Violence, malnutrition and lack of care reported in huge numbers in Australia's aged care system

By Dr. Ananya Mandal, MDFeb 12 2019

According to the reports of a recent inquiry, inspectors looking at aged care homes in Australia over the last year have reported an alarming rise in missing residents, violence that was not reported and severe degrees of malnutrition among the residents.

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Combined Pensioners and Superannuants Association policy manager Paul Versteege have reported to the royal commission in Adelaide this week (12th February 2019) the rise in the number of unpleasant experiences and incidents was not due to increasing numbers but because of the change in the inspection protocol and modus operandi of the government inspection agency. Earlier the reports were mainly checking off the tick boxes. Since last year, a more detailed report from the homes was prepared after a detailed inspection. This has revealed the truly horrifying picture says the inquiry report.

According to the report there is a 32 percent rise in incidents of reportable assaults on the residents in 2017-18 compared to previous years (a rise from 2,853 cases the year before to 3,773 cases in 2017-18). The number of missing residents from the facilities rose from 1,108 to 1,450 from the previous year to 2017-18. As a result of inspection accreditation was revoked for 12 facilities in 2017-18 compared to only 4 the year before.

Mr Versteege said these numbers raise the question of why there is such a steep rise in them. He said, “In my view ... the reason for this is the Aged Care Quality Agency started to do things differently.” There was a rise in number of meals left uneaten he said. He explained, “What they found was that people were served a meal but quite a few people were unable to actually eat that meal and because the staff was rushed they would not be able to assist them. And staff would come around and collect the uneaten meal and a person would basically not eat.” He explained that rates of 50 percent malnutrition among residents was very common.

Further continence pads were not routinely and regularly changed due to rationing of the pads and this led to sores. “Obviously the skin of older people is thinner and compromised much more easily. If a continence pad is soaked and has faecal matter in it and is in contact with the skin, if you keep that up for a while that is life threatening,” he said at the inquiry. Then there was the unavailability of appropriate sized wheelchairs. “If you get the wrong wheelchair and you are stuck in it and dependent on it for your mobility, it can also lead to depression, because you can’t get anywhere if you are frail,” he said.

He said that what changed was the assessment of the facilities adding, “Facilities were used to being assessed one way was suddenly assessed in a different way and the result was massive non-compliance.” He added that unannounced inspection review visits rose by 323 per cent over last year which also caught some of the irregularities at the facilities.

At present over 376,000 Australians are living with dementia and Versteege says that people with dementia “do become aggressive and can display that sort of behaviour to other residents.” He added, “There are examples of very violent attacks on resident-on-resident which makes facilities very unsafe. It's not reported, it's not even recorded, it's not subject to any administrative record.”

There is also a discrepancy in use of appropriate antipsychotic drugs to manage patient behaviour. The inspectors noted evidence of lack of adequate funding and also a 12-month waiting lists for aged home care. According to Older Persons Advocacy Network chief executive Craig Gear said that the waiting times were too long for some people until they have to choose residential care instead.

Peter Gray QC, the counsel assisting the commission in the inquiry said, “The dominant narrative in current Australian culture seems to be that older Australians are a burden. We reject that narrative... This is not a matter of bearing a burden, but of becoming the nation we know we should be.”

Scott Morrison just before the hearing announced a $662m funding for aged care. The Prime Minister has announced $320m for residential facilities amounting to around $1,800 per Australian resident. Rest of the funds would go to home care packages. The final report of the commission is due on the 30th of April next year.