“I live in the margins where it doesn’t go so well,” said Health and Disability Commissioner Anthony Hill at an NZACA conference a few years ago. “If we improve things here, it will improve the whole system.”
The cases in these “margins” are unfortunately what the public hear about. The latest case of its kind concerns Bupa Care Services, who were recently ordered to pay compensation for failing to deliver reasonable standards of care to a resident in its St Kilda Care Home in Cambridge. Bupa also won the Bidvest Excellence in Food Care award last year – but will the public remember that? Probably not.
Failure to deliver care is serious and the complaints made against Bupa do not make for pleasant reading. Bupa has apologised and more importantly, is making changes and improvements to its policies and practices, particularly around continence care – one of the major areas raised in the complaint.
“We realise that these improvements to practice in no way make up for the standard of care delivered in this instance, but we are taking all possible steps to demonstrate learnings from this incident,” a Bupa spokesperson told INsite. “We are continuing to review the ruling. We do acknowledge that there were some instances and aspects where we should have done better.”
But one major aspect in which Bupa and other sector agencies could have done better is the way it dealt with the resident’s son’s complaints. Bupa reportedly sent multiple letters of apology but according to the son, these were received some weeks and months after his complaints.
He repeatedly raised concerns with Bupa, the District Health Board (DHB), the Health and Disability Commissioner (HDC) and the Ministry of Health.
Yet he only had one reply, which was from the DHB, assuring him that they had been in contact with Bupa who had addressed their failings and there was no need to take the matter further.
Consumer NZ says it isn’t good enough.
“Rest homes receive significant public funding. When they fail to deliver services to required standards, they need to be accountable. A complaints process that’s responsive to consumer concerns also needs to be a priority,” says chief executive Sue Chetwin.
Consumer NZ’s Jessica Wilson told Radio NZ that complaints mechanisms need to be responsive and not “glacially slow like they are at the moment”.
“There needs to be meaningful sanctions where a home has not delivered its services,” she said.
Wilson said not every complaint was investigated and just because a complaint was made did not mean action would be taken.
“It’s time for a real look at the way we fund aged care, the way we staff it and a workable complaints process for consumers needs to be a priority as part of a review of the rest home industry,” she told Radio NZ.
New Zealand Aged Care Association (NZACA) chief executive Simon agrees the overriding complaints system is arduous. He says that while he understands why the HDC’s complaints process takes so long, it isn’t satisfactory.
“There is definitely room for improvement in the time it takes to address a complaint.”
He points out that under Code of Residents’ Rights, rest homes must provide a clear pathway for residents to voice concerns and make complaints.
However, Wallace doesn’t agree there needs to be a review of the rest home sector. He says that while the Bupa case shouldn’t have happened, it is a rare occurrence.
“It is not a catalyst for a full scale inquiry as Consumer NZ suggests.”
Wallace says the sector is held accountable to Health & Disability Sector Standards. He points out that unannounced rest home audits already happen.
“The sector is well-regulated – and we should be,” he says.
However Dr Chrissy Severinsen of Massey University says the isolated cases are indicative of problems across the sector.
She says that each time a case of neglect and substandard care emerges, like the recent Bupa case, there are urgent calls to improve the standard of aged care. Problems such as inadequate staff numbers, increasing workloads and workplace stress, and hurried or delayed care, are often explained by the industry as poor practice and management at individual rest homes, but are symptomatic of problems across many facilities.
“But so far, there has been little meaningful action,” she says.
In a recent article published in Ethics & Social Welfare, Severinsen, along with co-authors Martin Woods and Suzanne Phibbs argues that the structure of the aged care sector compromises the care of older residents through lack of accountability and adequate monitoring of the quality of care received.
“An ethic of care cannot thrive where individuals working in rest homes are blamed for situations often the result of several factors, many outside their control, or in a climate where the aims of a for-profit business and the aims of a care-based service cannot be reconciled.”
The current system promotes cost-cutting and dangerous under-staffing in the provision of care, they argue. Policies and regulations are applied in a punitive fashion, rather than being focused on improving quality of care.
The sector is laden with accountability. Providers must comply with a vast number of Health and Disability Sector Standards, and numerous pieces of legislation.
However, New Zealand Nurses’ Organisation’s David Wait says that it is still possible for staff to comply with the sector standards and ARRC guidelines with divergent levels of staff and skill mix.
In fact, Wait says that of the many providers the union works with, it would be highly unusual to encounter a provider who had the correct levels of staff to cater for the needs of their resident.
He says that while an audit might not directly identify insufficiencies with a provider’s staffing mix, it might pick up on these in other ways, such as an increase in skin tears or other clinical areas, for example.
Wait says the NZNO would like to see a review of the 2005 voluntary standards – Indicators for safe aged-care and dementia-care for consumers.
If such a review helps facilities maintain a focus on improving the quality of care, then it can only be a good thing. Similarly, we should be looking to improve the efficiency of our complaints process. Ultimately the goal should be to reduce the number of cases in the margins further still.