Registered nurses must be part of all assessment teams, researcher says.

Instead of simply inspecting documentation, Accreditation Agency assessors must evaluate residents to ensure adequate care is being given.

Further, the auditing process should take place in the clinical areas where and when care is provided.

Dr Maree Bernoth, a lecturer at Charles Sturt University, said many facilities were passing accreditation, despite poor standards of care. For that reason, registered nurses must be part of all the assessment teams.

They should be required to work with carers, identify clinical issues with management and work with the facility to ensure they are dealt with before the next review. 

“My research indicates that while the paperwork and the systems are in place, the residents’ incontinence pads can remain unchanged for nearly 24 hours; cries for help are dismissed as attention seeking behaviour; the elderly lady is screaming and being held down by a number of staff while having a urinary catheter inserted,” Bernoth said.

Similarly, the complaints investigation scheme needs to shift its focus away from simply reviewing documentation. She said this was illustrated clearly on ABC television’s 4 Corners program, The End of the Line, which was shown in June.

Bernoth’s PhD paper, ‘Bodies in focus – the implications for policy in aged care’, is based on three research projects on manual handling. She conducted research among carers in numerous facilities and later implemented best practice protocols with them. It was during this time she witnessed a wide range in the standard of care given, and varying responses by management when issues were raised, she said.

“Some facilities had a culture where feedback was welcome, they were open to change and that was terrific. In other facilities, responses were careless and dismissive. Ultimately, under the current system, everyone is vulnerable,” she said.

Pay parity with the acute sector for nurses is essential to ensure clinical support and mentoring for care staff, she said.

“The lack of enrolled and registered nurses means carers are left to their own devices. They don’t have the knowledge base to prioritise clinical care. This adds to the immense pressure they are under and can result in adverse events such as bullying, poor care and abuse.

“I saw two carers put a lady back to bed before breakfast because she said she felt tired. She complained about being hot, so they put a fan in front of her. They didn’t realise she was a diabetic and was hypoglycaemic.”

Evaluating the standard of education and mentoring available to aged care workers is essential in addressing the standard of care given to residents. Despite the nationally-accredited courses in aged care, the standards of delivery and outcomes vary widely, she said.

“There are people coming out from some courses who haven’t yet touched a resident. They’re just filling blanks in a workbook.

“The quality and effectiveness of some of the ongoing education in facilities is unclear also. Many providers are relying on electronic training, and often there is no mechanism of giving feedback, clarifying questions, or most importantly, the carers relating relevance of the lesson back to their own residents.”

The community needs to be more involved in aged care on a number of levels - visiting, volunteering and families being actively involved in care, she said.

“The community needs to get in there. We should be embracing aged care facilities, not treating them as isolated buildings where no one wants to go. We need to interact with them. If we’re all in there, carers are less likely to be infantilising residents as many currently do. It is in isolation and ignorance that abuse and neglect can flourish,” she said.