Dr Lisa Trigg, Assistant Director of Research of the Data & Intelligence at Social Care Wales, has done research comparing England and Australian aged care systems and found that many recommended “good providers”, ended up being very sub-standard in their care.
“The difficulty in Australia is that there was absolutely no way of finding out. So there’s no information in the public domain. 98 percent of providers pass accreditation. So there’s no differentiation between the people who’ve just passed and the people who are excellent,” says Dr Trigg.
"I found myself in... facilities which were doing, you know, great people work in there and great had intentions but clearly hadn’t grasped how to deliver good dementia care and good end of life care as well.
"What I’ve observed in Australia... is the good providers that were suggested to me didn’t seem to be that good at all. So that was one issue, that it’s hard to identify who they are.”
When engaging with State and Federal health departments, Dr Trigg often found the departments conflated the best-known Chief Executive Officers (CEOs) of aged care facilities as places with good quality care.
Dr Trigg also refers to person centred care as “relationship based care”, since person centred care was not being used appropriately by some providers.
In most of the evidence given throughout the Commission, the main factor of relationship based care came from community focussed involvement.
Alongside this, relationship based care relies on a whole community involvement, rather than just staff of a facility.
“If you're going to have a system that looks after quality, it needs to have many people involved… I also think it’s unacceptable for us as a society... us as the public, to not support that,” says Dr Trigg.
"Some of the stories you’ve heard this week are about the best care being
community-focused, bringing people in. So it’s not acceptable for us to sit and judge
providers without being committed to helping them provide better care because some
of that is links to the community."
ACFI doesn’t work and a management culture change is needed
Dr Trigg told the Commission that the Aged Care Funding Instrument (ACFI) is focussed on technical needs and activity based programs, which will lead most providers in Australia to provide less than desirable care.
She says, “Good providers will deliver good care... But if you have providers that don’t have either the competency or the values or the beliefs to do that, there are strong incentives in the Australian system that will dominate how they manage their organisations.”
The culture within organisations need to start at the top, in management, which encourages staff to show the same love and passion to the residents they support, states Dr Trigg.
While admitting she felt awkward pointing out an individual, Dr Trigg’s took aim at Japara’s CEO saying she was not impressed with his self-importance implied in his statement.
“For me, that's the problem. You're not the most important person in the room and if you don’t recognise that the most important people in the room are the residents and the relatives and the people that work with them every day, then you have completely missed the point,” Dr Trigg says adamantly.
Senior Counsel Assisting Peter C Rozen QC asked for a list of recommendations that Dr Trigg’s believes would help develop a better relationship based care.
She says there needs to be a set vision of what quality in aged care is, so that people know what it looks like when it’s there and when it isn’t; a change to the ageist language used around residents; and moving away from clinical models, because it won’t deliver relationship based care.
Dr Trigg’s last advice for the Commissioner’s was that they won’t find the answer to their problems in aged care studies overseas, but they will from every person that has spoken at the Royal Commission.
There are people in this room who know what you need to do. There are people in this room who have the answers, who’ve been doing this stuff for 10-20 years, and I suppose my biggest
wish is that those people become the most important people in the system, and they’re the people who will guide your work in what this needs to look like," finished Dr Triggs.
Mr Rozen closed this week’s Royal Commission with an overview of the last week’s topics, concluding that good relationships with residents is critical for person centred care and leadership is crucial to positive results throughout an organisation.
He brought up the case of Ms Noleen Hausler, and her father, Mr Clarence Hausler, who had their nursing home, run by Japara, poorly handling complaints of abuse.
He also says that it is up to the Commission to decide whether Japara used their management to fuel a battle with Ms Hausler. As well as their rejection of any wrongdoing of Mr Hausler’s abuse.
Mr Rozen expressed disappoint about the current sectors system resulting in a young physiotherapist feeling disheartened with the care she was able to provide to older residents in aged care facilities and ended up working in another health industry.
The Royal Commission has finished for June and will be returning in Darwin, Northern Territory, on July 8.