Those who know

129: If there was anything that I could say to the senate. Something that I hope they would listen too. Is please, please open your eyes, your hearts, your minds and really look at aged care in Australia.

132: We are now an industry that has been highjacked by big business. Care of our residents and staff come a very distant second. It is all about the bottom line not the care of our residents or our staff. - - - In services that talk about “person centred care”, the organisation talks the talk but does not walk the walk.

156: Please, please change things. At the risk of sounding melodramatic, the aged care system is truly a hidden humanitarian crisis.

198: I have been a nurse for 48 years and have seen nursing care for the elderly decline to an abhorrent level - - .

216: I do not want to ever be put in to a nursing home!! - - - - due to the low staffing levels l was concerned and regularly dismayed at the treatment endured by the residents of these high level care facilities.

218: - - - - the litany of distress and needless suffering might make any of us wonder if we really want to get old.

231: I hope you will also hear the voices of many individual aged care workers, aged care clients and their families because statistics and data rarely shed light on the real impact of policy decisions.

233 (family member): The aged care sector needs a massive overhaul.

234: I have been in number of meetings with General and care managers at these homes to inform them that this was the wrong skill set for safe practice in nursing homes but are repeatedly shot down by the corporate buearocrats at these large aged care providers and training organisations.

257: I do not believe that the residents receive adequate care, and more staff are required in order to make sure that the care is given properly The employers always say that they cannot afford to hire more staff, but at the end of the financial year, they have millions of dollars in profit (even if they are a not-for-profit business).
---- The accreditation process is useless. Management usually puts on more staff (or ensures staffing is covered) when a visit is scheduled.
—— Legislation needs to be tightened to stop facility managers cutting corners and using loopholes to save money

258: What I have found is that no matter where you work in aged care the staffing per client ratio is really bad.
---- The food in these places is really really bad. - - Most of these clients have dentures and are unable to eat the rubbery toast and that goes for a lot of the meat in roast etc as well
----  Some staff in these facilities should not be there. There is no care what so ever and I include management in that statement. In fact management is the worst.

259: The workforce in aged care is ill prepared to deal with the issues around dementia, and aged care facilities are not appropriately designed to meet the specific needs of people with dementia.

260: Aged care is a dangerous field to begin your nursing career. You are provided with little supplies, bare minimum knowledge of the elderly and completely unrealistic expectations. - - - I feel stressed at work. I feel unappreciated by my managers - - - .Our elderly are being neglected.

261: I have also worked with people that should have left the industry years ago. The one constant in the time I have been in the industry is staff shortages and the constant cutting of corners due to time and financial constraints.

271: Speaking from experience working in aged care facilities I am disappointed with the quality of care provided to this sector. - - - residents left in wet/dirty continence aids for far too long, - - - left sitting in day rooms or bedrooms with little or no stimulation.- - - - - - malnourished because they are unable to feed themselves and there is insufficient staffing to assist all residents who require help with meals.- - - going from resident to resident with little or no hand hygiene

273: The system is in disrepute. I do not blame the nurses. They are overworked and underpaid.- - - - Some staff simply “do not know what they don’t know”.

279: I am a retired Professor of Aged Care Nursing. - - - - it must be blindingly obvious from all reports that Aged Care is in crisis. - - - - What concerns me is that people die after years of criminal neglect, without adequate nursing care.

280: Aged care is like a monster that devours vast resources & finances, but with our population ageing, it must be addressed.

286: WAS EXCITED TO BE AT THE FORE FRONT OF PIONEERING ‘A BETTER WAY’!! Now, 30+ years later, I am very disappointed with how I see aged care going in our society. I always thought that integral to care provision, was to demonstrate to our frail elderly, that they were VALUABLE individuals, worthy of quality care and respect. Sadly, we are failing miserably in achieving this!
---- we have a system which DEVALUES residents, tricks their families and loved one’s by selling them poor staffing ratios and access to professionals in caring for their loved ones.
---- It is horrendous the deceit that prevails and anyone who is prepared to speak up to uncover it, is quickly ‘short shrifted’ out of the home, something that has happened to me personally a couple of times during my journey. IT DOESN’T PAY TO ROCK THE BOAT – - - - most are constantly looking for ways of reducing their costs.
---- most organisations, be they for profit or not, have hugely ‘top heavy’ hierarchies which consist of many very well paid executives who are ‘once removed’ from the realities occurring at the coal face.
---- I am - - - just someone who sees gross injustices occurring every day.

287: I am baffled by ‘aged care palaces’ that I worked in; facilities with magnificent interior design and no staff! - - - -Please can we focus on humanity for residents, rather than ‘glamour’

288: Over the years I have watched the industry move from a care industry where christian agencies were trying to care for their community to a business whereby private operators are concerned about share profits rather than provision of care.
---- Everyone talks about a person centred approach to care but these are words only as our research demonstrates that the work is task focused
The system is broken and needs a complete overhaul

Source: Future of Australia’s aged care sector workforce. Inquiry by Senate Community Affairs References Committee 2016

1: The lack of staff shocked me and often I would see people wandering looking for a drink of water or to be shown the toilet.

The lack of respect from the nurses also shocked me as they treated the patients like small stupid children - - -

6: - - - in contrast to most of the places I had visited while searching for a nursing home, where there was a strong smell of urine when you walked in the front door and often a bleak atmosphere.

8: I can't even begin to fathom how the Government could even propose this RIDICULOUS, STUPID, UNBELIEVABLE THING!!! Wake up Government and all the do gooders in it!

TO BE HONEST - YOU ARE MAKING ME SO ANGRY WITH THIS STUPID IDEA - Aged Care Facilities don't have enough staff as it is and you want to take away the TRAINED STAFF - SHAME ON YOU.

10: You are sending the message that the elderly don’t matter and don’t deserve to be looked after properly.

11: I have witnessed confusion amongst the staff from different countries, not being able to fully understand each other.

12: I am extremely concerned and somewhat dumbfounded that there is any consideration necessary of whether there is a need for registered nurses in aged care facilities.

15: The thought that Registered Nurse not be on site and available 24/7 in Nursing Homes and Aged Care facilities is unthinkable and appalling.

18: I don't want to live in an understaffed under funded facility.

21a: I was amazed at the dozens of stories of abuse, cover ups, lies, neglect and straight out rudeness at some facilities, which line up with media exposes at some facilities and specific instances, and it would appear that very little has been learned from these instances even when coroners were critical. Instances of proven cover ups lies, false death certificate but it is ok as they retained their 100% accreditation making current accreditation a meaningless joke.- - — - We appear to have developed a culture of denial.

25: I am writing this submission as I feel that the suggestion that there is not a need for RNs in Aged care is appalling.

27: You may find yourselves in one of these dreadful facilities. I urge you not to reduce RNs in aged care facilities

28: RN's have the education to treat and manage the health client. I know I want an RN 24/7 when I am in an aged care facility for my safety.

29: The proposed changes that could see Registered Nurses removed from residential aged care facilities would have a very detrimental effect on the quality of residents’ care

30: The registered nurses had to spend far too much time on paperwork and were not around the patients for most of their shift.

32: I write to express my first hand knowledge of the absolute necessity of having registered nurses in nursing homes at all times

40: Rns play a vital role in keeping residents safety and comfort. Without them, resident's lives will be in danger.

51: Over the years in working in aged care I have seen a change in the quality of care that has been provided to residents.

Source: Registered nurses in New South Wales nursing homes General Purpose Standing Committee No. 3 Legislative Council NSW

As one submitter wrote, these issues make people feel uncomfortable and most would prefer to take the easy option and pretend that nothing is wrong. But the reality is far different - the situation for people with disability is unacceptable.

Throughout this inquiry, the evidence presented from people with disability, their families and advocates, showed that a root cause of violence, abuse and neglect of people with disability begins with the de-valuing of people with disability. This de- valuing permeates the attitudes of individual disability workers, service delivery organisations and most disturbingly, government systems designed to protect the rights of individuals.

This inquiry heard highly distressing personal accounts from many people with disability. The inquiry also heard from dedicated family members and advocates speaking on behalf of loved ones, some of whom died as a result of violence or neglect.

The committee is very disturbed by the significant body of evidence it has received which details the cruel, inappropriate and, in many cases, unlawful treatment of Australians with disability. The committee is equally disturbed by the largely inadequate responses that these cases have received when reported to authorities and people in positions of responsibility. The committee is also concerned by the fact that many more cases remain unreported, partly as a result of inadequate responses to reporting. This is clearly unacceptable.

This chapter will focus on evidence relating to lived experiences in the general community and institutions—such as residential care, and aged care.

- - - - these accounts barely scratch the surface when compared to the huge body of lived experience evidence provided to the committee both in submissions and at hearings.

Taken as a whole, the evidence shows a systemic failure to protect people with disability, and has influenced the recommendations made in the final chapter of this inquiry report.

The committee has been humbled and shocked by the many examples of lived experience. Each person's personal experience is important and valued, but it is only by taking a consolidated view of this evidence that the enormity of the mistreatment of people with disability in Australia is demonstrated.

People with a disability are most likely to be abused in segregated service environments, where abusive practices go unrecognised and unreported and where client and family participation in services is devalued.

An issue that was repeatedly raised by different submitters to this inquiry is that the abuse reporting mechanisms, discussed in greater detail in chapter five, do not adequately protect people from abuse. In some cases, reporting mechanisms can actually cause abuse: (NB The example given of this was from aged care)

The inquiry received evidence from submitters in various states and territories, detailing the abuse of people with disability, often age-related disability, in aged care facilities.

Similar to other forms of residential care, aged care residents are particularly vulnerable to violence, abuse and neglect due to their age, frailty and specific disabilities such as dementia.

Those who live in aged care facilities face much the same risks as those living in other cared accommodation.

Concluding committee view

3.68 The committee also notes the high rates of abuse of people with disability that occur in aged care and the general community, with limited adequate response from mainstream reporting and investigating mechanisms. Clearly, protecting vulnerable Australians in aged care and the general community should be given greater focus from all levels of government.

Source: Violence, abuse and neglect against people with disability in institutional and residential settings, including the gender and age related dimensions, and the particular situation of Aboriginal and Torres Strait Islander people with disability, and culturally and linguistically diverse people with disability. Community Affairs References Committee November 2015

5: I am very concerned about elder abuse that is happening within the current system of Residential Aged care Facilities.

---- Even when residents are dying, there can be neglect and lack of quality care. When RNs are too busy to support the family, and to anticipate and manage the symptoms of the person dying, there is abuse

67: QACAG is concerned at the gap between what ‘should’ happen and what actually does. Similar accounts to these below are raised every time QACAG consults it own members or speaks to community groups, and frequently forms the basis for people initiating contact with our group.

The most common concerns that members raise are: dehydration, poor nutrition, poor pain management, hurried care, aggression from other residents, poor continence care, and poor level of social activity or human interaction. These are frequently connected to poor staff number and skill mix of staff, and the focus on task-orientated care, rather holistic care.

One practice that warrants a particular mention is rationing of continence pads

72 (Multiple examples of abuse seen by Aged Care academic): I heard about abuse, I witnessed abuse and neglect and I have experienced the consequences of reporting abuse.

---- Abuse ranges in severity from grossly unacceptable acts to acts of unkindness, absence of care, carelessness, negligence and ignorance of appropriate clinical care.

---- There is a broad disparity in the quality of care delivered to frail, older people in residential aged care facilities with no surety of quality care offered by the accreditation and standards monitoring system.

Source: Elder abuse in New South Wales (Inquiry) 2015-16 General Purpose Standing Committee No. 2. Legislative Council inquiry