In my study of culturopathic groups, I was struck by the bizarre way in which these groups held strong, assertive views about situations and events. These were based on a belief system. These were seen as the way things were. It was all made to sound sensible and look self-evident. But logical arguments and evidence were ignored. The people involved were credible and leaders. They ridiculed their critics.
This contrasted with the way reflective individuals, those who had been harmed, and those who had looked more closely, saw these same situations and events. Ultimately the latter were shown to have a much better grasp of the situation.
This was readily apparent in aberrant ideologies like apartheid and communism. On Wall Street and in the banking sector this was also obvious. Good examples I examined were Citigroup and Enron, but they were only representative.
There have been widespread problems in the vulnerable health and aged care sectors in the USA. The wide differences between those providing care and their critics are readily apparent.
In the previous linked section below (Cultural perspectives), I explored the conduct of some international and multiple local companies in several vulnerable sectors:
- Cultural perspectives:
Can so many of Australia’s leading organisations be this corrupt? It stretches our imagination. It only becomes explicable when we understand how belief systems work, not only to cloud our judgement but to filter what we see. The whistleblower in the poster company I used to illustrate culturopathy explained to me "this is the way they think".
We need to understand just how difficult we all find it to challenge our beliefs. This company, the Commonwealth Bank, the 7-Eleven executives and many more of the companies I have studied show that even criminal convictions and massive fines don't change the way these companies think. The more harmful and the more bizarre the illusions that support the beliefs, then the greater the need to clothe them in words that protect the illusions and hide the consequences.
The enemy of culturopathy is accurate information and those who supply it. True believers instinctively find ways of subverting or ignoring data, interpreting it their way and of discrediting the source.
Economic success has become so good and so important to them that, like Tenet/NME (my example of culturopathy), the acknowledgements, apologies and even guilty pleas are based on legal advice and do not really reflect their understanding of what happened. They can't change and the pressures in the system won't let them. They are likely to do something similar in another part of their business. This is a cultural phenomenon and when you get a culture that does not acknowledge what it dare not know because its success depends on illusions, then it becomes very difficult to deal with.
It was whistleblowers and concerned citizens supported by a responsible press who exposed what was happening in alomost all of the examples. Look at the way they were treated and how the companies pursued them.
The stigma of dobbing and responsible citizenship
Lets begin by looking at Australia’s tradition of mateship, a tradition rooted in Australia’s male past when the mostly Irish descended convicts needed to stand together against authority - the Ned Kelly tradition. Dobbing became the word that expressed betrayal. It has been used to stigmatise those who speak out in order to protect the public and to make loyalty to the corporation legitimate; placing it above loyalty to the community. It clothes what they do and makes the targeting of those who think differently legitimate.
The market: Dobbing and whistleblowing
Most of these people claim to be responsible citizens. They believe that what they are doing is in the community’s best interest. But it is a system built around the concept of loyalty and augmented by the belief that social responsibility in the marketplace was socialist and evil. Dobbing becomes evil and the people who do it are stigmatised.
Whistleblowing: the market's views
The patterns of thinking are well illustrated when we look at what happened after the HIH and One Tell corporate scandals in 2001. Once again, leading Australian businessmen, including the Packer family were involved. The government tried to make business more accountable and encourage staff to be more socially responsible. They wanted them to report unsavoury behaviour to authorities. Business Council of Australia president Mxxx (a member of the Reserve Bank board) "slammed the Government's crackdown on corporate misbehaviour as an attack on the rule of law and claimed the misconduct in HIH and One Tel were the inevitable flipside to business success". The corporate marketplace was horrified at this un-Australian support of dobbing and it never happened. Instead whistleblowers have been expected to take their issues to management in the first place and so expose themselves to corporate retribution.
He, (Mxxx) said it would put employees in conflict with the interests of their organisations and would turn them into "state informers".
Business has been furiously lobbying for parts of the bill to be watered down.
"The most important present problem, which the members of the BCA face - and with them, everyone involved in commercial and business life in Australia - is the attack on the corporation as a vital institution in our economic life," Mr Morgan said.
He (Mxxxx) suggested corporate misbehavior was an inevitable outcome of the rapid growth in capital markets, with the owners or shareholders of a company becoming more numerous and distanced from the managers - the so-called "agency problem" identified by economist Adam Smith.
"Every 20 years or so we have what seems to be an eruption of corporate malfeasance," Mr Morgan said. "There will always be corporations, somewhere, sometime, in which directors and/or management, put their own interests far above the interests of the shareholders, or who will deliberately defraud the shareholders, customers, and suppliers, for their own benefit."
"The agency problem is built into the very fabric of the corporation and the only thing that keeps corporations going is the engine of our economy, is the cultural and moral standards which prevail within the community at large," he said.
Mr Mxxxx also signalled the BCA would be more widely involved in political debates about the country's direction.
Source: Laws an attack on way of life. The Australian, 2 Dec 2003
Drawing inferences: So by implication the corporate misbehaviour, when providing aged care in Australia is an "inevitable outcome". We have to accept this "agency problem" and do nothing about it. Complaining about this is an "attack on the corporation as a vital institution in our economic life". By doing so we are harming Australia! Are we really expected to accept that all those examples on the web pages above are the "inevitable outcome" of capital markets and that we simple have to live with that agency problem.
We should expect our citizens to be loyal to their companies and allow the misconduct and misuse of vulnerable citizens to continue. Loyalty to the corporation should take precedence over our duties as citizens and our responsibility to one another. Note that it is the interests of shareholders and the defrauding of the shareholders that is placed well ahead of the defrauding of customers.
What about the bigger problem of companies exploiting customers for the benefit of shareholders?
Civil society: Mxxxx makes my point that in the sort of free market we have this problem is built into the "very fabric of the corporation". He looks to the "cultural and moral standards which prevail within the community at large" to contain the problem and keep corporations on track.
But it is the dominance of the market that has eroded civil society, the community at large, and rendered it ineffective.
- the stigmatising of dobbers,
- the muzzling of unhappy customers by calling them "trouble makers" and threatening them,
- the gag clauses in settlements prohibiting those they compensate from warning others of the risks they run, and
- the control of the way we all think by the market's stranglehold on much of the media - a form of censorship.
All this and more has put the market in control of civil society and rendered us all ineffective.
So the obvious solution is to take control of society and of the political process away from the market and place it in the hands of citizens both as customers and as civil society. This is what the Participatory Democracy and the proposed community aged care hub are intended to do. Dobbers need to be encouraged, admired and rewarded and when corporations start doing that we will know that the market has become a part of society and has adopted its values.
But before we go any further we need to look at it from the point of view of the dobbers.
Culturopathy, markets and the whistleblower
When there are big differences of opinion, breaches of logic, angry rejection of criticisms and establishment figures attacking the messenger we can be pretty sure we are looking at culturopathy. When the information needed to resolve these differences is being withheld or controlled we should be doubly alarmed.
My impression is that this situation now exists in aged care and I am alarmed.
But why is it so difficult to expose the failures in a culturopathy and why is it so enduring and so strongly defended?
Exposing failures in culturopathic cultures
A whistleblower who contacted the Gold Coast Bulletin said care at the facility had “slipped to dangerous levels”.
“They are not meeting their duty of care to the residents,” the source said.
Source: Ashmore Retreat nursing home has been sanctioned by the Health Department and put under strict government supervision (Gold Coast Bulletin, 9 May 2014)
When a culturopathic culture exists it takes great courage for nurses and even academics to speak out about failures by the rich and powerful. They know they will be attacked and their jobs threatened. As in the Gold Coast home in the quote above, it is whistleblowers who expose what is happening and alert the regulator. See also I am sorry 'Mary' I could not help you.
They take big risks, but under the current system we depend on them. They will be fired and no one else will employ them. They automatically lack credibility and are suspect. They show signs of stress, are considered to have mental problems and authorities distrust them.
In a culturopathy we depend on whistleblowers to tell us what is happening but they are seldom acknowledged, nor rewarded as they are in the USA. They do not speak out lightly. They try to remain anonymous, but it is difficult to do so.
Market and government behavior: The whistleblowers view
The late Jean Lennane, as president of Whistleblowers Australia was a warrior who helped many of them. Her classic paper tells of the fate that awaits those who speak out for the public and of the courage required. It is worth reading.
The organisation's response to the whistleblower is very powerful and follows a recognisable pattern. It is crushing in its intensity, as the organisation can use as many staff as it takes, for as long as it takes, to wear the lone whistleblower down.
There is almost always some kind of disciplinary action, often on "unrelated" matters, up to and including dismissal. - - - In the WBA study, 20% were dismissed and 14% were demoted; 14% were transferred (to another town, not just within the department); 43% were pressured to resign; and 9% had their position abolished.
There is often some kind of legal action, - - - - - this occurred in 20% of cases.
Source: What happens to whistleblowers and why by Jean Lennane 1996 Past president Whistleblowers Australia
In spite of this, many have spoken out over the years. Several inquiries have been told that residents, families and staff have been too frightened to complain. The nurse who ignored threats and reported that a death had been covered up to the police was fired the next day. She is no longer working in the industry.
Three nurses, who gave evidence that they repeatedly complained verbally to their superiors about the conduct of another nurse who raped four 90 year olds in the 2005/6 Gxxx Vxxxx rape scandal, were all fired.
The manager who was handed their written complaint tore it up in front of them. The manager denied their claims and remained in place (see page Scandal after scandal). This is what happened to the INTFPCompany 7 UK whistleblowers who stood firm and whose account of this illustrates Lennane's description. Their video account is on the same web page.
An article and embedded video on The Age web site describe the typical experiences of a nurse whistleblower who spent 25 years trying to get government in Victoria to act over very serious abuse and rape in a home for the disabled. It went on for years after government had been alerted and had documented it. During that period, the government covered it up and the whistleblower struggled to find work - Disabled were abused in house of horrors and governments covered it up - The Age, 10 Apr 2015
The staff we can trust and who should be there are fired, while those who should be fired remain in charge. Nurses with responsibilities to their own families dare not speak out. As a consequence there is always a far bigger problem than ever becomes public and it extends far wider than the facilities exposed as deficient.
Dr Mxxxx Bxxxxx, a nurse educator has had a long experience of aged care. In a wide ranging interview on Radio Adelaide she explains that our aged care system encourages abuse and neglect. She speaks of the difficulties in exposing this, the resistance to acknowledging it and the targeting of those who speak out. There is extensive research and she like many of us struggles to understand why a system like this is allowed to continue and why policy makers turn a blind eye. Her interview is well worth listening to.
- Dr Mxxxx Bxxxxxx: Preventing elder abuse in aged care - Radio Adelaide June 2016
Something is very wrong: What is clear is that there is something seriously wrong within the aged care system and in the way it is run. It has been like this for a long time, yet those responsible for policy and those running and supervising the service are blind to this. They do not see what those of us who actually look at the failures see so clearly.
Families have problems too: It is not only staff who are intimidated. The other source of information is the family of the residents. But many have pointed out that residents and their families are frightened of retribution if they speak out. As I show on another web page, a 89 year old resident who explained this to the 2010 Productivity Commission inquiry was brushed aside and little attention given to her.
A manager who blew the whistle in a company that he alleged was trying to cover up what was happening explained why he thought no one had spoken out about what was happening. He was fired some time later.
- - - - staff indicated (to management) that for some time they did not say anything as they feared having their shifts reduced, while the families of residents were concerned that speaking out would lead to more mistreatment. - - - -
Source: We covered up abuse: aged-care manager The Australian, 21 Feb 2015 (paywall)
Families of residents who are harmed are often stimulated to look more closely at what is happening and then act. If they are wise, they wait until their relative has been moved elsewhere or has died.
Families have been particularly effective in the USA. Ila Swan, whose mother was in a substandard nursing home, is a wonderful example of what can be achieved by ordinary members of the community when they are sufficiently disgusted by what they find when they look around and realise what is happening. Her efforts, in the face of attempts to discredit her, resulted in a congressional inquiry which confirmed her findings. She saw things in black and white and would never compromise. Not only did she speak out and act in the USA, but she warned other countries.
I corresponded with her over the years and she sent me information. I spent a few days with her in 2004. Her story is interesting. Some of her story is here. I am aware of a few relatives who have tried to follow this path in Australia, but like Ila are meeting a brick wall - even being threatened with law suits.
Residents acting themselves: Residents themselves are at an even greater disadvantage. If they are unhappy about anything or make allegations they are considered to have dementia and discounted. If they do speak out publicly then staff and management see them as trouble makers and treat them accordingly.
The lady in the quote below knew she was being robbed but she had all her marbles in place and had contacts in the surveillance industry. With a hidden "grannycam" video footage was soon in the hands of police. She is leading the way by doing this in Australia but in countries with market systems like ours (UK and the USA) CCTV is increasingly being seen as the answer to the problems of elder abuse we are having in nursing homes.
When the disabled 75-year-old attempted to report the incident to retirement village company Aveo, they dismissed her claims.
"They thought I had dementia - and for that reason I was a trouble-maker and I would have been making it up," Ms Jones said.
Unfortunately, elderly people are often preyed upon by fraudsters.
Source: Victorian retiree sets up hidden camera to catch thieving aged care worker - A Current Affair - Channel 9, 2 Jul 2015
Others in Australia are following her example and are calling for CCTV surveillance to be allowed, The coroner urged a facility housing aggressive residents with dementia to install CCTV as long ago as 2007 but it did not do so. In some poorly performing nursing homes and retirement villages, residents and families are forming groups, collecting information and taking collective action - sometimes with early success but at other times only after a long battle lasting years.
Why culturopathy is so enduring and so strongly defended
Adam Smith in the 18th century saw the market as filled by those with ulterior motives who had to be distrusted and watched carefully, but he also recognised that true believers could cause problems and this could be more difficult to deal with. Shakespeare explored the nature of good and evil - villians and their struggle with themselves. In his final play, The Tempest, he explores this more deeply and his hero finally accepts and forgives those who have harmed him.
Since that time much has been written about human nature and our responses to the world in which we find ourselves. So while our gut responses are unchanged it is easier for us to understand and seek to address rather than demonise. We are often not dealing with demons but with people who see things very differently because of their beliefs. They have had very different personal experiences and may be unable for various reasons to confront the evidence needed to resolve issues.
We can argue that it is the pressures and tensions generated by the culture, and the drive to become someone within that culture, that causes people to blindly identify with some belief system and defend it. In a sense, it is like religious fanaticism, meeting the same human need to find or create a meaning system within which individuals can define their lives. Once committed to a belief system, it becomes integral to who we are. The things we do and are proud of were done because of it. Challenging and changing it is very painful and we may even defend it with our lives.
We cannot detach the belief system from the often well-intentioned and motivated people who believe in it. We humans seem to have a need that causes us to believe in all sorts of crazy things - even that it is necessary to kill non-believers and ourselves if our chosen belief system tells us to do that. Its how we are.
Reluctance to confront ideologically unpalatable issues: There have been senate inquiries and a multitude of reviews and suggested changes to the aged care system. As a result of the scandals there have been knee-jerk responses and a lot of tinkering with the system following the reviews. The fundamental problems that I am outlining on these web pages have not been addressed and none have confronted the likelihood of a failed market, and the reasons for it.
This has been the big unseen elephant in the room at every inquiry. What is clear is that many of those who have experience of this system see it as a failed system, and are not happy. It is not working as it should. It can't be patched up. It requires a radical rethink, and that includes deciding whether aged care is an opportunity to boost our economy and the wealth of investors, or whether it is there to look after frail Australians at the end of their lives.
Much of the care provided to elderly Australians is now provided primarily to further the ambitions of entrepreneurs and for the benefit of investors. So we do need to look at the very different ways that people see and understand what is happening. That means looking at what has happened, what the various parties are saying about it and why the differences exist or have not been resolved. The way all this is done illustrates the development and maintenance of a culturopathy.
Many different views about aged care
In a system where there is no reliable information people believe what suits them and refuse to believe what does not do so. Those who actually experience the system are likely to think very differently. In the linked web pages below, I look at how the different participants look at what is happening in aged care.
How Aged Care is perceived - a broad view
Politicians, providers and those who engage with them vs the rest of us
On this page, I look at the very different views and priorities of politicians and the aged care providers on one hand and the people who examine the system and do some research in it on the other. It is clear that on the one hand we have people who believe they are doing OK and on the other a significant number of people who have looked or experienced the system and who see it very differently. To them it is definitely not OK.
As we look through all this material we see people talking past each other and not hearing what the other side are saying or responding to them.
What emerges is numerous critical, negative and unhappy views about:
- the care given,
- the way the system works,
- the organisations that are advising the government,
- the governments agenda,
- an unwillingness to believe or address issues,
- the way things are done behind our backs,
- the accreditation agency (now renamed 'quality' agency), and
- the response to the data that is actually available.
Although the industry have stopped using phrases like 'world class aged care', they and providers are still maintaining that the service is good. They seem to be deaf.
The elephant sitting behind all this is the total lack of any reliable data on which any sound opinions - let alone policy can be made. There is no indication that anyone is the least bit interested in actually looking at what happens in the nursing homes and measuring it. That is something that we as a community will have to take charge of and that is what the proposed hub is intended to do.
Learn more: How aged care is perceived
Residents' families confronting nursing homes
On the linked page, I look at a few example of this common situation to show how an angry standoff so often develops. Too often this is because the managers angrily reject the allegations and clearly disparage the person complaining. It is clear that too often, manager's expertise in dealing with these situations is poor. It should be noted that it is now policy to refer complainants back to the nursing home when families complain to the department or agency.
On this page, I try to drill down to see what I can find out about the people actually responsible for managing the facility and particularly the owners. Are there grounds for believing that there are systemic problems in the facility complained of, where does responsibility lie and can we conclude that these are industry wide?
It was a lot of effort, but there are insights and lessons along the way. I got a little information, but not nearly enough for me to assess their role in this. Too often the complainants don't realise that they are angry with the wrong people. The problem is higher up. I show how the proposed hub would resolve these issues.
Learn more: Families vs nursing homes
Not-for-profits vs staff and others
On the linked page I look at 5 examples involving not-for-profits in each of which the proposed hub would have played a critical role in preventing and/or resolving. If, instead of treating this and the other examples as isolated incidents, we recognise them for what they are, red flags to a pervasive underlying human problem it would finally get some common sense into the debate. I try to analyse these examples to see what we can learn from them and discuss issues that arise along the way.
This is important because because it illustrates the same sort of responses (ignoring or denying when this is not possible) that start with management and extend through the community, the industry and government. This is the way a culturopathy is maintained and prevented from collapsing. As I indicated earlier Adam Smith recognised this problem 200 years ago! It is those who genuinely believe in what they are doing who deny most strongly and who get so angry. When they are obviously right on some issues then they are even angrier.
Example 1: Allegations of major problems in a not-for-profit nursing home in Queensland were made by a major national newspaper. It was alleged that senior managers carefully planned and attempted to cover up major problems in one of their nursing homes. It was alleged that in spite of their lawyers advice, they did not adequately report what happened to authorities. Staff leaked documents to expose what was happening.
Angry denials and threats of lawsuits were made. Finally one of their managers was so plagued by his conscience that he spoke out about what was being done. There were multiple different points of view about what had happened and what followed. Ultimately the company was shown to have been unfairly treated and the Quality Agency at fault. There are many lessons along the way. The importance of the proposed hub in resolving this sort of situation is explained.
The response of the regulator, the Quality Agency in this case is interesting because it overreached itself and saw problems across the company's operations that were not there. The company took legal action and forced them to retract. The page illustrates the core problem for regulators in every culturopathy of initially not identifying what is happening and then, when embarassing problems are forced into the open, over-reacting by punitive regulation. But there are other consequences of what happened that impact on both the regulators willingness and its capacity to regulate effectively. What governments don't do is relate this sort of thing to their policies, try to understanding why it is happening and then fix the cause of the problems.
Example 2: This is a large not-for-profit faith based company that had a public bust up on its board with allegations of financial misconduct and other matters. About 9 months later community and family were up in arms about failures in care at a facility. Confidential Quality Agency documents were leaked to the press. The issue here is whether a change in policy direction might have been responsible for the dispute and then also been responsible for the subsequent problems at the bedside.
Example 3: This is a well established city based not-for-profit with a good track record that residents families believe has changed direction and become more focused on profit and growth. There are complaints, allegations and considerable unhappiness about the care provided at one of its facilities.
Example 4: Is a regional shire owned facility in which a highly motivated board and community have raised a large amount of money and secured grants to build extensions and more. But in the midst of all this success a schism opens up between staff and management. There are serious allegations and after an investigation the board is fired.
Example 5: is another regional not-for-profit community run service where without any public explanation an accreditation review was done after 1 year instead of 3 years. It found multiple problems. While this information was documented on the agency's web site it was not readily available and the company was able to rapidly correct the problems. A 1 year reaccreditation period was quietly turned into 3 years. It was as if every effort was being made to prevent the public and prospective residents and their families from learning about the facility's failures. This is not a good way to restore the public's trust. The issues are explored.
Many issues arise: There are many interesting issues raised by these examples but underlying them all are misunderstandings that would have been far more difficult to maintain had there been accurate data about care in the facilities to start with.
If the proposed community based hub had been there, they would have been there for the residents, for their families, for the staff, for the manager who spoke out and for those who were so indignant - helping them all to accurately assess what was happening and address it constructively. They would have had the data that would have shown what was happening and would have enabled the regulator to form an accurate assessment and not overreach itself. These are all stories of things that should not be happening. It is happening because the system is structured to create an idealised but flawed idea of a market instead of a system to care for the vulnerable in which the market plays its part. It does not even meet the basic conditions needed for a market to work.
The hub would be there helping, advising and restraining. I don't believe these examples would have arisen and if they had then the community itself, as on site regulator, would have had some responsibility We have a national political and market culture that preaches transparency while at the same time seeing knowledge in the community as a threat rather than a source of help and guidance.
Learn more: Not-for-profit management vs others
Profession and/or Community vs Market perspective
On the linked page, I look at a pervasive problem in our western society. I discussed this when talking about doctors and not for profit providers on the web page "Cultural perspectives". Our humanitarian cultures have been subjugated to a ruthless and impersonal mechanism which challenges and undermines the very nature of society and of the sort of people that we are.
This "self-evident" belief in unregulated markets simplifies and squeezes human society, with all of its emotive, cultural and humane components, into narrow frames of understanding where they are restricted. We are all trapped by these ideas. They control much of what we do and restrict our ability to be human. To express our humanity and behave with social responsibility we can find ourselves fighting a running battle with ourselves.
The professions and the community as we have seen are split along the fault line or else hopelessly conflicted in their responses. The issue is not about markets as such because markets are a useful and valuable part of society when they serve society and when society defines how, where and when they can operate. The problem is that currently society serves the markets and as a result large parts of it are losing control. Instead of society deciding where and how markets will operate, the market itself increasingly decides how society is sructured and operates.
On the linked page I look briefly at how this has played out in health care and finally look at a graphic example in aged care. On the one side we had nurses and almost certainly the main body of the physiotherapy association. The civil community as represented by ABC Four Corners can be seen as representing the way most in the community may have seen this. On the other side, were the department, providers of care and some physiotherapists who were providing services to the market.
It ended in law suits and compromises but my interest in this is the way it displays the differences in perspective between what the market (government and provider) sees, when compared with the bulk of the professionals and community. This example is a red flag that illuminates our society and our aged care system. It is not an aberration.
Learn more: Profession vs Market
Financial state of Aged Care
We have this endless complaint from industry about not having enough money. At the same time we see market analysts beating up the profits to be made from aged care and analysts describing how profitable it is. We see groups that generate the large income stream needed to float successfully and then continue to increase profits further.
When we do manage to get some information about staffing, it is clear that what the industry is saying about it is nonsense and that they are reducing staffing to increase profits.
How can we trust any of them? The proposed hub must have full financial transparency if the industry expects the hub to support them and bring the community in behind them. We need persuading with evidence - not rhetoric - and we need the industry to show that it can be trusted.
We don't like being treated as if we were morons who can't see what is happening.
Learn more: Show me the money
Coalface vs Business
There is a wide gap in perceptions between those at the coalface on the one hand and those in the business world and government who are intent on finding ways to reduce costs on the other. In an information free zone where there is a lack of useful data, human nature ensures that those faced by financial pressures who are not at the coalface will develop illusions. The most worrying one is the one about not needing skilled staff and that has been smouldering on since the sector was turned into a marketplace. That idea is so attractive to industry and government that it is almost irresistable.
I dealt with the recent flare up in the conflict about staffing on the page Risks in the marketplace. The linked page below is a reminder that the issue is a core one where there are Widely Contrasting Views. The NSW Legislative assembly controlled by Labor and the Greens held an inquiry into the need to have registered nurses on site at all times and recommended it. The coalition controlled lower house rejected the recommendation.
Learn more: Coalface vs Business
Wide apart on mandatory staffing levels
Across the world academics, community groups and nursing staff have been concerned about deficiencies in the number and quality of staffing in nursing homes. Australia has been no different. In all these countries, the move to introduce mandatory minimum staffing levels have been rejected by industry. The powerful industry lobby has been successful in squashing most attempts.
The introduction of minimum staffing requirements for government run nursing homes in Victoria has sparked a predictable critical response from the industry with claims that there was no evidence to support this.
This page examines the international evidence that indicates why minimum staffing levels are needed, not in government run services but in the aged care marketplace. Only months after Baldwin et al's paper showing that for-profits were sanctioned twice as often as not-for-profits, the agency once again reported out that both performed equally well.
The Australian Aged Care Quality Agency have known that the way they reported their figures was deceptive and inaccurate since 2008, but have continued to do so. On this occasion, they were challenged to substantiate their claim or else to retract it. They did neither.
The USA has had government recommended staffing levels based on data since 2000 but industry lobbing and political conflict has prevented them from being made mandatory. The current US minimum recommended levels for safe staffing are 4.1 hrs per resident per day and 0.75 hours of this should be by registered nurses. When the total level falls below 2.9 hrs then most residents are at risk of harm. They recognise that increasing acuity will require greater skills and indicate that the average figure for registered nurses should therefore be 1.08 hrs per resident per day. A little over half of all US facilities do not staff to minimum safe levels.
Not only would nursing ratios improve care among the worst offenders, but it would help to create a more level playing field in this market - one where performance in providing good care would not render players ineffective in the market game.
The proposed community hub combined with accepted recommended staffing levels based on evidence might accomplish these objectives, possibly without the need to legislate mandatory levels.
Learn more: Minimum staffing levels
Divisions within not-for-profits?
Faced by a requirement to conform to the market paradigm while still claiming to provide the community with the sort of traditional care-before-profit service creates tensions within the traditional not-for-profit sector. As indicated on cultural perspectives, these play out with total conversion at one end of the spectrum and total rejection at the other. Some have rejected this by selling up and vacating the sector. Others have adopted the thinking and behaved like for profits, but all are impacted.
The attempt by the for-profit sector and some not-for-profits to form a single organisation to represent and act on behalf of the whole sector can be seen as partly the continuation of this process of cultural assimilation. The debate surrounding this is interesting and illustrative.
The rationale for this merger is to create a more powerful and united lobby as government is seen by both as the problem and an obstruction to their giving the community the sort of service they think the community needs and wants. But would it do that?
Learn more: Views among not-for-profits
Is this culturopathy?
I think that the linked page is an important one. I have divided it into seven slider sections, which address this core problem. I start with a section looking at an attack on an academic who criticised aged care forcefully. The issue of trust and trustworthiness is discussed there. I am very critical of ACSA and the way it responded to to the experience of an academic who had carefully examined failures in aged care.
I then go on to look at multiple similar examples and at the negative and aggressive way the industry in general responds to information that they are not serving the community well.
Finally, I try to understand what is happening behind all this and why it is happening. I explore the role of language and the way it is used to hide the real world. I try to do a similar sort of analysis to that done by Canadian author J R Saul in his very insightful analysis of our society as "The Unconscious Civilisation". (Massey Lectures in Canada) - looking at how language is used to create an artificial world and obscure what is actually happening. I give real world examples of this and point out that the academics are actually using language to grasp the real world. They are even explaining how language in the industry is used to obscure what is happening.
Finally, I make the point that ACSA as a representative of not-for-profits, a part of the community, is on the wrong side of this divide in perceptions. As a result it has lost its credibility and our trust. Its CEO has expressed their association's desire to consult and communicate with the community much more widely but it is clear that this is only on their terms and about what they consider acceptable.
I have pointed out that the proposed hub offers him the opportunity to communicate effectively, if not always on ACSA's terms. It will also help him to restore credibility and trust. It will help ACSA and its not-for-profit members rebuild the community connections that have been lost. Its a challenge to ACSA to engage in discussions and support the hub. Its what it is asking for and needs.
In conclusion, I argue that it is unlikely that any of the aged care matters I have drawn attention to on this section of this site would have happened had a functioning community hub of the sort I have suggested been in place at the time.
Learn more: Is this culturopathy?