Response 136310997

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Introduction

2. Do you give consent for your submission to be published in whole or in part?

Please select one item
(Required)
Ticked Yes
No

Details about you

3. Are you answering on behalf of an organisation?

Please select one item
Ticked Yes
No
If yes, please list organisation name
NSW Nurses and Midwives' Association

4. Where do you live or where is your organisation based?

Please select one item
Ticked NSW
Vic
Qld
WA
SA
Tas
ACT
NT
City/Town
WATERLOO

Details about your organisation

5. What role best describes your organisation?

Please select one item
Aged care advocate
Aged care service provider
Peak body – consumer
Peak body – provider
Peak body – professional
Ticked Other
If other, please specify
Nurses and Midwives Union

7. In which states/territories does your organisation deliver services?

Please select all that apply
Ticked NSW
Vic
Qld
WA
SA
Tas
ACT
NT

Questions about accreditation and monitoring compliance of residential aged care services

11. Do you think that processes to accredit and monitor residential aged care services are effective?

Accreditation process
Please select one item
Yes, always Yes, mostly Yes, sometimes Ticked No Don’t know
Monitoring process
Please select one item
Yes, always Yes, mostly Yes, sometimes Ticked No Don’t know

12. Do you think processes to review and investigate non-compliance with the accreditation standards are effective?

Please select one item
Yes, always
Yes, mostly
Ticked Yes, sometimes
No
Don’t know

13. Are you aware that sanctions can be imposed on residential aged care services when they fail to comply with the accreditation standards?

Please select one item
Ticked Yes
No

14. Do you think these sanctions are effective?

Please select one item
Yes, always
Yes, mostly
Ticked Yes, sometimes
No
Don’t know

15. What features of the existing assessment and monitoring process should be retained?

Retain assessment & monitoring processes
We consider that purely unannounced site visits should be continued. Also, the assessment of resident outcomes through the SOFI methodology where people lack capacity to actively engage in the review process. However, we consider that the outcome of SOFI assessments could be more transparently reported and also more closely aligned to compliance against regulatory requirements.

16. What features of the existing assessment and monitoring process should be changed?

Change assessment & monitoring
The NSWNMA regularly attends Agency Meetings with the state branch of the Australian Aged Care Quality Agency (AACQA) where local and national data sets are provided. Data suggests there is a continual lack of compliance in regard to: staffing; medications management; clinical care and behaviour management. It is our view that this can be explained through a combination of the following: • Failure of consecutive Governments to address the fundamental issue of safe staffing in residential aged care and lack of impetus to establish minimum safe staffing ratios for aged care in all states; and • Inadequate systems for determining adequacy of safe staffing, including lack of commonwealth safe staffing methodology; and • Inadequate regulatory processes determined by risk management that allows for the same outcomes to be reported against at each site visit, leaving large gaps between reports on other outcomes (or absence of reporting); and • Inadequate system for assessing against each outcome upon re-accreditation of facilities and over-reliance on paper based audit and self-reporting; and • Lack of a case-tracking system for assessing care outcomes against individual care needs. The accreditation framework is inherently flawed with regulator performance targets more focused on reducing regulatory burden on providers . Also, ‘Better practice awards’ offered as incentives for providers to display innovative care; which portray this as aspirational rather than a basic regulatory requirement . Both of which do little to evoke consumer confidence and promote neutrality. The re-accreditation system relies heavily on self-reporting against care outcomes and is a largely paper-based audit. Yet accreditation may result in a licence to operate for up to five years . Interim site audits conducted more regularly are likely to be more detailed, longer and use more assessors. However, they are often targeted based on intelligence about the service. This means that a set of outcomes may not be assessed against, other than through an audit based system for over three years. Some providers are also notified of audits in advance which means a true picture of the day to day operation of the home cannot be guaranteed. This leads to huge oversights in care regulation and reduces protections for workers and residents. Changes proposed to the regulatory framework through the Single Aged Care Quality Framework to be introduced in 2018 support less, not more regulation of the sector. Regulation will rely more on risk assessment and self reporting and indications are that there will be less definition within outcomes, meaning that there will be greater chance of individual assessor discretion. It is also concerning that revised outcomes fail to define a staffing model that will enable assessors to determine optimum staffing skills mix and ratios. It is our view that this is fundamental to ensuring high quality care as demonstrated in the findings of the Oakden Report; which recommends mandated staff training and states minimum staffing and skills mix to ensure safe and appropriate care . Australian Nursing and Midwifery Federation research conducted in 2016 found that current staff hours not adequate to meet even basic care needs . Failure to ensure effective regulation of this area, and establish minimum standards to report against will no doubt lead to a continuation of the poor practices such as those displayed at the Oakden facility. To date, there has been no consultation or indication of any changes to aged care legislation. Unless there are clear links between outcomes to be measured and legislation, assessors will have little power to take swift remedial action where concerns are identified.

Questions about complaints

17. Have you made a complaint about a residential aged care service in the last 10 years?

Please select one item
Yes
Ticked No

Never made a complaint

25. Please identify why a complaint has not been made.

Please select all that apply
Ticked No reason to make a complaint
Didn't know how to
Too much effort required
Fear of retribution for making a complaint
No confidence in the handling of a complaint
You are welcome to provide further details on your response
Raising complaints would not be the core role of NSWNMA. However, we would support members to raise complaints if required.

26. Do you have any suggestions for how complaints handled by the Aged Care Complaints Commissioner could be better handled?

Note: this question is included for organisations and those individuals who have not made a complaint
Whilst ensuring safe care is everyone’s business; the power imbalance between aged care providers and care recipients, relatives and workers cannot be underestimated. Many of our members cite fear of reprisal should they raise concerns and even if this is not the case, they lack the training and capacity to do this. Often processes only allow workers to raise concerns through their employers and greater awareness of the complaints systems and processes externally would assist. Better protections for workers raising concerns, swifter and more decisive remedial action and greater transparency in reporting on complaints would also enhance the system.

Additional comments

27. Do you have anything else that you would like to contribute to the Review?

Additional comments
This review is set within a context of significant reform in the aged care sector and is one of a number of inquiries and consultations focusing on the future direction of aged care. Despite this, there has been a failure to address the systemic problems in aged care, and draw together the various strands that impact on safety and quality care. Recently there have been reports on the findings of the Senate Inquiry into the future of the Aged Care Sector Workforce in Australia and a report on the Elder Abuse Inquiry by the Australian Law Reform Commission. In addition NSW has held Inquires into Registered Nurses in NSW Nursing Homes and Elder Abuse. A common theme throughout are calls for enhanced regulatory safeguards and safer staffing. Despite this there has been little progress on the recommendations, with decisions deferred to disparate departmental committees. The resulting outcome has been stagnation of decision making and accountability at all levels. The provision of safe staffing ratios and skills mix in aged care is intrinsically linked to safety and protection against abusive practices. Any attempts to enhance safeguards through regulation will be futile unless legislative reforms also provide minimum standards for safe staffing in residential aged care facilities. The ANMF and NSWNMA have produced a number of informative documents over the past two years. These provide clear evidence of overburden at all levels within the aged care workforce and the impact on resident safety. It is hoped this review will be instrumental in drawing together the outcome of all associated findings and propose a meaningful and practical strategy for aged care.