Grace Stokes lives in Adelaide; her beloved, 96-year-old grandmother is seeing out her retirement 300 kilometres north in the rural community she has known and loved for the majority of her life: the small sea-side town of Port Augusta.
Stokes reminisces with pride how her Nonna, an Italian immigrant, emerged from persecution in her home country to build a prosperous life, including a family bonded by a culture of unconditional love and mutual care.
“She worked really hard in Australia and my Nonno built their house with his own hands; they had a hobby-farm… [my mother aunt and uncle] had a great life, and what they want for my Nonna, in her old age, is for her to also have a good life.”
With the family living hours away, entrusting her care to the local residential aged care facility (RACF), Edenfield Family Care-Ramsay, seemed the best way to ensure this, and for six years the family felt happy in their decision.
Little did Stokes know, as 2021 began to wind down, and the Christmas season neared, her Nonna’s facility was about to be found non-compliant with all eight quality standards by the Aged Care Quality and Safety Commission (ACQSC) after an inspection in November, when they were requested to investigate a norovirus (gastro-causing) outbreak at the facility.
Myriad disturbing observations were noted by the ACQSC assessors upon their visit.
Residents were locked in their rooms; some complaining of little more than an itch, were sedated with powerful psychotropic drugs to abate their distress.
Many residents from culturally and linguistically diverse (CALD) backgrounds were deemed to be deprived of culturally sensitive care and activities that celebrated their unique customs.
And more than half of the facility’s nursing staff reported understaffing to be so severe they had little confidence in being able to provide quality of care.
Assessors concluded that there was “an immediate and severe risk to the safety, health or well-being of care recipients to whom the approved provider is providing care”.
Upon reading the commission’s report, Stokes says her family was overcome with guilt.
“It has been a time of stress I didn’t know we, as a family, could feel,” Stokes says.
“I just can’t believe this is Australia. I mean, they’re the sort of horror stories you would hear about in America. But it’s happening right here.”
Not one, but two prior warning signs
ACQSC records show this fully-fledged failure did not come out of the blue; there were two previous warning signs that went unactioned.
In October 2019, the home was found non-compliant with two requirements of the Aged Care Quality Standards: ongoing assessment and planning, and personal and clinical care.
In a follow-up assessment in August 2020, the home again failed to provide the minimum standard of personal and clinical care required, especially relating to facilitation of palliative care.
One resident, who passed away on August 11, 2020, was not provided end-of-life care, despite displaying a week of warning signs.
“Seven days prior to the consumer’s passing, staff documented the consumer was not tolerating food or fluids, refusing medications and was unresponsive… however, end of life monitoring was not commenced on these occasions or a palliative care plan completed.”
Despite a nurse’s suggestion that palliative medicine be administered to ease the resident’s suffering, no action was taken.
Furthermore, site audits completed on February 9, 2021 to February 11, 2021 indicated, despite the facility passing personal care standards this time around, workforce capacity was insufficient.
Despite this, the ACQSC failed to respond, suspending any action under ‘exceptional circumstances’ due to the COVID-19 pandemic.
Stokes tells Aged Care News that discovering these past failures makes her even more aghast at the most recent facility failure.
“Sorry, it’s not a surprise to me if you fail in 2019, then again early 2021,” she says.
“There’s the two warning calls that you got. You didn’t just get one, you got two.
“And then you didn’t fail a little bit; you failed across every single aged care standard, every single one…I mean, that’s deplorable.”
A spokesperson for the ACQSC tells Aged Care News that despite deciding not revoke the facility’s accreditation on January 24, 2022, the commission initiated the following sanction process:
“The Aged Care Quality Safety Commission (the Commission) took action against the approved provider … by issuing sanctions and a Notice to Agree in November 2021…
“Under the sanction, the approved provider was not eligible to receive Commonwealth subsidies for any new residents at the service for a period of three months.
“Under the Notice to Agree, the provider must appoint and retain an independent adviser for a period of 6 months, to assist it to comply with its responsibilities (an advisor was appointed on 16 November 2021) and provide training for its staff in areas including in a number of critical areas related to the non-compliance.
“The provider must also participate in regular meetings with the Commission and ensure weekly written reports are prepared and submitted, as part of the Commission’s close monitoring of the provider’s progress towards achieving compliance.
“On 24 January 2022, the Commission took further action in relation to the findings and decided to shorten the service’s accreditation, with the service’s accreditation now expiring on 24 January 2023.
“This is shorter than the three years typically available to residential services with a strong track record of compliance and means that, in addition to other quality and assessment monitoring activities, the Commission will return to the service unannounced sooner, to conduct a comprehensive site audit.
“If the provider cannot demonstrate to the Commission that it has made or is making progress on implementing the required improvements, the Commission may consider further regulatory action such as revoking approved provider status.”
Jesse Selvarajah, managing director of Edenfield Family Care, discussed with Aged Care News his experience from the perspective of management, but declined to speak on the record.
Instead, he released a general statement to the media, expressing his wish to reassure residents and families that he is working alongside the ACQSC to remedy the crisis.
“We have made significant progress since the November report which has included changes in facility management and the employment of additional staff who have years of clinical experience between them.
“I thank all our families and staff that have reached out and given us their support during this period.
“I would encourage any of our families with a concern about our progress or any other matter to contact the home to contact Edenfield Family Care – Ramsay to make an appointment with me or one of our managers.”
Stokes push for greater government intervention
Stokes wants more than reassuring words; she and her family want decisive action to ensure no facility across Australia is at risk of such complete failure again.
But the last thing she is calling for is harder punitive action, including total shutdowns of negligent facilities.
“As a family member of somebody who I know has not received quality care, I want to be standing up, banging that front door down and demanding blood, but… it’s not the right solution.”
“Calling for them to be shut down doesn’t solve the problem for the community. It actually exacerbates the problem and takes services away from that regional area.”
With the facility being one of only two in the region, both owned by El-Jasbella Pty Ltd, revoking of accreditation would leave residents forced to seek refuge outside the local area, possibly hundreds of kilometres away in the capital.
“My Nonna doesn’t want to leave Port Augusta; my Nonno was buried there and she has lived most of her adult life there; it was a safe place that she moved to after being persecuted in Italy in World War II.
“So for her it’s home now and she shouldn’t have to leave that home just to get quality care.”
By way of response, Stokes has launched an online petition, appealing to the Federal Government to take greater action in such instances of comprehensive failure – and she has come to the table with some specific policy solutions.
First and foremost, she hopes for an emergency taskforce to be developed, comprising nurses and other relevant support staff to alleviate an acute crisis as identified via an ACQSC assessment.
“At present, [Edenfield Family Care- Ramsay] has only been required to hire a contractor ‘to review the quality systems’ and provide education to staff,” Stokes notes.
“This is insufficient immediate action to prevent my Nonna and other residents from harm.”
Additionally, Stokes hopes for Port Augusta’s local member of parliament, Rowan Ramsey, to advocate on the community’s behalf in Canberra by writing an open letter to Senator Richard Colbeck, minister for aged care and senior Australians, requesting:
- Creation of the aforementioned taskforce, with a guarantee it will be deployed to any aged care facility across the country that fails all eight quality standards.
- That the Liberal Party actively engages with and endorses the Fair Work Commission’s work value case, which is considering an increase to the minimum wage for aged care workers.
“If your organisation fails all of those standards, that’s going to take a toll on your mental health, and that’s something that hasn’t been spoken about a lot,” Stokes says.
“I do believe the staff deserve to be protected, and that this is not the fault of the staff… they do care and it’s just heartbreaking for them, as much as it is for the families of residents as well.
“When the regulator says, ‘the residents are left in severe and immediate risk of harm’, I think they should actually change that terminology to say, ‘the residents and staff’, because staff in that situation are also at risk; they are vulnerable in that situation.
“They don’t have the training to do their job safely; they might not have the PPE to do their job safely; they might not have the managerial support to be safe in their workplace and to go home feeling mentally well, every day.”
The petition has received more than 13,000 signatures at time of writing, just shy of its 15,000 target.
“I just feel so full of shame and guilt about what we’re [Australia] doing to people and their families, Stokes says.
“So I hope the conversation that’s now happening in several regional communities, and hopefully now across the country, because of the petition, is going to effect some change.”
Local member doubts feasibility of petition demands
Rowan Ramsey is the federal minister for Grey, the South Australian electorate covering 92.4 per cent of the state’s geographical land mass.
In response to Stokes request, Ramsey replied, via letter, indicating that he sympathised with the plight of residents at Ramsay, yet did not endorse Stokes resolutions.
“Failure across multiple standards is alarming and I fully understand why family members and the public generally are concerned,” he writes.
“However, I believe they should be reassured the regulatory process – put in place at the recommendation of the Aged Care Royal Commission – has worked exactly as it was intended.
“In the case of Ramsey [sic] Village, a complaint was made to the AGCSC [sic] and as a result an audit was taken of the facility last November which led to sanctions being implemented a week later after the mandatory notice period.”
He details the steps imposed on the facility by the ACQSC, including employment of a quality control officer, extensive staff training sessions, and weekly meetings with ACQSC officials.
He also notes the ACQSC barred new resident admissions during the administration period, “in themselves inflict[ing] a financial penalty”.
He furthermore questioned the capacity of the Government to implement Stokes requests, as well as indicating a potential conflict of interest.
“The Federal Government does not operate aged care facilities and simply does not have a suitable workforce to perform that task,” Ramsey writes.
“I also make the point that the Federal Government is the funder and regulator of aged care and, in that case, it is unsafe and inappropriate to suggest they should also be an operator.”
He notes that he is sceptical of Stokes’ approach, but is open to such submissions, presented in the right format.
“If your petition meets the required Parliamentary format, which my office often assists people to prepare, I would be pleased to present it in the Parliament on their and your behalf.
“Regarding your request that I stand up and advocate for vulnerable constituents in my electorate, I can assure you I do this and I do it vigorously and often.
“That may or may not include making aggressive public demands of government, but in my fairly long experience I have found a quiet, methodical and determined approach has yielded far more success.”
Ramsey noted that he has forwarded Stokes’ concerns to both health minister Greg Hunt and Senator Colbeck.
Neither have responded to date.
In a parliamentary debate on February 9, Ramsey rejected the premise that the Government has provided insufficient support to the sector, saying:
“On the issue of neglect: since we came to power in 2013, spending in the aged-care sector has doubled from $13 billion to $26 billion. Doubled. That is an astonishing amount. It is budgeted to go right out to $34 billion in the next three years… I don’t think that could be labelled as neglect in any way. It’s showing some attention.”
Stokes was incensed by the response, updating her petition with a statement on February 21, reading:
“Mr Ramsey, yet again, fails to acknowledge that this process and system does not work… He also fails to acknowledge that the regulator does not have the power to remove the immediate and severe risk by implementing solutions beyond sanctions and mandated training.
“This is what we are calling on Mr Ramsey and the Federal Government to change. It is unacceptable to have a regulatory body deem that a facility poses such risk and yet not give it the power to make it safe immediately.
“This system allowed this facility to fail all 8 of the industry standards in the first place, and this audit and the sanctions only took place because a family member bravely made a complaint.”