The unfolding scandals - press coverage
The spate of adverse reports that started with those triggered by the Riverside scandal were the first in an ongoing saga of low level unhappiness with recurrent exposures of major problems sparking many additional press reports. These reports were based on the accounts of residents who became victims of the system and of whistleblowers who spoke out about what was happening.
In my view their recurrent nature, their similarities and the very similar cultures revealed do not support the claim that these are isolated events. When brought together and set against what is happening in other countries with similar systems they provide compelling evidence of a deeply flawed system of caring for the frail elderly.
The rape scandal was particularly significant in what it revealed about the culture in this, and probably other nursing homes where sexual abuse was also exposed during this period. A dysfunctional culture can be identified in most of the scandals that have occurred particularly the more recent ones.
Dysfunctional and "culturopathic" cultures are something I am going to examine in much greater detail on this website as this is what the proposed Community Aged Care Hub will be seeking to change. Believers in the marketplace and the system we have now, consider these to be rare exceptions. I consider them red flags to something that is widespread and troubling in the industry. It only becomes glaringly obvious when something really bad happens. Too often it is shrugged off as an exception - but we have far too many exceptions.
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2000 to 2006: The early years
The Riverside scandal in 2000, followed a year later by the problems at the Ritz and Yagoona nursing homes were red flags. They were followed by many reports describing unhappiness and problems in many nursing homes over the next few years.
Aged Care Crisis (ACC) was getting feedback from staff and residents at this time. They included a selection of emails in a submission to the Senate Community Affairs References Committee - Inquiry into Aged Care, in June 2005. These had been received from nurses in aged care telling ACC what was happening in the nursing homes during this period.
They reveal what was happening ten years ago and ACC published this article in 2015 because it so closely mirrored what nurses in Queensland were saying about care in that state following strongly disputed allegations of problems in a nursing home in February 2015.
It shows how little changed in spite of a multitude of inquiries and "reforms" - reforms that carefully avoided addressing the core problems created by the 1997 Aged Care Act.
During this period I discovered that government had abolished the federal probity regulations. The state probity regulations had been used successfully to keep the giant US multinational health corporations out of Australia. There were disturbing US multinational aged care giants that I was doing my best to keep out of Australia and I wanted to object to this. I discovered that there were gaping holes in the new approved provider regulations that allowed these companies to enter Australia regardless of their track records. I was corresponding with the department about this.
Between 2006 and 2008 I studied the system in Australia and wrote a large number of pages on my Corporate Medicine web site. I wrote about many of the Australian companies that were a problem during this period. There is a large amount of information in web pages I wrote, mostly before 2008. You can follow these aged care links from the main Australia page, or if you want to be more specific there are brief summaries with links in the aged care section on a central Australian site map. A list and links to the selection of companies I analysed is here.
On those pages the shift from an ethic of care to an ethic of profit is readily apparent as is the thinking of politicians and the bureaucracy. A nurse sent me a satirical piece illustrating what was happening in nursing homes. I published it as People farming. Has anything changed?
The following web pages and the links from them, directly address the periods 1998 to 2006 by looking at the impact of each aged care minister. This has been going on for a long time.
- Bronwyn Bishop and the Riverside Scandal 1998 to 2001
- The Julie Bishop years 2002 to 2005
- The Rape and Sexual Abuse Scandal - Santo Santoro 2006
During the late 1990s period the illusion that you did not need skills or nurses to provide care was in ascendency. The liberal government in Victoria in the 1990s encouraged small time entrepreneurs to buy and manage small nursing homes, granted them bed licences to build homes and even gave them grants. They were encouraged to see this as a business opportunity. Many of them had no previous experience and no idea what was required. Not surprisingly during the ensuing years there were more small company failures in care and more bankruptcies in Victoria than elsewhere.
In 2006 I wrote about many of the companies in aged care. The links below are to pages that described some of the failures. I tried to look at why they failed. Some are from Victoria.
- S&N (problem managers)
- CH (slow response by regulators)
- Ei (worst of the worst)
- Mc (poor care & staff issues)
- SRS & M (two related companies with multiple failures)
- En (failures in care despite accreditation)
- ESN (prominent director shielded by delayed disclosure)
- Mu (whistleblowers sacked)
- E&L&L (three small companies with problem homes)
- Da (inexperienced management)
- HRN (another Victorian failure)
- Na & LM (internal disputes - government disengages)
The really major and very revealing scandal was the rape scandal in 2006 and that is under the next slider.
2006: The rape scandal
Particularly significant, is the rape scandal at the Gxxxx Vxxxxx nursing home in Victoria during 2005/6. This was a not-for-profit home caring for the blind, that had been acquired by a for-profit group three years earlier. The for-profit company had, at the time, undertaken to look after the special needs of this very vulnerable group.
My interest is in the culture within the facilities, the extent to which they reflect the culture within the operating/owning companies, and the extent to which this reflects what is happening more widely in the sector.
Managers and staff move from one provider group to another and they take the attitudes they developed in one group to the next one. Attitudes and practices can be infectious. This scandal illustrates the way a red flag example can lead to the exposure of issues across the sector.
At the Gxxxx Vxxxxx nursing home, a male carer assaulted and digitally raped at least four residents in their 90s over a period of about six months in 2005. Serious problems in another nursing home owned by the same group had been identified only a year before.
Their complaint about failures in care to the federal nursing home complaint system got nowhere. When they later lodged a complaint about the rape, the response - as even the minister later acknowledged, was underwhelming.
The nurses themselves gave evidence that the formal complaints they made to their superiors in the nursing home were ignored and they had stopped doing so. They had complained about the male worker for a year before any action was taken and had known about the rapes for two months. Their verbal complaints about this were ignored.
A written complaint handed to the CEO of the nursing home was torn up. Instead, it was an agency worker who complained to her own boss, who then took it up with senior management in the company. It finally got to the police. The two workers who had been complaining for months gave statements to the police. The nursing home then sacked them for not reporting this earlier. The families were informed by police and not the nursing home.
Mr Howard and his new Aged Care Minister, Santo Santoro insisted that "the overwhelming majority of homes were free of abuse". This was despite a damning Senate report in the previous June that criticised the complaints scheme for discouraging complainants.
Within days, it was revealed that in another nursing home in Victoria, a resident had complained to staff that she had been raped nine months before. The facility manager made her confront the person who had raped her, then dismissed her claims and did not report them.
Later, another resident in this same facility also complained of sexual assault. Then another case emerged in Queensland. There were soon 3 male carers charged with sexual assault, and a few weeks later, another in Canberra.
MARGOT O'NEILL: It's not only relatives that feel the system is in crisis, but many staff as well. ABC Lateline also revealed last night, allegations from a former staffer at a specialist Melbourne dementia unit, of physical and verbal abuse of patients, unnecessary sedation and serious medication mistakes.
Source: Aged care abuse reporting scrutinised - ABC Lateline, 21 Feb 2006
These events opened the floodgates with allegations of poor care in multiple other nursing homes in Victoria, the failure of the complaints system, and the ineffectiveness of the Accreditation Agency (now known as the "Australian Aged Care Quality Agency").
It seems that, as part of a "mediation process", residents who complained were sometimes expected to directly confront the person they accused of assaulting them. The new minister set about requiring police checks on staff and making changes to the complaints process.
Soon after in February 2007, two academics at Flinders University blew the whistle on what they described as "disgusting" standards of care in a number of nursing homes around Adelaide. They received considerable support from the public and were told of more failures.
In my view, what happened at this time illustrates patterns of behaviour, a culture within sections of the aged care system, that reappears on several occasions in the following years. Instead of addressing problems, structures that were set up to deal with problems were blocking those who complained.
There was a knee-jerk response to the rape scandals with a regulatory focus aimed to placate critics. I wrote on a web page:
... The draconian measures introduced will in my view have an impact in curtailing some of the more excessive examples of abuse - temporarily at least. It will push the problems out of sight and out of mind. Government, industry and some advocates will hail this as a success and vindication of their approach.
Because it does not actually address the problems, it will simply make them less visible. They will continue to fester and overall care will continue to deteriorate. A further scandal in a few years is likely ..."
There have been ongoing reports of failures and continued unhappiness ever since. The more confronting scandals in the last several years confirm my predictions.
2010 to 2014: More recent years
Since 2006, there has been a steady stream of reports of poor care, sometimes in facilities that had recently been fully accredited. Coroners have sometimes been very critical. Senate investigations and enquiries have found fault with the system and with accreditation.
There are accounts of nurse whistleblowers who have been fired, their credibility destroyed, and their careers ended. Those who provide a sympathetic ear like Aged Care Crisis (ACC) hear from nurses and families of residents and most of what they hear is very worrying.
Here is a confronting example of a nurse speaking out about a group owning a large number of nursing homes, headed "I am sorry 'Mary' I could not help you". People don't stick their necks out and make allegations about people with power, unless they are highly motivated and disturbed by what they have seen or experienced. We have no idea how many companies operate like this.
Also representative, are the June 2010 disclosures of major failures in care by Walkley award winning journalist, Rosie Squires who undertook an undercover investigation of two nursing homes operated by FP-CompanyA and INTFP CompanyB in June.
These failures were despite visits to the homes by the regulator in March and April. The failures were only confirmed by the regulator after the press reports. Attempts by INTFPCompany B to unfairly squeeze nurses salaries had been blocked by Fair Work Australia in January. Could an overly aggressive approach to cost cutting have resulted in alienation and loss of morale among staff?
I have argued for nearly 20 years that startling failures in care like this are red flags to systemic problems in the way the market operates. The thinking and operation of commercially-focused entities results in deficient or mediocre standards of care. These periodically reach a level in some facilities that causes someone to speak out, or, in desperation, take their concerns to the press.
Usually the failures are due to reducing staff in order to cut costs often justified by claims of increased efficiency. For example, in 2009 a FPCompanyD Aged Care nursing home had started on a program of staff reduction on the same day they were advised that a heat wave of 46.4 celsius posed a hazard. Although they had been warned repeatedly that extra staff might be needed to watch over residents, the staff reduction was continued by management. The two nurses on duty were unable to keep track of all the residents. One wandered into an uncovered courtyard and died before she was found some hours later. It was a coroner's case. Three years later in 2015 there were staff reductions at another facility owned by this company. A resident died after she was left lying against a heater for at least 6 hours. Nobody noticed.
These periodic scandals are only the tip of the iceberg. They are company wide, countrywide and worldwide. The public see only isolated reports and miss the big picture that appears when the many reports are examined together. When one family has experience of three successive nursing homes this becomes a bit more than coincidence.
- Care the key in ending aged 'hell' Sydney Morning Herald 14 Apr 2012
As individuals experiencing this for the first time we wonder what is being done to fix the problems and look after our parents. When we see it all together its obviously nothing much.
We are never told what has been done to actually fix the problems - and then we find it happening all over again and wonder why. Why people within the system, who have good intentions still fail to act is interesting. It occurs so commonly that it seems to be normal.
In our current thinking, aged care is seen as a business like any other. If we reflect for even a moment it is clear that the care of vulnerable people is something we do as a society. It a Samaritan responsibility of the community - of civil society. That we delegate that to government, or to the market (via government policy) does not absolve us of our responsibility. And yet we are kept out of the loop when things go wrong. Our expectation that changes made to address this will be transparent and will satisfy us are not met. Worse still government colludes in this while claiming to support transparency.
The proposed Community Aged Care Hub, an arm of the community would be there and be an active party when things go wrong. It would be in a position to act and be providing oversight when sorting things out. It would be asking why and then looking around to see if that was isolated or systemic.
Company wide and world wide
In the two companies exposed by Rosie Squires, an investigation by a community group found that 13 FP-CompanyA homes had already been found wanting in Australia. Almost identical things have been happening in INTFPCompany B's homes in the United Kingdom, (watch this fascinating video). As has happened in Australia, seven courageous INTFPCompany B whistleblowers (known as the INTFPCompany B7) were subjected to extreme pressure.
Something appears to be seriously wrong within INTFPCompany B care homes in Scotland as well. In November 2013 company bosses were summoned to a meeting with the Scottish Health Secretary because of multiple failures in care, some very confronting. The article reports that 10 of INTFPCompany B's 30 homes were causing concern. Like the video, the description of the failures at the Scottish nursing homes points to a very disturbing culture that has little to do with care, with, among other things, a member of staff feeding a demented patient dog biscuits. There is more detail about the failures in aged care in the UK and Scotland in the link below. The problems in INTFP CompanyB's homes, particularly those in Scotland are described.
- This Is The Shocking Face Of Abuse In Britain’s Elderly Care System Buzzfeed Apr 30, 2014
Less than a year after the exposures in Scotland, there were more serious problems in a nursing home in the UK in Feb 2015. Then in May 2016 it admitted to two health and safety breaches at a facility in the UK and was fined £400,000 by the courts.
- Middlesbrough nursing home told it cannot admit new residents after inspectors serve warning notices demanding improvements The Northern Echo 9 Feb 2015
- IntFPCompany B fined £400,000 after care home death ITV News 26 May 2016
IntFPCompany B sold its UK Home Care business in February 2016. It has refused to confirm information published in major newspapers claiming a decision had been made by its board in late 2015 to sell 200 of its 290 care homes within a year.
It is interesting that the Quality Care Commission had only 57 care homes listed on its web site at the end of May 2016. This might suggest that the remainder have already been sold or are in the process of being sold. But the quality assessments of these homes is surprising.
Of these 57 facilities only 18 (about one third) were listed as having been assessed as “Good”. Thirty Three were assessed as either “inadequate “ or “requires improvement”. The remaining 6 had no rating against their name but were last assessed in either 2013 or 2014. These figures are unimpressive.
There is much to suggest that in spite of their global reach and their wealth the company have not been able to provide adequate care in the UK. They may have decided to abandon those residents who put their trust in the company. Alternately they have decided not to use funds generated from their international operations to support and care for residents in the UK. All this must raise issues about their social responsibility.
Your Voice Matters is a UK communitty group that seeks to "help those who have no voice". It is very critical of aged care in that country. An article by Ian Cresswell analyses what has happened there. He concentrates on private equity but then offers an explanation as to why INTFPCompanyB, a mutual group which because of its structure should be providing much better care than the other for-profits is not doing so. He explains that "The money is being filtered away from its care homes and is being put into other areas of INTFPCompanyB’s ever increasing worldwide expansion of markets" and "Since around 1997 INTFPCompanyB have operated a deliberate policy of underfunding its care homes with the result it currently has around 100 care homes currently failing.
- Money, power and fear rule our care sector. Profit v care. Who wins? Ian Cresswell on Your Voice matters web site 1 Sept 2015
In a competitive market when one company makes money from something, then other competing companies soon perceive it as being acceptable, and a whole sector is soon doing the same thing. When the market is in decline and profits can't be made, the players in the game go elsewhere and minimise their losses if they can't get out of the market. Both financial success and the prospect of losses anaesthetise management to the consequences of the actions they must take in response to market pressures. They simply don't see them.
The UK's Care Quality Commission has recently reported on widespread neglect of dementia sufferers in 9 out of 10 nursing homes and hospitals in the UK. In 2014 the BBC in the UK put hidden cameras into some nursing homes in order to expose what was happening. There was a link to the 2014 BBC Documentary titled "Panorama Behind Closed Doors Elderly Care Exposed" (YouTube). That is now broken but the buzzfeed article above describes many of the same instances including at a home operated by INTFP Company B.
On 22nd February 2015, BBC News reported that "Thousands of complaints made about elderly care in England". Ireland has its problems too with allegations that residents are wasting away because of poor food and a lack of staff to feed them.
These reports are a red flag to pervasive failures that go far beyond isolated rogue facilities. They are the consequence of a high-risk corporate culture. We see low-level, ongoing dysfunction, with periodic breakouts of confronting failures in care across the organisations. There are no national boundaries to corporate culture.
So how do these companies deal with these problems?
Dealing with the problems?
You would think that after such bad publicity and so many problems, FP-CompanyA would have pulled out every stop to fix the culture in their nursing homes and make them safe. You would think their wealthy financial backers would have poured funds into them, government would have been all over the company and the Accreditation Agency would be closely supervising the changes in all their nursing homes.
But in similar situations, others have rationalised and justified, going into denial and refusing to accept the real cultural problems in what they do. We do not know if FP-CompanyA management attempted to address the cultural issues revealed in 2010, but whatever they did, problems seemed to recur in 2011.
Another failure: Only a year later, on 18th November 2011, a fire was lit in their Qxxxxx Hxxx nursing home by the disaffected, drug-addicted registered nurse in charge at the time. Eleven people died. At the 2014 inquest it was revealed, not only that the nurse had no aged care experience, but the managers had failed to track his referees or make any serious attempt to inquire into his very disturbing violent track record. They were prepared to put somebody, about whom they knew almost nothing, in charge of a nursing home containing very vulnerable residents at night.
Even worse, the managers at Qxxxxx Hxxx, who knew this nurse had come off the street, failed to heed the repeated warnings of worried staff, even when they were told he was stealing drugs. One of dozens of available reports (Nursing home managers ignored pleas about killer nurse Roger Dean, inquest hears) gives the best insight into what happened and the persistence of a worrying culture in this company.
This is a sector where a few years before, there had been a national scandal after it was found that women in some nursing homes were being raped by male staff, while management refused to listen to staff who told them about it. Five years later, staff at FP-CompanyA homes were being employed in this cavalier fashion and also not listening.
Now how did the company respond this second time? Did they and all the others rush to sort it out? Well they might have. We know they put in sprinklers when rebuilt. Government had responded by making sprinklers mandatory so they led the way. But did they do anything to address the culture, the patterns of thinking that allowed managers in the Qxxxxx Hxxx home to do what they did. Would it have reduced their profits and their plans for expansion if they had done so? The issue here is that we don't know.
Exactly what big corporations do to fix their problems seems to be "in confidence" so nobody outside the company knows. They wont tell us and we are left wondering why things happen again. In the proposed Community Aged Care Hub, corporate managers would be working with the community when making changes to address problems and everyone would know what was happening and if problems were being properly addressed. The community would be meeting its responsibilities.
A change of name: We do know that the company changed its name to FPCompany NewnameC Aged Care. This is a strategy adopted by companies for a variety of reasons. National Medical Enterprises (NME), which I use as an example to illustrate what I mean by a culturopathy on a later page, changed its name from NME to Tenet Healthcare in order to escape the bad reputation it had. It claimed that this new name represented its new commitment to integrity. It indicated it wanted to "put this behind it" and get on with business. But the problem was not really its integrity. It was the very successful and much admired business thinking, the business culture and the very profitable business practices. They did not put any of this behind them.
Thinking in images: In the market place perception and reputation are critically important for the business. Creating a positive image and selling is vitally important. Thinking is focused around the impact that events have on the business rather than the nature of the events themselves. Too often companies fail to recognise that the problems are cultural and systemic. Everything is seen within the context of the image it creates. This leads to issues automatically being conceptualised as an image problem. They address the image instead of carefully examining what went wrong, learning from it, and making the fundamental changes needed. Many employ a PR company to help them promote a new image. In the case of NME/Tenet Healthcare, it was simply incapable of accepting that the way it thought and behaved was wrong and could be the cause of the problems. Senior managers went to their PR company long before they visited its facilities to see what was happening.
Tenet was placed under close government surveillance for 5 years and did not make much money, but as soon as the oversight was lifted it started doing the same things again, making large profits and within 3 years was involved in another massive scandal in which patients were badly harmed.
One of the problems with any culturopathy is that the participants are simply incapable of understanding that what they believe in so strongly, what is being so profitable for them, and what others are doing so successfully in other sectors of the market, is actually very dysfunctional and harmful in a vulnerable sector. For them it is inconceivable.
I will write more about this later to explain how and why it happens, and why it happens to people who genuinely believe they are doing the right thing by others. Their success in the sector that they belong to is seen to validate how well they are doing it. They are not evil people although some might be. So we see that preserving credibility in the marketplace can be more important for companies than meeting their responsibility to the community.
What the company did: We do not know what action FPCompany NewnameC took, but we do know, from experience that profitability and not morality count in the global marketplace. In the US Health Care marketplace companies like Tenet Healthcare and HCA that built vast empires by defrauding and misusing patients were rewarded by being welcomed back by investors. They were seen, not as criminals but as having demonstrated good business skills in the past, and as still providing opportunities.
We do know that FPCompany NewnameC built a lavish new nursing home to replace Qxxxxx Hxxx complete with sprinklers, and held a by-invitation-only opening ceremony with prominent politicians to promote the new home. There was an "everyone can move on now" message.
The families of the dead don't seem to have been there. A year later they were unhappy about the way those who died were being commemorated - or rather the low key manner. They were angry when they heard the coroner's final report, particularly as no one from the company bothered to come to listen to it and talk to them. They demanded an apology from FPCompany NewnameC. They did not see why they should "move on" when no one had involved them or shown them that there had been real changes.
What we all need to know is whether FPCompany NewnameC has looked at the business culture across their empire as exhibited in the series of failures in 2010 and 2011. What has it done about that? Big successful companies seldom do this. They brush it aside and move on.
We do not know what FPCompany NewnameC eventually did to address its problems but we do know that there have been no more disturbing disclosures. So it probably did restructure its services so that these things did not happen again and they deserve credit for that. Hopefully that would have addressed any cultural problems.
Addressing the suffering: The press reports suggest the company’s relationships with the families of the residents, particularly of those who died has not been good. In a situation like this it is essential to genuinely empathise and grieve with the victims and to include them transparently in what is done to address the issues and make them central to what happens in your activities. This requires genuine humanity and empathy. The reports suggest that the company fell short on this.
Markets and human values: This is an opportunity to make a very important point about markets. I want to distinguish between markets as a useful mechanism for doing business and markets as a belief. When markets are simply a mechanism that we use they become our servants. They do what we require of them. We humans impose and insist that they serve our humanity and that its managers and staff are free to express theirs. The market follows and adapts to our requirements.
When we believe in something implicitly and it governs how we behave and what we do then we become its servant. We serve our religion and live our lives according to its dictates. Religious cults seek to convert others, and resist criticism because there can be no doubts. Fortunately most religions embrace and foster our humanity.
But markets are an impersonal mechanism and they have no values and no humanity. When we become their servants we are required to live according to their dictates and to meet their objectives. There is nothing human about these. When we express our humanity and empathy this distracts from and impacts on the goals of our master. Humanity and empathy require a gift, a gift of our valuable time. When we give expression to our humanity we become dissidents and this displeases those who are more focussed on serving this master. The more competitive the marketplace the more important it is to give priority to our master's goals - and the less room for empathy.
If we look at what is happening in this way we can see why there is so much unhappiness coming from staff whose motives express their humanity and from the families who expect this humanity. We can also see why those who are focused on serving their master react negatively to this.
What the proposed hub will do is to turn the aged care market into our servant and so release those who work there from the constraints that prevent them from expressing their humanity.
A new partner: in June 2014, eighteen months after the fire the new FPCompany NewnameC Aged Care launched a partnership with Alzheimer's Australia NSW to position itself as a provider of specialist aged care services to those with dementia.
We can understand, from its track record, why a manager in FP-CompanyA was able to employ a nurse without checking his track record. But here we have Alzheimer's Australia, the national body, a not-for-profit group, which professes to represent and serve those with dementia, the most frail and vulnerable of all citizens, partnering with an organisation whose recent track record for failing them has been easy to find. Did they examine this and consider its suitability - or was it simply a business decision.
Perhaps they missed the research done in 2010 by the community group, the Combined Pensioners and Superannuant's Association, whom they might not have seen as a credible source, but they could not have missed the 2010 reports and the 2011 Qxxxxx Hxxx fire.
Too often companies explain failures away by saying it was because they were not getting enough money, but we cannot believe that when they are actually making a reasonable or large profit. Their responsibility as responsible citizens and ethical providers in this sector dictates that they should put the patients interests first even when that means running at a loss.
Alzheimer's Australia will be recommending the new "untarnished" FPCompany NewnameC's facilities to the families of those with dementia when they come to them for advice. They may well be a new and reformed company, but its up to FPCompany NewnameC and Alzheimer's to persuade the rest of us that this is so by telling us what they have done differently. If the hub were there it would be involved, would know and would keep us all informed
Apart from the claims to excellence on their web site, I am not aware of anything that suggests a change in the way FPCompany NewnameC does business. It is still focused on growth and possibly listing on the share market. If Alzheimer's has solid information that FPCompany NewnameC has changed, then they need to show the public the evidence of that and explain why it believes its OK to do that.
I am not aware of any newspaper that has looked at Alzheimer's Australia's decision with a critical eye, not even the Australian Ageing Agenda web site that reported it. I don't have any information about the culture at Alzheimer's Australia, but I find it concerning that they are prepared to align themselves with an organisation that has a tarnished track record, particularly when they have not discussed this publicly or explained it to the public.
An alternative perspective: There is another way of looking at this. FP-CompanyA, now a sanitised FPCompany NewnameC, seems to have generated sufficient capital and income stream from its very successful and profitable business operations (keeping costs down) in aged care over the past few years. It has wealthy institutional backers with Singapore's G. K. Goh Holdings and AMP together holding over 90% of stock. It has positioned itself to seize the opportunity, presented by the consolidation of the sector, to grow rapidly. It has started by acquiring all of Stockland's Aged Care Portfolio.
The government wants, and analysts predict, that the industry is consolidating and the sector will soon be in the hands of big corporate owners. This is the way of the future. Any not-for-profit organisation that wants to look after itself and be part of the future is going to want to be part of the act so that "those it serves can benefit". No one wants to be left out, and a company with FPCompany NewnameC's potential and business expertise is very attractive. Little wonder Alzheimer's Australia was seduced by the opportunity offered. The residents in their homes in 2010 and 2011 were similarly seduced by glossy brochures.
A global problem
This is not an aged care problem that is localised to Australia, it is affecting most Western countries that have embraced free market solutions. Free market thinking has taken control of previous community structures like aged care, often in the face of hundreds even thousands of years of human knowledge. It has then "reformed" them to make them comply with the belief in unfettered markets.
As we have seen above the UK, Scotland and Ireland have major problems. But it has been a bigger problem in the USA for much longer. Governments in other countries have been aware of what was happening there and were sent evidence. In spite of this they have followed the same policies. This is the nature of ideological political systems and we should not be surprised, nor angry. There is a long history of well intentioned ideologies that have ended up by harming some citizens for the benefit of others. Belief blinds us to facts and logic.
The USA, the oldest market
The USA has been and still is worse than any other country. I was acutely aware of the potential problems during the late 1990s for Australia if large US chains obtained a foothold in this country. The company founded by the charismatic businessmen I referred to on the 19 years of care page did so but only temporarily. This company was successfully blocked by state probity regulators who were supplied with information. When its practices were exposed the company went bankrupt in the USA and Australia.
There is a recent very confronting video (be warned) on YouTube Fault Lines - Elderly Incorporated ("Fault Lines investigates the business of elderly care, and what happens when corporations put profits ahead of care" - 20 Sept 2013). After showing frightening images of carers abusing helpless old people taken by families using hidden video cameras there is an analysis of the situation in the USA. The video explains the close links the big private equity and corporate owned aged care chains have with politicians. The close links between industry and politicians in Australia is similarly very worrying. Politicians turn to the market for advice and support - not to civil society, the community we all belong to.
I wrote about aged care in the USA 15 years ago when contacts sent me similar video clips and I forwarded some to authorities. I wrote about "Politics, Markets and Democracy" in relation to aged care in the USA and Australia on a web page in 2004.
Twenty years of trying to beef up oversight and of aggressive lawsuits by citizens in the USA have made very little impression. The USA has concentrated its efforts on oversight and punitive legal action by citizens. As the video indicates, this failure is largely but not only because politicians have protected the corporate chains.
No one in the USA that I know of has tried to change the operation of the market. The proposed Community Aged Care hub is an attempt to address the problem by taking the age care agenda away from the behind-closed-doors network of industry and politicians. Instead it will put it into the community and so turn off the high pressure tap which is driving this system. If the community takes charge and uses its power it will change the way this market works.
July 2016: The latest revelations occured when a daughter's concerns about her father's care were revealed when a video camera was recording for 48 hours.
If that is what is revealed in 48 hours, what would we find if everyone had this option?
2013 to 2016: The current Australian marketplace
My experience examining the conduct of the corporate market in health care is that when a company or a sector in this market starts doing very well and is attracting large corporate investors then there is a distinct possibility - even probability - that operators have found some vulnerability in the system and are exploiting it. It often points to cost cutting or overservicing and suggests a culturopathic culture that is not serving patients.
On a health care web page I wrote ten years ago, I listed a number of red flags - the first is below. Is aged care different and should we be watching more carefully?
1. Large profits particularly disproportionate profits. Strong institutional investor support. Market praise. Rapid expansion, particularly when others are struggling.
The US experience suggests that in general the more profitable a health care company, the more glowingly it will be praised and the more likely are its practices to be questionable. Excessive analyst praise and high profits are red flags. Most health funding is capped in some way, yet these profits must come from somewhere. When one sector booms too spectacularly or a particular company makes much larger profits in an area where others are struggling it should set red flags flying until an adequate explanation is found.
Source: Red Flags: Pointers to problems in health care corporations (see final item in "Contents" on "The Great Divide In Perceptions" page on Corporate Medicine web site 2004
And the past three years: There have been disclosures of widespread neglect on Lateline, problems with the accreditation and complaint systems, and calls for a royal commission (21 May 2013 --- 15 July 2013a --- 15 July 2013b --- 16 July 2013 --- 22 July 2013 --- August 2013). The Women's Weekly (August 2014 page 76-78) published a three-page article "The Shocking Abuse in our Nursing Homes". The steady stream of reports highlighting problems continues. In September 2014, we have a report from Canberra of problems in care due to poor staffing and another about poor food and hygiene.
The system is not working. The complaints and other mechanisms through which citizens try to assert their rights and do something about this are deaf. When nurses draw attention to problems they are threatened. They are bullied if they complain and fired if they persist. Families fear that if they complain the resident will be targeted rather than benefited.
- Care crusade: Many who have been let down by the aged care system are being further frustrated by the official channels of complaint The Age Aug 25, 2013
- Call to set up independent aged-care watchdog The Age Aug 25, 2013
- Donnybrook Tuia Lodge aged care workers claim residents are ‘at risk Perth Now Aug 30, 2015
We have a market culture that sees cost cutting as a good in itself, a part of being efficient. It considers cost cutting essential for success in this marketplace. Those of us who have worked in countries and situations where there was a real shortage of money and resources and who stretched what we had for maximum benefit see this deliberate pursuit of cost savings ahead of residents needs in a wealthy country as ruthless, abhorrent and cruel.
We hear allegations of inadequate staffing, inedible food, a failure to properly toilet and feed residents, rationing of pads with patients lying in filth for many hours, and the use of chemical restraint. In spite of a steady stream of complaints about these issues that have been going on for many years, little effort has been made to collect information or do anything about it.
- Palmerston nursing home cuts jam rations and staffing hours to save money NT News Aug 4, 2015
- Vaucluse Gardens Aged Care facility 'understaffed' on night 85yo Bxxxxx Wxxxx died, inquest told ABC News 15 Dec 2015
Retirement Villages: There has also been ongoing unhappiness about the way retirement villages get their profits and run their businesses. Recent articles The Great Retirement Maze by Alan Kohler (and another article here) are very critical of the latest payment system, a payment system that is seen very differently by the industry, which would have contributed to its design.
More information: There is more information about care in the UK and the USA and a large number of links on the International aged care page in Part 4 on the Aged Care Crisis website.
Please look and listen to this:
I would urge anyone wanting to understand what has happened to aged care to listen to the ABC Radio National's Background Briefing audio program Death in a five star nursing home presented on 21 September 2014. (full audio and transcript).
It tells the story of what has happened to aged care and exposes the problems - all in one program. Once again, it is INTFPCompany B, and a large for-profit FPCompanyF. And in spite of the ABC's revelations that same FPCompanyF home is reported in Oct 2014 to be still having problems. A demented patient was assaulted and injured. The home is also being investigated by the coroner because of another death. The response has, once again, been to sack the staff involved rather than to look at the culture in the organisations that results in people behaving like this.
A TROUBLED Melbourne nursing home has been probed over claims an elderly male dementia patient was assaulted and an 89-year-old woman died of undetected injuries.
A carer and a supervisor were sacked after police were called to FPCompanyF Hampstead on April 4 when the carer allegedly struck the elderly man in the face, causing him to fall through a glass pane. He needed hospital treatment but no charges were laid.
The Herald Sun can also reveal the May 2013 death of a frail female resident is being investigated by the coroner amid claims she had suffered neck injuries following a fall that may have gone undetected for several days.
Source: Nursing home probed over alleged assault of dementia patient, 10 Oct 2014
After listening to the ABC program Death in a five star nursing home, please read through the full transcript carefully.
There is a lot of emotion and impact in this program, which pulls at all our heartstrings. The discussion that follows about palliative care is interesting. But what I find most revealing, is the way the companies operate, the culture that results and the response of the staff to this. This is easier to see in the transcript accessed from the button at the top of the page.
Also revealing of the culture of our nursing homes is the way anxious family members who are unhappy about the way their parents are being treated are targeted by staff and barred from visiting their aged parent - sometimes the only family contact the parent has. Anxious family members can be difficult to deal with but the examples here illustrate how badly some manage the situation and suggest that others hide the poor care they are providing by getting the family members out of the way.
I suspect this has much to do with the cultures in these facilities - the poor care that results and the way that the staff then respond. The proposed Community Aged Care Hub would know what was happening and would be in a position to assist and ensure care was provided when needed. They would also be well placed to resolve issues when conduct by staff who interact poorly resulted in anxiety and stress flaring into hostility.
- Nursing home ‘banned me from seeing mum’ The Australian August 28, 2015 (Paywall)
- Aged care residents and families 'bullied by facility staff' after complaining about treatment, advocacy group says problem widespread ABC News 28 Sep 2015
- Woman denied access to dying mother condemns 'monstrous display of evil' by nursing homes ABC News 9 Oct 2015
After 20 years we still have problems with younger people who should not be in nursing homes with the old and frail. Staff are unable or too busy to manage them appropriately. These might be people with premature dementia, with head injuries or even younger people who are mentally of intellectually impaired. Some can be physically impaired but mentally active and others mentally impaired but physically active. They are out of place, need different treatment and respond differently.
Because they don't fit they can be targeted by irritated staff, neglected or inappropriately restrained. That the staff can't identify with them points to the culture that exists. These articles illustrate both sides of this. If the proposed hub were present they would be aware of these issues and would try to address the issues and the special needs of this group.
- Drugs, straps used to control residents The Age 8 July 2013
- The terrible curse of Young Onset Dementia St Kilda News 22 May 2014
- Heaven help residents Letter in the age about care in NH Letter The Age 13 Nov 2015 (letter is halfway down page)
Workforce and patient care issues 2016
Several inquiries into nursing and workforce issues and elder abuse in late 2015 and early 2016 have caused journalists to looked at what the nurses and families are saying about aged care and at what is happening to the residents in aged care facilities as a result. They are publishing more articles about this. Family members who have had real experiences are also writing articles and making comments on them.
The focus of debate has become more focused on the problems in the market system - specifically the pressures for profit and the fact that cost cutting reduces staff and impacts adversely on the lives of the residents. Articles look more broadly at the care provided in the nursing homes. The comments from staff and families below the articles are often more revealing than the articles themselves. They are the people who have experienced the system with their eyes open.
What is happening will clearly be very distressing for those who are providing good empathic care, who are trying hard, who "believe" in the market system. You should not feel that you are being attacked and that your efforts are being denigrated. But it is clear that the system is failing far too often and that it has to stop denying, start engaging and start listening and then start working with its critics. It is not your fault. We want a system that works for you as well as for us and one that you and we can be proud of and where your efforts are recognised.
- Nursing home profits soar as patient care declines Sydney Morning Herald 1 Jan 2016
- Aged care: We all face same fate so we should take a stand Comments The Age January 5, 2016
- Aged care bed licences should be issued to consumers not providers Editorial Sydney Morning Herald 6 Jan 2016
- The aged care gravy train The Age January 9, 2016
- Our elderly need homes, not warehousing The Age 11 Jan 2016
- Reports of assaults in aged care up 10 per cent in past year SMH 17 Jan 2016
- Elderly suffer from malnutrition as diets fail to meet needs Gold Coast Bulletin 24 Jan 2016
- Failing standards in nursing homes and aged care Choice 8 Feb 2016
- Older people abused and exploited, NSW parliamentary inquiry hears SMH 22 Feb 2016
- Absurdly Utopian Requirements for Nursing Home Admission? 25 Feb 2016 8.03 (Blog)
- My Dad was given drugs 'like potato chips': how the elderly are being restrained The Age 6 Mar 2016
- Newcastle nursing home accused of failing to deliver care, resulting in elderly resident's death ABC News 7 Mar 2016
- It’s time for a ‘new national conversation’ on elder abuse Australian Ageing Agenda 9 Mar 2016
- Dear kids, don't ever shove me in an old people's home Sydney Morning Herald 25 Mar 2016
- Staffing concern raised at Coastal Waters aged care home South Coast Register 5 Apr 2016
- Aged care provider cuts enrolled nursing jobs, puts patients' lives at risk, union says ABC News 9 April 2016
- The workers we trust to look after our mums and dads are changing - and struggling The Age 10 Apr 2016
- We're ignoring the needs of our ageing population The Age 17 April 2016
- Relatives bear load Letter to The Age 19 Apr 2016
- Talking Point: Elderly dental care in crisis The Mercury 26 Apr 2016
- More competition may not be the answer to reforming the aged care system The conversation 27 May 2016
- Aged care providers seeking profit instead of residents' wellbeing The Age 28 May 2018
- There is something very wrong with our aged care system The Medical Republic 2 June 2016
- Complaints pour in over inadequate care at Gold Coast aged-care facility Gold Coast Bulletin 8 June 2016
- Burleigh aged care centre under fire for mismanagement The Gold Coast Bulletin 11 June 2016
- Calls for politicians to address crisis in aged care during election campaign ABC Radio AM 11 June 2016
- NANNA DESERVES BETTER: THE FIGHT FOR RETIREMENT HOUSING STANDARDS Victorian Council of Social Services 16 June 2016
- Nursing home laws consign some residents to premature death Echo net Daily 19 June 2016
- Queensland aged care residents left lying in pain without medication because of staff shortages The Courier Mail 22 June 2016 (Paywall)
- AGED CARE CRISIS: Elderly left in their own waste South Burnett Times 23 June 2016
- Home care examined after 75yo Perth woman died with infected pressure wounds ABC News 5 July 2016
- Relatives say overnight aged-care incidents prove need for 24-hour nurses Sydney Morning Herald 14 July 2016
- Secret camera captures abuse of elderly man in nursing home including attempted 'suffocation' ABC News 25 Jul 2016
- Cxxxx Lxxxx stressed about work when he abused Cyyyyyy Hyyyy at nursing home, court documents show Adelaide Now 27 July 2016 (Paywall)
- David Penberthy: Mitcham aged care scandal goes way beyond perpetrator Adelaide Now 28 July 2016 (Paywall)
- Jxxx Cxxx Aged Care investigated after 89yo receives serious burns during sponge bath ABC News 2 Aug 2016
Health care worker says she was sacked for blowing whistle on nursing home launches legal action Gold Coast Bulletin 3 August 2016
Nursing home’s medical mix up The Bendigo Advertiser 4 Aug 2016
Hobart 85yo nursing home resident died with head stuck between bed and pole: inquest ABC News 14 Dec 2015 (staffing issues)
Aged-care industry in a downward spiral The Age 1 October 2016
- Hunter nursing home sued over resident's death Newcastle Herald 30 Oct 2016
- FPCompanyI aged care facility on notice for compliance Australian Financial Review 31 Oct 2016 (Paywall)
The links 33 to 35 (above) refer to what was revealed when a video camera was recording for 48 hours. If that is what is revealed in 48 hours, what would we find if everyone had this option?
We can end with three quotes that describe what is missing from aged care for residents, for staffing and from community. They can be seen as the three victims of the belief in free markets that now governs aged care.
The residents who are the ultimate losers, the nurses who have no power and are being exploited and a community which as I will explain later has been trapped in a system that focuses on self-interest and has ceased to see itself as a body of citizens with responsibilities to its society. We have lost our ability to stand in the shoes of others and feel their pain. We have gone awol when fellow citizens need us to act on their behalf.
We need a moral approach to the care of older people based on kindness. We need to recognise in older people an inner life much like ours; complex, full of memories, filled with desires, passions and vitality even if their bodies and minds are no longer as agile. There is a significance to late life. It has purpose. Its meanings need to be seen and celebrated.
Source: Our elderly need homes, not warehousing The Age 11 Jan 2016
Department of Health figures showed the proportion of registered nurses in aged care fell by nearly 30 per cent between 2003 and 2012. In that time, unregulated "personal care attendants" grew from 57 per cent to 68 per cent.
Source: The workers we trust to look after our mums and dads are changing - and struggling The Age 10 April 2016
Rather than supporting those at the end of their lives and their family members, we seem to have lost our way and our ability to empathise.
You can judge a society by how it treats its elderly. Health and aged care are community responsibilities and the onus is on us all to ensure the best outcomes for those who are approaching the end of their lives.
Source: Aged-care response a true test of society's caring Sydney Morning Herald 24 Aug 2015
Finding out about culture: To try to find out what any particular company or nursing home is like we can talk to families of residents or past staff if we can find them. A search of the internet may find stories of events that suggest all is not well. There are now a multitude of websites where residents, families and friends record their impressions of individual facilities. A good inside source that few consider is the web sites providing advice to prospective employees. Past employees say what it was like working there sharing their experiences. These include examples like those on the links from websites like jobadviser.com (and here) or glassdoor.com.
It is important to remember that all of these sites can be gamed by companies themselves or deliberately maligned by disgruntled employees or competitors but they can alert you to possible problems. For example, comments on the links above vary from "Rewarding" to "What a mess", "terrible culture" or even "great place to stay away from".
Pulling this together
The things I would like you to look at carefully and consider on this page because they are important for what I am proposing are:
- The corporate culture revealed by much of this material, Consider INTFPCompany B, and FPCompany F, both major for-profit providers of care, revealed in the radio program "Death in a five star nursing home". Then there are the undercover investigation by a journalist referred to earlier, the allegations that families made about the way they were treated when they complained, the experiences of the young with disabilities when they end up in aged care and the many other matters linked to above. Look at what is revealed by the video of a UK whistle blower at the foot of this web page, the story of multiple failures in Scotland all of which give additional insight into INTFPCompany B's culture and its global extent,,
INTFPCompany B is a company, which I researched and wrote about in October 2007 after it bought Australia's largest nursing home group. I considered that while it marketed itself as if it were a not-for-profit organisation serving its members, which I thought at the time it was, its mode of operation was anything but. I was sufficiently concerned to write to the Approved Provider section of the health department about it.
In a subsequent section "Cultural Perspectives" I am going to look at what happens, and has happened to organisational culture in both not-for-profit and for-profit groups in failed markets. Understanding this is important if you want to see how the proposed Aged Care Hub will work to change market culture.
- The failure of and behaviour of the Accreditation Agency. Look at the ABC transcript of Death in a Five Star Nursing Home linked above, where it is clearer, to get an insight into the failure of the accreditation system. Look at the comments of some of those who have carefully examined the track record of accreditation in Australia. The same thing happened with accreditation in the USA, but the USA did not abandon the state oversight of nursing homes that collected and published failures in care, as happened here in 1997. I am going to explore the political priorities and illusionary beliefs that gave rise to total reliance on accreditation in Australia, and continued to support it in the face of evidence. I will show how the proposed hub would address this issue.
- The relationship between ownership and failures in individual facilities. Our regulations focus on "key personnel" and not owners.
- That this is a problem that Western Societies that have adopted economic rationalist policies and free markets have. It is not just Australia. Like Aged Care Crisis in Australia, it is groups in the community rather than government or industry that are collecting information, analysing it, giving citizens good advice and putting pressure on the system to reform. Two of several sites in the UK are "The Bank of Aged Care", which is no longer active, and a facebook page Your Voice Matters. They have all been saying the same thing about this market in misfortune. Its when you bring all the information together in one place, away from the barrage of words from politicians and the public relations exercises of the companies, that you see what is happening.
- Ask yourself whether all this would have been possible had there been any reliable way of actually measuring and documenting the incidence of failures in care in Australia and if this knowledge was publicly available. I am going to explain how and why this failure to get information occurred and how the sort of hub I am proposing would address this.
The first quote is from an article that was not published digitally and the second is behind a news outlet paywall
The shocking abuse in our nursing homes
Clive (husband of Beryl) agitated for an inquiry and, earlier this year, he was proven correct, when the NSW Coroner, Michael Barnes, found that staff at the INTFPCompany B centre where Beryl stayed for just three weeks had made a "series of mistakes" with regard to her care, leaving her agitated and without sufficient food or fluids. (INTFPCompany B, which operates 63 nursing homes across Australia, says it has changed its procedures to ensure such mistakes won't happen again.)
"I feel like I've done the right thing by Beryl, following this through to the end," Clive says. "But it's not an isolated case. Since I've been involved in this, I've heard from so many people and they'll all tell you, what goes on in nursing homes in this country, it's a disgrace."
The founder of the Medical Error Action Group, Lorraine Long, says the standard of care in many homes is "extremely poor, worrying and alarming. They are not adequately staffed and they have a high turnover of staff.
"Looking after the elderly is boring and burdensome, and nursing homes get away with failures in care constantly. The lengths they will go to smother incidences and re-do paperwork to cover-up is extraordinary [and] it's because the people are elderly and the view is, they are going to die anyway."
Source: Short extracts from "The shocking abuse in our nursing homes" The Australian Women's Weekly, 1 Aug 2014
The great Australian retirement maze
"The worst thing about retirement living and aged care in Australia is its complexity. So cruelly, skillfully taxing for the elderly mind are the intricacies of the system that one can only conclude that it is deliberate."
"- - - - arrangements - - - - are often so unintelligible that even the adult children can't work it out,---."
"- - - - - every time the bureaucrats go near this business they only make it worse."
"- - - - - The changes to aged care regulation - - - - - definitely made them worse."
- - - - - that is, retirement villages and ‘lifestyle communities' -- more convoluted maze of separate state regulatory systems, - - - ."
"- - - - - contract to give the developer anything from 30 to 100 per cent of the proceeds - - - ."
- - - - - usually means there is no capital gain at all."
- - - - - fees are demanded for months and sometimes years after the death because the unit can't be sold.
- - - - - contracts of more than 100 pages that are simply impossible for most elderly people to take in.
- - - - - In these situations governments can't simply say they have enforced disclosure and then say it's buyer beware. Consumers need to be protected, and a good start would be to enforce simplification.
Source: Short extracts from The great Australian retirement maze by Alan Kohler, The Business Spectator, 16 Jul 2014 (Paywall)
Video: summary and background
Eileen Chubb - How I became a Whistleblower: Our barrister called us the INTFPCompany B 7 - the perfect whistleblowers because we did everything right. Yet the law failed us. We reported our concerns about the abuse by staff of elderly patients in their care to our employer first, and when no action was taken we went to the regulator. This meant our employer knew we were the whistleblowers and our lives were made hell.
What happened next: The regulator carried out an investigation and published a report which upheld the allegations but by this time we no longer had a job and were forced to seek the protection of the Public Interest Disclosure Act. However the employment tribunal did not admit the regulators report, which upheld our case, but proceeded to judge the disclosures as our employer denied they were true. This resulted in the disclosures we had risked everything to expose being summarised in general terms.
To us, the elderly people who had suffered were lost in the legal process that should have exposed their suffering. Other staff involved in the abuse and in driving us from our jobs continued to be employed and some were promoted, the company director who we appealed to for help went on to advise the government on elderly care and was awarded an OBE for services to the care industry. The seven whistleblowers would ring up for an advertised job, but as soon as we gave our name would be asked, are you one of them INTFPCompany B people? Sorry the job has just gone.
What I do now: I am the founder of the Charity Compassion in Care and have written a book called, Beyond the Façade, which looks in detail at why the law failed. Edna (one of the patients) was not protected and that is why I want a new law to protect whistleblowers - because those who pay the highest price are the victims of silence - for Edna who suffered so much.
The Whistleblower Interview Project is a documentary archive of interviews with people who have made public interest disclosures.