In slider (1) on this page I am going to look at how ACSA responded to criticism by attacking the messenger and claiming this was a disservice because it reduced trust in the system. I use it to discuss the issue of trust and trustworthiness.
In the sliders (2), (3) and (4), I look critically at the way ACSA has behaved when criticised by academics and the press. I look at the way ACSA and the rest of the industry has responded to criticism and allegations of poor care. I look at the likelihood that this is a culturopathy.
In slider (5) I take a more theoretical look at this with some illustrative examples and try to bring it all together.
Finally, in the last two sliders, (6) and (7), I come back to the use of language and the way words are used to either distort the world we see in front of us or to reveal it as it actually is.
I challenge ACSA on this and then suggest to them that the proposed hub is actually what they are publicly claiming they want and which they should be supporting. It would reconnect words to the real world that we all live in. It has the potential to help them solve their problems, restore their damaged credibility, and regain the trust they don't realise they are rapidly losing.
(1) Attacking the messenger
Very different perceptions: In some instances it is difficult to believe that people are talking about the same system. This is probably because there is simply no reliable information available. A good example is the gut response of the industry on their Aged Care & Community Services (ACSA) web site, to an ABC News report on 31 Jul 2014 which reported the observations and criticisms of a university academic who was studying nursing homes.
The people who adopt culturopathic patterns of thinking are often eminent, widely known, honoured and reputable. They are indignant and angrily deny criticism. Here is an example.
Academic's criticism: Dr Bxxxxth, an Academic from NSW, expressed concerns that the 2014 revisions to the Aged Care Act would be ineffective. Bxxxxth has studied aged care and a list of her papers is here. She is talking about what she has seen with her own eyes.
Like Bxxxxth, many of us saw changes to the aged care act as simply more of the same - a placebo to placate the public and a facade behind which the government could introduce its marketplace ideology and shift most of the cost of that to citizens. It revealed the unwillingness of politicians and the industry to grasp the nettle and do something constructive. Bxxxxth had previously given telling evidence to the three Commissioners at the Productivity Commission Inquiry on 5th April 2011. There may already have been anger about this.
She was among those who spoke out to Lateline in 2013, exposing a situation that caused ACSA, the group representing not-for-profit providers, to apologise on their website. In 2014, a year later, she did not think that anything had changed. Evidence was simply being ignored and the same processes continued. The ABC reported her views and a contrary view by the CEO of ACSA. ACSA's CEO may already have been incensed by what she had said in the past.
Comments by Dr Maree Bxxxxth in 2014:
"I've seen aged care facilities with chandeliers in the foyer and the residents laying in their own faeces," she said.
"Residents who haven't had their incontinence pads changed for hours, residents who can't access the food that's being served to them.
"Residents whose call bells are removed from their reach so that they don't call staff."
"If we continue with our accreditation and standards monitoring system the way it is and we will continue to have people in residential aged care dying of malnutrition, pressure areas and sexual abuse."
Doctor Maree Bxxxxth says despite numerous cases of abuse, complaints and deaths, nothing's been done to fix the inconsistent and broken system.
Source: Questions raised over how national changes will impact aged care sector - ABC News, 1 Aug 2014
A suitable response: Dr Bxxxxth has spent 10 years studying aged care and sees it very differently to the providers of aged care. Many others including nurse whistleblowers have said the same things. I would have thought that they would have taken the trouble to discuss the problems with her and support the calls for a Royal Commission made in 2013. If there were no problems then this might have restored some trust to the system. If there were, they could have been addressed and resolved. Instead the industry apposed it ensuring that the complaints and adverse publicity would continue.
This is the response to Bxxxxth's claims reported by the ABC. It is from the ACSA website:
"... a number of unsubstantiated claims ..."
"... This is shoddy research and trashy journalism ..."
"... The Australian community deserves better from its purported academics and journalists. This unsubstantiated scaremongering unreasonably erodes the trust that exists uniformly across the age care sector between providers and their residents. Our recent National Open Home Care Day in June reflected a national spirit of unanimity and support between providers, their residents and their families ..."
Source:Academic scaremongering with unsubstantiated claims (ACSA Media release, Aug 2014)
Either an academic at one of our universities was glaringly wrong and the peer review process in the journals that published her work fatally flawed, or the industry was indescribably blind.
The university has supported her and many others have said the same things. Its hard to believe that such a credible group as ACSA could be wrong, but most of the many similar indignant denials have been made by executives in large culturopathic companies that have been highly dysfunctional. What is more, they genuinely believed they were right.
Good examples include Richard Eamer and John Bedrosian from National Medical Enterprises, Richard Scrushy from HealthSouth, and Andrew Turner(go to Part II: Culture) from Sun Healthcare. These are the sort of people who rise to the top in what I am calling a culturopathic situation. I could find more. All three companies indulged in fraud and misused those they were charged to serve. They operated in Australia but were not accepted here because of their track record and left. We are as human as they are in the USA and simply cannot claim that this could not happen in Australia. It has.
Look at the response of Mayne Nickless in 1994 and at the behaviour of Mr Pratt in the packaging scandal in Victoria. Then there is the abuse of trusting investors by the Commonwealth Bank and not to forget the Catholic Church's behaviour. I describe these and multiple other examples on the web pages Failed markets and culruropathy and Contracting government services to the market. We have to get to the bottom of this. Is the same thing happening in aged care?
I wrote about what I called the Great Divide in Perceptions in a section of a web page I wrote 10 years ago. I suggested that to solve this "Any health care company, operating within a democratic society, would be expected to contribute to any debate and justify their position and actions".
Note that ACSA is not the threatened for-profit sector attacking a critic but the not-for-profit sector, representing church and community organisations, attacking the messenger and not addressing the issues.
What does it say about the not-for-profit sector's willingness to form partnerships with and listen to the community, when the organisation that represents these community-based organisations, the largest provider sector, responds to allegations of poor care in this manner?
On the Dilemma for not-for-profits page I indicated that because the not-for-profit groups were now trapped by having to operate using two conflicting paradigms, they could sometimes respond in unpredictable and inconsistent ways. This seems to be a good example.
Trust and Trustworthiness: We all share ACSA's desire for trust and trustworthiness, but this is now a competitive market in a vulnerable sector, and customers have been misused in almost every vulnerable sector where markets operate. It has happened in aged care in other countries - and, dare we say it, in Australia. The adage "customer beware" must apply. Potential customers should be warned, not reassured. We simply cannot afford to be trusting of the system as it is today. Too many are speaking out about failures. We cannot sweep it under the carpet and expect customers to gullibly swallow the "trust us we're credible and rich" line.
Compare the Catholic Church: The Catholic Church and Cardinal George Pell's conduct as revealed on ABC Four Corners In the Name of the Law on 11th August 2014 shows just how fallible claims to credibility and trustworthiness can be. Because of the priests' power and the nature of faith this was another example of a vulnerable and trusting at-risk community. What these senior priests rationalised as fair and reasonable behaviour over a period of probably 40 years has come back to haunt them. As in so many similar examples they simply did not look at what they did not want to know about.
Again at 8pm on Monday 25th August 2014, the ABC's "Australian Story" told the story of the attacks and criticism by the Catholic church and the catholic community (the same community whose children had been abused) on the award-winning journalist who wrote extensively about sexual abuse of children in the Hunter Valley. She was, as Prime Minister Gillard acknowledged, largely responsible for getting government to set up the Royal Commission.
Then we saw the same thing in the Jewish community in the program "The Code of Silence" on ABC's Compass program on the 12th August 2014. The family who spoke out were victimised and ostracised by the entire community. On 19 August 2015 on ABC News, we learned of the frequency of sexual abuse of children in state care, and the tardiness of the system in investigating these.
- Child abuse report calls for overhaul of residential care system ABC News, 19 Aug 2015
This is human nature. This is how we humans behave, singly and in groups. Usually we don't think we are doing anything wrong when we do so - or else we prefer not to know and look the other way. Is the same sort of thing now happening in aged care?
Perspective: These church groups saw it only from their own point of view. They made no attempt to enter into the lives of the community and the victims. Had they been forced by the community to confront what was happening; had they the courage to open their records at the time these things occurred; then it may have been very different. Had they transparently involved those communities who had been harmed, directly as partners in the process of investigation and remediation, the church might well have dealt with its problems. In doing so the church would have regained trust. It would not be where it is today.
But we humans simply don't behave like that. Gut responses, steeped in our need to survive, trump common sense much of the time. Have the providers of aged care been behaving in the same way?
We must act to protect our community: As a community we need to closely examine all of those vulnerable sectors where there is a lack of transparency, and restructure them so that things like this cannot happen again. Aged care is a very vulnerable sector and we should start there.
Addressing the problem: The only way to address this problem is to put knowledgeable customers in charge, and then expect the providers to clearly demonstrate trustworthiness. Trust must be earned, not claimed.
Con men trade on trust: Charlatans and con men succeed by claiming to be trustworthy, and those who trust are conned. If providers, particularly market-listed companies need more of the community's money to care for the old and frail, then the industry must convincingly persuade citizens that it is genuinely short of cash. Citizens need to be satisfied that there is really a shortage of staff, rather than diversion of money to profit. They need to be satisfied that staff are not leaving (and new staff not enrolling) because of working conditions, or because what they are expected to do is not compatible with their humanitarian mission.
This suspicion applies particularly to the market-listed corporations and private equity owned facilities. They do not have a good track record and it is clear from analysts' reports that they are doing very well in Australia, thank you. When citizens united against what was happening and took to the courts in Florida, staff leaked to them the instructions they had received from central management directing them to reduce staff, or not to replace staff when they resigned, in order to boost profits. It happened there and without full transparency we cannot be sure that it is not happening here.
(2) Is this culturopathy
Typically, culturopathic groups discount their critics and are derogatory about those who challenge their views. They angrily reject criticisms and attack the messenger. ACSA's outburst is not the first time academics have been attacked and attempts made to neutralise their findings by destroying the messenger. The objectivity of academics has been challenged and universities pressured to silence them. This is the sort of thing that culturopathic groups do and they don't see anything wrong with it. When I blew the whistle in Australia on the US multinational that I used as an example on the "Cultural Perceptions" page, my university was threatened.
Who should we believe - the industry protecting itself, the accreditation agency with its dodgy use of data, or the academics who have been trained to be objective, and who have been competitively appointed to university posts because of their skills. Bxxxxth is not the only aged care academic to be treated in this way.
Dr Axxxx De Bxxxxs in her PhD in 2007 detailed incidents of neglect concerning some aged-care facilities in South Australia. Her thesis indicated that:
"...Through this thesis my aim was not to indict or deride any individual or organisation and I do not propose to have the solutions. My aim was to question and open up dialogue within the nursing profession, together with the relevant government bodies and aged care organisations, to debate a system that has:
... inadequate funding allocated for nursing care;
a lack of trained and qualified nurses with 'non-nurses' attempting to provide very complex nursing care classified as 'non-nursing';
a documentation quagmire; and the distant gaze of RNs who are accountable and responsible for the care provided - who are leaving the profession because of the system..."
Source: Dr De Bxxxxs's Thesis is entitled ‘Behind Open Doors – A Construct of Nursing Practice in an Australian Residential Aged Care Facility’
De Bxxxxs and her supervisor were both alarmed by what they had seen not only during the thesis, but in supervising students placed in nursing homes around Adelaide. They decided to go public.
TWO Flinders University academics have called for a public inquiry into widespread aged care abuse, citing "disgusting" examples witnessed during student fieldwork.
Acute aged care lecturer Axxxx De Bxxxxs and tutor in aged care palliative care Maree Khoo told The Advertiser that urgent public attention was needed to end the suffering of neglected elderly patients.
Ms Khoo said she had decided to go public because she was "devastated" witnessing the "degrading treatment residents were subjected to" and the situation was becoming worse.
She (De Bxxxxs) said the three patients she had studied for her PhD - two elderly women with end-stage dementia and a 32-year-old woman dying from a brain tumour - lived in what she called an "environment of neglect".
Source: Fears over aged care abuse The Advertiser, 6 Feb 2007
In the article they detailed a long list of major failures in care which by any standards were "disgusting". Decide for yourself by visiting the links.
There was widespread support for what they had said including by a professor who was an expert in elder abuse. The paper published again the next day and included another long list of failures in care.
Yesterday, overwhelming support from relatives of aged care residents and aged care sector leaders emerged for the academics, Dr Axxxx De Bxxxxs and Maree Khoo, who went public in The Advertiser with numerous examples of abuse.
"What appears to be abuse and neglect and regimented routine rather than catering for individual needs is because of short staffing," said Professor Luszcz, an expert on elder abuse in residential aged care.
Ms Khoo and Ms De Bxxxxs said they would gather their information for the minister today and include further material which had come to light following yesterday's report. These include: - - -
Source: Experts agree on aged abuse The Advertiser, 7 Feb 2007
Presumably the material was given to the minister and investigated by the department, but I do not know what happened to that investigation.
The industry strikes back
This was the response to the academics' attempt to initiate debate about failures in aged care, from Aged Care and Community Services SA & NT (ACCS), a not-for profit member of ACSA, as described on their website, presumably addressing their own members:
"... The recent adverse publicity given to aged care by The Advertiser has again reminded us that we work in an industry that is ‘open' to criticism when situations are taken out of context. As is always the case with this type of reporting there are always gross generalisations.
While understandably you are frustrated and angry it is important to remember that you are valued - by your fellow industry workers as well as the relatives and older people in your care. Those in positions of authority who understand the industry are also aware of the invaluable contribution that you make.
ACCS responded on your behalf with a letter to the editor, which was published in The Advertiser on Friday 9 February 2007. Consideration was given to taking a stronger approach but decided against because of concerns that the media might not be interested in learning about the facts - unfortunately that doesn't sell newspapers!
We have also met on two occasions since with Flinders University staff (including the Vice Chancellor) and are working with them to develop an appropriate strategy to ensure that we cooperatively work towards achieving positive publicity for the industry. This will be backed up by initiatives ensuring that researchers and students entering the work place are better educated about aged care issues.
It is worth mentioning that those senior people we met with at Flinders are genuinely appalled by the action taken by a staff member but unfortunately the principle of academic freedom applied. In short the university has no authority to gag the publication of such information ..."
Source: Update on the recent Aged Care Publicity - Extract: ACCS - Snippets, Volume 7 Issue 2, Feb 2007
Universities are increasingly beholden to big corporations and depend on them for grants and other support. That industry feels that it can demand that universities muzzle their staff and crush free speech speaks volumes about the way they think and the challenges to academic freedom in Australia. I could not track down the letter in response sent to The Advertiser.
Interesting observation: Prof Axxx Exxxx, the retiring vice-chancellor of Flinders University in 2007 was soon to become president of COTA (Council On The Ageing) in South Australia. Ixx Yxxxx who had been president of COTA in South Australia since 1989 and subsequently became CEO nationally, had been on Flinders' Council since 1994 and became Deputy Chancellor in 2007.
Ixx Yxxxx is well known as the community spokesperson for NACA (National Aged Care Alliance) when either they or the government wants to claim that they have community support. Were they involved in this? COTA has been the seniors organisation that has ignored the concerns of other seniors organisations and worked closely with providers and government (perhaps being too close to them). COTA often sees things their way. Was this happening in 2007 as well?
- Former Officers: Flinders University, accessed Oct 2016
(3) The allegations should not surprise anyone
Dr De Bxxxxs and Dr Bxxxxth's observations should not have surprised anyone. After all, only a few years earlier the Minister of Health herself was telling industry that they didn't need trained nurses. Reports suggested that operators rapidly complied with the policy. Regulators could hardly act when nursing homes were simply doing what the Minister was telling them was OK.
In an interview in the Australian Nursing Homes and Extended Care Association's monthly newsletter last March, Bishop was quoted as saying the only standard of training required in a nursing home was "middle-aged women providing tender, loving care".
Source: Crimes of neglect (The Australian, 4 Mar 2000)
Indeed, there is evidence arising that many people who are unqualified and who are working in nursing hostels are repeatedly being asked to do jobs they are simply not qualified to undertake.
Source: Outrage over nursing home treatment (ABC 7.30 Report, 25 Feb, 2000)
Erosion of independent state oversight had commenced in Victoria in 1995. To keep a lid on the system, the government and the minister quoted above, had three years earlier in 1997 removed all oversight and complaints-handling from the states. What has been happening ever since was already clear in 2000. The inadequacy of the response to complaints was confirmed nine years later, in 2009, by the Walton Review of the complaints system.
Victorian Health Services Commissioner Beth Wilson said the case highlighted a complaint system in disarray. Her office had lost power to investigate complaints against nursing homes in 1995.
Source: Kerosene baths scandal puts heat on aged care. The Australian, 26 Feb 2000
After the 2013 scandals Professor Kxxxx apologised on behalf of ACSA:
ACSA CEO Adjunct Professor Jxxx Kxxxx expressed his deep concern and apologies to the residents and families involved.
He stressed the need for a substantial injection of funding to deliver high quality care and urged the government to move quickly to introduce its Living Longer, Living Better reforms, cutting the 10-year timeframe by half.
LASA (For-Profit group) CEO Pxxxxxx Rxxx said the program had revealed what industry had known for some time, that there is a critical workforce shortage, recruitment and retention is difficult and government funding does not match care needs.
He said the government’s focus on regulatory compliance rather than quality clinical care had to change.
Source: Aged Care Under Fire - Australian Ageing Agenda, 16 Jul 2013
In light of the facts, the industry had no choice but to apologise. But they immediately diverted the blame from the industry and turned it to their advantage. ACSA and LASA may be right and more money may be needed but in a sector at risk, one where, in other countries at least, vulnerable seniors have been fraudulently misused to generate profit on a massive scale, we need real across-the-board access to what is happening to our seniors and what is happening to the money.
When we look at the large profits being generated by the companies that listing on the share market and the wealth of some of their owners, then it is clear that we simply cannot accept these claims at face value. They sound like self-serving rationalisations. Dr De Bxxxxs claimed that nurses are leaving the sector in droves because of the system. That seems far more likely.
I will continue to advocate for a wider community conversation about aged care and how it is best provided. It is essential that members make their views clear to the association so that the experiences providers can bring to the policy discussion are taken on board. Last year there were negative media reports that sucked the oxygen out of sensible community debate about how we all plan for a better future in aged care.
Source: ACSA National Report 9th Jan 2014 From the ACSA CEO, Adj Prof Jxxx G Kxxxx AM
By 2014, these 2013 scandals for which ACSA had apologised were simply "negative media reports that sucked the oxygen out of sensible community debate". Did they actually accept the revelations on Lateline as real? Is there any indication that the leaders in this sector are actually looking at what is being said about them and then addressing it? Are they simply in denial?
In the example of a culturopathic organisation I gave on the Culturopathy:A for-profit example page the company executives rejected the evidence when the scandals broke. They thought it was a media beat up and instead of going to their hospitals and fixing the problems, they went to a public relations firm for help. They could not accept that what they were doing was wrong. Is this similar?
I would have thought that any sensible community organisation would want to actively debate serious allegations that their seniors were being neglected by those responsible for their care.
But culturopathic groups typically turn to one another to reaffirm their beliefs and downplay the significance and veracity of the evidence they are challenged with. They are reluctant to seriously engage with evidence that is obvious to everyone else. Is this happening here? Do the other quotes on this web page similarly reinforce complacency and seek to counter doubt among believers?
If Professor Kxxxx is genuine in his desire to have a sensible community conversation, he only has to put his ear to the ground and listen.
Downplaying criticism is not new. The same happened in 2009. The ABC Four Corners program on 1st of June had presented a series of very confronting stories illustrating failures in care.
They tell how their parents were mistreated, how serious illnesses were ignored and how the complaints procedure, that is supposed to protect patients, did not properly investigate cases or refused to acknowledge significant evidence of negligence.
Source: "End of the Line" - ABC Four Corners, 1 Jun 2009
ACS, along with the rest of the sector, was dismayed and shocked by the distressing stories presented on ABC’s 4 Corners program (1 June). It was very disheartening to see the industry portrayed in such a negative light once again.
We can take some solace from the fact the report was very unbalanced (for example, interviews with associations’ representatives were not included) and DoHA was the main target rather than providers, although of course we suffered.
The industry and not the community "suffered" but what did the industry and the minister do? As 89-year old resident, Ms Clark, said in her evidence to the Productivity Commission in 2010 - "but the thing is, nothing gets changed". Instead the industry rejected the allegations out of hand and between them, ACSA and ACS wrote to every federal and South Australian politician protesting. The link to their letter to politicians in now broken so I could not find it.
If we consider the multiple allegations that have been ongoing since then, we can see that they were denying then and still are now. If only they had looked instead of going to politicians, and then joined with and enlisted the help of the community to have something done. Is this the Catholic Church all over again?
A glimmer of light: Amidst this attack on critics there was a glimmer of light. The invitation of Ita Butrose, who had strongly cricised the providers, to address the ACSA was seen as controversial as she was a critic of the sector but, although not everyone in ACSA agreed, there was support for it. This is the correct and obvious way to deal with your critics. You involve them and look at their concerns together to see how valid they are and where they are coming from. What is worrying is that it was seen as controversial.
As a member of the organising committee for the Aged and Community Services Australia (ACSA) National Conference 2013 I supported the decision to invite Alzheimer's Australia President Ita Buttrose to address the Conference. My view is that aged care must be open to criticism and must engage with critics of the sector - not "hunker down" and hope they will go away or that they won't get publicity. I think this is applies at a sector level and and at an individual service level.
I think some provider representatives felt that Ita had abused the invitation she had been extended. There was a view that she had been given a platform to take "free kicks" at the expense of the sector in the media and that it would have been better not to have her as an invited guest and key note speaker at the Conference
Source: Aged Care providers must engage with critics like Ita by Rod Hunt, Ideas in Aged and Community Care, Hunt&Fitzgerald Business Services, 14 Nov 2013
If we look at the second part of this quote and ACSA's outburst against Dr Bxxxxth in 2014 we can guess whose point of view prevailed.
The last word to Bxxxxth: Finally, in this stoush between providers and academics, Dr Bxxxxth should have the last word. Is the aged care industry blocking research, preventing even academics from studying aged care? Do we believe the industry's demonization of academics or do we believe the academics and wonder at the lengths to which the industry will go to neutralise their findings? Isn't this what the giant cigarette companies have been doing? Are we prepared to allow them to go to these lengths to stop information from getting out, or are we as a community going to step in and find out what is really happening?
It is our parents, and all too soon ourselves when we are old and vulnerable, who are going to be part of this. This is what Bxxxxth told the Productivity Commission.
DR Bxxxxth: The other thing that I wanted to talk to you about was the issue of research in aged care and the issue of researching in residential aged care. When Prof Nay published her PhD in the mid 90s she was banned from residential aged care facilities on the mid north coast because her findings were adverse to those wanted by the industry.
I found the same situation when I was doing my PhD and I have been subjected threats of violence, verbal abuse, constructive dismissal.
I've had contracts terminated and we sold our home and moved to another town because of the professional bullying that I was undergoing because I was revealing the outcomes of that PhD research.
Subsequently it's then difficult to get back into residential aged care to do other research, however I have found a wonderful place on the mid north coast that will allow me back in.
Source: Productivity Commission Inquiry - Caring for Older Australians: - evidence of Dr Bxxxxxx: Transcript of Proceedings - Canberra see page 1371, 5 Apr 2011
(4) Not-for-profits behaving like for-profits
The not-for-profit sector was once part of the community. It depended on them for funding and support, so was working with the community all the time. It responded to the concerns of that community. There was seldom a need for those with concerns to go public. Aggressive attacks on those who expose failures was something that I used to associated with the large corporate entities, whose prime responsibility was to their shareholders.
Intimidation strategies: Large corporations have a legal fiduciary duty to put their shareholders first. They usually aggressively discredit whistleblowers and subject many to the sort of treatment described by Dr Bxxxxth. Typically they threaten then mount SLAPPS (Strategic Lawsuits Against Public Participation). They do so even when they know that they cannot successfully prosecute the cases, or that it would do them too much damage to do so. Most of those who have tried to speak out are intimidated, withdraw the allegations, and give them the apologies they demand.
When I objected to Tenet Healthcare (at the time called "National Medical Enterprises") operating hospitals in Australia and supplied authorities with documents, Tenet Healthcare first threatened me, then my university, and when I refused to retract and apologise served me with SLAPPS in two countries.
They had already pleaded guilty to criminal conduct in the USA. The damning documents I supplied were obtained from lawyers and whistleblowers in the USA and another country. They were used in many of the court actions they settled.
Although they had initiated the action, the company resisted every effort I made to bring them to court in Australia. My lawyer told me that if Tenet had been his client it would have been his duty to advise them of the potential advantages of doing what they did. It usually worked.
Not-for-profit culture has changed: I believe that the attacks by ACSA and its subsidiary ACS illustrate how far the not-for profit sector has lost touch with the community and moved away from its roots. On the page Dilemma for not-for-profits, I suggested that not-for-profits put market and community patterns of thought into two separate mental compartments. To survive they had no choice but to ignore the logical conflicts, and then operate from one or other mental compartment depending on the situation and pressures on them. This seems to be an example where the pressures have caused them to respond from the wrong compartment to that actually required by the situation.
Many of its managers, including Professor Kxxxx have worked with or for for-profit groups. In his legal business, Kxxxx advised them. He would be well aware of the advantages of threatening litigation. What would he have advised his clients if the person, speaking out about failures in care in their facilities, was likely to buckle? Families who complain have been threatened. Are we going to get to the stage where organisations that arose because of the community's concern have become so far removed from that community that they will threaten defamation actions in order to silence critics and protect themselves - or are we there already?
"... In fact, many say they experienced bullying by the nursing home when they did complain. Astonishingly, Jane Green was threatened with defamation for complaining about her mother's treatment to the health practitioners authority ..."
Source: Aged Care Crisis - ABC Lateline, 15 Jul 2013
Letter from a for-profit owned facility to family member who described problems in the care of a relative in a blog on the web:
I refer to the XXXX and the request previously sent to remove 'Home'. Can you please remove any reference to our facility within your complaint. If our name is not removed from XXXX by 5pm today the xxth Mnth 20xx we will have no option than to forward this matter to our solicitors.
Source: Recent threats from the home - Aged Care Blog (link no longer working)
Letter to family member who had gone to the press and had obtained assistance from a member of parliament (For-Profit company):
---made a number of false allegations about our client to other residents, families, the media and XXXX
Should you continue to make public defamatory remarks about our client's staff we are instructed to explore the prospects of civil action against you.
Lawyers' letters to a daughter who was quoted by the media after speaking out about her parent's death. From a not-for-profit nursing home and then by the CEO:
From Nursing Home:
The article and your statements quoted in it contain serious defamatory allegations
These allegations are false and you are requested to withdraw them and apologise and provide redress to our client.
The article and your statements quoted in it contain serious defamatory imputations concerning XXXX (CEO)
This letter is a concerns notice under the Defamations Act 2005
The proposed Hub and Strategic Lawsuits Against Public Participation (SLAPPS)
Threatening and even initiating lawsuits is a common response by legal departments in big companies anxious to silence critics. Here it is generally impersonal. But when you have a culturopathy, then those who are part of the culture will often genuinely see criticism as unreasonable and rush to their lawyers in indignation. In my limited experience this situation virtually always arises as a result of the failure to handle the initial situation well, to listen and try to see it as the person who is unhappy sees it.
I don't know enough about the cases above to comment on their validity, but what concerns me is that they are occurring, and the number of them. They are all within the last few years. Whether the allegations are valid or not, it is strongly suggestive of a culturopathy when people are so deeply concerned about what has happened to a relative that they will speak out and refuse to back down. In the vast majority of cases it is because they have not been listened to, their concerns have been rejected out of hand, or no effort was made to address the problems exposed by the failure in care. A cynical and evil provider who knew what it was doing would go through the motions and placate the person complaining. But in a culturopathy they believe in what they are doing and the critic cannot be right. The response is to deny and then rationalise and demonise the complainant to justify rejecting the complaint. When the complainat persists the response is anger and action.
These are often people who have recently lost a parent or seen them suffer. Instead of empathising, culturopathic cultures will see these people as vengeful, vindictive or after money and respond aggressively to them. But in the vast majority of cases that I know of it is the determination to stop what has happened to them, or their loved one, from happening to anyone else. Sometimes it is to protect a loved one. It is always extremely stressful.
The proposed Community Aged Care Hub: This is the sort of thing that the hub would largely stop. It would be the hub that addressed the issue, involved the complainant in sorting it out and in fixing any problem. If there was resistance to sorting out a genuine problem then the hub would be behind the complainant. If it was a reasonable complaint they would support the complainant if they went public - and they would have the information to do so. This would not limit the rights of anyone if they did not agree with the hub, but they might not have its support.
(5) Pulling this all together
Canadian John Ralston Saul in his Massey Lectures describes how, in our western civilisation, instead of using words and ideas to grasp and understand our world, we use them to serve an ideology and build an artificial world in which to live our lives. To do this words and beliefs are used to render us unconscious of the real world we live in. He quotes Mussolini to illustrate how it happens. While he does not use the word "culturopathic", he is describing how and why culturopathic cultures, like the fascist regime that developed in Italy in the 1930s, develop.
We suffer from an addictive weakness for large illusions, a weakness for ideology. Power in our civilization is repeatedly tied to the pursuit of all inclusive truths and utopias. p 19
In a society of ideological believers, nothing is more ridiculous than the individual who doubts and does not conform. p 20
For the ideologue, language itself becomes the message because there is no doubt. In a more sensible society, language is just the tool of communication. p 42
Yet in a corporatist society, most people in positions of responsibility -- public or private -- are rewarded for controlling language. "Knowledge is Power." p44
"The crowd doesn't have to know," Mussolini often said. "it must believe - - - - If only we can give them faith that mountains can be moved, they will accept the illusion that mountains are movable, and thus an illusion may become reality." Always he said, be "electric and explosive." Belief over knowledge. Emotion over thought. p65
It is through language that we will find our way out of our current dilemma, -------- ---------. But language, when it works, is the tool that makes it possible to invoke reality. p176
Source: John Ralston Saul " The Unconscious Civilization" (The Massey Lectures, Penguin Books, 1997)
Please consider each of these extracts carefully and look back at what I have said on this and other pages. How relevant are the short extracts. Look at the next two extracts and the examples I give below.
I think Dr De Bxxxxs and Dr Bxxxxth, who have both been so aggressively attacked, have by far the clearest view and understanding of what has happened in aged care and where the problems lie. Dr De Bxxxxs uses language to address reality rather than render us unconscious. Dr Bxxxxth tells us how language, that bears no relation to reality, has been used to create a false reality.
I will quote from De Bxxxxs' submission to the Productivity Commission in 2010. After that, I will give a real world example of an unconscious culture built on illusions, that had devastatingly real consequences for the people it was there to help. Finally in the next slider, I will quote from Bxxxxth's contribution to a recent ABC program: Do you think she is describing the same thing and have there been similar real consequences?
Unfortunately the reality is far from the ideal, and in fact, it is tragic for so many residents and relatives, as well as the nursing profession. The system in place under the Aged Care Structural Reforms of 1997 and the Aged Care Act 1997 that was started with the 1987 reforms, has had a profound detrimental effect on the nursing care provided on the ground and at the bedside for residents who require a high level of extensive, intensive, and complex nursing care.
Unfortunately, non-nurses who provide the majority of care, under the distant supervision of nurses relegated to documentation, are providing a substandard level of nursing care to residents. Compounding this skillmix are atrocious staffing levels and punitive measures through the funding and accreditation schemes.
The federal government has a policy of non-nursing in residential aged care and the industry uses economic rationalism that aims to make a surplus or profit. This has been at the expense of nursing and the quality of nursing care able to be provided, and has also led to never ending battles between relatives who advocate for their loved one’s care with staff or managers in the aged care organisations. Instead of a partnership – it becomes a struggle.
Source: Dr Axxxx De Bxxxxs - Submission 248 to Productivity Commission - Caring for Older Australians Inquiry, 10 Jul 2010
She is talking as an insider from a nursing perspective. In my long and detailed submission to the Productivity Commission in 2010, I made exactly the same points and proposed a community partnership very similar to the proposed hub to address the problem.
The Aged Care Act of 1997 established corporate competitive marketplace paradigms and commercial managerialism as dominant patterns of thought in aged care. These were prevailing political ideologies. As a consequence inappropriate patterns of thought became legitimate. There have been multiple consequences of this but a number stand out.
- The exploitation and misuse of vulnerable senior citizens - wrinkle ranching
- Alienation of the work force and groups in the community.
- The detachment of the community from their responsibility to the elderly with consequent disengagement and disempowerment.
- The creation of oversight processes that hid the sort of information that might have exposed the new system to criticism.
We cannot turn back the clock but we can reduce the adverse consequences of what has happened. This submission proposes two core solutions.
- The proper collection and analysis of information about financing, staffing, care and quality of life.
- Giving local communities leverage by involving them more closely in nursing home care, in the resolution of complaints, in oversight, and critically in the collection of financial information, staffing information and in measuring standards of care and quality of life.
Source: Submission 368 Caring for Older Australians Inquiry, 2010
The commissioners did not hear or notice. De Bxxxxs' final paragraph accurately sums up the situation we have today but because it is underpinned by a culturopathic culture it extends much wider than just changing nursing structure, and wider than simply aged care. It is the culture that is the problem and the Community Hub is intended to address that.
Example: The first time I personally encountered this illusionary world was when, in 1991, I met with a manager from an international hospital run by NME, the US company I used as an example on the "Cultural Perspectives" page. We were meeting to discuss my concerns about standards of care in his hospital, as well as a report from its Quality Assurance Committee, which I felt did not reflect the true situation in the hospital. Instead I received an hour's lecture in glowing terms about the Quality Assurance processes in all this company's hospitals from the enthusiastic manager, including the one in question. I was impressed and felt totally out of my depth. I departed cowed, and with my tail between my legs.
It was only later, as I sifted through what he had said, that I realised that I had been listening to a gobbledegook of impressive-sounding words. There were no logical connections. It was impressive gibberish and he believed it. In 1994 I saw in a statutory declaration from the chairman of this quality assurance committee that the matter I was concerned about was the first time the committee had met. It had been called together to respond to a complaint which it is likely the company thought was vindictive.
As part of my investigation of the psychiatric scandal in 1993 I obtained a letter from a US doctor, written around the same time as I was meeting the manager. This was to the chairman of the company complaining about the standards of care in his hospital. He complained that the quality assurance committee in his hospital had never met.
A similar situation of ineffective quality assurance was revealed in another hospital in a second scandal exposed in 2002. In this instance hundreds of patients had had their chests split in half, and were put onto bypass machines in order to do unnecessary operations on their hearts. Management had resisted requests from worried doctors in the hospital for a review of this very profitable unit by a Quality Assurance Committee.
As was so clearly revealed in my interview with the manager, the outward form of quality assurance was surrounded by words and it became real for them. It was a grand illusion but deep down they knew it and resisted having the myth exposed. There was no substance behind the outward form and the words - nothing real. The word "quality" was the only thing that was really there and there was no "assurance" for anyone.
This impressive and assertive use of words was something I would later see in this company's correspondence and documents many times. If they said it then it was real and they proceeded on this basis. Regulators like those in the NSW Health Department were impressed and initially ignored evidence from a group they did not see as credible. They swallowed it all. They granted the company's hospitals licenses to operate in their state. But after they received accurate information from more credible sources subsequent licenses were granted only when their advice to reject the license, based on real documents they were given, was overruled by a judge who was later shown to be at risk of improper influence.
In my correspondence I labelled the company's letters "NMEspeak" to draw a parallel with George Orwell's "newspeak", then destroyed their credibility by using language and evidence to set the glowing assertions they made in their letters against their actual conduct.
NSW Health advised that NME's application to operate hospitals in NSW be rejected on the basis of among other things their lack of "frankness and candour". The judge delegated to make the decision rejected this advice and granted a license to operate. Victoria thought otherwise and their probity review did not accept the judges decision, but that is another story! The evidence I used was a deluge of internal documents revealing that a bizarre and illusionary world had been created within the company, one where unconscionable money making activities were seen as legitimate.
As the unnecessary surgery scandal 10 years later illustrated particularly well, susceptible doctors became part of this. They developed illusionary ideas about their skills. They lost insight into their own limitations as the company's public relations machine marketed their supposed skills to colleagues and the public. They were proud of their status and that their skills were being recognised. Nurses, who were a cost and so were exploited by the company, had fewer illusions but they lacked power and could not do anything to stop what was happening.
Now there was nothing illusionary about the experience of the hundreds of children who were taken from their homes, or the large numbers of patients who were persuaded they needed psychiatric hospital care and were harmed. Many gave evidence to the senate inquiry chaired by senator Mike Moncrief, whom I met. He kindly gave me access to the transcripts.
There was no illusion for those patients who were needlessly split wide open to get to their hearts, or for those who developed complications. A number of others developed major life threatening infections following similar surgery at another company hospital. This was due to inappropriate strategies developed to get more operations done in faulty theatres, that the company had refused to renovate because of the cost. The grief of the relatives of those who died in these two hospitals and, perhaps in others where similar problems were never detected, was a real experience.
Now none of this would have been possible had there been real information, real oversight, in fact anything real, and had it been available to people who were in contact with a real world.
All of these hospitals were fully accredited, some by more than one agency. I have long considered that the accreditation process with its emphasis on process, and its failure to measure and track real data about failures in care, is particularly at risk of similar illusions. This would explain why it has been so ineffective in aged care in Australia.
I almost predicted it! It is interesting to look back at what I wrote in 1996 long before the heart surgery debacle was exposed (see quote below). This web article was based on a paper presented to a National Symposium on the Planning and Management of Health Care Programs in which I used NME as an example. I was talking about how the frames of understanding we used were changing and how this impacted on medical care. It was almost prophetic as I indicated that "surgery cannot be immune".
The frames of reference through which we interpret the world we live in and the actions we take have a profound impact on the plans we make and their consequences. - - - - - surgery cannot be immune.
Decision making is increasingly made within a financial or marketplace frame of reference. This dominates the thinking of politicians, health managers and businessmen who increasingly fund modern healthcare. Doctors are identifying with this and thinking in the same terms.
This paper - - - shows how the subjugation of alternative frames of interpretation to market perspectives resulted in a severely dysfunctional health system which had disastrous consequences for health care. Hundreds of doctors abandoned their medical traditions as they adopted a purely market mindset, transferred their allegiance to the corporation and cooperated in the systematic exploitation of their patients for profit.
Source: The impact of financial pressures on clinical care lessons from corporate medicine Corporate Medicine website, 29 Dec 1996
At the time I was worried that this would happen to health care in Australia. I had also addressed the surgeons at a private session at an earlier surgical meeting. It was surgeons who played a leading role in the resistance to managed care contracts in Australia in 1998 and the walk out of Mayne Health hospitals in 2002.
In 1996 I was not thinking about aged care in the USA or Australia. NME now renamed Tenet Healthcare sold up in Australia and their CEO, who had launched a SLAPP against me when I produced documents describing his negotiations about contracts with doctors, returned to the USA.
NME, now renamed Tenet Healthcare, started doing the same things in cardiac surgery in the USA about 3 years after all this. The international hospital manager whose deputy I spoke to about Quality Assurance in the international hospital became CEO in Australia. Later in a senior position in the USA he negotiated the contracts with the doctors who were responsible for the unnecessary heart surgery (see 4th reference below)! He obstructed the doctors in the Redding hospital who wanted the Quality Assurance Committee to examine the cardiac program.
It is a story which illustrates the persistence of culturopathic thinking and the difficulties that participants have in accepting that the way they think and do things is fatally flawed. To them the psychiatric scandal was all a beat up and they were the victims of this. This administrator's superiors in the international division, who were actively involved in supervising his activities were all brought back into senior positions in the US company in 1994 and were once again this administrator's bosses. The company claimed that these people from their international division were far away and clean as they had nothing to do with the fraud in psychiatry. But they held the same beliefs and would have accepted the explanations about what had happened made by US colleagues.
In this company and the many like it the words were all that mattered and while they were detached from the actual world it became that world for them. It was a world of illusions and they had no doubts.
- Tenet Healthcare's Redding Hospital Unnecessary Cardiac Procedures I (written 2003)
- Tenet Healthcare's Redding Hospital: Unnecessary Cardiac Procedures II (written 2007)
- Unsafe Theatres: Dangerous Heart Surgery in Florida (written 2007)
- From Singapore to Redding - - - A Long Trail to Follow (July 2007)
- Coronary: A true story of medicine gone awry by Stephen Klaidman Scribner New York 2007
(6) Using language and finding real leaders
Dr Maree Bxxxxth, has spent many years studying aged care in Australia. She is even more direct in telling us how language has been used to obscure reality and render us unconscious of what has and is happening in aged care.
I have witnessed a great disparity between what they say they do and what they actually do and that's not being picked up by the accreditors. The facilities can put on a face that is different to what is actually happening
There's this bureaucratic speak where families who complain to them get this letter back that's full of bureaucratic language that doesn't show any appreciation for the stress and distress that the families have gone through. It pays token recognition to the complaint and it talks about things like; they've looked into the complaint and the facility has changed their policies or changed their procedures.
What can often happen is yes, they've changed their procedures, but no one knows about it, there's no education being provided, there's nothing to inform the care staff that there has been a change, and there's no one to follow up that the care staff are implementing the change.
Source: Extracts are from the transcript of ABC Background Briefing audio programme Death in a five star nursing home (21 Sep 2014)
Even if they don't enjoy finding out, both sides of these very different ways of seeing the world of aged care need to know that their understandings about the sort of care being provided are firmly grounded on solid information about what is actually happening. That means that both need to gather and share information equally - and talk to one another about it.
In a market it is the customer who must own and control the information. The successful operation of a market in a socially responsible way depends on that. Until then it will continue to be a struggle and there can be no trust on either side. They will become more and more polarized.
My thesis is that, as Saul indicated in his Massey lectures, politicians, the industry, the commissioners and even the public have been rendered unconscious by the rhetoric of the ideology they serve. They are incapable of seeing or hearing what is put in front of them. What they see and consider as the real word is the words they hear.
They are unable to see or understand the real world that is repeatedly put in front of them because it, and the world they think is real, no longer bear any relationship to one another. They are incapable of doing anything about it. Aged care is in the grip of a culturopathic culture. It could be resolved by inspirational leadership from the sector to realistically confront what has happened.
What we need is Mandela-like leadership that recognises how badly the aged care system is broken and to seize the opportunity to fix it. In it's absence we must do the next best thing and empower the community to examine the realities of what is happening, to seize the initiative, and to forcefully step in to address the myriad problems we are facing.
I am suggesting that the proposed community aged care hubs, if properly implemented, can be the tool which empowers society to act.
Not only Australia: It remains simply to remind you that the way "the system" turns a blind eye and the way failures in care are not confronted is not limited to Australia and the USA. You will recall the situation exposed in a INTFPCompanyB nursing home in Australia by an undercover journalist in 2010. I wrote about it on the page Scandal after Scandal. As indicated there, similar exposures were made by a group of 7 nurses in a INTFPCompanyB nursing home in the UK. Then there were the multiple problems in Scotland.
INTFPCompanyB is a UK for-profit that professes a not-for-profit ethic. It has aggressively expanded into many countries, including Australia. The main whistleblower's account of the way INTFPCompanyB, the police and government responded is very revealing. INTFPCompanyB operates in many countries across the world. It's board and those who manage it are very distinguished people. This is worldwide and I argue a consequence of a culturopathic ideology and the countries that, like large groups in Australia, embrace that ideology.
(7) Providers cannot logically reject a Community Hub
ACSA cannot credibly reject the idea of a community hub. They must support it. It is exactly what their CEO publicly indicated he wanted. What better way for the industry to engage with the community than to be working closely with them in every part of Australia.
VIDEO: As the Aged & Community Services Australia National Conference was getting underway in Adelaide this morning, CEO Adjunct Professor Jxxx Kxxxx spoke to the NEWSROOM about the conference, which he said was a great opportunity for the 900 people in attendance to share ideas and information.
Adjunct Professor Kxxxx said his biggest hope for the next five years was for the community as a whole to engage in the conversation about how to care for older Australians with the respect that they deserve:
Source: Engaging in a conversation (Australian Ageing Agenda - Newsroom, 8 Sep 2014)
Professor Kxxxx is speaking for ACSA, the largest group of aged care providers in Australia. He is in not-for-profit mode. Is he talking about genuine partnerships, as required by government, and informed discussion? Or is he mixing this up with simply selling the industry's views better? We saw this abused in the psychiatric scandal in the USA, where corporations ran "health fairs" in schools, running mental health education and discussion sessions. Thier primary function was to market the company and funnel the children of anxious parents into hospital, regardless of whether hospitalisation was actually required.
Rewards and praise for staff were based on measured "conversion of inquirers to admission" rates. This is what they recorded, entered into a tracking computer program and reported in their internal reports to management. The conversation and its agenda, were set by the industry, and the intent was to serve the industry and not the community.
If Professor Kxxxx is genuine, then he and ACSA should seize the opportunity. Community hubs meet their stated objectives. There can be no reason for their not supporting and advocating for the creation of community hubs. It is a way out of the situation that they now find themselves in.
A failure to address these issues can only lead to more adverse publicity, and more distrust. The debacle in the Catholic church is there to remind all of us.
Aged care cannot continue down its current path. And the lessons of the 2009 Walton Enquiry into the Complaints System should be heeded. You cannot simply pick and choose what you like from the community hub proposal. Those parts that are essential for it to work must be included.
If a working community hub of the type proposed had been present then:
- ACSA's criticisms of academic research: The local hub would have been working with any academic doing research in their facilities and would be in a good position to evaluate the findings and assist the academic to have needed action taken. The academic would be dealing with them.
The hub's central body would certainly have been dealing directly with ACSA in regard to the statements made and the actions taken in lobbying the universities. If the findings were inaccurate, then they would have had the data to talk to the university about the accuracy of the research and have it peer reviewed. They would not have attacked the messenger.
Universities will generally not tolerate unprofessional or fraudulent research. That the universities took no action indicates that the data was sound and the industry had no data of their own with which to challenge the findings. It is the duty of every academic and university member to report their findings accurately and to speak out in the interests of the community. The hub, with its collection and control of information, would be in a good position to provide the university with evidence to challenge any fraud and ensure it was addressed.
- Victimisation of critics and whistleblowers: The critics and whistleblowers would have come directly to the hub and not to the industry. The hub would be there to see that they were fairly treated, and when required would be there to protect them.
- The conflicting understandings: With the community firmly in control of objective data, and sharing it publicly, there would be little room for the wildly conflicting views about the services provided.
I argue that it is unlikely that any of the aged care matters I have drawn attention to on this web page would have happened, had a functioning community hub of the sort I have suggested been in place at the time.