AN Australian expert has called for forensic accountants to be engaged to scrutinise just how Australian residential aged care facilities (RACFs) spend their money, in response to what has been described as a “horrifying” appraisal of staffing levels.

Professor Joe Ibrahim, Head of Monash University’s Health Law and Ageing Research Unit, told InSight+ that part of the confusion about RACF staffing levels and funding, is a lack of transparency for what things cost in the aged care sector. RACFs are currently not required to disclose how many staff they have nor how they spend government funding.

“We need a team of forensic accountants to go through 10 or 20 homes that volunteer to be scrutinised,” said Professor Ibrahim.

“Then we will know where the money is being spent. We will see if they don’t have enough money or if it’s not being managed as well as it can be. Or whether the market forces are such that no matter how brilliant they are, it’s always going to be a struggle. At the moment we can’t really tell which of those scenarios are there.”

When compared with international staffing benchmarks, Australia’s RACFs meet none of the minimum criteria for adequate staffing, an article published in the MJA confirms.

A lack of staffing in aged care is not a new assessment. In fact, it was one of the key observations from the Royal Commission into Aged Care Quality and Safety. To inform their final report, the Commission requested a research study comparing Australian staffing levels to benchmarks determined overseas.

Just how badly our staffing levels sit when compared internationally surprised even one of the article’s authors, Professor Kathy Eagar.

“I’m a professor of health services research and I have been totally horrified,” she said in an exclusive Insight+ podcast. “I think for the average consumer, this is very scary stuff.”

The report found that Australian aged care residents receive on average 188 minutes of care per day, which includes 36 minutes of care by registered nurses, 8 minutes by allied health professionals and 144 minutes by personal care assistants.

A five-star rating system used in the United States by the Centers for Medicare and Medicaid Services was considered to be the most relevant international system for judging the aged care services in Australia.

Using this system, the researchers found that RACFs are more likely to experience quality concerns when they dip below a three-star rating, which is equivalent to 30 minutes of registered nurse time and 215 minutes of total staffing time a day.

The report found:

“Using these metrics, more than half of all Australian aged care residents (57.6%) are in RACFs that have inadequate (one or two stars) staffing levels. A little over a quarter (27.0%) are in RACFs that have three stars, 14.1% of residents are in RACFs with four stars, and 1.3% are in RACFs with five stars, which we consider best practice.”

Professor Eagar said that this total care was unacceptably low.

“We have [an average of] 180 minutes of total care time per day in Australia, which makes us one-star using the American system.”

The report found that to bring Australia up to a three-star standard would need a staffing increase of 20% across Australia. For all residents to be receiving four-star level of care, staffing would need to increase by 37.2%.

According to Professor Eagar, part of the problem was the increasing trend towards home style residential aged care versus the traditional nursing care model.

The Aged Care Act was updated in 1997 and aged care was conceptualised as a lifestyle choice where people were living in a home rather than an institution.

However, the people using aged care facilities are different now to those who were 20 years ago, Professor Eagar and colleagues wrote.

These days, only 15% of the residents in RACFs are independently mobile, with 50% needing mobility assistance and 35% not mobile at all.

According to Professor Eagar: “For the past 20 years, Australia has sat back while the sector and government has traded off clinical competency for socially engaged care.”

Dr Stephen Judd, CEO of HammondCare, told InSight+ that quality care and a home-like environment shouldn’t be mutually exclusive.

“I really want to resist the idea that you either have clinical care or you have a domestic environment, but you can’t have both … We cannot believe that to give more clinical care, we have some form of quasi-hospital. I think you can have both,” he told InSight+.

In HammondCare’s model of care, most residents live in small cottages of eight to 15 residents, he said. They have the same staff each day and have access to a kitchen and other home-like facilities.

According to Dr Judd, this model benefits not just the residents but also the staff.

“In smaller houses and apartments … multiskilled staff are deployed to manage the household. So that means you use the clinically trained staff to be clinical leaders,” he said.

In contradiction, Eagar and colleagues wrote: “Anecdotally, registered nurses and allied health professionals are required to spend a disproportionate amount of time on paperwork for funding purposes, leaving even less time to spend on care.”

It’s not only the excess paperwork that frustrates aged care staff, according to Professor Joe Ibrahim, Head of Monash University’s Health Law and Ageing Research Unit. He also believes some staff aren’t trained with the correct skill set to do their jobs.

“The personal care workers are being paid to look after people’s personal care needs. It’s not fair or reasonable to ask them to step up and do a whole lot of other work that they haven’t been trained for, they’re not being paid for and they’re not being recognised for,” he said.

Professor Eagar recognised that training and remuneration were big issues in aged care staffing.

“We don’t value aged care and therefore we haven’t valued aged care nursing. Aged care nurses get paid less than registered nurses in a hospital. Personal care workers are being paid less than if they worked in a supermarket,” she told Insight+.

According to Professor Ibrahim, people have also confused the argument that there aren’t enough staff with an assumption that not enough people want to work in aged care.

“Even if every position was filled, it still wouldn’t be enough to deliver the appropriate level care for individuals,” he said.

Ultimately, it’s an economic argument. Has the funding model provided sufficient funding for staffing?

No, it hasn’t, according to Professor Eagar.

“The government subsidy for a day in residential care is about a third of what it costs to deliver a day of care in a subacute hospital … Aged care providers can’t afford the levels of staff that I believe they require,” she said.

Dr Judd agreed that the current funding model is flawed.

“The model we have today is how much governments want to pay and how much they believe residents should pay, then somehow we have to manage a staffing mix from that.”

He suggested the government needs to work out how much care is required then decide how to pay for it.


Poll

The funding of the Australian aged care system needs root-and-branch reform
  • Strongly agree (94%, 1,084 Votes)
  • Agree (4%, 51 Votes)
  • Strongly disagree (1%, 9 Votes)
  • Neutral (0%, 5 Votes)
  • Disagree (0%, 2 Votes)

Total Voters: 1,151

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60 thoughts on “Aged care staffing: send in the forensic accountants

  1. Anonymous says:

    I would like to see a retrospective forensic investigation of the Murchison Community Care home that went broke last year. Having seen inside (my mother in law was a community volunteer and it was a really nice place), I wonder if they had an appropriate level of care per staffer and therefore went broke – or were they poor managers? I have no idea?

  2. Anonymous says:

    My dear cousin died in an excellent aged care facility. His previous aged care home was not so excellent. He was a medically qualified man who provided skilled and compassionate care for his patients for his whole career. His reward? ‘Dinner’ was saveloys on mashed potato. So much for eating a balanced diet with 5 veg and 2 fruits per day. No chance in some of these facilities.
    Forensic auditors are desperately needed, or at least government being held accountable for the money trail we give these places.

  3. Anonymous says:

    There are already a number of comparative analyses undertaken by groups like Stewart Brown https://www.stewartbrown.com.au/news-articles/26-aged-care

    Unfortunately with much of the Aged Care Sector now becoming corporatised / publicly listed and focused on a for-profit motive the only feasible approach is compulsory staffing ratios and the ability to pay for them. And to pay at a level where aged care staff earn the same amount as acute hospital staff with similar training / skills.

    The Aged care sector has many areas where it is in ‘catch up’. The other is in quality of care where it is a legalistic and compliance framework, not a quality improvement framework.

    So much work to be done

  4. Anonymous says:

    My mother died five years ago after being forced into an aged care by a social worker to turf her out of a hospital bed instead of providing rehab so she could return home with an appropriate home care package. She lasted about three months even with me visiting daily.

    I often describe it as going down the rabbit hole, where nothing quite made sense. it appears nothing has changed. The RACF system is completely dysfunctional, and relies on overworked and undertrained carers and insufficient RNs.

    There is also the fiction that the RACFs are health care facilities which makes it easier for hospitals to get rid of residents who land in hospital for some reason; or for the health department to pretend that RACFs are appropriate facilities to treat COVID patients.

    As for the visiting GPs, one put my mother onto a Fentanyl patch for her back pain without even thinking of other options. Another was so rude and rushed he would not speak to myself, the only family member. For me, sadly, the visiting GPs were part of the problem. The current RACF system is a schmozzle and will never succeed due to the conflict between profit and care and the dysfunctional funding system.

  5. Anonymous says:

    I am RN with several post graduate qualifications including an Aged Care Graduate Certificate. Do not work in the area due to horrendous staffing conditions, feeling that registration is always at risk because of inability to provide good care due to poor material resources. Staff training is abysmal and if you try to change anything that costs money you are seen as trouble maker. Federal audit inspections are used to take money away from facilities that are not up to speed instead of investigating issues. Management of medication is frequently bad (including schedule 8 drugs. Needs forensic accounting and forensic overhaul of whole system. Currently systemic abuse of clients and staff. Relatives are often ignored or intimidated if they complain. Needs full overhaul NOW

  6. Anonymous says:

    It was 98 homes out of the 3000 in Australia. It is much more than clinical care. There is certainly more many homes can do. My late mother in laws home provided a caring environment and the Governments consumer reports for the home are positive. I think it is unfair to workers to make out all homes are bad. Why can’t we hear what the residents themselves are saying rather than the complaining of family and some who hardly ever visit their Mum.

  7. Verna Wooldridge says:

    Was an RN in Aged Care, for many years. At night, only RN for up to 150 residents, with 3 Personal Care Workers. Did 12 to 16kms per shift. Exhausting. Residents are now very high care, with complex physical, behavioral and emotional needs. There are simply not enough staff, and much training has been haphazard for years

  8. Anonymous says:

    Generally speaking and amongst other important variables, increased supervision of care delivery by RN staff makes a significant positive differnce to the overall care of older people.

  9. Anonymous says:

    I work in aged care mostly night duty. 2 worker’s to 40 residents we are offered one break of 30 mins which is not possible as it would leave only one member of staff on the floor as some residents are 2 assist this doesn’t work. Also during night shift EN are cleaning toilets yes all that study to clean toilets as they have cut back on cleaning staff. Person centred care is non existing every worker just trying to get tasks done each shift. I would never put my parents in aged care.

  10. Anonymous says:

    Independent and thorough forensic nursing, allied health, personal care, hospitality and lifestyle audit plus forensic financial audit at randomly selected RACFs, without prior notice being given, to ensure that RACF documentation relating to every resident correlates to actual delivery and funding received. Long overdue.

  11. Anonymous says:

    I worked in aged care for over 28 years, rot started with the Aged Care Act 1997,when funds for clinical were no quarantined and had to be accounted for at the end of the financial year. Providers run models on a loose basis of an 80/20 split, 80 then becomes 100% and then approx 56% of that is to pay the clinical wages and I use the word clinical loosely as there are very few Registered staff to tend to the increasing acuity of the residents to their detriment.
    As for the living longer living better this program is a misnomer it is about lining the pockets of the providers and their share holders as there is a cost associated with every item the resident may require.
    Not for profits are not what they seem either they receive extra benefits from the Govt as they referred to as the charitable.

  12. SCooma says:

    Absolutely agree. The place my mum is in costs so much & the excellent nursing & personal carers are worked so hard & literally have to run from one place to another. I have raised this issue on many occasions with the current director of care who never responds to any correspondence & never accepts any suggestions. She takes it all personally. I have cc the owner & his son to no avail. Their parents/ grand parents lived there & have since passed away. They walk around without talking to residents. Really bad PR skills from DOC & the owners.
    Too late to move mum. Communication is shocking now with current DOS . I have to be proactive & have to call in regularly to try to ensure all is well. I feel for the excellent nurses, pcs , receptionist & director of admissions who work tirelessly .

  13. Dianne says:

    While so much of the funds available go to administration fees, the care will not be adequate. Age care is big business, it’s all about getting more funding not about care, absolutely forensic accountants need to go in, but it won’t happen the aged care sector is not open to scrutiny or accountablity. They hide behind the privacy and confidentiality policies to keep staff from speaking out.

  14. Anonymous says:

    Having a parient in a nursing home which was a decision us kids had to have our parient admitted our care of her would not be possible as she needs to be regular attention due to health risks.
    I personally have worked in a nursing home and in a Hospital public and have seen first hand for myself what happens in these places my personal opinion in regards to this I definitely think that there SHOULD BE A FORENSIC ACCOUNTANT sent this would help the management Dept and allow the Government to get a clear view on WHERE THE FUNDING IS GOING, All staff do the best they can in there field and yes I did see lot of staff are over worked and underpaid these issues Always come from the facilities, But it’s the DIRECTORS AND OWNERS OF THE FACILITIES THAT HAVE THE LAST SAY, JUST HAVE A LOOK AT THERE PROFIT MARGINS AT THE END OF YEAR, Example my parients facility has a ANNUAL PROFIT EARNING OF ABOVE $300,000,000 million Gain. THEY ARE THE OWNERS OF THESE FACILITIES THEREFORE HAVE THE LAST SAY. MAYBE they should work for a week in these there own facilities instead of LINING THERE POCKETS AND BUILDING THERE WEALTH. That’s my opinion.

  15. Anonymous says:

    I used to work in aged care and regularly cry for the unnecessary suffering. I started out doing laundry as a little job to help the budget when my kids were small but ended up being used as a carer and reprimanded when i didnt do things the right way because id had no training. Later i trained as a nurse and saw so much incompetence because they only staff they can keep are the ones who dont care about lower wages, that they have to regularly work hours of unpaid overtime just to do a reasonable job or cut corners even more. The aged care facilities use and abuse volunteers and students. If you complain about a higher standard for residents, you are quietly managed out the door with things like being unsuitable (i once saw a dedicated RN student volunteer who in her own time wrote some issues relating to accreditation standards that were being overlooked once the care home passed the test and she proposed very workable solutions if we had an extra staff member. Management agreed to shut her up. They hired an extra staff member who was a migrant who barely spoke any english and didnt even understand how to make a sandwich if a resident requested it. The student was told that she couldnt be hired because she was too qualified and the budget simply didnt allow. When she came back with actual factual information they tore shreds off her saying residents had complained about her and theyd have no choice to take things further is she persisted. The only complaints were about t he new hireling who was allowed to get away with jobs not finished at the end of the shift, whereas the rest of us ENs PCAs and services staff were told we’d be performance managed and racism would not be tolerated and that any substandard performance would be noted. So we were bullied into continuing an hour of unpaid overtime. When it was brought up at a work meeting and we thought we’d have a win with management they simply added an extra half hour break into our shift and extended the shift by an hour but we still all ended up working thru. So all we got was longer hours really.
    Most of the long term staff slowly resigned over the next 6 months. I was one of them. I loved the residents and even the families would stop and chat if you saw them at the shops, i was even invited to homes for dinner, and when the time came i attended 2 funerals. I would never go back to aged care until RNs run staffing instead of accountants and minimum ratios are reasonable and guaranteed in law, and accreditation checks are impartial and random instead of expected and “dressed up”for.

  16. Sylvia says:

    As my mother’s carer for past 3 years, before that my father for 5 years l have come to learn the truth about the aged care nursing homes and why they exist, “MONEY” and “GREED”. The aged come last unfortunately, (in my opinion) YES, YES, YES please call in the forensic accountants. The monthly accounts we receive are absolutely impossible for any of us to understand. For about the past 6 months l have contacted, head office, who put me onto the manager of our area, we had a meeting with manager, accountant and co-ordinator, where it was agreed l would get an itemised account each month. I received the first itemised account as a sample of what l would be getting. The 2nd month yet another sample. When l called the co-ordinator she told me the sample was to help me work out the actual account. Doesn’t that just prove they do not know what they’re doing. So now l am left with samples, to help me understand the most unfriendly, misunderstanding accounts we receive each month. Their accounting is just ridiculous, $90 an hour for cleaning, tell me who is ripping who off. Yes please do something about aged care working for the aged, not the owners.

  17. Anonymous says:

    I work in aged care as a Registered Nurse. Our residents are well taken care of. We have wellbeing and lifestyle staff, physios,registered and doctors visit us weekly or when requested to help with families and right cares. We have regular podiatrist, speech pathologist, dieticians, Dementia Specialist, pharmacists, quality officers, health and safety officer, hair dressers, Resident service officers,nurse managers and supervisors. Our residents enjoy indoor and outdoor activities. Yes the funding is not sufficient for the care and time we give.

  18. Anonymous says:

    I have a family member in Aged Care where there are some amazing staff. Some of the RNs are more concerned with “protocols” and box ticking! The physios employed there are like “the fish that John West rejects” & the Locums who attend – gosh I wonder if some of them even went to school – their level of dumbness never ceases to amaze me! So why our are Senior Citizens being treated as second rate! Shameful!!

  19. Anonymous says:

    Ive worked in hospitality in aged care for many years, its continuously been getting worse, we are always short staffed, if a carer rings in sick, they dont replace them. We are always running behind, not because we arent doing our jobs its because we are doing the jobs of 2 people, some mornings I walk in to start my shift and the few night shift that are trying to look after 60 people are exhausted, we all are.
    I donate 1/2 to 1 hour every shift so I can have my lunch break, if I dont, then chances are I have to work the full shift with no breaks or lunch. And yet, if I can finish 15 mins before knock off Im questioned why?
    They keep shuffling duties between hospitality and carers, we are so flat out now, all they need to do is employ another person, to free us up to do things properly, but no, they would rather spend $10000s of dollars on landscaping, than to put it where it would benefit the residents and workers.
    When they have spent money on a new kitchen its unworkable, they never once asked the option of the workers on the layout or how its going to work. We wash our dishes now in a laundry sink they put in a brand new kitchen! We are working with equipment that is non compliant.
    What peeves me most is the fact that my son works in Hungry Jacks and earns the same amount of money as I do!!! If bosses were on the floor doing a shift at least once a week, things would change very quickly, but as we rarely see them they have no idea on what goes on under their own noses.

  20. Anonymous says:

    I worked in Aged Care for over 30 yrs. We even had an audit type person come to our facility to teach us how to gain more funding by completing the forms for resident classification., So most of our residents were classified as high care. We were then promised more staff which never eventuated.

  21. Anonymous says:

    Aged care needs more qualified Managers to manage facilities. Most of the facilities are managed by glorified Registered Nurses who have no idea how to even use let alone excel. There’s a culture of bullying Personal Care Assistants by nurses due to zero people management skills. This results into poor service delivery. There’s a lot of wastage, no flow of how things should be done, anyone can have their different opinions over one issues. There’s no standardisation. After all these confusings, it creates very high staff turnover. High staff turnover means more expenses that is beyond money value.
    I literally believe a nurse that does not have a management qualification, skill should not be put in management position. Thats what is greatly messing up this system. We need managers that can think and apply outside the box. Managers with great people skillset because this is a people sector in as much as it’s health. I feel very bad when the end user suffers and we are all getting old and will one day have a bed in these facilities. Having said that, am sure there’s a few doing the right thing

  22. Jason says:

    Money making, bottom line, staff never replaced,

  23. Pat(anonymous) says:

    Quote 30 to 36 minutes RN care per resident per day
    I was only RN with over 50 residents at times over 60
    Rostered shifts were 8 hours
    Even with no lunch breaks and doing extra hours each end of the shift unpaid as was nearly always the case this time with each resident not possible with the numbers we cared for daily
    My required documentations for each shift also done on top of unpaid overtime
    Once seen as caring etc given extra duties
    Every xmass and Easter for years was rostered to work * as agency too expensive *so management said
    Our families had to come second to keep our jobs
    I have several degrees and worked in high care etc
    The most complex job if done correctly is aged care
    Their is such a waste of registered nurses in offices “getting the books right for funding ” when their skills needed and be a big help hands on
    Funding should reflect care given not “care plans well written mostly not followed”but ÷better funding
    ?,need to be asked and answered
    My heart breaks as do a lot of families with loved ones so poorly looked after as I was one of them
    Even as a RN was denied answers from staff to grave concerns I had re my mother’s care in many apects
    She has died Hopefully in a better place
    I have retired but can see little progress in the addressing the real issues in aged care for residents and staff since I first began nursing in AC 1984

  24. Anonymous says:

    I work in aged care, I certainly wouldn’t send my elderly parents into care it’s disgraceful, PCAs not only do personal care, they also do cleaning, laundry & serve meals, infection control at it’s worst, as for the Royal Commission what a joke, remember folks it’s a business all they care about is the profit they expect to make out of our elderly people.

  25. Anonymous says:

    I’m happy with the SASH programme (Safety and Support at Home) funded by Aged Care. It has enabled me to improve mobility, stay out of hospital (thus reducing costs) & remain at home. The whole purpose of the Aged Care funding. Nobody wants to be in residential care homes.

  26. Anonymous says:

    I work in aged care,we make home made cakes biscuits and fresh sandwiches every day.We employ leisure and lifestyle officers,OTs physios,a chaplian,registered and enrolled nurses,Senior Hospital palliative drs visit us weekly to help with families and right cares. We have OPM Health team ,Dementia specialist visit our home regularly,pharmacists audit and check our drugs,we have education officers,quality officers health and safety officer,hair dressers,Resident service officers,nurse managers supervisors.Our residents visit beaches restarunts bbqs,happy hours,mens shed.music shows,bingo.bus trips,we have over 100 volunteers that visit the home dozens every day,every day ,Stop saying crape about aged care and go and see what they do,Go see thier financal books iam sure they would be happy to share,as 70% of aged cares are in debt by hundreds of thousands to a couple of million.The lies that i hear saddens me,as our residents are loved.the funding model is rubbish we need a one set amount for each resident with extra money for high clinical cares.make it fair for all older australians that built this country

  27. Robyn from Aged Care says:

    Aged Care is all about 2 things only. Occupancy and staffing hours. Trying to cut costs anywhere else is stupid. 1. Nothing will fix the cost of a “too generous” roster. Especially the number of RNs on nights. If your residents are not well, and you need extra RNs its all over.

    2. If you don’t have 98%+ Occupancy (which means usually entering the new resident in THE DAY AFTER THE LAST ONE DIED…YEAH..) ..then the home will lose money. End of story. Its how the payment system has been set up by multiple governments of all flavors.

    Then all you need is a brilliant Clinical manager to ensure the care is there, an awesome Quality Manager to run the IT so the paperwork isnt killing, a maintenance manager who doesn’t mind 3:00am call outs, and a Residence Manager who can pull it all together, ensure the Wait List is always up to date so you can fill a room in 24 hours, fill shifts at zero notice when the staff do no shows..which is Every Single day….make sure the place sparkles, the lifestyle organised, and Medicare and the families paying up…yep. And they should all work for peanuts because they should “care”, and not be thinking about it as a job. That’s Not for Profit.

    It’s MUCH WORSE in For Profit where certain foreign owned multinationals take their 20% cut FIRST then say Make Do with what’s left….

  28. Anonymous says:

    So much discussion, so little action. After 38 years at the coal face, as a carer and then registered staff member , I can say the workload has always been heavy.
    I have observed an increase in staffing but with it a ridiculous increase in documentation and unnecessary duplication of information.
    While there are more staff employed, less time is being spent on resident care.
    I often work a 9 to 10 hour day and get paid for 7.5.
    This is the norm. And also my choice so I can get the basics done.
    I am still harassed by management to complete more care plan reviews , more assessments…..it goes on. We are ed never doing enough to satisfy the industry’s insatiable appetite for paperwork.
    The system is inefficient and unwieldy and heavily skewed toward helping the corporate sector gather information.
    I enjoy my job but occasionally feel discouraged and let down by the lack of competent managers and support.

  29. Anonymous says:

    Professor Eagar absolutely hit the nail on the head when she said that RACF RNs get paid less than hospital RNs, and PCWs get paid even less than supermarket workers. Want better quality of care? PAY MORE. It’s an extremely stressful job with an almost insurmountable workload.

    That’s at least a starting point!

  30. Anonymous says:

    Currently working in a private up market age care in QLD. Have noticed the same issues under trained staff dealing with medications. Unexplained falls or missuse of equipment ie hoists.

    Staff working in dementia unable to leave floor for breaks as not to leave other pca alone with residents with behavioral issues.
    I’ve witnessed this in two of the up market age care I have worked. Am yet to discover what a not for profit age would be like.

    Unfortunately the saying from four corners

    “Bleed them dry till they die” is what age care is about.

    Time to name and shame these organizations.

    They know who they are….. shame!

  31. Anonymous says:

    It’s 1 AIN to 64 residents at night shifts. It’s heartbreaking seeing residents sometimes cry and staff can’t even give them 1 on 1 emotional support because of time. Managements deliberately never want to provide full staffing and when a complain is made about understanding they make so many false promises. I guess in general all nursing home staffs and residents should be interviewed before funding them because management always lie.

  32. Anonymous says:

    I have a parent living in residential aged care, the facility’s staff do not have time to build any relationship with any of the residents, only the necessary basic talk around the topic being addressed: transfering; toileting; showering; changes; and medication administering. In what we’ve observanced as to what degree of dignity is shown to our aged parents the answer is None or very Least. No dignity shown to our elderly by giving acknowledgement to their lifetime of wisdom learned ( yet most young people like to learn from the elderly); no attention paid to the uniqueness of each one’s personality and how do they prefer themselves to be personally groomed on a daily basis, but instead they are given not even the very basic of care and attention, and most elderly residents do not even get to see their face in a mirror! A Zoom meet up, which could’ve been made into a nice regular event for each resident by getting them all dressed up for it, instead was rushed whilst the nurse stood listening in so no privacy. The residents were mostly in shock at seeing themselves on the ipad screen for the first time, that each were put completely off any video link to family as they saw their new identity, a faded appearance of the person they once were. So no surprise the second Zoom wasnt happening at the resident’s insistance! So that didn’t go down well.
    Ought there be 20 minutes devoted to personal hygiene? The morning showering, change and dressing, this is the time it actually takes. Do we all agree, at least 20 mins is reality?
    RNs ought to be carefully following up any report on the resident that the AINs give them. The RNs I see there work around the clock doing the medication trolly and they are very tired looking as their shifts are very long. AINs there have acknowledged that they would get occtrocised by the other AINs if they did not follow the expected time given them for each resident, always saying they need to ‘Get back on the floor’.
    Why are’nt our elderly parents given the dignity? Such as being taken out into the garden during the week? Because a AIN told me “Theres not enough staff to sit for 10 minutes with them”. If not then why haven’t aged care facilities paired volunteers up with elderly residents to take them out into the garden and spend time building a relationship?
    There is so much to be done: Better staff ratios, more RNs and ENs and AINs; higher wages; rewards given to nurses and aged care facilities as incentive to those giving above and beyond expected requirements to individuals.
    Government policies in place generically with all aged care facilities being under the one umbrella. I see it would be better, less misuse of money by greedy CEOs who have displayed their lack of attention to detail for aged care. There is a general need for more quality time for personalised care to those with high care needs as well as to those with low care needs. Quality care allround for best personalised aged care. CEOs and management have shown to us all that their sincere interest lies in their economic business interests, and no attention to empathy and dignity to these resident’s is given, just herding the elderly ritually from one thing to another every day, this is not giving them any individualism, not much to look forward to to enhance their living, ones quality of life.
    The CEOs earn big money from the interest made daily on resident’fee deposited upon entering into permanent aged care. Why cannot this interest be put back into each resident’s care to make their care more quality and personalised to their needs and wishes? It is way past the right time to bring changes for the better in the aged care industry. Just start! Now is the right time for putting it all into best practice so our aging residents live their day to day lives being attended to in a timely way not being made to continually wait for nurses.
    Why are we letting these aged care homes treat our parents this way? It needs to stop. When you see somethings wrong, it is better to do something for the wellfare of another person than to do nothing. When you know someone is suffering inside, shrinking within themselves and who is feeling like they are invisible, it is definately way time to step up!
    Let us all pull together for this great acheivable outcome and goal in looking to keep the dignity of every aged person intact until God carries them home, lets make their journey through their toughest time one of importance, showing them thoughtful attention to make them feel like…themselves.

  33. Anonymous says:

    Not ONLY ratio’s of care staff also better quality/ caring of staff would go a long way. But minimum wages, difficult conditions, unrealistic expectations and undocumented behaviours, due to cut backs in senior staffing aswell

  34. Sukarni says:

    Anonymous says:
    I work in Aged care for 15 years still finding very dificult to look after 15 resident in two care staff. No way has time to sit down with residents from 6.30 am showering, making bed,feeding, breakfast, toileting, morning tea, lunch, ansering the call bell and other things, paper work. Always work.work..work.. Its very demanding job from residents, Boss, and family. Most of care staff very frustrated stress because of lots of work to do and not enough time. The way Care staff work and the wages is not enough. We get only $24 hour. Before tax

  35. A/Prof JP Sturmberg says:

    This information shouldn’t be any surprise, it highlights another facet of the systemic failure presided over by successive governments. What we need is a system of accountability that matters to residents, not proprietors, funders or bureaucracy. – ‘False Accountability’: The Harmful Consequences of Bureaucratic Rigour for Aged Care Residents. DOI: https://doi.org/10.31128/AJGP-04-19-4907

  36. Mim says:

    I work in aged care 75 residents only three Personal Care Assistant and one RN at night .It is high care but the company site mentioned low care. Its bevoming worse day by day .The linen and towel is being washed in the facility supposed to be white but the colour is like a dirty colour. No ironing i cant believe it sometimes its all money making .PCA is doing the crole of EN .We need to work its heartbreaking to see these resident being neglected.

  37. Anton Hutchinson says:

    What all the above aren’t aware of is that every facility has to supply independently audited accounts to the federal government each October. These accounts tell exactly what is spent on staff, food etc.
    There is nothing happening in nursing homes the government is not aware of. Most people have only heard of Oakden nursing home, the place that triggered the Royal Commission, what they don’t know is Oakden was government run with abundant staff and endless money and they failed.
    The sad fact is that if you are delivering quality services in a nursing home your business is running at a loss and the government knows this and refuses to act.
    I’ve been calling for a Class Action because I believe the Government has failed in its duty of care by not allocating sufficient funding to facilities to deliver sustainable and appropriate care to vulnerable residents.
    The government has failed as have associations that are supposed to support same. The Royal Commission may eventually look at increasing the funding but we should be also looking at compensation for the years if losses brought about by poor government.
    75% of facilities are running at a loss. The federal government has a lot to answer for.

  38. Anonymous says:

    Staff always told no more staff unless we keep up with huge amounts of documentation, though even when done , no extra staff.
    Definitely need more RNs and ENs to assist them with clinical care and extra training for cert 3 & 4.
    Unfortunately we never actually deliver care according to new standards due to above. Waste of royal commission if nothing changes.

  39. Anne says:

    Yes definitly send in the accountants!! I work in age care and it is a struggle to provide the quality of care the residents deserve, also is hard to spend time with them.

  40. Anonymous says:

    Yet another group of people out to get an ever diminishing share of the aged care funding pie. We are paying more and more bureaucrats who don’t do any care in the aged ‘care’ setting to investigate what’s going on in the industry. It is the bureaucrats who are killing the system. Decrease funding, providers decrease staffing, care quality decreases, hire a group of investigators to police the providers. Providers spend more time preparing and ticking off useless checklists to pass the ‘audits’ than in caring for residents. Medicare doesn’t pay for provision of medical services in aged care. When some GPs go in there despite this, Medicare sends threatening letters because those GPs are outside the norm. Of course they are outside the norm, nobody else goes to nursing homes. The whole system is rooted because of all the bureaucrats who are more interested in climbing up the ladder in Canberra and building empires than in providing care to the most needy in our community.

  41. Anonymous says:

    When the budgets are over the first area looked at and reduced is staffing. This is because BOMmembers do not understand theTIMEthst simple tasks take with the elderly. Meals is also an area where managers are looking to cut costs. Some care staff are only there for the money but the majority genuinely care about their residents. Too much documentation is required to obtain the present inadequate funding.

  42. Anonymous says:

    With 5 empty beds the facility, I can’t name, is not replacing staff member on sick leave. Kitchen staff has been cut expecting 1 person to do the job of two staff on shift leaving casuals out of work. This is when the facilities have been given large sums of money per resident for corona virus extras like ppe equipment.

  43. Anonymous says:

    I have a mother in aged care who is self funded. She is paying a lot of interest since she is a self funded retiree and unfortunately it has proved very difficult to sell her house. She needs to sell it because she has to pay the remaining $200,000 to the aged care facility. The family has kept reducing the price of her house but there is no demand in the very small town she used to live in. The food quality is bad, and my mother said the meat is such poor quality that no-one at her table can eat it, even though my mother was never a fussy eater. She has been given the wrong medications twice. Luckily my mother recognised that the medications didn’t look like hers. The girl was apparently new. I think 2 people should be checking the meds before dispensing. We have no other choice of a nursing home and this home is considered “good.” My family believe that it seems to be all about profit and keeping costs as low as they can. The amount of money spent on food per resident should definitely be increased as well as staffing levels. We owe it to the elderly who helped build this country and worked hard. They can’t even look forward to a good meal.

  44. Nelly says:

    I have been working in Aged Care as a PC for a number of years and I’m exhausted and burnt out, so I’ve decided to look at different industries which is less harder on the body. I do not want to continue to run a marathon every shift I’m on…its not sustainable and its definitely not fair on the residents to have to continually wait to go to the toilet or be given a drink because of staff are unable to get to the resident straight away. We have to prioritise who goes first.

    I do not feel its going to prove anything by having aged care facilities/organisations volunteer to have forensic accountants go through their books to see where they spend their money….I can’t see any organisation happily volunteering to have that done.

  45. Anonymous says:

    Of course only the better facilities will volunteer to be checked. Why on earth would you want aged care facilities to volunteer for this check? All it means is that we have experts talking the talk again and not doing a professional check on these places. All the large Aged Care corporations around the country should be checked as the bigger the corporation the more influential they seem to be. Nobody wants to touch them! Come on if you really want to know the truth go in and check out the big boys first!

  46. Anonymous says:

    Surely they need to audit those that don’t volunteer….

  47. Anonymous says:

    Anonymous: My aged care facility is constantly not replacing shift and cutting out shifts completely. They still want to cut hours down from 7 1/2 hour shifts to 6 hour shifts. I have a 5 minute break and still only manage to get the very basic things done. There are 2 staff members to look after just under 30 residents on an afternoon shift … staff are exhausted

  48. Anonymous says:

    I am new to the environment of Aged Care in Residential care, l don’t know why I’m staying, perhaps it’s more about hope, hoping for change and that I’m a caring person and get into more trouble than others because l support my residents. Residents pay good money for squat, the meals are crap, and the allocation for continent aids is poor, you would think it was coming out of staff pockets. I don’t like the way residents are spoken to, treated the same and sometimes the way some are treated and handled by minority of staff. The ED is a tattle tail, and lack of confidentiality is poor, so when compliants are made they are managed poorly.
    Some of the nursing staff treat personal care workers like dirt. Workers want to see change, residents want change. Personal Care Attendants want to be able to build relationships with residents and residents want time to talk about what’s going on and also build relationships.
    There just seems to be lots of talking but no action!

  49. Anonymous says:

    Have worked in Aged care for nearly 30 years, recently retired. It is all about staffing, especially at the coal face, where there is never enough time to care properly for residents. Management always used to cut the PCA staff, as soon as there were a few empty rooms. Even EEN’s now refuse to do hands on care, running around with medication trolleys. We need caring staff not necessarily triple certcicated RN’s.

  50. Anonymous says:

    I have worked as RN in aged care years ago, and now have a family member in one. Management rarely appreciates what quality care involves- time, adequate trained staff, resources and support. So at grass root level, staff are left struggling to get everything done, on top of the amount of paperworks to ensure assessments and care plans (merely paperwork hardly able to be translated into real care given, and more for ensuring funding ). Spread too thin it is impossible to give the care one wants to give. That was the reason I resigned. Now with a family in aged care I continue to see the same situation and of course am concern for the well being, that must be balanced between physical, emotional and mental aspects, of my loved one.

  51. Anonymous says:

    There needs to be a model of care review for aged care facilities. They are no longer older people needing basic care. Some aged care facilities who cater for complex older persons deal with many clinical and behavioural issues and must have a higher level of skilled clinical staff. Pretty pictures often get painted of residents living in individual accommodation and having the ability to fully engage.The Aged Care Standards 2018 has not helped as it has been made more generic then ever.
    To maintain a ‘home like environment’and provide the clinical care required is not always possible. One has to just look at the many aged care brochures or the departments video on the new aged care standards then talk to families and staff who have worked in these areas for a long time to get a reality check. Money is not all that is wrong with the current model, it is a major profitable business with very little humanity or compassion from these businesses mostly run by financial administrators.

  52. Anonymous says:

    It’s really bad how are care facility under staffing. Somuch resident living inside the care but staff are so tiny, to be able to give a quality care that elderly needed u needed more staff as well, all the pressure and hard work is with the staff woke the management and the owner of the facility doing paper works only. So many injury and psychological bad outcome that under staff dealing but ignored by the the care management. They just thinking to earn not thinking the well being of the staff, if you try to tell them your simple injury because of the elderly management blame staff not doing they job properly when reality it can be avoided if enough staff doing and sharing the time in proper ratio. Over work load less salary it’s not right it should really goes to staff additional salary and more staff. I hope the government will see this and better interview all staff not just the management of the care facility. I wish government sector will sent hidden official to see what’s really going on inside facility how workers are really in having too much load of work how heavy it is physically and how salary not giving justice to job staff dealing with.

  53. Anonymous says:

    I work in aged care,there is no time to spend with residents as the work load is ridiculous. Staffing is well below what it should be,it’s all about money not the residents.

  54. Vicki McCartney says:

    I believe there is also cost shifting & double dipping with clinical work that should be done by RN staff referred to GPs who then charge for their visit.
    Example – funding to ensure influenza immunisations completed in RACF – GPs called to do this rather than having a credentialed RN to complete this.
    This is a structural problem – not enough RN staff. Often requests for GP visits are initiated by the personal care staff – well intentioned, but often clinical decisions that could have been dealt with by a RN.

  55. Ian Chenoweth says:

    My observation from some years ago, was that a lot of staff time was spent in documenting levels of care carefully so that they could claim the maximum subsidy. This was a lot of paperwork that took staff away from resident care. So that might be one avenue to tackle. Perhaps technology can help there.
    Talking of which, it takes investment to upgrade technology and (like the lack of capital investment in General Practice) this is probably sorely lacking in RACFs.

  56. Anonymous says:

    Nursing homes need to be more transparent and it needs to be a random audit that is compulsory, as after all,we – the tax payer -are funding these organizations .
    The issue of staffing started way back in the 1990’s when RN’s were replaced by En’s and PCW ‘s.
    In the nursing home that I visited there was 1 RN rostered on at night for the whole complex of some 250 patients .The RN on duty in the court spent all her time writing in charts to justify the level of care and therefore the funding and the people stayed in their rooms
    They have become institutionalized – once upon a time the clients could cook the morning tea and the workers could take the clients in their cars to the local hotel for lunch but that was stopped on the pretense of WPHS -these are older Australians that are being treated as children

  57. DR J N Parikh says:

    Interesting observation about the time spent and so called star ratings >I really love to see the basis of star rantings
    That said we need committed staff with significant empathy to improve the quality of care
    Remuneration is always an issue particularly when traveling time can not be legally included as apart of actual amount of time spent

  58. Anonymous says:

    I also agree but it should not be voluntary as if it is only the better RACF will put their hands up to be audited.

  59. Anonymous says:

    I totally agree that nursing homes need to be more transparent about how money is spent. The elderly already pay an enormous amount to be in care. The staff are poorly paid. Where does the money go?!

  60. Anonymous says:

    Urgent reform of RACFs is needed. Sending in forensic accountants is a great start. Ultimately, our commitment to funding RACFs appropriately depends on how we respect and value our elders.

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