industry & policy
for the next 20 years to have a system
that we’re all very proud of and serves the
country well.
Did the government talk to academics
such as you about this?
They did to an extent. Obviously, we
would’ve liked to have been far more
involved with both the government and
the sector. I think that people find it very
confronting to be talking about premature
and preventable deaths or premature
or preventable harm of any sort. Also,
people tend to focus on a single case, not
recognising that the issues affect the whole
sector and that it’s not one facility or one
doctor, but it’s in every state, territory and
type of home, be it private, not for profit
or public.
Our frustration was that the only publicly
accessible data was on deaths from the
coroner’s court. What we had wanted to
look at was the quality of clinical care in
particular, dementia care, management of
depression and the more common types
of ailments that you’d see in residential
care. That data is not publicly available nor
is it shared with researchers generally.
We’ve been looking at the issue of safety
and quality in residential aged care through
our team’s work since the mid-2000s and
with the specific emphasis in the last five
years. The funding and support for this type
of research is very limited, as is the funding
for any research into aged care.
Do you think the wider issue is about
funding or is it a wider cultural disrespect
for elder Australians?
I think it’s more than a single factor. The
question of whether there is sufficient
money in aged care to deliver the type of
care we want is very confusing. There are
many differing opinions on whether there’s
enough or not. We need some facts and
figures about the true cost of provision
of care, and how the money is spent and
where the money is coming from. That
area is not my research expertise.
What we do know is that the culture
and evidence base for good practice
isn’t being utilised, that aged care has a
culture that is much more in keeping with
the 20th century, where people look to
blame individuals and find a bad apple
to explain deficits. The thinking in health
changed radically in the 2000s, where
people understood it was the systems of
care, the teams of care, the teams of how
you configured health professionals to
deliver care, and you need an organisational
culture that is open, transparent and just,
that rewards people for reporting things
that go wrong, and an organisation that
looks to correct and learn from that.
So a culture that’s just and learning
is critical. The next layer is, do we have
sufficient staff and sufficient staff with the
correct skill mix? That again is an area that
is hotly debated.
people. Workforce or employment strategies
need to be promoting aged care as a good
place to work.
Each ministry or portfolio has a
responsibility for older Australians, and yet it
all gets shunted back to a junior ministry. And
this happens with repeated governments. If
we want reform, then this is a problem for
all of us to solve; it isn’t just for the people
working in aged care to solve.
What do you think about staffing ratios?
Well, the example I always use is this:
everyone knows a football team’s got a set
number of players, and how good the team
is depends on how well that team works
together and how well it’s supported. So
I think the issue of ratios is too simplistic.
We really need to be looking at what care
is required and what the skill sets are that
deliver that care. These will vary from one
place to another, but I think we can do
better at documenting and debating what
those models should be.
As for the other work around gathering
information and responding to it, again, in
health, you will have registers of adverse
events, and the Law Reform Commission
called for a register of serious incidents. So,
examples of resident-to-resident violence,
physical restraint, suicide, those types of
really dramatic events, we ought to be
collecting as they occur, and investigating
as they occur, and then feeding those
messages back to the whole country, not
keeping them essentially hidden.
We’ve advocated for a national group
to oversight learning from adverse events,
which would really need to be non-
partisan. I think one of the dilemmas
with aged care is the sheer diversity of
groups in it, which means we don’t work
collectively together very well. There are
900 different providers operating 2700
facilities for over 200,000 people. We’re
not working together, we’re not using
the same information, and we’re not
learning from each other. This wouldn’t be
acceptable in healthcare.
The other thing to raise is the issue goes
beyond the aged care sector. I’ve been
working in it now for 30 years; I’ve got a lot
of respect for the people in the industry,
and if it wasn’t for those caring and well-
intentioned people, we wouldn’t have a
sector. We don’t get sufficient support
from the other ministries or portfolio in
government or society.
The acute hospitals need to be helping
more with residential care. The Department
of Education should be promoting training
and qualifications for nurses in care of older
Scott Morrison said the sector provides
some of the best aged care in the world,
bar these few instances. Can we still
claim that if we’ve got to the point of a
royal commission?
I think the royal commission’s a good
move in the sense of consolidating all of
the inquiries that have been done. I think
like every industry, there are pockets of
excellence and pockets where things are
poor overall. I still have confidence in the
sector as whole but ... we’re trying to guess
the future, and it’s a bit like the banking
royal commission and the commissions
into family violence and child abuse: what
we think, what we know and what actually
happens can be quite different. Only at the
end of the royal commission will we know
what the true picture is.
The frustration is that we’ve known
for a long time that we haven’t had the
information to make broad statements
about the health of the sector, and I think
the royal commission now provides an
opportunity for everyone to be engaged,
and to participate in arguing for what we
want in the future.
So, you wouldn’t agree with Ken Wyatt
that money would be better spent on
frontline services?
Well, I do think money would be better
spent on frontline services, but we’re stuck
now. The opportunity to have spent that
money has been there for the past 10 years
and both governments have not put up
a system that provides confidence to the
sector or rebuts the issues that come out,
and I think that with the ABC getting 4000
families lodging complaints, it shows you
the system isn’t as good as I like to think it
is but until you know the content of those
complaints, it’s hard to know how wide
spread the issues are. And so I think the
royal commission is welcome in terms of
providing a light on the area.
Would we have this royal commission if
Four Corners hadn’t acted?
I don’t think so. ■
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