Solutions through evidence and dialogue
The media has been reporting story after story of appalling treatment in aged care homes. But aged care is much more than residential care. It also includes home care packages and the Commonwealth Home Support Programme.
Opinion Piece in Michael West
A new independent study by Dr Sarah Russell, of Research Matters, titled ‘Working Well in an Aged Care Home’ asked staff to fill out a survey on what they enjoy about their jobs. Conor Burke reports
10 July 2019
Last week, I was invited to comment on the requirement in the new Aged Care Quality Standards for open disclosure. I suggested all aged care homes and home care providers should be required to report adverse incidents not only to the older person and their family but also on their websites.
I am pleased both Ian Yates (CEO, COTA) and Darren Mathewson (Acting CEO of ACSA) have contested this idea for improving transparency. I always welcome debate. A public debate about transparency in the aged care sector is long overdue.
My research on residential aged care and in-home care indicates the public want more transparency in the aged care sector. Although many people, myself included, believe the care of frail older people istoo important to be left to the whims of the free market, both COTA and ACSA promote lighter regulation and a consumer driven and market based system, as outlined in the Aged Care Roadmap.
In a free market, so-called “aged care consumers” require access to information to inform their choice of product. For example, to make an informed decision when choosing an aged care home, “aged care consumers” require information about its standards of care. However, aged care homes are not even required to disclose their rosters/staffing levels. How can people make informed decisions about an aged care home’s standards of care when they do not have access to this vital piece of information?
In addition to staffing levels, I have tried unsuccessfully to get data on adverse incidents in aged care homes such as the incidence of pressure injuries, dehydration, malnutrition, medication errors and falls. This information is needed not only to help people make informed decisions when choosing an aged care home but also for an evidence-based discussion about standards of care.
The most common reason providers give for not sharing clinical indicators with the public are: (1) Privacy and (2) Commercial-in-confidence. It is not surprising, therefore, that Ian Yates opposes my suggestion for all adverse incidents to be reported on a providers’ website because it “would raise privacy and other issues”.
In my view, claims about breaching privacy are a red herring. I will use 2 examples to illustrate this.
Example 1
When my mother had a fall in an aged care home that contributed to her premature death, the manager informed me and apologised (i.e. open disclosure). I am not suggesting the provider should post on the company’s website “Joan Russell had a preventable fall that contributed to her premature death”. Of course that would be a breach of my mother’s privacy.
I am instead suggesting the company be required to publish information about the adverse event. This would include information such as: a fall occurred in the lounge room, the date of the fall and how/why it occurred. The web site should also contain information about what the aged care home has done to prevent a similar adverse event occurring to other residents.
Example 2
A 94-year-old woman was resuscitated in an aged care home despite having an advanced care plan stipulating ‘Do Not Resuscitate’. The aged care home did not practice open disclosure. The daughter had to fight to find out why/how/who resuscitated her mother.
In my view, the aged care home should be required to share information about this adverse event with the public without breaching the resident’s privacy. The public need to know the policies and procedures have been introduced to ensure other residents are not resuscitated against their wishes.
Several years ago, I asked Ken Wyatt to improve transparency in the aged care sector. I suggested public access to all reports produced by the Australian Aged Care Quality Agency by linking them to the ‘My Aged Care’ website.
Ken Wyatt took my suggestion to the Aged Care Sector Committee. The minutes of the meeting (obtained under Freedom of Information) show that Ian Yates opposed this suggestion for increased transparency. The committee decided the information in these reports was “too technical” for the public to understand. In my view, this was patronizing.
In the 1980s, I was part of a group of registered nurses in an intensive care unit who advocated for open disclosure policies. These open disclosure policies are now legislated in all public health services. I would like to see similar legislation in the aged care sector. I also welcome public discussion about this idea.
14 June 2019
The United Nations (UN) has designated today (15 June) as World Elder Abuse Awareness Day. The types of abuse to be aware of include financial, physical, sexual, social, psychological and emotional abuse. Financial abuse appears to be the most common.
While some older people are enjoying their wealth – travelling the world, their luggage broadcasting that they are spending their children’s inheritance – others live in aged care homes, with their children keeping their eyes peeled on the ‘Bank of Mum and Dad’.
As economic conditions worsen, this second group is at greater risk than ever of being financially abused. Financial abuse involves taking or misusing an older person’s money, property or assets. It also includes persuading an older person to change their will through deception or undue influence.
Research has identified adult children, particularly sons, as the most common perpetrators of financial abuse. The victims are often women over the age of 80. Like other crimes perpetrated mostly on women – domestic violence and sexual assault – financial abuse is often a silent crime, unreported and unacknowledged. As a result, there is little reliable data on its extent.
The most vulnerable include older women with diminished capacity due to dementia and depression. According to the Office of the Public Advocate, older women are more likely to be declared legally incapable than older men. This may be due to the fact that women live longer than men. It may also suggest that older men are revered whilst older women are infantilised. This was certainly the case in Julie’s family.
Julie is a middle-aged woman with four older brothers who were all educated at elite private schools and have had successful careers. With unseemly haste, a few days after her father’s death, a GP was asked to declare Julie’s elderly mother legally incapable. That she was bewildered, grieving and in the first weeks of widowhood after 64 years of marriage was not taken into account.
After Julie’s mother was declared legally incapable, the youngest son, Tony*, became her financial power of attorney. Without any guidelines to help him manage his mother’s money in an ethical manner, Tony recommended his mother gift some of her money to her children. This gift would help his siblings with mortgages and other debts. “Mum doesn’t need this money and it’s going to be ours soon anyway”.
Julie was horrified. Should middle-aged men who all have professional jobs with decent salaries rely on inherited money to help them with loans they chose to take out to support their lifestyles? Julie told her brothers they had ‘early inheritance syndrome’.
Adele Horin coined the phrase ‘early inheritance syndrome’ to describe children with a sense of entitlement to their parents’ assets. These impatient children are not prepared to wait until their parents die. Children with ‘early inheritance syndrome’ often make ageist and sexist assumptions that devalue the rights of their elderly parents.
Tony assumed his mother, who had not been the family’s breadwinner, would find discussions about financial issues complex and stressful. He arranged family meetings to discuss ‘the family estate’ without his mother present. This was not only patronising it also disempowered his mother.
Julie’s eldest brother told his siblings he was planning his retirement. He unashamedly cast his eyes towards the Bank of Mum. Without blinking, he requested regular spreadsheets of his mother’s expenses so he could know his “financial position”. He assumed what was once ‘Mum and Dad’s money’ was now his money, not his mothers’ money.
There have been several legal disputes in which sons have sued their mothers over a ‘family estate’. In one case, a former pupil of a private boys school took legal action after the family estate was left to his mother rather than to him. The judge castigated him for having a “highly developed and unhealthy sense of entitlement“.
This gendered sense of entitlement is reminiscent of the Victorian era. In those days, a wife became her husband’s property, his chattel. A married woman could neither own property in her own name nor control her own money. The laws changed over a hundred years ago. Thankfully so too did attitudes towards married women. Older women may be the last bastion of Victorian traditions.
Soon after Julie’s mother’s 90th birthday party, three brothers complained that their mother’s monthly expenses were “excessive”. They wanted Julie to curtail these expenses. They also wanted to restrict their mother’s visits to her beloved beach house. Julie’s sister-in-law explained: “Your brothers are worried about their inheritance. What’s wrong with that?”
Julie defended her mother’s right to spend her own money. One brother supported her; the other three bunkered down, ensconced with others who shared their privileged views. These brothers refused to engage with Julie. They simply dismissed Julie’s views as offensive, describing her as mad and bad, as powerful men often do.
The financial abuse of older women is on a continuum of violence towards women. It should be a criminal offence. For financial abuse of older people to become a criminal offence, attitudes towards older people, particularly older women, need to change.
Recently, a woman contacted me because a 94-year-old woman was resuscitated in an aged care home despite having an advance care plan stipulating Do Not Resuscitate. Rather than die peacefully after breakfast, this woman had a slow and painful death in a hospital palliative care unit.
20 May 2019
A confidential internal inquiry into the office of the Aged Care Minister Ken Wyatt was leaked to the media during the recent election campaign. The journalist described the leaker as a “whistle blower.”
Whistle blowers are honourable people who are motivated by altruistic intentions. Anonymous disgruntled staff members who are dissatisfied with the outcome of an internal grievance process are not whistle blowers.
I have never worked in Minister Wyatt’s office so I do not have inside knowledge. However, this leak had all the markings of a political attack. Normal administrative processes resolved this grievance. That should have been the end of it.
Instead, a confidential document was leaked to the media in the middle of an election campaign. The leakers’ aim was to throw the Aged Care Minister, the first Indigenous frontbencher in federal parliament, and his Senior Advisor under the bus for political purposes.
The leakers went so far as to accuse Minister Wyatt’s Senior Adviser of bullying. The oldest trick in a bully’s handbook is to accuse others of being a bully. Is this yet another case of the pot calling the kettle black?
Recently, false allegations of bullying have been made against many strong, intelligent and forthright women in senior positions. When a male is forthright, he is “assertive”. When a female is forthright, she is “aggressive”. This gendered disparity was ever thus.
I am a researcher who advocates for improving standards of care in residential and in-home care. As such, I have had many meetings with Minister Wyatt and his Senior Advisor. Paula Gelo is one of the more honourable political advisors I have met. She is intelligent and committed to her job.
Minister Wyatt’s Senior Advisor and I often discussed my ideas for improving the aged care sector. She was not only respectful but also provided evidence to support the government’s position. I contested this evidence. Paula welcomed this robust contest of ideas.
Others on the Executive of Aged Care Matters have also challenged both Minister Wyatt and his Senior Advisor. Paul Dwyer (Aged Care Finance Solutions) said:
“I have found both the Minister and his adviser, Ms Gelo, exceptionally devoted to the aged care portfolio. Ms Gelo has been available 24 hours, 7 days a week, in any matters. She has shown me respect and courtesy, both face-to-face and via correspondence.”
In my experience, bullies do not welcome alternate views. Instead, they react aggressively. They see disagreement as combat they must win. They either attack people who disagree with them, or ignore them. Either way, they ruthlessly shut down dialogue. Bullies perceive those who disagree with them as enemies who must be silenced. If the evidence does not fit with their worldview, they will simply ignore the evidence.
A new member of the Aged Care Sector Committee blocked me on Twitter after I questioned the value of the Aged Care Workforce Strategy Taskforce’s report. He refused to engage with my alternate perspective. In contrast, Minister Wyatt and his Senior Advisor always replied promptly to my emails and texts, including when I was critical of the government’s policies. They always picked up the phone when I called to discuss an urgent matter. Most importantly, they always did what they said they would do.
On several occasions, Minister Wyatt took my request for access to data to the Aged Care Sector Committee (ACSC). On each occasion, the ACSC denied the request. For example, when Minister Wyatt requested all reports on spot checks be made available on the My Aged Care website, the committee provided a patronising response about the data being “too technical”. According to notes from meeting on 12 May 2017 (obtained by freedom of information): “Members expressed caution about releasing unpublished reports from the Quality Agency as they believed that these reports were more technical and, without explanation, may not provide useful information for consumers or their families.”
According to the media’s report: “Ms Gelo spent $108,000 on airfares as well as $31,000 in travel allowances in one year.” Why did this spark alarm? Surely Minister Wyatt was entitled to take his Senior Advisor with him when he visits aged care homes around the country.
The Aged Care Minister, Minister Wyatt and his Senior Advisor visited over 130 aged care homes in urban, regional, rural and remote locations. Unlike Minister Ley (the previous Aged Care Minister), Minister Wyatt consulted widely with residents, relatives and staff. Both Minister Wyatt and his Senior Advisor should be praised for this, not criticised.
During her Christmas-New Year holidays in 2017, Minister Wyatt’s Senior Advisor read my research report “Living well in an aged care home”. She told me she welcomed reading relative’s critical feedback. She suggested a qualitative research project with older people who receive in-home care. Paula said it was important for Minister Wyatt and herself to hear genuine first-hand experiences of in-home care.
The Commonwealth Department of Health generally commissions research from consultants working in large organisations such as KPMG and Korn Ferry. I am critical of this research – it is not only extremely expensive but often lacks rigour.
I was excited to have the opportunity to bring some genuine ‘consumer’ voices into the debate about in-home care. However, working with the Commonwealth Department of Health was an eye-opener, to say the least. Without Minister Wyatt and his Senior Advisor’s help, it is most likely my research report “Older people living well with in-home support” would have languished in the bottom of a drawer (with all the other reports that have provided the Department with unwelcomed critical feedback).
Working in a politician’s office is not for the faint hearted. The hours are long and the stress is enormous. Minister Wyatt is fortunate to have employed a Senior Advisor who showed him such loyalty.
A smear campaign in the media will soon be forgotten. Instead, aged care stakeholders will remember Minister Wyatt and his Senior Advisor’s work to improve the quality of life of older people who receive residential and in-home care.
Speech at Candidates Forum on people seeking asylum in Australia (2019 Federal Election campaign)
I acknowledge the Wurunjeri people of the Kulin Nation and recognise their continuing connection to land, waters and culture. I pay my respects to their Elders past, present and emerging. I acknowledge that I am standing on stolen land and sovereignty has never been ceded.
I also pay respect to all refugees here tonight, and I offer you a heart-felt apology for the way you have been treated by our government – both LNP and ALP.
Last night I attended a forum with some Indigenous people living in Cooper. One of the discussions involved the need for truth-telling. There is also need for truth telling in debates about refugees and migration.
The Reason Party form policies based on evidence. There is no evidence to support our refugee policies.
Human rights lawyer, Shen Narayanasamy, presented her research at the Di Gribble Argument in 2016. Shen shows how yet again those in power control the narrative – even when that narrative is not true.
Shen suggests it has been a deliberate political strategy to focus the public’s attention on a few thousand asylum seekers rather than the 800,000 people arriving each year from Asia, Middle East, India and Africa.
Historically, we have been a country that welcomed refugees. How did our narrative on refugees change so radically?
For example, we now suggest that refugees might be ‘economic migrants’. Yet we welcome 800,00 economic migrants each year. In fact, our country is built on economic migrants.
The first wave of post 2nd world war migration began with Displaced Persons. These people fled their countries that had been utterly destroyed by war. And we welcomed them.
In 1976, we welcomed the first boatload of refugees fleeing Vietnam. By 1982 Australia had accepted close to 60,000 Vietnamese refugees. And we brought them here by plane.
The current narrative: “Offshore detention is the only way to save lives at sea”. This is complete nonsense. Flying refugees to Australia would certainly save lives at sea.
Shen put the number of immigrants from 1984 – 2013 into Excel. The graph showed a steady increase that suddenly skyrocketed after the election of John Howard. By the time Howard left office in 2007, the LNP government had more than doubled Australia’s intake of migrants.
The big difference is the number of migrants that came to Australia on a humanitarian basis. Prior to Howard it was around 1 in 5. By the time Howard left office, that humanitarian intake plummeted to 1 in 50.
I regularly invite refugee families for a short holiday in my beach shack. I’ve had some fabulous holidays with people from Sri Lanka, Iran and Sierra Leone. The most recent family was from Afghanistan. The father applied for a skilled migrant visa but he was flagged by the Immigration Department. Why? Because he, his wife and children were from a war-torn country and trying to seek safety here.
This family ended up on a boat and they spent 4 years in a detention centre in Australia. They now live mostly on charity. Not working has had a terrible effect on the father. But the most dreadful thing is the trauma on the 12-year-old son. He is old enough to remember the terror of being on a boat and the terror of being in a detention centre. This young boy is deeply traumatised. And we are responsible for that.
On a positive note, this family were lucky not to become part of the Pacific Solution. What a disgrace calling our policy of transporting asylum seekers to detention centres in the Pacific Ocean, a “Solution”. A solution for who? Certainly not people from LGBTI community were have been detained in PNG, a country hostile to LGBTI people. This must never ever happen again.
The Reason Party believes the solution to the Pacific solution is to close all offshore detention centres and facilitate the immediate evacuation of Manus and Nauru.
However, if the next government delays the evacuation of offshore detention centres (as Ged suggests an ALP government might), the next government must:
When people apply for asylum, there should be a strictly enforced time for security screening. After security screening, asylum seekers should be brought to Australia and assisted to settle in regional towns and cities while their claim for refugee status is assessed. A predetermined timeframe should be set for processing these claims.
Thank you.