The Royal Commission into Aged Care Quality and Safety hearings in Hobart this week have focused on two aged care facilities operated by Southern Cross Care Tasmania, Yaraandoo and Glenara Lakes.
The forensic case study has revealed dangerous medication mismanagement, neglect, poor leadership, and staff shortages.
The focus has been on the governance practices of SCCT, with Peter Rozen QC, explaining governance is the systems organisations use to control their operations and the mechanisms it has to hold people to account.
“If appropriate and workable governance arrangements are not in place, the frail and vulnerable older residents in our aged care homes will not receive the high quality care that they deserve,” he said.
“Left as a carcass in an aged care abattoir”
In the first week in August 2018, Yaraandoo aged care facility cut 14 hours of care per day, eight hours in the morning and six hours in the evening. There was also a reduction of 15.2 hours of registered nurse care time every fortnight and a reduction of one hour per day in the kitchen and servery staff area.
Further cuts in staff hours were expected.
The cuts were part of a ‘pathway to breakeven strategy’ employed by SCCT when it began to experience a declining financial performance.
In his written submission to the commission, resident Brian Patrick Harvey explained the real-life consequences of staff cuts on the residents.
“I ask the Commissioners how they would feel if it they were left alone on a mobile toilet, unable to stand up and get off, after being abandoned for 30 minutes or 45 minutes, or 60 minutes or even as long as 90 minutes,” he wrote.
“Equally distressing experiences have involved lengthy delays waiting to be transferred from bed to toilet, often with degradingly humiliating results.
“When neglected like that, I feel I have been dehumanised, left as a carcass in an aged care abattoir ready to be processed like a slab of meat in a sausage processing factory at some future time.”
Mr Harvey has cancer that has left him with bony metastases in his spine and pelvic region.
“Pain dominates my whole existence,” he wrote. “Every second of every minute seems like an eternity.”
Mr Harvey said he is being neglected because there are not enough staff.
“My experience over time indicates that both problems appear to derive from lack of staff, carers,” he said.
“I had to watch him in agony”
On Monday, the commission heard from Ellie Valier, who was married to Brian Harvey, a former resident of Yaraandoo. She explained that her husband experienced a decline in the quality of care over time at Yaraandoo, and also failed to receive proper palliative care at the end of his life. He died in excruciating pain.
“He had an agonising death, which, on the information available to me and subsequently checked, was avoidable, inexcusable and unforgivable,” she told the royal commission.
“Brian, a very tactile, caring, loving individual, who was a big huggy kind of person, and he couldn’t bear to be touched. So I couldn’t hold him in my arms. I couldn’t – I couldn’t comfort him. I just had to watch him… in agony,” she told the commission.
Older people plan to suicide rather than go into aged care
On Tuesday, Judith King told the commission of her husband’s harrowing experience at Glenara Lakes. Her husband was Professor Neville King, a highly respected psychologist who helped to introduce cognitive behaviour therapy in dozens of countries all over the world.
In 2018, Dr King was named an Officer of the Order of Australia for services to humanity, in recognition of his distinguished service to medicine and medical education, particularly in the field of cognitive and behavioural therapy.
Ms King said he was diagnosed with Huntington’s Disease in 2011, and moved into Glenara Lakes in July 2018.
She said Dr King wasn’t given his medications accurately, which seriously jeopardised his health. Many of his possessions were stolen, including a $6,000 hearing aid, his spectacles, and clothes.
He was told not to worry about toileting because he was wearing pull-ups. “It was alarming. And it was said in such a casual way, that that was just normal practice,” Ms King said.
Professor King became delirious because of “acute dehydration”. “That’s negligence at the nursing home,” Ms King told the commission. He was on all fours, yelling, agitated, and “in a lot of discomfort”.
Ms King made complaints to management, even writing to the CEO, Richard Sadek, but nothing changed. Staff accused her of lying, and it was suggested she move her husband to a different facility. Area managers were “dragons” who were brought in to “intimidate” her, she said.
In her written statement, Ms King wrote that people would rather die at their own hand than go into residential aged care. “I see that at Glenara Lakes there are good people trying hard to work in an antiquated system that is broken. There is a lack of effective management from the CEO down at SCCT.”
“At present frail aged people are existing in an underfunded, poorly run system and it is terrifying that is possibly my future. Many of my older friends have a plan to suicide rathar than ending up in a nurisng home, which speaks voluems about the massive challenges ahead.”
In November 2018, Yaraandoo failed 18 of 44 expected quality outcomes, due mainly to inadequate staffing levels.
During the quality assessment, the assessors were told SCCT was running at a loss and management had cut staff hours. Sanctions were imposed, but in June 2019, a follow-up audit found the facility failed to meet 39 of the 44 expected outcomes.
“Pathway to break even” strategy
In a December 2018 audit, Glenara Lakes failed to meet seven of the 44 quality standards. A serious risk decision was made about the facility in January 2019.
“One illustrative example of serious risk was a man who had been prescribed pain relief medication to be taken every six hours. Records at Glenara Lakes showed that for most days between July and December last year the medication was only given to him once a day. Proper pain management is, obviously, critical to a resident’s quality of life,” said counsel assisting the royal commission, Paul Bolster.
An assessment in March 2019 found the facility met all expected outcomes, but witnesses say problems at the facility remain.
“The documentary record at each of Yaraandoo and Glenara Lakes points to an organisation that allowed budgetary outcomes to take precedence over ensuring that quality and safe care was provided to the residents of those two facilities,” Mr Bolster said.
Deep concerns about Yaraandoo and Glenara Lakes
The commission heard that Yaraandoo hired an inexperienced manager because the position was hard to fill given the home’s location.
Morning staff were expected to help prepare breakfast, which meant they were not able to attend to residents, to help with feeding, attending to showers, toileting and bed changes.
The commission heard of low staff morale, and of deep concerns held by residents and their families.
They heard the loss of the dementia supplement in June 2015 added to financial pressures in the industry.
Southern Cross Care Tasmania CEO apologises, but dodges questions about
On Tuesday, the commission heard from Richard Sadek, CEO of SCCT.
“Our mission is to provide the highest possible care within the funding that’s made available,” the told the commission.
Mr Sadek said sanctions cost the operator more than $1 million.
He apologised for the lapses in care residents and their families experienced.
“I would like to apologise to those residents and their relatives who have experienced the circumstances that have been portrayed here at the trial – at the commission. We’re not about providing poor care.
“Our whole mission, our 47 years of existence is about providing the highest quality of care. So I apologise and I say I’m sorry for them to endure the tension and the anxiety that they have,” he told the commission.
Mr Sadek accepted that the manager they hired lacked adequate experience and did not receive enough support.
“I have to accept the responsibility as CEO that we didn’t provide him with the support that he obviously required as a newly appointed, young facility manager,” he said.
When asked if he was concerned that reducing staffing hours would compromise quality of care, Mr Sadek said he had not been worried.
“We had up until that time no adverse findings in terms of accreditation reports,” he said.
But only months after the cuts were introduced, the facility failed a quality audit.
Leadership extremely lacking
Peter Williams, who worked as a facility manager at Glenara Lakes for ten weeks, said he quickly became concerned about a lack of leadership at Southern Cross Care Tasmania.
“To be honest, I felt (leadership) was extremely lacking in their support and direction. There was very limited contact from the senior executive team,” Mr Williams said.
Mr Williams said senior management did not seem interested in implementing improvements.
“I was just not able to influence the executive or the organisation to fix the gaps in governance and systems that were clearly evident to me,” he said.
“I guess I could look up and see that things were not going to change,” he said.
Mr Williams’ concerns about Southern Cross revolved around staff education and training for basic care needs, the inadequacies of policies and procedures to govern clinical practice, a lack of clinical governance structures, limited HR support, and broken IT systems.
Managing ACFI has become an industry
Andrew Crane, who was executive finance manager at South Cross Care, told the commission he believed the aged care system could be improved if resources were directed away from securing funding to delivering front-line care.
“I would do everything in my power to stop the organisation devoting so much expense and overhead to such a system that needs a lot of attention,” he said.
ACFI management has become an industry, he said, which is “a shame”.
“You don’t want your care staff investing your time in that process. You want your care staff investing your time in relationships and understanding and getting that deep understanding of the client. Because it’s a complex time in anyone’s life.
“I would unquestionably make a fixed component of ACFI that covered, essentially, most things about daily living… so I would move away from a needs-based system… and then there would be things that you could specifically claim on top of that if it was really complex,” Mr Crane recommended.