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The industry friendly accreditation and
complaint handling agencies set up by the
government in 1997 have failed. This is illustrated
by the ongoing problems in care, the recurrent
scandals and the increasing seriousness of the
problems encountered. This page examines these
processes, the reasons why they failed and why the
measures to make them effective have not worked and
are unlikely to work in the future.
Australian Nursing Homes
- The USA
- Australia
- State oversight closed down
- Conflicts of interest
- Role conflicts
- Consequence of role conflicts
- Critics and spot checks
- Restrictive legislation
- Appeal system helps the owners
- Funding and policy critics
- Voluntary codes of conduct
- The dilemma in closing down homes
- Government bodies left out in the cold
The chronological story of nursing homes and accreditation practices in Australia is intimately related to the story of government policy over the years. It is told on the government pages. This page more specifically relates to the failure of the accreditation process and the complaints mechanism. It examines the reasons for this. It looks at issues and is not chronological. Because accreditation is such a central part of the story there is some duplication in content and in illustrative extracts between this and the government pages.
It is also an opinion piece rather than a statement of fact and is based on an examination of the US and Australian systems as an outsider and not on any personal experience. There will inevitably be some errors because of this but such an outsiders view can often throw light and raise issues. In some sections the explanations are those made by others. In other sections they are suggestions and ideas of possible or likely explanations rather than assertions.
In 2000 I wrote a series of linked web pages looking at the reasons why regulation and government oversight have failed. More specific pages examined failures in regulation in the USA and Australia. Another page written at this time examined failures in the accreditation process.
This page looks at the failures of the accreditation and complaint handling system in aged care up to 2006.
Lurking behind the sections on this page is the issue of interpretation - what I have called the divide. The view of those who exercise power and make decisions including politicians, the regulators and the industry is in stark contrast to the views of nursing home advocates, the nurses, the residents who are misused and their relatives.
As in the application of most ideologies it is the former group who are out of touch and who are unable to accept the real life consequences of their policies and practices. They are also unable to form an intelligent analysis of what is going wrong. They nevertheless set the frameworks of understanding (world view) within society. We all experience some emotional instability when we deviate from this.
Activists and families consequently also tend to use these frames of understanding and will squeeze their solutions into them. Although they will be critical of the commercialisation of aged care they seldom openly challenge the marketplace view of the health system, and the applicability of a market in health and aged care. Instead of pressing for real changes to the system they squander their efforts by pressing for greater regulatory vigour and larger penalties.
Accreditation and market forces were used to drive reform of a system which was not working well. This page examines the many reasons for failure including the power structures driving aged care, the lack of insight of decision makers, and the way an industry driven and industry friendly focus has emasculated the structures set in place to protect citizens.
The similarities and differences between surveillance in the USA and Australia are examined and it seems that the Australian system is even more vulnerable than that in the USA.
Conflicts of interest, role conflicts, restrictive legislation, the discouragement of critics, close relationships with industry, excessive political control, an intrusive bureaucracy, revolving doors for staff in the different sectors, under funding of oversight agencies, deteriorating agency staff morale with under staffing, and the abandonment of probity as a key prerequisite are all considered as possible explanations for failure.
It is suggested that an excessive focus on process and the appearance of care has contributed to the failure by shifting the focus in the nursing homes away from actual care and by taking carers away from residents in order to fill in forms.
While transparency was a key concept in the proposed system the pressures within the system have ensured that it has been anything but transparent.
Legislation requiring mediation and preventing prompt investigation rendered the complaints system ineffective. Probably as a consequence staff in the government's complaints unit shrunk from action. They minimised the complaints and labelled the complainant so that they could be discounted.
The accreditation system was ineffective. The pages on this web site contain many accounts of continuing failures in care in the nursing homes..
There was extreme reluctance to accept that the system was not working. When those in authority were forced to confront what was happening they attempted to insulate the events by claiming they were isolated and not representative.
Failures were considered as a failure of individuals or specific organizations. They made every effort to avoid any suggestion that the problems were systemic and integral to the patterns of thinking around which the aged care system was structured. (see response to the rape scandal) Even those exposing the problems and advocating change shied away from this.
The response has been to regulate, to detect and to deal with the offenders while maintaining an industry friendly and consultative system. The minister reiterated his faith in the marketplace as the best way of providing aged care.
In this Australia follows the USA. I have suggested than this will do no more than hide the rot in the system by reducing the visible manifestations.
I found it interesting to review some of the correspondence between myself and the aged care minister's department in early 1999. In this I referred to many of the issues that have subsequently been shown to be so important in the failure of the government’s nursing home and regulatory policy. I commented on the impact of these policies on staff motivation and so on care.
At the time I was objecting to the plans of the US giant Sun Healthcare to enter Australian aged care but that is not the interest now as it was discredited, entered bankruptcy and never did so. The interest is the claims made 7 years ago by the department to the effectiveness of the accreditation and complaints system and my responses to those claims. In retrospect I think I was correct.
Click here to read the correspondence
Politicians and industry advocates have insisted that the accreditation system is working, that standards are being improved and that the exposures of multiple instances of failed care are a measure of this success. They have claimed that the instances of neglect, elder abuse and rape are isolated exceptions rather than pointers to serious systemic problems and a deep malaise across the sector.
The nurses, patient advocacy groups and whistle blowers take a very different view and see the system as broken and residents as at high risk. Experience in other health and aged care sectors suggests that these groups perceptions are much more likely to be accurate. Evidence supports them.
I find it worrying that in their eagerness to address the issues advocates have concentrated on more effective oversight processes including complaints mechanisms, frequent spot checks and mandatory reporting of abuse. The focus has been on tightening (patching) a fundamentally flawed system at the expense of the fundamental changes the system needs.
It is not clear to me whether advocates are practising the art of the possible at this time or whether they really believe that a market based aged care system is acceptable and will give the best outcomes. My argument is that it is not acceptable and is most unlikely to serve us well.
I do not think that there can any longer be any serious doubt that the malaise in the system is widespread and that the accreditation system has failed. The glaring examples are pointers to problems across much of the sector. These are concentrated in but not isolated to those sectors which have adopted a strong market focus.
The continued frequent exposure of poor homes shows no signs of abating 8 years after the accreditation system was introduced. There has been a deterioration in the type of scandals. Resident neglect, due to staffing and management deficiencies, in the early years has grown to rape and sexual abuse in 2006 - tragic offences which were not promptly reported. This must reflect a dramatic deterioration in the quality and morale of staff.
Other pages examine the manner in which the aged care marketplace was imposed in Australia and the failures in government when introducing this into nursing homes. This page suggests reasons for the failure of the accreditation and complaints processes.
The failures in the aged care system are multifactorial and different weights are given by people with different perspectives. My argument is that the most important of these is the decision to turn aged care into a competitive marketplace, to drive for profit companies into the sector and to allow them to create the ethos and ambience in the sector.
I argue that real change and a functioning health and aged care system cannot be developed while the sector is dominated by market system thinking and market processes. The two approaches are fundamentally contradictory.
This analysis concentrates on those factors related to the competitive market.
The overall reason for failure of oversight processes in both the USA and Australia has been the disproportionate power and influence of the marketplace when contrasted with that of the regulating agencies and of residents.
The world view of the competitive for profit marketplace is all embracing and self evident for many in society. When it is challenged true believers respond with ridicule and anger.
Accreditation and oversight on the other hand are subjective and uncertain with many ifs and buts. It is more difficult to be certain. In a court of law the certainties of the market are easier to press. Sanctions may be challenged and overturned by the courts.
Convinced of the validity of their perspective corporations challenge aggressively and not infrequently overturn adverse findings. They have access to the best lawyers. Regulators are worn down and become weary. The best and the motivated leave. Apathy prevails. Staff shortages occur, skills decline and regulation becomes ineffective. Consistency is replaced by differing and sometimes conflicting assessments.
In Australia health care companies which have challenged aggressively include Gribbles, Macquarie Health, and Primary Health. Healthscope is now challenging allegations made in Tasmania. In aged care Primelife has litigated aggressively as has the nursing home company owning the Riverside nursing home, and the owner of Belvedere Park and Kenilworth nursing homes.
Credibility is a powerful shield and regulators are hesitant about taking on the rich, the powerful and the friends of their bosses.
Within the system itself there are a number of other factors which contribute to the emasculation of regulation.
Wishful thinking and misconceptions about the nature of aged care and its needs was widespread and is reflected by the aged care minister's (Bronwyn Bishop) views on staffing of homes and her belief that government policy and accreditation was being successful when it had already clearly failed.
For a large number of the other 135,000 people in nursing homes around Australia, the revelations pose the question, How many Riversides are out there?
Feb 2000 Is Riverside an aberration or a symptom?
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All the while Mrs Bishop has trumpeted the triumph of the Government's aged care reforms and the move to better standards in homes these days.
Throwing frail aged to wolves. Daily Telegraph February 28, 2000
The Australian Nursing Federation said the overwhelming evidence of a crisis in residential aged care showed the Government should urgently change the Aged Care Act to restore day-to-day accountability to nursing home proprietors for the provision of quality care.
Feb 2000 The nurses in the homes knew
Nominate Administrator Or Risk Licence, Nursing Home Told Sydney Morning Herald February 28, 2000
A spokeswoman for Mrs Bishop yesterday hit back at criticisms by the Aged Care Standards and Accreditation Agency's general manager, Mr Tim Burn, who said the accreditation process was drastically behind schedule.
Mar 2000 But not the minister
The spokeswoman said that 90per cent of the industry supported the accreditation process and that the other 10 per cent were the "bad apples'' spoiling things for the rest.
New Claims As Aged Care Crisis Widens The Age March 2, 2000
"It's a very, very thorough accreditation system which has never existed before," she (Bishop) said.
Mar 2000 Minister confident in system
Bishop Says System OK. Herald-Sun March 2, 2000
According to Clutterbuck (Australian Nurses Federation), there are now "thousands of people working in the sector who have not had the luxury of training". This raises serious questions about the quality of care.
Mar 2000 middle-aged women providing tender, loving care?
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".
Crimes of neglect. The Australian March 4, 2000
In the USA accreditation has been an industry activity and for companies a marketing opportunity. As a consequence senior staff from the largest corporations have on occasion been directors and funded the agencies. The 1992 US House of Representatives investigation "Profits of Misery" found that the psychiatric accreditation body was founded by the big companies and had directors from these companies. They failed to carry out inspections or to penalise anyone but accredited all of the psychiatric hospitals exposed in the scandals of the early 1990’s.
The Joint Commission for the Accreditation of Health Care Organisations (JCAHCO) is a highly credible US body which now accredits facilities internationally. It has had many failures, been extensively criticised and been forced to revise its processes on a number of occasions. During the psychiatric scandals most if not all of the National Medical Enterprise hospitals that misused patients for profit were accredited by the JCAHO. The policies and practices were spelled out in hospital practice documents they would have seen. They could not have been ignorant. In the second 2002 scandal involving this same company now renamed Tenet Healthcare many hundreds of cardiac patients were harmed even though JCAHO inspections had detected problems in the hospitals concerned.
There are credible claims that instead of investigating the JCAHO sometimes gave the companies the names of those who had complained so that they could be disciplined. Columbia/HCA hospitals scored highly when other investigations showed that they understaffed and simply did not provide less profitable services.
Over the years staff from the health care business sector in the USA have been appointed to senior JCAHO positions in spite of their close links to large corporations with tarnished histories. Representative Pete Stark has documented the JCAHO’s failings and made attempts to legislate in order to make them serve the community rather than the hospitals who pay them for accreditation.
In spite of its failings and its commercial structure the JCAHCO is promoted by the industry and consequently remains highly credible, is admired throughout the world and is used as a role model.
In the USA industry wanted industry controlled accreditation to become an oversight and regulatory body. Even Ronald Reagan shied away from this. Oversight was left to separate state bodies independent of industry. In Australia the Howard government was not constrained in this way and went all the way with the industry.
In the United States, as the Reagan administration cut back on welfare it came under enormous pressure from the healthcare industry to deregulate nursing homes by dismantling inspection in favour of implementing accreditation schemes administered by the Joint Commission on Accreditation of Healthcare Organizations. Accreditation would have replaced public inspection with a form of privatised peer review or self regulation. As tempted as the Reagan administration was by deregulation, public outcry ultimately persuaded them that it would be a mistake.
Aug 2001 Australia has gone further than the USA
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The current Australian government, led by Prime Minister John Howard, is the only example of a simultaneous attempt to cut welfare, encourage rapid growth of private care by large corporate organisations, and deregulate nursing homes.
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001
The Australian aged care accreditation agency was set up as an industry friendly body. Industry input has had a potent influence on its design and its operation. They have been consulted at every point and their acceptance of any changes has been crucial.
Without industry agreement the government would not act and without intense public pressure and adverse publicity the industry would not go along with any restrictions on their freedom to operate as they thought fit.
The response of ministers Bishop and Santoro to the 2000 and 2006 scandals was to seek a probably reluctant industry’s backing for the changes forced on them by the public.
Despite also releasing details of a new industry forum to help the Government develop strategies to improve the quality of care in nursing homes, Mrs Bishop looks set to remain under intense pressure.
Mar 2000 Bishop turns to the industry
New Crisis For Battered Bishop Australian Financial Review March 31, 2000
Senator Santoro said experts from his Aged Care Advisory Committee - largely comprising aged-care providers - were split on the issue of forcing people to report cases of suspected abuse.
Mar 2006 Santoro turns to the industry
Cabinet to consider plan to stamp out elderly abuse Australian Associated Press General News March 14, 2006
State regulators were disbanded after the 1996 federal election. In the USA state regulators have many failings but are separate from accreditation and provide the main and most accurate information about standards and that information is readily accessible. Accreditation information is not relied on by those researching standards of care in the sector.
Additionally, then candidate Howard (he became prime minister in 1996) promised that he would shut down the state run standards monitoring process and replace it with an industry controlled accreditation scheme.
Aug 2001 Shutting down state oversight
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001
The accreditation agency was not set up as a regulatory body but primarily as a body to assist nursing homes to improve standards. There is no problem in a cooperative body assisting nursing homes to improve but it is problematical when that body is also assessing and publishing results into the marketplace. Its positive assessments were used in marketing and this creates a conflict of interest for the agency. It is put under pressure to accredit by its supporters, and is at risk of criticism if it does not.
Manager of Sir James Terrace Retirement Village Brian Amos - one of the villages to recently go through the accreditation process - said his village was now recognised as meeting industry standards.
Oct 2002 Accreditation a PR tool
"From a marketing perspective it's a good PR tool," he said.
"Other villages that are not accredited don't get the prestige and recognition that we get."
Accreditation ensures high quality of care. Sunday Mail October 20, 2002
In Australia the agency was also an assessor of standards, the regulatory body, and the body that imposed penalties. Its ability to regulate and impose sanctions was limited among other things by having to refer such decisions to the industry friendly minister and her department who had the final say.
She (Agency Spokeswoman) said where a published report indicated an unacceptable, critical or serious risk rating for one or more of the 44 expected accreditation outcomes then the agency continued to work with the service until a satisfactory rating was achieved.
Aug 2001 Primarily a support organisation
Ms Vesk said the agency was monitoring the progress of implementation of required improvements at all 46 homes (with problems) through a program of support visits, review audits and spot checks.
"Homes that do not implement the required improvements may have their period of accreditation reduced or revoked altogether," she said.
Ratings under review. Herald-Sun August 20, 2001
The contradictory roles imposed on the agency could only reduce effectiveness and compromise objectives. One of the consequences was the failure to utilise the powers the agency had. By 2000, more than 2 years after the system was introduced, it had never carried out a surprise visit because it considered these unfair for the homes, and it had not closed down a single home.
There is no reason to doubt that the minister, her staff and the agency all identified with the industry friendly role. It was there to help the homes attain standards. They were blind to the social dynamics of the system and all parties subjugated the regulatory and oversight role to the role of accreditation facilitator.
A part of this better standard is a policy of not imposing on nursing homes by paying unannounced inspection visits. This is despite a promise last August by Mrs Bishop that all of the "tools" at her disposal, including surprise visits, would be used to rid the industry of rogue providers.
Feb 2000 No surprise visits
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Despite this pledge, it was revealed that for the past two years the agency had not carried out a single surprise visit in two years.
Throwing frail aged to wolves. Daily Telegraph February 28, 2000
The federal government today admitted it had never used its licensing power to close down substandard nursing homes.
Mar 2000 Never closed a home
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But today she (minister Bishop) said the government was aiming to work with nursing home providers to improve standards, rather than just closing them down."There has not been a home closed by deliberate action," she told ABC Radio.
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"The whole aim of the reforms is to work with providers who are not meeting the best standards that we want to bring them up to that standard
No nursing homes closed down by government, Bishop admits Australian Associated Press March 2, 2000
But general manager of the accreditation agency, Tim Burns, remained defiant, claiming Mrs Bishop declared in February nursing home spot checks were "a last resort". "The reason we chose not to do them ... we felt very much we need to engage the residents and the staff in the audit process and just to turn up on site and barge into somebody's home was not appropriate," he said.
May 2000 Agency's justification
Mr Burns also said the average notice period of up to seven days before an agency inspection did not allow a home time to cover up significant problems. The agency had conducted more than 1300 prearranged monitoring visits to nursing homes as well as 800 visits to determine a home's accreditation over the past 18 months.
"So I think the spot check is a bit of a sideline in that we have been conducting a huge number of visits but we've been giving an average of seven days' notice," Mr Burns said.
Official blast on aged care Courier Mail May 4, 2000
This was an industry friendly body and as one article indicated when assessors from the agency said that things were bad then they really were. There were many critics of the accreditation system but they were discounted and ignored.
Reforms to aged care will fail unless Bronwyn Bishop overcomes her reluctance to properly police them.
Mar 2000 The agency doesn't have the power anyway
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Who is keeping an eye on our parents?Not, it seems, the new industry watchdog, the Aged Care Standards Accreditation Agency; not the nurses union; not the Federal Government; and not one of the numerous industry bodies.
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The Aged Care Standards Accreditation Agency can recommend a reduction or withdrawal of funding or, in extreme cases, the cancelling of a proprietor's service provider licence. But only the Federal Government has the power to impose such sanctions.
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The agency, responsible for overseeing the industry, has attracted criticism for its failure to maintain proper controls through regular monitoring and surprise inspections.
Crimes of neglect. The Australian March 4, 2000
But it is becoming clear that the implementation of the reforms has been flawed. Previously, nursing-home proprietors had to account for every cent given to them in government subsidies for the care of residents and even return the proportion not spent. This was a cumbersome and highly bureaucratic procedure, and was destined to be replaced. But doing away with this so-called acquittal system, as the Howard Government has done, without adequate safeguards or effective complaint mechanisms has put patients at risk.
Mar 2000 Sprucing up the homes before a visit
Now that they are entitled to spend government funds as they wish, a minority of unscrupulous nursing-home proprietors are cost-cutting in crucial areas such as the number of qualified staff, the quality of meals and provisions such as dressings and linen.
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Despite claims by the industry to the contrary, unannounced inspections are a crucial weapon in the war against bad-quality care. Nursing-home proprietors know when members of the Aged Care Standards and Accreditation Industry are coming and can make the necessary preparations.Nurses have told The Australian this week of extra staff suddenly appearing on the roster, of menus being changed from mince to something more nutritious and of outspoken residents being sent on "holiday" to another nursing home during the week of the visit.
We all must nurse some responsibility The Australian March 10, 2000
But frankly, it is the whistleblower nurses and the nursing home ``assessors'' I would pay more attention to. This new monitoring and accreditation system was introduced by the Howard Government in 1997 to please the industry, who loathed the old regime of nitpicking government inspectors. If the new assessors, whose brief is to work co-operatively with proprietors, deem a home ``unacceptable'', or of ``serious risk'', you can believe it.
Mar 2000 If they are found to be bad they are very bad
Be It Ever So Awful: No Place Like Home Sydney Morning Herald March 11, 2000
Mr Thomson (union spokesman) said nursing homes were given about six weeks notice before an inspection, allowing them to clean up before inspectors arrived.
Nov 2003 Six weeks notice of inspection
Dirty secrets of millionaire's nursing home Daily Telegraph November 3, 2003
Aged-care staff claim some homes are bringing in more workers and improving standards ahead of inspections only to revert to poor conditions.
Mar 2004 Still sprucing up the homes in preparation
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Enraged aged-care staff have told the Herald Sun the accreditation system is a farce, with homes hurriedly employing extra staff, changing menus and improving cleaning standards before inspections.
Nursing homes in jeopardy Herald-Sun March 12, 2004
Mrs Horniak was a night supervisor (who resigned from Tricare in disgust) responsible for four personal carers and 70 beds. Accreditation teams inspected the home to test standards, but administrators used the advance notice to create the illusion of quality care.
Sep 2004 A nurses allegations
But when the accreditation team left, it was back to normal.
The home replaced the experienced workers with cheaper agency workers without benefits, she said.
Money matters more, says carer The Courier-Mail September 1, 2004 (NOTE ALL ALLEGATIONS STRENUOUSLY DENIED)
UNETHICAL Queensland nursing homes were easily rorting a system designed to monitor standards of aged care, whistleblower staff and former accreditors claim.
Sep 2004 Carefully planned deception and dishonesty
Nurses at several Queensland homes have told The Courier-Mail that supervisors asked them to change records and claim training they never received to fool teams working for The Aged Care Standards and Accreditation Agency.
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To beat the system, extra equipment and staff are added before visits and supervisors coach staff on answers, and roster off staff that might give negative answers.
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One former nursing home care worker, who asked not be identified for fear of being blacklisted by employers, said The Courier-Mail's story only touched the tip of corruption within the aged care sector.During the accreditation of her home, 10 extra staff were rostered, with extra cleaning duties. Menus were changed and residents received extra baths to impress family members, he said.
But after accreditation, residents were sometimes left in their beds for two weeks at a time, resident belongings were stolen, and staff ignored the buzzers of residents they didn't like.
The nurse, who formerly worked in a NSW prison, said she saw better care for prisoners.
Care system easily rorted The Courier Mail September 2, 2004
The accreditation body like the complaints mechanism was effectively nobbled as a regulatory body by its supportive brief and its regulations.
Additionally, there is no credible hierarchy of sanctions. An effective regulatory regime requires the capacity to move up a pyramid of enforcement sanctions. Draconian sanctions, such as the revocation of a licence, are so hard to impose in practice that they are rarely used. More graduated sanctions that reflect the severity of a problem are needed. For example, suspending government payments for new residents until a problem is solved can be used before suspending payments for all residents.
Aug 2001 Friendly assessments
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In October 1999, the Aged Care Standards and Accreditation Agency quoted the director of nursing in a private home in its newsletter as saying of her accreditation visit: "They gave a lot of positive feedback to the staff [and] they did not make excessive demands!"
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001
Appeal system helps the owners
As indicated this system was set up to help the providers and protect their rights. The rights of the individual operator rather than their probity or the welfare of the residents were protected by the law.
As I have indicated elsewhere there is a divide in perceptions between the aggressive entrepreneurs who seek to exploit a market and those who provide and receive care. The system also selects for the often charismatic but unrealistically self confident so that they are unwilling to acknowledge any failings in their homes and respond aggressively to criticism.
As in the USA these groups challenge the sanctions aggressively through the appeals process. The judiciary is familiar with marketplace perceptions, rather than the complexities of the health and aged care environment. As the owners are plausible in this environment they frequently succeed in overturning sanctions on appeal. This is depressing and demoralising for the regulators and seriously impinges on their willingness to sanction other homes and so protect residents.
A good example of this is Graeme Menere whose companies aggressively and successfully appealed the sanctions imposed on the Kenilworth and Belvedere Park nursing homes through the courts in 2000 and 2001. It was only when the law was changed that he was prevented from managing these homes.
Marnotta was almost successful in appealing the closure of the dangerously substandard Tangerine Lodge in 2003.
Criticism was not encouraged and Non Government Organisations (NGO) that received government money and criticised its policies had to worry about their funding.
Once in government, he (Prime Minister Howard) also ended public funding of the Australian Pensioners' and Superannuants' Federation, which had been the leading advocacy group for improving standards in nursing homes, and cut funding to other nongovernmental organisations in the belief that this would silence criticism of the accreditation scheme.
Aug 2001 Silencing critics
The challenge of regulating care for older people in Australia by John Braithwaite BMJ 2001;323:443-6 ---- 25 AUGUST 2001
Pensioners input into the Minister’s industry consultation process after the Riverside scandal had little chance of being accepted by the market or the minister. Instead the industry came up with a voluntary code of conduct requiring staff to report the abuse of the elderly. Six years later staff were looking the other way while their colleagues raped and sexually abused 90 year old ladies.
"Accountability for the care of residents has been reduced to an almost non-existent level,'' the APSF's (Australian Pensioners' and Superannuants' Federation) president, Ms Edith Morgan, said yesterday.
Apr 2000 Problems a direct result of government policy
"There are basically no strings attached to their $3.5 billion annual taxpayer funding, or on the contributions that the Government requires from residents' pockets,'' she said.
The superannuants group said that while the system was definitely in need of reform, many of the problems being experienced were a direct result of the Federal Government's moves to deregulate the industry.
The action plan, to be presented to the new aged-care industry forum which is expected to meet in the next two weeks, also includes calls for penalties for proprietors who provide sub-standard care, legislative changes to require adequate and appropriate nursing staff, and greater availability of information on the standard of care provided.
Pensioner Plan Advocates Suing Australian Financial Review April 4, 2000
Nursing home staff would have to promptly report adverse events such as falls, injuries, drug mix-ups and significant weight loss suffered by frail elderly residents under a new draft code of conduct developed for the industry.
Oct 2000 A voluntary code of conduct
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The key points of the proposed code of conduct and ethical practice aim to dampen some of the other main concerns of nurses, relatives and others over nursing home care. Some nurses in the industry alleged they had been warned not to complain to health authorities about care standards after the scandal erupted.
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The Australian Nursing Federation's Victorian branch assistant secretary, Hannah Sellers, said an industry code of conduct was an excellent idea but she queried what impact it would have if it was not backed up by law. It would also need to win the support of key players in the industry, such as provider groups, nurses' groups and others, she said."It's not necessarily going to improve those elements of the industry that need to be improved because the honest brokers, the reputable providers, will already be providing acceptable standards of care,'' she said.
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The draft code was developed after Aged Care Minister Bronwyn Bishop set up a forum of industry representatives about seven months ago.
Aged Care Industry Moves To Protect Frail The Age October 17, 2000
General practitioners also went on the attack over aged care today, saying that a voluntary code of practice for nursing homes was not effective.
Nov 2000 Voluntary code not effective - a poor substitute for action
Royal Australian College of General Practitioners (RACGP) president Paul Hemming said the code was a poor substitute for decisive action.
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Dr Hemming said independent watchdogs backed up by financial penalties were needed and that role would most effectively be undertaken by GPs.
Aged care department contradicts minister Australian Associated Press November 22, 2000
The new voluntary code aims to protect the rights of nursing home residents and improve nursing home standards. Under the code, nursing home staff would be encouraged to report any failures in care standards, such as medication mix-ups or significant weight-loss among residents.
Aug 2001 Bishop praises industry
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"This commitment to ethics is a world first, to have the industry be prepared to come in and support ethical behavior not just legal behavior,'' she (Bishop) said. The code's release comes just days after two suburban Melbourne nursing homes drew criticism for care standards.
Bishop Releases Code For Aged Care Standards The Age August 14, 2001
The dilemma in closing down homes
The government’s right to take over a nursing home and to bring in its own administrators and staff to protect the residents was compromised by excessive industry friendliness.
Industry involvement in the policies had ensured that regulations protected the operators commercial rights rather than the wellbeing of the residents. The owner could for example choose the new administrator for their sanctioned homes when this was a requirement.
There was no effective means of mitigating the severe trauma to residents when homes were forcibly closed because it was unsafe for them to operate. The government had provided no other options.
As a consequence some critics pressed for homes to be closed. Others wanted the state to take over and run the homes until new owners were found.
Six Victorian nursing homes are still operating despite being censured by the Federal Government for posing an ``immediate and severe risk'' to the safety, health or wellbeing of their elderly residents.
Jul 2000 Bad homes still operating
Residents `at Risk' In Six Nursing Homes The Age July 29, 2000
"We do not want to see them closed," Senator Lees told reporters in Melbourne.
Jul 2000 Don't close homes, fix them
"What we should be seeing from this government is a flying squad, a pool of qualified people who can simply move in and take over."
Senator Lees said she wanted to see administrators employed until such time as the nursing homes were back providing adequate care to residents.
Don't close homes, fix them - Senator Lees Australian Associated Press July 29, 2000
"The sanctions are failing, poor providers are not being forced to improve their standards or being driven from the industry," Senator Evans said.
Aug 2000 Sanctions failing
Home funds cut off Herald-Sun August 21, 2000
The "relief teams" would take over day-to-day running of the facility in an effort to keep it as a going concern and minimise disruption or the need to move residents to new facilities, it said.
Sep 2000 Another patch to the system
Substandard nursing homes to be taken over under new plans Australian Associated Press September 16, 2000
Government bodies left out in the cold
Even the bodies set up by the government to assist the minister in addressing problems were sidelined and ignored. It should not escape our notice that the two who spoke out and are quoted in the article have a background in the not for profit sector. In the political climate of the time they would be less credible.
AGED-CARE experts appointed by the Federal Government to deal with badly managed nursing homes have been ignored by Aged Care Minister Bronwyn Bishop for the past 18 months. Her own department described the role of the eight regional committees as providing "expert analysis and advice" on how to improve or penalise homes which habitually failed to meet standards.
Apr 2000 Government appointed expert committees ignored
But she has never used these committees to investigate any complaints or allegations of mismanagement.
The chairman of the South Australian committee, Alan Beaton, last night said he had not heard from the department since his appointment two years ago.
He had tried to contact the department by phone and fax three times but had not received an answer.
"There's been no contact of any description, whether written or verbal," said Mr Beaton, who is also chairman of Clayton Church Homes.
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Under the Aged Care Act principles, the Residential Care Standards Review Committees were created to investigate unsatisfactory homes and advise on whether sanctions are necessary.But they have not been used despite the Department of Health and Aged Care applying sanctions on 16 homes since the start of 1999.
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The chairman of the New South Wales committee Noel Howard, who ran nursing home operator Illawarra Retirement Trust for 30 years, was appalled by the situation."The whole thing is extraordinary, to make an appointment under legislation for a two-year period and then just leave me sitting here," Mr Howard said.
"I keep ringing the department and saying, `what's happening?' "
He has been told it is up to Mrs Bishop to decide whether to use the committees.
Mr Beaton said the SA committee had never met.
"If something happened in this state that required intervention by this committee, it would be literally an impossible task because we have not been formed and we've never been briefed on what to do," he said.
Bishop ignored us, say experts on aged Adelaide Advertiser April 6, 2000
The committees are created under the Aged Care Act principles with powers to investigate bad homes and advise on whether sanctions are needed.
Apr 2000 Bishop had promised to use them
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This is despite a pledge in Parliament in August by Mrs Bishop to use all the tools available to her, including spot checks, to get rid of rogue providers.Mr (Noel) Howard accused Mrs Bishop of ignoring her own laws and risking the safety of nursing home residents.
Homes advisers ignored Herald-Sun April 10, 2000
A consistent complaint throughout the accreditaton story, particularly after the failures at Riverside, is that nursing homes with serious problems are treated leniently. It takes many months or years before a home which is a recurrent offender is forced to sell or closed down.
Of particular concern were decisions taken by the agency’s management and/or the health department to overrule both the assessments and the advice of the staff doing the assessments when they advised that a home be sanctioned or closed. This was still happening in 2006. Little wonder the assessors lost heart and enthusiasm.
That residents would suffer if the homes were closed was a convenient justification. It was however no excuse for not setting up an industry unfriendly process to intervene and install government appointed administrators to run the homes until new owners were found.
As the pages describing the governments role in Australian aged care show the accreditation system has failed on multiple occasions and has continued to fail after attempts to patch the glaring problems.
Homes where there was extreme tardiness in acting or where the assessors findings were overruled include.
Homes operated by Milstern, a company owned by the ministers friend. Other homes included Riverside, Belvedere Park and Kenilworth, Tangerine Lodge and Ripplebrook, Emerald Glades, Templestowe Private Nursing Home, St Catherine's Nursing Home, and Albury and District Private Nursing Home.
The nursing home accreditation process in NSW is under scrutiny after a second recommendation that a home lose its accreditation was overturned.
Jul 2001 Assessors overruled
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It follows the recent recommendation to revoke the accreditation of Sydney's Yagoona Nursing Home, which was later overturned.
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The (Albury) home was found to be not complying with State nursing home regulations, Health Department infection control policies, Quality of Care principles, WorkCover requirements, State poison regulations and the Aged Care Act.Despite the bad report, the agency's NSW manager, Mr Rod Bushrod, overturned a recommendation that the home's accreditation be revoked.
Reprieve For Second Aged Care Home Sydney Morning Herald July 4. 2001
The home (Bartonvale Nursing Home) has kept its accreditation despite a recommendation by the assessment team to revoke it.
Jan 2006 Another assessment overturned
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Opposition aged care spokeswoman Jan McLucas said she was concerned the facility failed so badly after passing compliance checks earlier in the year.She questioned whether unannounced spot checks were occurring. "This is exactly what the spot check system was set up for - to ensure that confidence in the provision is maintained," Ms McLucas said.
Residents ignored, left in soiled beds The Advertiser January 7, 2006
The assessment team recommended that the agency revoke the accreditation of the home (Hastings Regional Nursing Home), but instead of closing it down, the Department of Health and Ageing decided to let it operate under sanctions.
Mar 2006 And again
Action on abuse of aged The Age March 30, 2006
As should now be clear the conflict model of market pressures to dysfunction countered by government regulation and oversight has failed. The socialist government run service model when properly funded seems to provide better or equivalent care at less cost. It has not done well partly because of under funding. It has not provided the extras which a wealthier community desires.
What is also clear is that the community is so distracted by the pressures of their own lives, or diverted by other crises created by government that aged care does not rate highly in their lives. Were this not so the government would have been under greater pressure.
It should be obvious by now that I favour the development and exploration of a community driven and focussed paradigm within which to cautiously develop a new community system for vulnerable services - one in which people can "realise themselves" and act out their lives in a more diverse and humanitarian manner.
It would capitalise on the skills of people whose qualities and expertise are wasted because they are unsuited to the market paradigm and cannot bring themselves to operate in that way.
The difficulty today is that the community is so engulfed in their commercial lives that they have little time for the development of the sort of civil society where such a civilising system could flourish.
THE sad situation at the Riverside Nursing Home highlights shortcomings, not only in the monitoring regime for aged care, but in our determination to meet the needs of older Australians.
Mar 2000 All of our responsibility
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Third, we need to re-evaluate funding for aged care and give consideration to returning to a system of funding that ensures adequate levels of trained staff, rather than the proprietors pocketing profits.
Beyond Riverside Herald-Sun March 18, 2000
The accreditation agency in Australia takes on the role of regulator and penalises offenders. In the USA this is done by state regulators responsible to state politicians but the matters are frequently referred to a federal agency which has the power to review and water down fines. There are consequently two layers of politicians who exert influence.
The leaders of the healthcare corporations in the USA are part of the establishment. They can be politicians or relatives of politicians. Many have friendships with politicians. Most donate generously to political parties. Some US critics see this as the prime reason for the failures in oversight.
Regulators in the USA are appointed by the politicians of the day. Corporate leaders in the nursing home chains indignantly go to their political friends when regulators find them wanting. They accuse the regulator of ineptitude, bias or worse and politicians are persuaded. With their jobs at stake regulators learn to look the other way.
In Australia similar associations are common. Both Doug Moran and Paul Ramsay have had a strong political influence on government policy. Minister for aged care Bronwyn Bishop was accused of using her appointee to the agency to influence accreditation. Concerns were expressed about the leniency displayed to homes run by her friend Millie Phillips.
There is a revolving door between politicians and their staffers, the directors and officers of large companies, and the lobbyists who pressure politicians on their behalf. Companies are wealthy and their public relations exercises have a large impact on the way the public and politicians perceive the situation. The minister for Health Dr Wooldridge is now a director of companies. Macquarie Health, Moran Health Care and Mayne Health are revolving door examples which spring to mind
In Australia the accreditation agency was claimed to be an independent organization but some of its officers were appointed from the minister’s close political associates and even her policy adviser, although Bishop eventually decided to make him her chief of staff. It is clear that aged care ministers have imposed their will and their control over the agency. This was particularly evident during Bronwyn Bishop’s tenancy as minister. The favourable treatment afforded the homes owned by a friend, the owner of Milstern, was attributed by some to her influence.
JOHN Howard was last night under pressure to sack Aged Care Minister Bronwyn Bishop over nursing home-related deaths and a growing crisis of confidence in the industry's inspection system.
Jun 2001 Allegations of political interference
The former head of the national nursing home watchdog, Penny Flett, claimed public confidence had been "shattered" in the Aged Care Standard Accreditation Agency because it was unable to do its job independently of government.
"The minister's style is very controlling," Dr Flett said in Perth. "She certainly doesn't step outside the rules and regulations, but the agency is not free to decide how it is going to do things."
Dr Flett's comments came as aged care groups demanded an inquiry into the agency over concerns of political interference.
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The independence of the standards agency is under question, following revelations that John Lang, the 1998 campaign manager for the Aged Care Minister, Bronwyn Bishop, is on the board. The former board chair, Dr Penelope Flett, has also said that the agency was gagged by the minister, and was not independent enough. This might explain the defensive, siege mentality reporters have come to expect of the agency.And this week the Opposition alleged in Parliament that at least one operator, Yagoona's long-time proprietor, Millie Phillips, had received favourable treatment because of her support for the Liberal Party.
Handle With Care Sydney Morning Herald June 23, 2001
Senator Bishop airily dismissed suggestions of a conflict of interest in her appointment of Mr Lang. "The fact that someone is a friend or a political ally of mine should not disqualify them from playing a national leadership role in raising the standard of care provided for older Australians", she declared severely.
Jun 2001 Appointment of Bishop's 1998 Campaign manager
Aged care scandals erupt again The Guardian June 27, 2001
The pool of trained staff of necessity come from the nursing home industry itself and from government departments as these are the people with experience. A revolving door occurs as staff move between government and regulator and between regulator and regulated. (see above extract for appointment of liberal campaign director by Bishop)
Staff who have experience and training as accreditation assessors are a valuable asset for the companies seeking to be accredited and to those seeking to circumvent the process. This is apparent in the US system and is likely in Australia.
The spokeswoman confirmed that Mrs Bishop's policy adviser, Stan Piperoglou, had been appointed to the (agency) job in April but Mrs Bishop decided to retain him as adviser and then appoint him as her chief of staff in December.
Feb 2000 Revolving door between regulator and minister
Kerosene scandal reveals staff crisis in Aged Care Courier Mail February 28, 2000
Mrs Bishop faced further calls for her resignation following revelations that the man appointed to head the aged care and community services section in Melbourne was taken by Mrs Bishop to become her chief of staff.
Feb 2000 This decsion was attacked
No boss for complaints Herald-Sun February 28, 2000
As market thinking and market practices become the norm regulators come to think like the market and adopt market understandings in their decisions. This is particularly well illustrated in Florida (USA) where state regulators condoned and accepted the market justification for simply ejecting frail nursing home residents in need when their funding expired. It required a public outcry and intervention from a federal body before they were charged and penalised. I have already described the Australian accreditation agency’s industry focused approach to spot checks.
A web of friendships and personal contacts develops between the two sides of the oversight process as staff move from one to the other. Loyalties are divided.
Not only can this result in a more friendly and less rigorous oversight process but the nursing homes owned by the largest groups get regular and early warnings of planned visits. Even surprise or random checks are rarely a surprise.
It is clear that some in the agency considered that surprise visits were unfriendly and unfair on the nursing homes. The minister agreed and considered them only a last resort.
What I am saying is that the informal networks of contacts and social networks in the real world we live in works against the effectiveness of formal processes and regulation when there is a lack of congruence. Current thinking ignores these powerful forces and fails to harness them. This is always going to be a problem when the objectives of those working in the system differ from those regulating it.
It is a personal view of mine that the informal structures of friends and contacts in a civil society are far more important in the creation of a successful and functioning society than any amount of regulatory vigour.
Any sort of accreditation and oversight costs money and in a marketplace context this turns out to be far more expensive than anticipated. Market theory claims that the market is self correcting. Politicians and the public have little idea of the resources which are needed to control a system which instead of being self correcting is driven in the opposite direction.
Regulatory funding must compete with other government priorities with far more voter appeal. As a consequence under funding is the norm. The costs of funding oversight are seldom included in the total cost of health care when examining different systems.
It is clear from the reports that under funding of the accreditation and complaints systems has been a problem in Australia.
Nursing homes have only been regularly surveyed and accredited every three years which is no more than a token exercise. Homes were warned well in advance. Bigger commercial groups are able to bring in their teams to beef up staffing and processes so that they rarely fail accreditation.
They big companies may in fact all be as exemplary all the time as their records suggest but we don’t know that. My view is that it is unlikely and if it is then it is unlikely to be sustained when financial pressures mount.
Homes where there are serious problems often go for long periods before further inspections occur.
The Federal Opposition spokesman on aged care, Senator Chris Evans, said Government funding cuts had reduced the number of inspection staff and the standards and accreditation agency was 60 to 65 assessors short in Victoria and New South Wales.
Feb 2000 Agency underfunded
Probe Widened Into Aged Care The Age February 28, 2000
FEDERAL Aged Care Minister Bronwyn Bishop last night defended Howard government aged care reforms, warning the sector would not be getting more funds and the national nursing home watchdog was adequately funded.
Feb 2000 Bishop rejects the agency's claim to under-resourcing
Mrs Bishop was responding to claims by the Aged Care Standards Accreditation Agency that it was swamped with work and struggling to carry out accreditations of nursing homes.
Agency general manager Tim Burns claimed the watchdog faced a shortage of assessors in NSW and Victoria.
Mrs Bishop said the industry could forget about the Government boosting funding, as the system was working well despite concerns over the adequacy of subsidies and the state of some nursing homes.
Bishop dismisses demands for funds. The Australian February 28, 2000
THE (Australian Nurses) federation complains the agency is hopelessly under-resourced for the job. "It's supposed to pick up all the pieces and sort out all the problems, and I don't believe it's designed to do that or has that capacity," says the federation's aged care officer, Jill Clutterbuck.
Mar 2000 Agency not funded or designed for job
Crimes of neglect. The Australian March 4, 2000
THE worst nursing home in NSW has not had a follow-up report for almost half a year, despite being rated completely unacceptable.
Mar 2000 Delays in publishing findings and in follow up visits
The Fairlea Nursing Home, at Penshurst, was given an "unacceptable" rating on all criteria used by the Federal Government's new nursing-homes watchdog after an inspection in July last year.
The agency waited until November last year to report the damning results, and no follow-up report has been published since.
With three "unacceptable" ratings, Fairlea found itself holding the dubious honour of being the worst nursing home in the State.
Waiting for action at our worst aged home Sunday Telegraph March 12, 2000
Most groups attending the meeting also want greater funding for the Aged Care Standards and Accreditation Agency to investigate complaints.
Apr 2000 Calls to fund agency properly
Call to act on aged. Herald-Sun April 17, 2000
NURSING HOMES FUNDING for the nursing home industry watchdog has belatedly been boosted in the wake of the Riverside kerosene bath affair.
May 2000 Bishop bows before the pressure to increase funding
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Mrs Bishop will also provide extra resources for the Department of Health and Aged Care to expand the investigation of complaints through the Government's Complaints Resolution Scheme.
Funding infusion for aged care watchdog The Australian May 10, 2000
ONLY one Queensland nursing home had a full inspection by the Federal Government agency responsible for monitoring standards in aged care facilities before July this year. Figures from the web site of the Aged Care Standards and Accreditation Agency show a total of seven homes were inspected in Queensland between last September and June, which represents only 1.4 percent of facilities. Six months after the kerosene bath scandal in a Melbourne nursing home, the figures throw doubt on the Federal Government's ability to ensure reasonable standards of care in the country's aged care facilities. Despite promises to increase full inspections and surprise visits in nursing homes in the wake of the scandal by the Minister for Families and Aged Care, Bronwyn Bishop, monitoring remains sparse. Figures on unannounced inspections can be supplied only by the agency and were not available yesterday.
Sep 2000 Agency simply not coping with work load
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In New South Wales, only six facilities were visited in the period September to June, five of them in the months following the kerosene baths scandal at the Riverside Nursing Home. In South Australia, a total of three inspections are recorded, or 1 percent of all facilities.
State aged homes miss checks on standards Courier Mail September 16, 2000
Revelations that audits of nine nursing homes had to be done again because the assessors were not registered proved that the accreditation process was under pressure, the federal opposition said today.
Oct 2000 An agency under pressure
Aged Care Minister Bronwyn Bishop told parliament that accreditation audits of the nine homes would be carried out again after it was discovered that the assessors involved were uncertified.
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"Despite the government's predictions that only 33 per cent of facilities would gain three-year accreditation, we now find that 97 per cent are being granted this level of accreditation - with just one per cent failing the government's standards."Every residential aged care service in Australia in receipt of Commonwealth funding must be accredited by January 1, 2001, to continue receiving it.
Aged Care Act breach raises questions about accreditation Australian Associated Press October 10, 2000
Another Queensland home, the Yumba Binda Aged Persons Hostel at Woorabinda, is also listed as facing sanctions over a risk to residents but the website says it has received the full three-year accreditation. Opposition spokesman Chris Evans said the simultaneous three-year accreditation and sanctioning of Yumba Binda emphasised that the agency's left hand did not know what its right hand was doing. "I do not for the life of me understand how a home could be under sanction for posing a serious risk to residents and, at nearly the same time, receive a three-year accreditation," Senator Evans said.
Jan 2001 In disarrray
Aged-care audit net spreads. Courier Mail January 2, 2001
Mr Thomson (Health Services Union of Australia) said budgetary restrictions meant audit teams showed up at nursing homes only once every three years and the heavy use of contractors to perform inspections contributed to huge variations in standards from state to state.
May 2003 Funding and staffing - agency unable to meet its responsibilities
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The finding (by the commonwealth Auditor-General) said budget restraints and a focus on regulation had stopped the agency from meeting its responsibility to educate nursing home managers about quality control.
`At-risk' nursing home to stay open. The Australian May 22, 2003
In a marketplace oversight bodies are at a distinct disadvantage, particularly when the oversight body is designed to be market friendly and when its processes are tightly regulated so reducing its flexibility. These bodies are too often under funded and under resourced.
What they are asked to do is not possible and if they make a serious attempt to do so powerful figures will attack and discredit them to their political masters.
Oversight agencies usually employ salaried lawyers to prosecute offenders. The big companies in contrast can employ the best legal minds. The oversight bodies are outclassed.
Losing appeals in court cases impacts on the accreditation process, on the careers of those who decided to prosecute and on the funding of the agency. A consequence of this is that larger companies and those who are aggressive litigators are less likely to be found wanting and penalised. It becomes a large and very public legal battle. Many entrepreneurs are supremely self confident and seem unable to recognise or confront their failures. They respond aggressively.
Australian examples include the battles between Mayne Nickless and regulators, Macquarie Health and the tax office, Gribbles and the HIC, and Primary Care and the HIC. In aged care the owners of Riverside, Kenilworth and Belvedere Park Nursing Homes as well as Primelife have resorted to appeals and to the courts.
The consequence of the pressures, the difficulties, the political interference and the legal failures is for regulators to become demoralised and apathetic. This leads to unacceptable variation between accreditation teams. (e.g. see Enhance Aged Care)
They hide their inaction and shield behind process. They use the failure of those who complain, and of other agencies, to use defined processes as justification for their refusal to act.
Staff leave. New staff are difficult to recruit particularly at a senior level. Administration becomes sloppy. Homes get plenty of warning and staff get the job done with a minimum of fuss. As a consequence homes which should not be accredited get full marks from disillusioned staff when others would fail them. There is much to suggest that this has happened in Australia.
AGED Care minister Bronwyn Bishop has admitted there is no permanent manager to respond to nursing home complaints in Victoria.
Feb 2000 Complaints mechanism under staffed
The complaint office has not had a permanent head for almost 18 months.
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THE AGENCY monitoring nursing homes, the Aged Care Standards and Accreditation Agency, said it needed 65 more staff to assess nursing homes with only 370 of 3000 homes being assessed so far.
No boss for complaints. Herald-Sun February 28, 2000
A dossier on the New South Wales aged care system detailing two instances of death from morphine overdose was never acted upon because it did not name the sites, Aged Care Minister Bronwyn Bishop said tonight.
Mar 2000 Using process to evade responsibility
The dossier had been compiled by registered nurse Anne Fuller, who sent it to the federal department in June last year, the ABC's 7.30 Report said.
Despite the seriousness of the reports, no one from the departmen rang Ms Fuller, even after the dossier was tabled in federal parliament by the opposition in December, the program revealed.
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"A complaint per se could have gone through the (federal department's) complaints mechanism but you do have to name the facility," Mrs Bishop told the program.Asked why no one in the department rang Ms Fuller, Mrs Bishop replied:
"The important thing was that there wasn't any facility that was identified."
Aged overdose report not acted on in eight months Australian Associated Press March 2, 2000
In the wake of the kerosene baths scandal, an investigation by the Commonwealth Ombudsman has found federal public servants running the scheme were confused and did not know how to deal with complaints. There was little guidance as to when they should be referred for further investigation and incidents of assault and harassment were given as examples of "urgent" complaints but not health care matters. The report also found:
Jul 2000 Complaints system employees confused
- A lack of information on the complaints scheme for the public and poor staff training.
- Poor record-keeping of past complaints.
- A lack of surprise nursing home inspections when serious complaints had been made.
- A potential lack of impartiality in some