Quality Case Management and Care Coordination are Essential if we want Quality Aged Care!

On Sunday, 16th September, 2018 the Prime Minister of Australia announced the Royal Commission to assess the quality and safety of care in the aged care system. This was done a few days before the Four Corners aired its findings on the neglect and abuse of the elderly in the aged care system. These problems have been around for a long time and they have been highlighted many times before. The setting up of the Royal Commission means that the government is ready to deal with these problems thoroughly. With the announcement of the Royal Commission, share prices of many listed companies fell as investors possibly started to get rid of the shares of such disreputable organisations. The Four Corners brought to light the pain that the old people and their families go through because of the care industry which is 75% funded by taxpayers.

How did Australia get into this mess? The aged care industry is regulated and the major players in it are calling for deregulation. I am already worried, and I don’t think I am the only one, that if there is fraud, gross neglect and abuse of the old people now, what will happen if the industry is completely deregulated? Already regulation has been reduced since the 1990s when privatization of aged care started. The simultaneous rise in privatisation and deregulation of aged care caused a crisis in the quality of care causing reduction in motivation, quality, quantity and dedication of staff. Yet the industry is calling for further deregulation? Do they want more taxpayers’ money and no accountability?

Australia has had 20 reviews in the last 20 years, mostly to look at one aspect of aged care each time. Some of the recommendations led to the Living Longer Living Better Act of 2013 which was reviewed in 2017. Still, most of the recommendations were never implemented, maybe because there has never been a comprehensive review. Aged care has many issues such as financing, staff training, staff-to-residents ratio, governance, quality of care and many others that need attention and should be looked at together. The question on many people’s minds is: will the Royal Commission be any better?

The $20 billion per year aged care industry itself is mostly responsible for the current mess because they chose to focus on profits only instead of providing high quality care at a profit. Both the major political parties are also responsible, to a lesser extent, for the mess because they have both been responsible for regulation and setting the budget for aged care in the last 20 years. It appears as though political correctness and worry leading up to the elections have stopped both parties from addressing the aged care issues and implementing real solutions.

The Four Corners highlighted staffing as a huge problem. The aged care facilities simply do not employ sufficient staff to take care of all the residents. That leaves a lot of elderly people neglected and the staff overworked and frustrated. It’s not just a shortage of personnel, it’s also a shortage of appropriately trained personnel. The elderly people are simply not getting quality care. In fact, they are mostly neglected, and even abused, despite the taxpayers forking out over $10 billion in subsidies every year. All the talk about consumer-directed care is empty talk because there is hardly any focus on the aging people.

At present, half of the people living in aged care facilities suffer from depression, dementia or some other mental health or behavioural condition. Between 2009 and 2016, the proportion of elderly people who need high care (which includes assistance with eating, bathing and other activities of daily living) quadrupled from 13% to 61%. That demands an increase in the number of caregivers in every facility. With the subsidies that they get from government for high care, we expect these elderly people to get the right care at the right time. But that is not happening. Skills shortages and manpower shortages are huge problems.

The Tune Review came up with strategies for Australia to develop staff for aged care. As at now, the strategy, which can be implemented in one to three years, is with the government. Meanwhile, the industry can import skilled labour from the Philippines to fill the staffing gaps.

Still with the Tune Review: Why is Commonwealth Home Support Program (CHSP) not yet income tested? Why do we not have a Level 5 Home Care Package (HCP) in place? Why do the HCP providers who deliver CHSP cherry-pick who they take and who they do not based on limited hours and using it for a feeder program into their lucrative HCP programs?

Some of these organisations lack any AHPRA registered staff as case managers and have unqualified people doing assessments and case management. The unqualified case managers make errors and some errors are causing hospitalisations and in some cases death of the elderly people. The aged care facilities know they have and they can get away with this practice so they continue it. They know that the Commonwealth government has no standards for staff who manage these Home Care Packages nor do the agencies publish their staff qualifications for the consumer to be aware.

Quality case management and care coordination are essential if we are going to provide quality aged care in Australia. The role of the case managers is to work with the elderly and their families to determine the old people’s needs, to develop individualised care plans and to implement those plans. They liaise with service providers, medical and allied health professionals and sometimes legal professionals to ensure that each aging person’s needs are met. They share information with everyone who is involved in an individual’s care so that the old person does not need to retell their story over and over again.

Whether the person needs support while living independently at home or the person has illnesses and/or disabilities, the case manager coordinates the care. Case managers can help for a short time but sometimes their support is required on an ongoing basis.

That is why case managers must be properly qualified and be registered with the Australian Health Practitioner Regulation Agency (AHPRA). Only properly trained and qualified people get registered with the AHPRA.

The problems highlighted by Four Corners all indicate that there are insufficient case managers in place working with aged care facilities. That is why, as reported on Four Corners, people who need a lot of help are being ignored and neglected while the aged care organisations save on staffing costs. At the same time, old people who need less help are being presented as frail so that the aged care organisation can claim higher subsidies per person. It looks like the focus of some these organisations is not quality care but profits. If they do not change their approach, the Royal Commission might catch them in the act and probably penalise them.

Care organisations do not have to wait for the Royal Commission to catch them neglecting and abusing old people. They can actually lead in the transformation of the aged care industry. Instead of crying for deregulation, they should insist that government put missing regulation on staff-to-resident ratio and other necessary regulations. They should insist that everyone in the industry should comply with these regulations. While they are at it, they can ask government to stop running care programs as silos and merge some of them where possible to save on administration costs. The care industry can basically turn out to be the best care industry if they so choose.