: I think what happened is the Department did not go in as effectively as it could have. Now whether you class that as failure or you class that as deficient attention, it's up to the investigation that we'll conduct during the next few days and I intend to be very open about this whole process.
Aged care debate LATELINE ABC TV February 21, 2006

Mar 2006 Minister makes promises

MATT PEACOCK: It's a can of worms confronted by the Minister for Ageing, Santo Santoro, at yesterday's summit. Already, the minister agrees the complaints commission needs improvement.

SENATOR SANTO SANTORO, MINISTER FOR AGEING: How can you have conciliation between an elderly person who has been abused and the person who's done the abusing? So, the Complaints Commission has recommended that in fact it be given investigatory powers and I'm certainly considering that, plus a whole host of recommendations.
Elderly abuse prompts Govt measures ABC
7.30 Report MARCH 15, 2006

Apr 2006 Accepting inspection system is flawed

Lobby groups claim the level of abuse nationwide could be as high as 80,000 incidents a year.

Canberra has been forced to take action following concerns the present system of inspections is deeply flawed, allowing many facilities to cover up abuses and sub-standard conditions.
Random checks on aged carers The Australian April 10, 2006

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The response to failure

The problems with what was happening in the Australian system were clearly spelled out by someone who had responded to the situation in the USA by developing an alternative framework for care. In 2000 the authorities were not listening and in 2006 they are still not listening.

They are unable to understand that health and aged care are in essence, humanitarian activities, something which we as a community do for one another. In dong so we build values, norms, relationships, understanding and insights. It is a community activity situated in the community and run for and by the community as part of a civil and civilising society. The challenge is to provide a structure which allows integration and high technology care within this framework. My argument is that the market cannot do this because of the paradigms on which it depends. It cannot do this and function as a competitive market. The minister was told this quite clearly in 2000 after Riverside 6 years ago.

Mar 2000 An outsider tells the minister she is wrong

MORE rules and regulations will not achieve the radical reform needed in Australia's aged care industry, a leading international physician to the aged said yesterday.

Dr William Thomas, founder of the revolutionary "Eden Alternative" style of aged care in the United States and Canada, said bureaucratic reaction to Victoria's Riverside nursing home's infamous "kerosene bath" incident was simply treating the symptoms, not the malady.

"Riverside is a terrible story, a shocker, a tragedy ... but it was the system that let it happen," he said. "The real lesson from Riverside is that the current system should, and needs to be changed. "You can close it (the nursing home) down, but there'll be lots more. You'll still have the Riverside situation happening ... you cannot legislate for kindness, tenderness, compassion and respect."
Dr Thomas said if he could say one thing to Aged Care Minister Bronwyn Bishop it would be: "Don't think you can make rules and regulations to solve the problems. To change the culture of aged care you need to make the move away from the institutionalised framework ... to become more concerned with the needs of the human spirit". Dr Thomas's Eden Alternative, now practised at 200 nursing homes in the US and Canada, was created to combat what he says are the real diseases which are killing the aged prematurely - loneliness, helplessness and boredom.

The programme encourages companionship and opportunities to care for other living things as well as fostering variety, spontaneity and an enlivened environment. In some of Eden's ground-breaking nursing homes, whole kindergarten classes have been set up within the facility to encourage interaction between the generations, childcare centres have been established on the same grounds and after-school programmes set up.
Aged could be in Eden, not hell. Courier Mail March 24, 2000

Regulations, oversight processes and the law are of necessity impersonal and unable to respond to the complexities and nuances of everyday life. When we rely on them we get impersonal miscarriages of justice. There are many examples in the USA and a good Australian example is the case of a disabled person (for details) in a Tricare home in Queensland.

Mar 2006 Press report on incarceration in Tricare home by government agency

"It is unbelievable that a person's express wishes could be trampled on by a government agency and that then, by law, we prevent even their closest family from raising this case of serious infringement of rights."
State keeps woman as a 'prisoner' The Courier-Mail March 1, 2006

The argument then is for a community filter and decision making process based on community involvement, humanitarianism, norms and values mediated by simple common sense in the community. Regulation, oversight and prosecution provide a background structure embodying and reinforcing principles. We should not minimise their importance in giving form and legitimacy to accepted norms and values governing conduct. When the community embraces these norms and values then they should rest lightly and be seldom used. The letter of the law can be dysfunctional when it rides roughshod over community values and sensibilities.

The response to the failures in aged care, including the failures in process, regulation, oversight and legal constraint has been simply more of the same.

Feb 2006 Consulting the supporters of the system

SENATOR SANTO SANTORO: - - - - - Out of this experience we are going to learn how to improve a system, Tony, which I think is working well, but clearly it needs to be fine tuned, it needs to be certainly better performing and I'm prepared to put every bit of energy that's available to me to make sure that it works better.
I intend to consult stakeholders and my ministerial colleagues interstate. I intend to be very proactive, very open and I'm inviting anybody who has any issue with the department, with the complaints resolution scheme to come directly to my office, and I'm saying to my office, not necessarily the Department, although I want the Department to be fully involved because we need to learn from this experience.
I want to get together with the stakeholders, I want to get together with my state counterparts, I want to convene the ministerial advisory committees that advises the federal minister in relation to contentious issues. I'll be convening that committee very quickly. I intend to talk to my state counterparts and I think there's an enormous amount of goodwill.
Aged care debate LATELINE ABC TV February 21, 2006

Mar 2006 More of the same - patching the system and driving problems underground

KERRY O'BRIEN: Welcome to the program. The Federal Minister for Ageing, Santo Santoro, has promised tougher measures to deal with complaints of rapes and other abuse of elderly residents in Australian nursing homes. Those measures, including more spot checks on nursing homes, police checks on staff and a review of the way the government deals with complaints, have emerged from a summit of aged care representatives yesterday.
Elderly abuse prompts Govt measures ABC
7.30 Report MARCH 15, 2006

To make the system more market like the government explored methods of empowering the residents and their families and so turning them into distrustful customers. They explored the option of a Michelin guide to nursing homes.

Jul 2006 A Michelin's guide to aged care!

A five-star rating system was just one of the options considered in a report commissioned by the federal Government on how to best match people with available aged care homes.
Aged care Michelin Guide mooted The Australian July 24, 2006


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Resorting to litigation

The question now is whether we will continue to go down the US path towards a confrontational system of profit, suspicion, wariness and competition instead of the trust, trustworthiness and cooperation through which humanitarian services are best provided.

In the USA accreditation, regulation and oversight, have been ineffective in constraining market misuse of the elderly. The only resource and the most effective tool has been to sue the proprietors of the homes and to have the jury penalise them in a way which really hurts.

Faced with evidence of deliberate understaffing juries and judges representing the people have awarded massive damages. Those organising and urging the mistreated to sue have driven the worst corporate offenders from their states.

Large corporations have spent vast sums lobbying state and federal governments to restrict the punitive damages which the courts can impose. They have been successful in many states.

As we go down the same path there is a risk that our community will also have to organise and assist residents and their families to drive poor commercial enterprises out of the market.

This is not the sort of society most of us aspire to. There is nothing worse for both the provider and the resident or patient than to be sitting opposite each other gathering and watching in preparation for the law suit which will come. In this situation "care" becomes a disconnected word which is unrelated to the encounter which it is used to describe.

Apr 2000 The advice of desperation

Nursing home residents will be encouraged to sue proprietors who fail to provide them with satisfactory care under a plan presented by the Australian Pensioners' and Superannuants' Federation.
Pensioner Plan Advocates Suing Australian Financial Review April 4, 2000

Feb 2006 Asking the law to punish for what a sensible policy should have prevented

GAVIN JENNINGS, VICTORIAN MINISTER FOR AGED CARE: - - - - - - - I share their absolute determination to ensure that justice is brought to bear and the most likely outcome that justice will be brought to bear in the most immediate sense will be through the criminal justice system in Victoria where the truth of the allegations will be tested and I, for one, are hoping that the full force of the law will apply and give them some sense of justice in what has been a very tragic and disturbing issue for them, other families of residents in that nursing home and for the people of Victoria.
Aged care debate LATELINE ABC TV February 21, 2006

The web address of the Australian Aged Care Accreditation Agency is

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More information

For Updates:- A good way to check for recent developments in aged care is to go to the aged care crisis group's search page and enter the name of the company, nursing home or key words relating to any other matter in the search box. Most significant press reports are flagged there. The aged care crisis web site has recently been restructured and some of the older links used from this site may not work.

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Web Page History
This page created Sept 2006 by
Michael Wynne