Submission to the Standing Committee on Health, Aged Care and Sports Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia
CPSA's response to the Standing Committee on Health, Aged Care and Sports Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia. More information can be found on the Parliament of Australia website, along with CPSA's submission.
CPSA is pleased to submit the following comments to assist the Standing Committee on Health, Aged Care and Sport (House) in its Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia. CPSA’s comments are grouped under headings that coincide with the Inquiry’s terms of reference.
Mistreatment of residents in residential aged care facilities and associated reporting and response mechanisms
The incidence of all mistreatment of residents in residential aged care facilities and associated reporting and response mechanisms, including the treatment of whistle blowers.
It is unclear what precisely is meant by “mistreatment” in the terms of reference for this inquiry. However, in this submission it is interpreted as any abuse or negligence by nursing home staff or residents resulting, or likely to result in mental or physical injury.
In the table below are listed the number of assaults nursing homes were obligated to report to the Department and to police from 1 July 2008 to 30 June 2017. These data are sourced from the annual Report in the Operation of the Aged Care Act 1997 for the years listed in the table. These are departmental data published under the signature of the Ministers responsible for aged care in the period covering those years.
This table shows that, since reporting began, the reported rate of reportable assaults has more than doubled.
It should be noted that a reportable assault is a significant physical or sexual assault within a nursing home by a person who is compos mentis. It is therefore very likely that, by and large, assaults by residents on other residents go unreported. A high incidence of this type of assault can be assumed.
It should also be noted that where the same perpetrator assaults the same victim multiple times these multiple assaults are reported as a single assault.
It is therefore fair to say that the published data do not accurately represent the true horror of the incidence of physical and sexual assault in residential aged care in Australia.
While significant physical and sexual assaults clearly fall within the definition of “mistreatment”, neglect and omission in the discharge of care functions by nursing homes are likely to be significant causes of mental and physical injury, including death.
Reporting and response mechanisms
Despite boasts by Australian Governments, both current and previous, that Australia has a world class aged care system with a compliance system to match, no “mistreatment” data apart from the reportable assaults discussed above are published.
The Australian Aged Care Quality Agency published compliance reports following audits of individual nursing homes. These reports contain, however, no meaningful concrete data. They are useless in themselves and useless for the purpose of compiling data on anything that occurs in nursing homes and that might offer insight into residential aged care practice and performance.
Adding the inadequate reporting on residential aged care performance and the near impossibility to obtain any information relating to aged care performance through Freedom of Information, one is left with the impression that aged care regulation in Australia is framed to enable non-disclosure of provider performance.
CPSA recently applied (under FOI legislation) for information on the aggregated incidence of reportable assaults in nursing homes in the Queensland Gold Coast area. CPSA did this after the Department of Health advised a local journalist it did not have data relating to Gold Coast nursing homes and could not compile those data. This turned out to be incorrect. It is illegal to withhold information applied for under FOI if the information exists and is not exempt from release. The Department initially came back to CPSA with the same answer it had given the journalist. CPSA applied for an internal review under FOI legislation, pointing out that the Department did have the information as it was capable of publishing annually data for all nursing homes in Australia. If it could do that, it could compile data for any subset of nursing homes. Implicitly accepting this argument, the Department then refused CPSA’s application on the basis that the information sought constituted ‘protected information’ and that it would be illegal for that information to be released. A review application by CPSA to the Information Commissioner finally forced the Department to release the information sought, which showed that the reportable assault rate for Gold Coast nursing homes was significantly higher than the national rate during 2015/2016.
What this example shows is that the regulator, let alone the industry itself, prefers to operate in secrecy and to a large extent is successful in doing so. It demonstrates a culture of systemic cover-ups. The victims of this culture are the residents of Australia’s nursing homes. The horror for many of ending their days in a nursing home is shown regularly, if anecdotally, in media stories and coroners’ inquiries with depressing regularity. Data that would enable compilation and collation of neglect and omission in residential aged care exists at the level of individual facilities, where they cannot be accessed through FOI. It is quite obvious that the industry, the regulator and governments of the day prefer them to stay there.