On Wednesday the Royal Commission into Aged Care Quality and Safety turned its focus to Bupa South Hobart, and the decisions that led to it failing 32 of the 44 quality standards in October 2018.
Commissioners Pagone and Briggs visited the aged care facility before the hearings.
The hearings focused on the effects of the organisation’s governance and culture on the quality and safety of care.
The commission heard that Bupa implemented a policy of significant cuts to its nursing staff at South Hobart as part of a Bupa-wide policy of staff cuts to save money because the business was facing financial difficulties.
Peter Rozen QC told the commission, “In devising and implementing this policy, inadequate attention appears to have been paid to the likely impact on the care of the residents.”
Bupa South Hobart failed 32 of 44 quality standards
In an audit conducted between 15 and 18 October 2018, assessors found Bupa South Hobart failed 32 of the 44 expected quality outcomes.
Among the other failures, Bupa South Hobart failed to meet outcome 1.6, which requires an aged care facility to have appropriately skilled and qualified staff to ensure services are delivered in accordance with the standards.
On 25 October 2018, the Department of Health determined that Bupa South Hobart displayed and “extremely high and concerning level of noncompliance” and sanctions were imposed immediately.
South Hobart was one of 10 Bupa homes that was sanctioned between July 2018 and March 2019.
Doctor ostracised after raising concerns
The commission heard from Dr Elizabeth Monks, who was a GP at Bupa South Hobart from January 2016 and remains so today.
In September 2016, Ms Monks wrote to Stephanie Hechenberger, Bupa’s then regional director who was responsible for Bupa South Hobart.
Dr Monks wrote she believed Bupa South Hobart was having “premature deaths and hugely increased morbidity” due to “lack of nursing staff and paralysed ability to deal with those staff who I believe need to be performance managed and educated properly.”
In November 2017, Dr Monks sent a detailed email to the director of medical services, Dr Tim Ross, about her concerns about substandard clinical care at Bupa South Hobart. She specifically wrote about the impact of the cuts to nurses on resident care.
“The home was in chaos. No one knew their roles,” Dr Monks told the commission.
Dr Monks wrote in her submission to the royal commission that she was “ostracised from the business by the members of the operations team for bringing to light and questioning their actions around the deterioration of clinical care.”
During her hearing, she said, “There was a feeling amongst those in the central office that I was histrionic, over-reactive, over-passionate and, therefore, my information to them was not valid.”
Counsel assisting the royal commission Peter Rozen, said Dr Monks’ evidence raised important questions about governance and culture at Bupa.
Mock audits findings ignored
Mock audits at Bupa South Hobart also raised compliance problems, including failings of standard 1.6, but it seems that nothing was done to remedy the failings until an audit by the regulator led to sanctions being imposed.
Committees that oversaw Bupa’s clinical care did not appear to address issues raised by the mock audits.
Former Bupa regional director, Stephanie Hechenberger, told the commission the mock audit tool “was clearly not effective in what it was intended to do.”
Staff numbers slashed to lower costs
Between 2016 and 2018 Bupa’s head office brought in a number of cost-cutting measures in response to increased financial pressures. It stopped employing clinical managers in its nursing homes, and reduced the number of registered nurses and enrolled nurses it employed. At the same time, nursing hours were cut, and when staff called in sick, they were not replaced.
In June 2017, Bupa’s regional director, wrote to Daniel Thomas, a financial planning and reporting analyst at Bupa’s head office, that the new rosters would not save enough money.
Mr Thomas replied, “If we want to save on staff costs, we need, essentially, to cut hours month on month…
“The goal each month should be to have worked less hours each week than we did in the corresponding week of the previous month. This will result in a continual reduction in staff costs. This is the only strategy I believe will work.”
Finances put ahead of care
Tiffany Wiles, an independent advisor appointed in November 2018 to help bring South Hobart back to compliance, said Bupa seemed more interested in its financial performance than caring for residents.
“I felt that with Bupa South Hobart there was an interest in cutting costs rather than caring for people.”
“That’s a very broad statement, obviously, but my general feeling was that, yes, the financial KPIs were very important beyond the care KPIs,” she told the commission.
90-year-old resident too “terrified” to complain
Complaints were ignored, and families making complaints were criticised. When Merridy Eastman complained about the care her mother, Berenice Eastman, received, the family was described by the general manager, David Neal, in an email as “wealthy, spoilt, sense of entitlement, very difficult, all vying for mum’s attention, all guilty at a distance.”
Ms Eastman said hundreds of dollars was stolen from her mother, and a member of staff had boasted she’d paid for a trip to Melbourne using Berenice’s credit card.
Complaints to management about staff stealing from residents during night shift were ignored.
The family did not pursue action over the thefts because Berenice was “terrified” the member of staff would “kill us in our beds” or “poison our food,” Ms Eastman told the commission.
Forced to leave double room after husband died
Berenice was pressured to leave the double room she had shared with her husband soon after he died.
“We were put under incredible pressure,” Ms Eastman’s daughter said. “We were writing a series of emails almost begging him to be kinder and compassionate to Mum and not make her move three weeks or even four weeks after she lost Dad.”
“She, and all of us, would have preferred that she could stay in her room, which wasn’t her room, it was her home.
“We were prepared to all come back to Hobart and help facilitate this move… none of us were there to help… to make her go through this on her own with so little notice at such a time in her life was cruel,” she said.
Cries for help unanswered
Diane Daniels told the commission her mother often missed meals, and received bruises from inexperienced staff. She said one day her mother accidentally dialled her phone number, so she could hear her mother’s calls to staff going unanswered.
“I could hear that Mum was calling out for a nurse and getting more agitated. Because it was lunchtime, I thought someone would come into Mum’s room, but I could hear that no one did.
“I waited, but Mum began sobbing and saying ‘I wish I was out of it.’ And this broke my heart,” Ms Daniels told the commission.
Advisor overwhelmed with families’ concerns
When Tiffany Wiles, an independent advisor, was appointed in November 2018 to help bring South Hobart back to compliance, she said families raised many concerns with her.
“There were multiple concerns raised,” she told the commission. “After the initial residents’ meeting, I was overwhelmed with contact from families.”
CEOs should spend time with residents
An administrator brought in in March 2019 to help Bupa South Hobart return to compliance, John Engeler, told the commission that CEOs in the aged care sector should spend time with residents.
“It informs,” he told the commission. “Not only is the information there, but it’s real and lived from your own experience. You absolutely know what a noisy trolley sounds like at 4 in the morning or you know what it’s like for someone to knock on your door to check how you’re going with a torch at… 3 in the morning.”
The Hobart hearings conclude today. The next hearings will be held between 9 and 13 December 2019 in Canberra and will concentrate on the interface between the aged care and the healthcare system.