The latest sector report from the Aged Care Quality and Safety Commission (ACQSC) reveals that complaints about residential aged care facilities (RACFs) have increased by almost 20 per cent, and home care by more than 30 per cent, as compared to the same period last year.
The report, which details the ACQSC’s activity during October to December 2021, showed that the regulatory body processed 1639 complaints about RACFS (a 19 per cent increase on the fourth quarter of 2020) and 878 (a 31 per cent increase) about home care services across the country.
In context, this means that one third of all RACFs were the subject of complaints last quarter, with 12 per cent of these providers referred to the ACQSC multiple times over the three month period.
Workforce shortages and elder abuse most common issues for RACFs
Staffing levels was the most frequent reason for complaints about RACF providers, just overtaking medication administration and management concerns.
But the report also details instances of neglect and abuse that must be reported on by providers themselves.
Priority 1 incidents are those deemed severe enough to merit police action or are reasonably believed to put a resident at risk of physical and psychological injury, and sadly, there was no shortage of such occurrences in the last quarter.
The ACQSC received reports of 2443 cases of unreasonable use of force, 1014 cases of neglect and 515 cases of unlawful sexual conduct or inappropriate sexual contact from October to December 2021.
Family members and/or carers were shown by the report to advocate on behalf of residents most prominently, lodging 53 per cent of all complaints.
In contrast, only 8 per cent of complaints came from residents themselves.
Thirty per cent of all complaints were made anonymously, which is not surprising, considering the widespread fear of reprisal from providers felt by residents and their families.
Maria Sampey, whose mother was briefly living in a Melbourne RACF in mid-2021, says after making an open complaint about the provider, she was subjected to abuse by management, despite this being an explicit breach of the Aged Care Quality Standards by which all providers are meant to be bound.
“The manager wouldn’t let me see my mum, because I put in the complaint,” Sampey says.
“She was really obnoxious to me … one of the residents stuck up for me and said, ‘why are you treating Maria like that?’
“And they said, ‘because she put in a complaint to the Commission’.
“They are not allowed to be vindictive toward a resident if a complaint is made – but they are.
“It’s a farce.”
And while many opt for anonymity to mitigate risk of reprisal, the option comes with a cost; such complainants are not allowed the right to review outcomes dictated by the ACQSC, nor do they have the ability to provide added information or testimony to support the claim’s progression.
Moreover, only 264 site visits occurred during last quarter, palling in comparison to the 1176 carried out in Q4, 2020.
These visits revealed 86 services to be non-compliant with at least one quality standard, but only 36 non-compliance notices and nine notices to agree were issued in response.
The most common reason for non-compliance was a failure to provide safe and effective personal and clinical care, followed by inadequate risk management systems and practices.
Home care recipients cite financial concerns and lack of control over their care
Issues with the home care sector were different to those seen in RACFs, mainly pertaining to a lack of consultation and issues with fees and charges.
This aligns with the accounts of advocates, with Danijela Hlis, member of the Council of Elders, detailing these issues further in this Aged Care News article from March.
As a primary example of the dubious financial operations of some home care providers, one home care provider (name not disclosed by the ACQSC) received a sanction after it was found to have failed in its duty to transfer unspent funds back to the Commonwealth, after a consumer exited the provider’s care; it furthermore failed to provide the ACQSC information about the situation when asked.
Elders receiving home care were more likely to lodge complaints with the ACQSC themselves, accounting for 46 per cent of all complainants.
Only 17 on-site audits occurred in this segment of the industry, with none occurring in multiple states.
Only 11 home care services were found to be non-complaint, but inadequate personal and clinical care was also the top concern for the sector.
ACQSC minimises significance, but consumers cite concerns about the Commission
In the report, the ACQSC claims that low or high compliant numbers are not, by themselves, a measure of good or poor service delivery.
“A service with a positive complaints culture encourages feedback and uses it as an opportunity to improve service delivery,” the report read.
“The Commission takes all complaints seriously and works with providers and consumers to resolve the matter.
“Complaints to the Commission inform our understanding of risk to consumers and can influence our regulatory activities.”
But some consumers are not convinced that the Commission is taking abuse allegations seriously enough.
An older woman receiving home care in Sydney, who wishes to remain anonymous, tells Aged Care News that the statistics fail to reveal the level of difficulty faced by consumers facing abuse.
After only receiving a small percentage of services listed on her home care plan, as well as being on the receiving end of alleged verbal and psychological abuse after complaining to the provider directly, she lodged a complaint with the ACQSC last year, and was disappointed with the shallow nature of the investigation.
“All they apparently did as their ‘investigation’ was to request all the emails from the provider between her and me, and [they] only looked at some of them.
“I wish you could hear the patronising way the delegate speaks to me,” she says.
After months of negotiating with the Commission, to no avail, she says that she has become deeply disillusioned with the process.
“The ACQSC is all about power and control when they are dealing with powerless little old ladies, but not with the abusive providers who have neglected their duty of care, broken contracts and ripped off the Australian tax payer by agreeing to provide services and then not providing them.”
Warning or a sanction? How does the ACQSC deal with non-compliance
RACFs and home care providers who are found to have breached the quality standards are not necessarily sanctioned first time around.
A lack of immediate decision action from the Commission has been the cause of anger for families whose older relatives have been on the receiving end of sub-standard care, as explored in this Aged Care News article from March.
According to the ACQSC, various levels of action are employed depending on how the Commission classifies the acute risk posed to residents at the respective facility.
The two main responses are as follows, in the Commission’s own words:
- Regulatory Action
Regulatory action may be considered where risk to consumers is assessed as low to medium. This approach reflects the level of trust and confidence the Commission has in the provider’s motivation and capacity to manage the risk and rectify non‑compliance. It signals to the provider there has been a failure to meet responsibilities and encourages the provider to rectify the non-compliance and take action to sustain improvements, usually through a direction notice.
- Enforceable Regulatory Action
In cases where the risk to consumers is assessed as medium to severe, or where a provider has failed to remedy non-compliance following regulatory action, the Commission may respond with enforceable regulatory action. An enforceable regulatory action is intended to oblige the provider to take action to address quality and safety risks and to comply with its responsibilities as quickly as possible. This can include a compliance notice, which compels providers to follow explicit instructions/demands from the Commission; variations to the provider’s accreditation; infringement notices/fines and, in worst cases, cancelling of accreditation.