Open Letter to the Aged Care Commissioner, Rae Lamb

Dear Ms Lamb

While the move (and renaming) of the Aged Care Complaints Scheme from the Department of Health / Health & Ageing / Social Services to the new Aged Care Complaints Commissioner was largely a political move by government to distance itself from this hot potato and the subsequent exposure to any negative imagery of aged care services in Australia, it also provides us with a wonderful opportunity to review the way the Scheme operates and ensure that it appropriately balances the rights of residents and providers ... something that it fails dismally to do now.

I have been blessed through opportunity to accumulate a set of skills and experience across industry, government and academia which gives me a view of our industry from almost every angle. I thank God every day that I haven't lived through the final facet of experience as an actual resident of an aged care service but I thankfully receive quality feedback on this experience on a daily basis from those in our care.

My experiences of nearly 25 years in this sector (which include 8 years working on your side of the fence in both the old Complaints Resolution Scheme and the newer Aged Care Complaints Scheme as a Clinical Adviser) has taught me the importance of robust complaints handling processes and the need for an independent review of concerns. This is important both for providers of aged care and the complaints scheme itself.

One area that is very concerning with this move is the loss of an independent reviewer of complaints handling decisions and processes by the Scheme. This used to be you, as an independent body with the power to direct the Scheme to re-examine cases they got wrong. This was an important avenue for both complainants and providers when the Scheme failed to meet the required standards of process or made decisions that defied logic.

With the changes, I note that you have now become the investigator, the decision maker and the reviewer (with a final avenue to the Commonwealth Ombudsman ... but only after you have reviewed your own decision). It is very interesting that the legislation now allows you an opportunity to rectify the Schemes stuff ups without being subject to external review or criticism but does not afford approved providers working in the industry the same luxury to fix their mistakes with the same level of protection.

The reality for anyone having to deal with the Scheme is that it is such a drawn out exhausting process, to make the review process so biased will result in many REAL complainants and quality approved providers simply giving up in despair.  

I use the word REAL complainant deliberately because this is the biggest challenge that must be addressed as a priority. The Aged Care Complaints Scheme has become the play thing of disgruntled staff (and ex-staff), dysfunctional family members and people with ulterior motives and agendas and to date, the Scheme appears unable or unwilling to identify or act appropriately in these cases. Despite having the powers to determine a complainant vexatious, the Scheme appears to lack the clinical and operational aged care expertise and judgement to make this decision which results in a horrendous abuse of tax payers money for no demonstrable outcome.

Don't for a second draw the conclusion that I am anti-complaints ... I have long been an enthusiastic advocate of residents rights and tried my level best to champion the delivery of quality holistic care in the aged care sector.  My success as an aged care manager has primarily been attributable to the philosophy that we don't hide anything ... people make mistakes ... people get things wrong - you find it, you work together and you fix it. Open communication is key.

Unfortunately, in the past year I have been inundated with anonymous, vexatious complaints that have been lodged with the Scheme. The home I now manage had significant compliance issues and a toxic organisational culture driven by a very small number of recalcitrant staff. These staff members have successfully driven away at least 3 previous managers using these tactics and because of their previous success, their efforts are relentless.

I have now been here a year and have had more unfounded complaints in the last year than in the last 25 combined. Unfortunately, the feedback I have received from colleagues throughout the industry is that this is not an isolated case and indicative of the problems of external complaints mechanisms in general.

I understand completely the rationale behind the opportunity to lodge anonymous complaints - in some instances the fear of retribution is real and sometimes complainants need protecting. The problem is that sometimes it is the approved provider that needs protecting and the relentless inquisition that the Scheme represents, amounts at times to little more than government sanctioned bullying and harassment.

Given that the Scheme already has the "confidential" complainant option which still keeps the complainants identity secret from the provider, it is unclear why the "anonymous" classification is even necessary. The advantage of the "confidential" classification is that the Scheme will know if the same person is continually lodging unfounded complaints which would in turn allow the Scheme to make a more meaningful decision about whether a complaint is vexatious or not. All complainants need to be identified to balance the process and assign appropriate responsibility and consequence as a minimum starting point.

The current process allows anyone to ring or fill in an online form and raise the most ludicrous, fanciful issues without consequence. And they can do it again and again and again and again like a cat playing with a half dead mouse ... AND IT IS KILLING US.

It is simply just too easy for anyone to send off lies and misinformation that is damaging to organisations, damaging to individuals and ultimately damaging to residents. You don't even have to have visited the home ... just get out the yellow pages, go to the nursing home section and start writing. Unfortunately this is not new - I still remember having to do a compliance visit at the direction of the then Minister for Ageing to an aged care home that was supposedly so bad you could smell the faeces from the road outside ... (which in truth was a fantastic facility that had just put down blood & bone in the garden to fertilise it) but the advances in technology and the Schemes willingness to accept every delusional story presented to it without question now makes this situation intolerable.

The time I spend answering ridiculous emails from the Scheme demanding more and more documents and asking clinical and operational questions (to which they lack the qualifications, skill and experience to determine validity of my responses), effectively removes me from making tangible improvements to the lives of those I care for. You are actually making residents lives worse not better and as a result you fail everyone.

A current case in point.

A resident presented with an unexplained rash. The nursing staff noticed it and referred it to the doctor. We advised the residents husband who visits us daily. The doctor reviewed it and prescribed treatment. The staff carried out the treatment. The rash worsened and blisters starting appearing. The doctor reviewed it regularly (as did another doctor) and when it failed to respond we consulted the husband as we wanted to send her to hospital. He said no. So we continued to treat and review and as the rash and blisters continued to spread, we eventually convinced the husband to consent to transfer. We sent her to hospital.

Then I get a phone call from the Scheme about an anonymous complaint stating the rash was because we didn't wash the resident properly and didn't apply paw paw cream that was requested by the husband. The complaint coincided with me flying out of the country for my first holiday in a year and was a calculated attempt to undermine the management in my absence.

We gave the Scheme the husbands number. On my return from leave, the husband came to see us and asked why the government was ringing him as he didn't complain about anything. He said that any time he has a problem with anything, he sees us, we talk about it and we fix it. The way it is supposed to work.

Unfortunately, like many misguided relatives, he believed that the external complaint was a good thing because the government will help me get rid of troublesome staff - if only it worked that way.

By this time, the resident had been in hospital a couple of weeks and was still unresponsive to treatment. I had received assurances from the consulting physician that there was no clear cause and to their best ability, they could not see how anything we did or didn't do contributed to the rash. I conveyed this advice to the Scheme.

So then I received the email ... hand over your progress notes, care plans, medical notes, investigations and provide a response.

I spoke with the Scheme again, including escalating my concerns to the NSW Director.  When I asked why it was being investigated when there was no clinical evidence to suggest non-compliance, I had provided a plausible response to the allegations (and the complaint was anonymous) and that the husband had advised he was not interested, I was advised it was only in "early resolution" and they were not undertaking a full investigation.

I also asked why, given the number of complaints being lodged over the past year, a Scheme Officer hadn't managed to remove themselves from their chair and actually visit us. I pleaded with them to send someone so they could witness that there is nothing to see (so they would stop the harassment) but I was told that this was deemed unnecessary. I openly welcome visits by anyone as we have nothing to hide and are proud of what we provide. 

While she appeared sympathetic and promised to review the situation and advise me, I have never heard from her again. I had forgotten that "leave it with me" was departmental jargon for please go away I am never getting back to you. My mistake.

A week later, I received the follow up call from the Scheme Officer ... Please supply the requested documents.

I again voiced my concerns but of course complied and diligently photocopied and scanned all the requested documents and put together another formal response.

Last week, after over a month in hospital, my resident passed away. In the last weeks of her life she endured everything modern medicine could throw at her. She was tested for everything under the sun, filled with every drug known to man (including vancomycin via a PICC line) and in the end, died with no cause being identified beyond a new diagnosis - autoimmune disease with unknown cause. The hospital categorically ruled out any unnatural misadventure and put it down to the fact that this resident was bed bound, in the end stages of a dementing illness, had had previous cerebrovascular accidents, was frail and elderly.

So did the Scheme stop?

Oh not on your life. Like the effervescent energizer bunny, the Scheme just keeps on keeping on. 

Yesterday I was advised that after six weeks with the Scheme, the complaint is now being sent to the Clinical Advisers for a clinical review. The email advises that this process will take approximately another two and a half weeks. I was advised that the Scheme apologises for the delays but they will be in touch in due course.

This will mean that an anonymous, completely vexatious complaint that the Scheme has no hope in hell of substantiating will take over 2 months of the Scheme's time, waste enormous amounts of tax payers money, completely waste my time, negatively impact upon my residents and achieve absolutely nothing.  The stress that this causes to organisations and individual practitioners is unwarranted and unacceptable. The whole thing is a disgrace and the Scheme should be ashamed of itself.

I understand that like most government agencies, your office is inherently risk adverse and my former association with the Scheme is open to questions about "perceived conflicts of interest". I am also aware that the Scheme has taken the extraordinary step of having all staff declare whether they feel there is a conflict with dealing with me as an individual and this has resulted in complaints about my service being handled by offices all over the country instead of in NSW (although NSW does continue to also deal with cases so it is not consistent).

While I enjoy the networking opportunities this provides, the issue for your office should not be how do we deal with me as an individual but how you deal with every case in a systematic, transparent, logical manner that is robust enough to be open to scrutiny.

I am aware that you are in the process of forming a consultative committee to assist with reviewing certain aspects of the Scheme's operations. I sincerely hope that you insist that appointments include at least some people who actually have experience dealing directly with residents and the Scheme and not the cast of usual suspects, who while are eminently qualified as academics and CEO's know little about the actual nuts and bolts of the day to day operations or working as a health practitioner in a residential aged care facility.

All that I ask is that we have a robust complaints scheme that is balanced and respectful of both parties and does not assume every complaint is true and every provider is conversely doing the wrong thing. Maybe that is just too much to ask.