restoring stability in aged care

Residential aged care facilities are home to over 200,000 frail older Australians and is one of the country’s rapidly growing employment sectors. Turbulence in the sector has a significant impact on many.

In August 2018 there were 15 residential aged care facilities in Australia deemed to be non-compliant with the Aged Care Standards and two received sanctions; this is on the back of the doubling of both non-compliance and sanctions in the past year. So for many older people, their families and those working in the sector it is a very troubling and distressing time.

Changing resident profile

Those entering care are older and frailer and have increasingly complex care needs. In many cases the older person and their family have been ‘managing’ at home for a long time with support from family, friends, community services and home care packages. The decision to enter care is based on there really being no other feasible alternative care option for the older person and their family that can safely meet their care needs. Often the decision is emotionally gruelling, financially challenging and confusing, and there is a great sense of grief and loss in leaving the family home, treasured possessions, neighbourhood and social connections. Through all this the goal is for the older person to be safe, happy and cared for.

residential aged care

Building a culture of excellence and best practice in aged care takes time and investment in people, equipment, knowledge, resources and infrastructure. An analysis of non-compliant facilities highlights that this list includes providers, who for many years, have prided themselves on providing high standards of care and being an employer of choice. Most take their responsibility as an Approved Provider very seriously and a very shocked when their accreditation status is blemished.

The vast majority of people who chose to work in the aged care sector do so because they are caring by nature and want to make a difference to other people’s lives. Spend time in aged care and it is uplifting to see the efforts that many staff go to on a day to day basis to ensure that those in their care are content. Modern aged care facilities are 90+ places; they are busy environments; and may have over 100 staff. There is a huge focus on financial return and meeting benchmarks set by ‘high performers’.

At a facility level keeping it all together are the Facility Manager and the Care Manager who are at the front line for residents, families and staff. These are the roles that lead the facility and create the environment that brings out the best in staff and ensures the residents receive the care and support they need.

the impact of poor quality outcomes

Of the facilities that were made non-compliant or received a sanction in August 2018 the most common unmet outcomes were human resources and clinical care. The human resources outcome focuses on having appropriate numbers of skilled staff, who understand the requirements of their role and safely provide care; a weakness in this outcome impacts many others. The clinical care outcome focuses on residents receiving appropriate clinical care; it underpins the other outcomes in Standard Two.

The transition to the Single Quality Framework will change the terminology however good leadership, robust human resource practices and providing good clinical care will be paramount. If there is weakness in these areas it will manifest throughout the compliance measures.

Compliance issues evidence a period of time during which the focus on many elements may have slipped. It may be a change of leadership, expansion of the facility or the service offering, significant changes in the resident mix, significant changes in systems and processes or a combination. It won’t have happened ‘overnight’ and when you go back and analyse the issues more often than not a pattern emerges. Even the best systems, processes and audits can breakdown.

rebuild

For those facilities facing a stormy time look closely at the leadership team and how they are being supported and how in turn they support the staff. Invest in building skills. Ensure they those leading know what good practice is and how to implement it.

The important thing for those who call an aged care facility home and for those who rely on it for their livelihood is to restore stability and rebuild trust. This takes time. Troubled facilities are placed on a ‘timetable for improvement’ during which they need to address their issues. Many providers focus solely on addressing the issues identified by ‘the agency’ however during this time period it is crucial that the Approved Provider creates and supports the leadership to achieve long term stability.