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Home truths


Serious allegations of ill-treatment in residential care facilities were recently made on the ABC television program Lateline, but the solution isn’t simply a matter of more funding and tighter regulation. 

The public crisis of trust that followed the report on the ABC’s Lateline about problems in residential aged care facilities on July 15 is just the most recent in a long list of such sad episodes.

Lateline revealed serious allegations of poor treatment of the most vulnerable and frail residents. There were also accusations of malnutrition amongst residents, as well as examples of bullying and intimidation towards family members who sought to intervene to correct problems.

Other media quickly picked up the theme. For the next few days, talkback radio, letters to the editor and other forums including Twitter were filled with more chilling stories. This all served to remind us all of the kerosene baths incidents of a decade ago, as well as similar incidents in the 1980s and 1990s.

Of course most homes are not like this, but while industry leaders pointed this out they also quickly used the opportunity to request more public funding for all homes. Naturally, more funding would be nice, but somehow this solution didn’t seem to fit the problem this time. If the incidents of abuse are truly exceptional, what would be the guarantee that they would not remain exceptional?

Many in the industry point with some justification to the failings of the current accreditation scheme. Accreditation of residential care is an admirable end in itself, but is strongly based on paper trails, documentation and accountability. It requires large amounts of staff time – taking senior staff away from direct engagement with residents – when this is what is most needed. All the paperwork in the world will never deal with undocumented acts of abuse, intimidation and loss of trust.

Is a return to the Outcome Standards monitoring system that operated prior to 1996 worth considering? Certainly that system has a proven track record and was successful in lifting standards across the board before it was abolished by the Howard Government. No need to abolish accreditation, but neither can it be left as the main method of quality assurance.

Other questions arise. What is it that causes such problems in residential care? Despite the limits of funding, the problems don’t seem to be endemic to all aged care, as the community care system has shown.

Why has there not been a single critical incident reported nationally in the media in the home and community care or packaged care system over the past 20 years? There is no loss of trust in community care services. Nor is there is a cry for government to act to guarantee standards.

The positive results for community care can hardly be a result of the tight regulation of standards or the generous funding available to those who receive their care in their own home. Is it that those who need care in their home still feel responsible for their own choices? Or is it that we are willing to accept occasional evidence of neglect in people’s own home much more readily than when a person surrenders responsibility for their wellbeing to the management of a residential care facility? Are residential facilities simply more prone to problems because of their institutional character?

After the bad news, perhaps the ABC’s Lateline could do something to help. They could promote trust in aged care by following up their story and drawing attention to the extensive systems of care in the home currently available. The days in which aged care was confined to residential care facilities have well and truly passed.

Michael Fine is adjunct professor in the Department of Sociology at Macquarie University in Sydney.

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  1. I agree with the author, more money much as it may be needed is not the answer, nor is relying on the accreditation scheme. If I am correct in believing that the abuse was by a singular person, then surely the management or HR of the aged care home should stand up and take some of the responsibility. After all they employed the abusive person.

  2. What I find most disturbing about those reports was that family members made complaints through several different complaints mechanisms and none of them seemed to provide effective redress. I think it’s inevitable that there will be cases of abuse and neglect of elders, no matter what the care setting. The only real safeguard we have is an effective complaints mechanism, and the failures in that respect reinforce the fear that making a complaint will only lead to worse treatment of the older person.