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This web page examines the importance of
staffing levels, staffing skills and staff morale,
and their interdependency. It explores the impact
of funding restrictions, profit priorities and
market myths on altruism and staff motivation with
an ultimate impact on the care given. It looks at
the role of the nursing unions and at the
importance of whistle blowing by nurses.
There is one critical determinant of nursing home care and that is nurses with the skills and motivation to provide care. Nurses are also the single major cost for the operator of nursing homes, comprising over 50% of all expenses. Staff numbers and staff skills are consequently the first target of cost cutting and profit taking.
Food, medical consumables, equipment and the state of the physical resources are additional costs which if compromised also impact on care. With the possible exception of food these are not obvious to the relatives of a prospective resident seeking accommodation. The marketing material, the impressiveness of the foyer, and the sales pitch of the homes’ manager and the person at the front desk are only too obvious yet these essentials in the marketplace contribute little to care.
Two financial factors ultimately impact on care, funding and profits. If there is insufficient funding then the staff and resources needed for care will not be there. If a profit is taken then there may not be enough left for care. In a system which is largely dependent on limited funding either from government or the average person’s retirement savings there is seldom money to spare. Some rationing of resources and so indirectly rationing of care is the rule.
If the service is for-profit then that profit must be taken from the money provided for care. Care must be rationed to fund it and those who do this must justify it to themselves and others. This usually means fewer less skilled nurses. Convenient explanations are used to justify this - such as claiming that skilled nurses are unnecessary for the simple tasks required and calling it efficiency.
In addition the ethos, values and norms of those providing care play an important part. The support of the wider community and their identification with the norms and values of care contribute. These are not separate entities. They are heavily influenced by the funding, the marketing, the bureaucracy, the thinking of management, the current political ideology, the community’s world view and any number of other factors in the wider society.
Elsewhere on this web site I have made the point that each of us has to build our lives within the context within which we find ourselves. We can of course walk away and go elsewhere or rebel. We can blow the whistle and if we are not crushed by the pressures and power structures in the prevailing social system we occasionally succeed in radically changing the context. This is exceptional. In practice most of us will acquiesce and identify with the system. Those who identify most strongly, and most readily adopt the justifications for the belief system used (world view), are likely to become leaders. When the measures of success conflict with the desired outcome of the service to be provided then they are likely to be poorly suited for this.
Where the system is incompatible with the requirements of the context as occurs when aged care is provided through market mechanisms, then enthusiastic participants driven by the pressure to succeed will develop rationalisations and justifications which will make it legitimate, even desirable to do things which fly in the face of evidence and of common sense. These myths arise most readily in the minds of those who are not at the coal face and so less confronted by the consequences.
Those who are unable to identify with the system but are forced to remain within it become disillusioned and demoralised. Those who can leave and find work elsewhere.
An excellent example of this is the myth about the sort and quantity of staffing required in aged care.
The elderly currently stay at home much longer than they used to. They are older and sicker than they have ever been by the time they enter nursing homes. Technology increases the complexity of care. To care for this group of elderly residents we need more staff and higher levels of skill than ever before.
Multiple studies have shown and continue to show that the standard of care in nursing homes is closely tied to the number of staff and their training.
It was probably inevitable that businessmen would create and promote the myth that you do not need training to wipe bottoms, feed, lift and hand out pills to people and that employing expensive trained staff was inefficient and wasteful. Politicians struggling to find funds for projects which would ensure their re-election found this rationalisation irresistible.
One of the strongest proponents of this myth was the charismatic and self styled nursing home authority Andrew Turner. He strenuously asserted that there was plenty of fat in the nursing home system including staffing. The market would soon fix all that.
Turner made his fortune and turned his company Sun Healthcare into a market leader by under funding care and by exploiting the vulnerability of the Medicare system in step down care which Sun provided in its nursing homes.
Turner’s charisma is undoubted and there can be little doubt that his claims to be an authority on nursing homes and on step down care had a major influence on political thinking when Sun Healthcare entered Australia in 1998. Dr Wooldridge, the minister for health at the time promised to revolutionise hospital care using step down hospitals.
Within 2 years Turner and his US company dissolved amidst a series of allegations involving poor care in its nursing homes and Medicare fraud. Turner had been discredited by early 2000, and was soon to be forced from his company, which entered bankruptcy. But the irresistible nursing levels myth lingered on. In February 2000 aged care minister Bronwyn Bishop considered that "middle-aged women providing tender, loving care" was all that was required to care for residents.
It was only in 2006 after the rape scandal that the failures in the system and the need for adequately qualified and properly trained staff seems to have been recognised. The response was to throw money at training programs.
There has been even more reluctance than in the USA to address the real problems including staffing levels and deteriorating morale. Competitive market pressures and profit priorities are major contributors to both. The challenge to market ideology and the government’s market supporters is too great. They have chosen to ignore it and the minsiter is once again talking up the market reform myth on which his party's policy is based.
A recent article from Florida in the USA sets out another study confirming the importance of the amount of time nurses need to spend just providing the services needed to limit the incidence of serious life threatening complications. This does not include the time spent talking to and relating to the residents i.e. actually caring for them by taking an interest in their wellbeing.
Why is 2.9 hours per day so important? An eight-year federal study found that below 2.9 hours, most residents "needlessly suffer harm." This means residents aren't fed when they are supposed to be; they aren't turned in their beds often enough to prevent bedsores; or they aren't assisted to the bathroom.
US ARTICLE 2006
For those who are too feeble or impaired to feed themselves, the extra time means someone can spend five minutes helping them eat, provide a simple but desperately needed glass of water, or help them to the bathroom so they don't end up in wet or soiled clothing. For many residents, it is the difference between life and death, pain and comfort, dignity or humiliation.
Still waiting for nursing home staff increase (02/10/06 Orlando Sentinel, FL)
The coalition state government in Victoria lifted all requirements specifying nursing levels in 1995 handing this over to the market. In 1997 the new federal coalition government followed suit deregulating the market across the country.
The problem is not only about profitability. It is also about funding and if there is no funding then cuts must be made. In the face of a funding shortfall management boards even of not for profit operators will usually cut staff rather than more visible costs. They are not at the coal face and do not understand what happens there.
Nurses faced by pressures to downsize and dum down nursing have gone to their unions. The unions were the first to speak out and have continued to do so pressing for change.
The union refused to comment on specific complaints yesterday but warned regulations protecting the standard of care in all nursing homes were being eroded.
Jul 1998 Unions speak out
A union spokeswoman said the key concern was the deregulation of federal funding, which allowed nursing home proprietors to change the mix of skilled and unskilled staff without losing funds.
She said nurses in private aged care facilities, who earned 15 per cent less than their colleagues in the public sector, were being pushed out of the system.
NURSING HOME UNDER FIRE. Herald-Sun July 11, 1998
Australian Nursing Federation federal secretary Jill Iliffe has called for nursing homes to be more accountable over the use of funding. Iliffe claimed on 27 February 2000 that the ruling to allow nursing home proprietors to make their own decisions over expenditure had seen massive cuts in nursing hours and an increase in the number of unqualified staff. She said it was imperative that proprietors were forced to spend the money providing high-standard health care.
Feb 2000 Consequences of deregulation
Nurses demand hospice owners be accountable. The Canberra Times February 28, 2000
"(There are places) where patients can't be toileted because there isn't enough staff, where staff have to lift inappropriately and injure themselves," she (Ms Iliffe from ANF) said.
Mar 2000 Under-staffing
"There's a whole range of things, patients that aren't fed, aren't properly hydrated, people who are restrained because there aren't enough people to monitor their whereabouts."
Nursing Union members to report substandard nursing Australian Associated Press March 1, 2000
The numbers of qualified staff in nursing homes was declining, particularly in Victoria, since the Kennett government removed state regulations in 1995, she said.
Mar 2000 No staffing requirements
"In Victoria at the present time, there is absolutely no legal requirement to employ qualified staff of any kind, or indeed in any number," she said.
Six deaths to be investigated at Riverside nursing home Australian Associated Press March 10, 2000
FORTY residents of a NSW nursing home were put at risk on Friday after being left without nursing staff for an eight-hour night shift, nurses said.
Mar 2000 The church adds its voice
The news came as one of the nation's leading non-profit health providers, Catholic Health Australia, said some homes and hostels were being run without nursing staff because there were no minimum staffing requirements.
Australian Nursing Federation federal secretary Jill Iliffe said the incident had been reported on Saturday after the 40 residents had been left under the supervision of just two carers overnight.
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Catholic Health Australia executive director Francis Sullivan said evidence also suggested several nursing homes and hostels had "no nursing staff at all"."The first thing providers who are doing it tough do is to cut back on nursing hours," he said.
Mr Sullivan said the Government had to ensure the most appropriately trained staff were employed whether that meant personal carers or trained nurses.
"At the moment the sector is insufficiently funded for that to occur," he said.
No nurses for eight hours in aged home The Australian March 13, 2000
Meanwhile, many in the industry are calling on Aged Care Minister Bronwyn Bishop to introduce wholesale changes to nursing home staffing to ensure minimum standards of care following a series of scandals over the treatment of residents.
Mar 2000 Pressing the minister
Nursing home beds a licence for profit. The Australian March 27, 2000
The ANF wants tighter rules on the hiring of qualified staff in nursing homes, guidelines on drug administration and accountability on how proprietors spend government aged care funds.
Apr 2000 Union calls for accountability
Call to act on aged. Herald-Sun April 17, 2000
But Ms Hutchinson (nurse in church owned home who was suspended after criticising) spoke out, agreeing with some of the allegations, and saying the standard of care at the home had declined after staff numbers were reduced in February.
Apr 2000 Nurses speaking out
Nurse says she was sacked for complaints about nursing home. Australian Associated Press April 20, 2000
Unions are concerned the sale (of Moran hospitals to Ramsay or DCA) could become a quality of care issue for nursing home residents.
May 2003 Concern about market practices
"We don't want this to be an opportunity to cut staffing numbers which often happens when people take over businesses," Health Services Union of Australia national secretary Craig Thomson said.
Family values and home truths - Mystery surrounds future of $300m Moran empire. Daily Telegraph May 17, 2003
The Health Services Union of Australia, which covers aged care workers, believes nursing home neglect is the result of poor staffing, with staff unable to guarantee standards because they are struggling to complete essential duties.
May 2003 Staffing problems continue
`At-risk' nursing home to stay open. The Australian May 22, 2003
"Over two-thirds of respondents (a national survey of employees) believe that there is not enough staff at their workplace and almost one in four employees felt there was a danger to their safety simply turning up to work," the survey found.
May 2003 Nursing home staff problems
News - Pay `threat' to aged care. Australian Financial Review May 27, 2003
He (Mr Thomson Health Services Union of Australia) said Australia was one of the few countries in the world that didn't have mandatory staffing levels and the union campaign would also push employers and state governments to introduce minimum staffing levels.
May 2003 pressing for minimum staffing levels
Fed - Union to conduct snap aged care inspections. Australian Associated Press General News May 27, 2003
"It's absolute hypocrisy. It's pathetic," she (whistleblower) said this week. "We are talking about kids 18 or 19 years of age giving out medication. We are talking about heart medication and insulin.
Jan 2004 Deskilling and under-staffing
"Until recently we had one staff member to 78 residents overnight. There has got to be some laws about staff-patient ratios in aged care."
Whistleblower nurse sacked Sunday Herald Sun January 18, 2004
The Australian Nursing Federation said about 28.5 per cent of nurses had left the sector since 1995.
Mar 2004 Staff leaving in droves
"At the moment there is no requirement from the Government to employ a nurse at all in Victoria in aged-care homes," ANF industrial officer Paul Gilbert said.
Nursing homes in jeopardy Herald-Sun March 12, 2004
The Health Services Union says it has won unanimous support from opposition and independent senators for an inquiry into the $5.8 billion aged-care sector that could lead to mandated minimum staffing levels and training.
Mar 2004 Pressing for a senate inquiry into staff levels
But the managing director of one of Australia's largest aged-care companies has criticised the plan as impractical.
A 2003 Australian Institute of Health and Welfare study shows the number of carers for the aged and disabled rose by 44.1 per cent between 1996 and 2001 , but nursing home staff dropped 18.2 per cent .
HSU national secretary Craig Thomson said that since mandatory staff-resident ratios were removed from the 1997 Aged Care Act "it is not uncommon to have one person looking after 70".
"As soon as you have a profit motive then businessmen will try to maximise returns and minimise costs, and unless there are safeguards I don't think anyone can have confidence that costs won't dictate level of care."
Support For Guaranteed Staff Levels In Nursing Homes Australian Financial Review March 15, 2004
The dispute centres on restructuring of the operation which HACSU says will cut up to 16 jobs from the roster _ or 310 hours.
May 2004 Staff cutting at not for profit facilities
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"There is no way you can cut 310 hours per week from the roster and not have a dramatic impact on the quality of care provided to the elderly residents at both homes. It will also create an unsafe work environment for both staff and residents."
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"Eliza Purton is a community based organisation with a volunteer board employing staff from the local area to provide care to the frail elderly within our community."The bottom line is that we cannot continue this community service while operating in the red.
Volunteers to cover aged-home strike action Hobart Mercury May 18, 2004
The union wants minimum staffing levels introduced in nursing homes and a system of accountability to ensure commonwealth subsidies for residents in nursing homes are spent on quality care.
Oct 2004 Ensuring the money goes to care
"We need transparency so relatives and residents have some confidence taxpayers' dollars actually get spent on looking after the elderly. Until these regulations are introduced, then these horror stories will continue to happen," Ms Brownrigg said.
Funding penalty for nursing home The Australian October 9, 2004
The worst staff shortage-related problems in aged care facilities as highlighted in a union submission to a Senate inquiry today:
Apr 2005 Union submission to senate inquiry
* Valencia Nursing Home, WA: Residents washed on alternate days only despite all 45 being incontinent. Care staff too busy to have conversations with residents.
* Kenalla Aged are Facility, Victoria: Some residents were physically and chemically restrained because staff had no time to supervise them. Relatives had to feed some residents because of a lack of staff.
* Sir James Terrace Facility, Queensland: Repeated occasions at the 50-bed facility where only one carer was on duty. One resident received an unnecessary "large skin tear" due to staff "rushing".
* Mount Carmel Hostel, South Australia: Delays in answering call bells. Residents woken at 5am to have their showers because of insufficient staff.
* Armitage Manor, Victoria: One staff member was left alone with 60 residents overnight. Staff could not hear the buzzers of residents when they were working in the laundry, raising safety concerns.
* Elizabeth Lodge, NSW: One recreational officer responsible for the care of 129 residents, including 16 high care residents. Impact of staff shortages included "continence management" problems for residents.
Aged care facilities suffer major staff shortages, union Australian Associated Press General News April 26, 2005
Funding is a major problem in Australia. Caring for people is time intensive and requires dedicated and motivated staff. Typically staff comprise over 50% of costs. Quite apart from the problems which arise from too few cheaper less trained staff there is the problem of morale. Nothing impinges on dedication and motivation more than feeling that your generosity and commitment is being exploited by penny pinching governments with huge surpluses (as in Australia) or by managers of companies earning large bonuses by cutting costs to give investors returns.
Government funding is a concern across all sectors including the not-for-profit sector. Part of this is related to governments’ acceptance of the myth that you don’t need numbers or skills in nursing homes and that cutting costs without breaching accreditation standards is efficiency.
This is a political problem in both socialist and conservative governments, but the latter more readily reduce public funding as this drives citizens into paying for their care so creating an illusion of the competitive market they believe in.
I don’t have a problem with people paying, if they can afford it or if they want more luxury. I do have a problem with what is happening as a consequence of government driving the process as a profitable competitive marketplace. I have a problem with inviting in the share market. In such a system the experience is that the residents will be short changed.
My own view is that whatever system we have, communities should play a pivotal role in running and overseeing the operation of nursing homes in their community. Neither politicians nor market moguls can be trusted to deliver the care the community expects.
The community needs to place itself in a position where it has the muscle to ensure that funding is fair in the light of what the country can afford and what the community is prepared to contribute. It also needs to be in a position where it not only knows but sees what is happening in the local nursing homes so that it can balance funding and care. Organisational structures in the community are needed to accomplish this.
The problem with all the opinions expressed in the press is that all parties are playing games to get more money, some to provide better care, others to get bigger profits. What is clear is that the minister in 2000, Bronwyn Bishop believed that nursing homes could be run on a shoestring. She was wrong and many hundreds if not thousands have suffered poor care and probably earlier deaths because of it. As revealed on the pages describing the government’s role the situation has improved only slightly since.
To Lynn (a Riverside resident’s relative), the main concern within the aged-care system is a lack of money, which manifests itself in low wages and inferior quality staff.
Feb 2000 A Riverside relative sums it up
``It's my understanding that, within aged care, the nursing staff aren't paid highly and it's very hard to attract staff,'' she said. ``And I think that's something the minister needs to look at because if we are not going to care for our elderly in an appropriate way, and make the environment such that it attracts qualified staff, then it is an indictment of our society.''
Angry Families Ask: How Could This Happen? The Age February 26, 2000
Nursing homes are facing a funding crisis that threatens their ability to provide quality care, industry representatives claim.
Feb 2000 The industry complains but Bishop rejects them
They say the general standard of care is likely to get worse rather than better unless the Federal Government changes its policy.
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But they warned that while most nursing-home operators and staff were committed to high standards, the future of aged care looked grim.The president of the Australian Nursing Homes and Extended Care Association, Mr Brian Fitzpatrick, said: ``Unless something's done about (funding), we're going to end up with unregulated, untrained staff running our facilities because we won't be able to afford registered nurses.''
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Ms Lyster said nursing home professionals were frustrated by the Federal Government's refusal to adopt recommendations in a Productivity Commission report issued last year, which found that the manner of calculating subsidies was inappropriate.The Minister for Aged Care, Mrs Bronwyn Bishop, yesterday rejected criticism of the level of Government assistance and said the coalition had injected an extra $148million into aged care in response to the commission's findings.
Homes Warn Of Care Crisis Sunday Age February 27, 2000
The NSW College of Nursing, however, yesterday reiterated its concern that nurses would be unable to guarantee that residents in aged-care facilities would receive the standard of care they require.
Mar 2000 Declining numbers of professional nurses
``We are witnessing a decline in the numbers of professional nursing staff and the results of inadequate funding to address the quality of care issues,'' the College of Nursing's executive director, Professor Judy Lumby, said yesterday.
The college's call for an immediate funds injection into the sector was backed by Catholic Health Australia, which also moved to step up pressure on the Government to address the problem of funding indexation.
Bishop Denies Aged-care Crisis Amid Rising Fury Australian Financial Review March 1, 2000
Key problems in Australian nursing homes are the number of staff, the level of skills and the motivation of staff. Salaries, working conditions as well as altruism are key factors for staff providing humanitarian services. Paid nursing carers may put up with poor salaries and working conditions when their dedication and altruism is valued. When these are no longer valued and play second fiddle to profitability, cost cutting and efficiency staff become distressed and will not tolerate it any longer.
Skilled nurses have been undervalued and have left the sector in droves. They have been replaced by unskilled people off the street - the sort of people which politicians felt could adequately wash, lift and feed. Although there were clear warnings a low priority was given to training.
Training for staff is essential. Staff turnover is high. Basic medical, dementia and nursing knowledge of unqualified workers is low. Continuing training is a key to good care. Previous initiatives included the training guarantee levy, and the Residential Care Training Initiative, which has received no government funding since the new act in 1997. A concerted, continuing, compulsory education program is required.
Mar 2000 Need for training
The Aged Need More Care Sydney Morning Herald March 10, 2000 BY Professor Henry Brodaty who is Professor of Psychogeriatrics At The University of NSW. Lewis Kaplan is chief executive of the Alzheimer's association NSW.
While increasing salaries and training improves the situation and may hold more staff this does not address the problem of morale created by the marketplace context. (see section in Riverside page)
It took 10 years for the message about staffing to sink in and even a senate inquiry was ignored. Only when the elderly were raped did a new minister devote funds to training the staff better. Little if anything has been done about working conditions or the destruction of motivating forces in the system.
US governments are slowly responding to public pressure to impose minimal staffing levels. In Australia, July Bishop, the minister in 2004 was still describing this as "a union wish list".
The chief executive officer of Aged and Community Services Australia, Ms Maureen Lyster, warned that the value of the Federal Government subsidy "is going to fall over the next three years, and there's a real question in the minds of a lot of providers as to how they're going to meet things like increasing WorkCover costs and increasing nurses' pay rates ...''
Feb 2000 Everyone is telling a deaf government
The chief executive of the Victorian Association of Health and Extended Care, Ms Mary Barry, said a shortage of nurses, and wage discrepancies, exacerbated the problem by forcing homes to use personal care assistants "to perform tasks that perhaps would be better done by trained nurses''.
Homes Warn Of Care Crisis Sunday Age February 27, 2000
But complaints about substandard care keep pouring into the Federal Department of Health and Aged Care 4,000 in about two years and to the Australian Nursing Federation. The federation believes the reforms have made it easier for unscrupulous operators: "Nurses say they can't look after people properly, there is not the staff; they don't have time to feed residents or supervise recreational activities,'' says Jill Iliffe, the federal secretary of the Australian Nursing Federation.
Mar 2000 Worsening staff shortages
"People have to be restrained in chairs because of staff shortages, nurses don't have the equipment to lift residents, or enough bed linen. And just yesterday, we were informed that a nurse who complained to the proprietor of a lack of face washers was told to cut them in half.''
Part of the problem is the lack of spot checks on nursing homes under the new system and there is also a serious shortage of nurses. As well, the perennial question of how much money is enough for nursing homes is raised in defence of cost-cutting proprietors. Mrs Bishop notes the Government has spent $1 billion more than Labor did in its last budget.
Golden Oldies Sydney Morning Herald March 2, 2000
Mrs Christie (Wallgrove Nursing Home's director of nursing) said aged care nurses were also paid poorly. According to the NSW Nurse Association, aged care nurses are paid three per cent less than their public sector colleagues.
Nov 2002 Nurses still underpaid
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"We love our work as nurses, but the conditions need to change to ensure our frail aged residents receive quality care."
Pink staff sees red. Canterbury Express November 19, 2002
More than half of 3000 nursing home staff surveyed by the union said they did not have the time to manage incontinence or skin infections, a claim repeated in audit reports prepared by the Government's accreditation agency.
May 2003 No time to care
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The Howard Government's nursing home policies will come under further attack today when an Access Economics report on the looming Alzheimer's epidemic castigates financial constraints that have led to corner-cutting and compromised standards of care.
Elderly at risk in failing aged care. The Australian May 27, 2003
There has been a mass exodus of trained nurses from aged care, leaving inexperienced workers to care for the elderly.
Jan 2004 Deskilling
The latest figures show the number of nurses specialising in geriatrics and gerontology fell by 8.7 per cent in the four years from 1997 to 2001. Untrained workers in aged care outnumber professionals by about five to one.
The number of nurses in the fields of intensive care, casualty and surgery recovery increased by 20 per cent in the same period.
The national secretary of the Health Services Union, Craig Thomson, said the elderly were at serious risk because university-educated nurses were given no incentive to work in aged care.
"Why is it that you can earn more for emptying garbage or serving fast food than caring for the most elderly, vulnerable members of the community?" Mr Thomson said.
"For one personal carer to be left overnight caring for 70 residents is, unfortunately, not unusual."
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A report by the agency found that residents (in Kaniva Hostel) were asked to bring their own bedding and furniture. However, primitive working conditions were the main concern.
Breaches endanger elderly Herald-Sun January 6, 2004
THE nation's elderly are being put at risk by inexperienced nursing home carers whose pay and qualifications are the same as fast-food workers.
Jan 2004 Inexperienced staff as trained nurses leave in droves
An investigation into the aged care industry by The Daily Telegraph has found that trained nurses are leaving the industry in droves, while untrained and low-paid staff are stepping in to fill the positions.
Commonwealth nursing home inspectors have found NSW nursing home residents and staff in appalling conditions.
In the worst cases, staff members:
* CONTRACTED the deadly staph virus at a Hunter Valley nursing home because of poor hygiene;
* WATCHED in horror as maggots crawled across the floor in the kitchen of the Collaroy Nursing Home at Narrabeen; and
* WERE forced to juggle cooking, cleaning, and caring for up to 70 residents on their own.
Most aged care workers earn just $13 or $14 an hour, despite many having to care for about 60 or 70 residents a night.
Fast food giant McDonalds pays its workers over 21 years of age $13.89 an hour.
There has been a mass exodus of trained nurses from the aged care sector in recent years, leaving inexperienced workers to look after the elderly.
The latest figures show the number of nurses specialising in geriatrics and gerontology fell by 8.7 per cent in the four years from 1997 to 2001. Untrained aged care workers now outnumber the professionals by about five to one.
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"It is just not acceptable that personal carers are paid so little to do such an important job and offered, in many cases, inappropriate training and no proper career path."The federal Aged Care Standards and Accreditation Standards Agency imposed sanctions on the Albury and District Nursing Home in Albury (see separate page) for endangering residents safety because of poor staff training.
Untrained caring for aged - Nursing home safety fears grow Daily Telegraph January 6, 2004
In large part it is because of a lack of minimum standards of qualification, pay and staffing covering those we trust to look after the vulnerable.
Jan 2004 Lack of minimum standards
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Too often it is because costs are kept to a minimum by pay rates of $13 an hour, no better than fast-food workers, and poor working conditions. This will not attract qualified nurses, leaving staff with minimal qualification to dispense medicines and care for elderly residents
Opinion Herald Sun Editorial January 8, 2004
LABOR'S plan to introduce minimum staff numbers in all Australian nursing homes was a union wish list that would never work, federal Minister for Ageing Julie Bishop said yesterday.
Jan 2004 Minimum staff numbers a wish list
Libs hit plan to boost nursing Herald-Sun January 9, 2004
The nurses have pushed strongly for salary increases and it is an important factor in addressing the problems. While government has given salary increases to the nurses it has employed, it is far from clear whether payment to private operators of nursing homes have been increased to permit similar increases. Nursing home operators, particularly the for profit sector strongly assert not.
It is difficult to assess the extent to which this is valid or simply a business ploy to secure more money to increase profit.
Aged-care nurses are pushing for a 27 per cent pay rise, threatening Australia's aged-care sector and potentially the $300 million sale of Moran Health Care group assets.
May 2003 Battle for wage increase
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The wage case is before the Industrial Relations Commission, which late last year awarded NSW's 35,000 public sector nurses a 15.75 per cent pay rise.The Health Services Union of Australia increased pressure for the wage claim yesterday by releasing a national survey of more than 3000 of its members that showed that nine out of 10 employees were prepared to "support a campaign" over aged-care staffing.
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Mr Moran, said he was "appalled" at the pay discrepancies between public sector and private sector aged-care nurses. Public sector nurses are paid 25 per cent more than private sector nurses under the award."[But] if we paid the public sector award, the aged-care sector would be broke overnight," Mr Moran said.
Moran could not increase salaries "because all aged care is directly linked to Commonwealth funding", Mr Moran said, adding that the unions should push the federal government.
News - Pay `threat' to aged care. Australian Financial Review May 27, 2003
Rising wage costs, high overheads and a multi-million dollar bill for upgrades would send a number of struggling nursing home operators to the wall, a peak industry body has predicted.
Jan 2004 Homes under pressure because of funding deficit
Aged Care Association of Victoria chief executive Meigan Lefebure said nursing homes had been hit with a 28 per cent wage rise over the past seven years, while Federal Government subsidies had increased just 10 per cent.
"In relative terms we've gone backwards," Ms Lefebure said.
Breaches endanger elderly Herald-Sun January 6, 2004
One of the problems with deregulating an industry is that government can no longer regulate and require that services are provided in a certain way, or that money provided by government goes to where it was intended.
Government may wish to fund staffing but there is no way in which it can insist that the money it has provided will be spent in that way. In support of their ideology they have revoked their own power and delegated this to the market, a market whose prime concern is to keep costs down and increase profits. Increasing staff salaries pushes up costs and decreases profits.
One of the complaints in the USA was that when additional funding was given specifically for staffing, for-profit corporations did not use it for that purpose. Market operators are there to make money. Quite rightly they can decide who they employ and how they will spend their money. The problem is not the market but the applicability of a market system to aged care.
IT should be of no surprise that the incident at the Riverside Nursing Home has happened. Why? The Howard Government has been deregulating this industry by stealth in response to the long-term aim of private providers calling for self-regulation. It should be noted that subsidies for these "private" nursing homes come from public funds through government grants and, more recently, from the residents themselves.
Mar 2000 Deregulation, care and Riverside
The Union of Australian Women has observed great changes in the daily care of residents of nursing homes in recent years. For example, the instability caused by the loss of professional staff familiar with medical procedures and basic healthcare needs of the aged.
Previously, the funding for nursing homes was split between two components, funded separately: funding for care, and funding for food and maintenance. Under the Howard Government that division has disappeared. Now there is no legislative accountability for these two aspects of care except through the complaints mechanism within the department.
Aged care deregulation by stealth The Australian March 8, 2000 Letter EDITH MORGAN Union of Australian Women Melbourne
"Also under the current legislation a proprietor does not have to account for any money that is received from the Government as having been spent on staff," she said.
Jun 2003 No accountability
Tighter controls needed in aged care - Nursing Federation. Australian Broadcasting Corporation (ABC) News June 6, 2003
There is a stark divide between the perspectives of company boards, managers and politicians on one hand and of the nurses who care on the other.
Demand for aged-care facilities is soaring as the population gets older, guaranteeing growth for the companies involved. But it doesn't follow that they will be profitable.
Aug 2004 More intereted in profits than altruism
Therese Watt has been a nurse for 30 years, the last four in a 135-bed aged-care hostel in Sydney called Woodberry Village. She is the first to admit there are mundane, unglamorous, even unappealing aspects to her work dealing with residents suffering incontinence, aggression or dementia but she loves her job.
"Anyone employed in aged care does it because they enjoy it you don't do it for the money," Watt says. "The elderly have so much life experience and joy to share just a smile or a laugh from them outweighs the unattractive stuff."
Unfortunately, the corporate sector doesn't see it the same way. Companies with an eye on Australia's ageing baby boomers the greying motherlode in the potential aged-care goldmine are more interested in profits than altruism.
The boom in retirement villages Australian Financial Review August 7, 2004
The nurses experience of what is happening is described on several pages on the Aged Care Crisis Web Site. Some nurses and nurse aids have given vent to their frustration by writing about it. Joanne Bryant in a piece, on the Aged Care Crisis web site, entitled The Truth Behind Aged Care writes of her experiences coming back to nursing after many years and going into an aged care system dominated by "greed based management". She writes of the disillusionment, yet dedication of staff.
This disillusionment and frustration is particularly well illustrated by a satirical piece describing commercially focussed nursing homes as people farms. It was written by an experienced nurse aid who for obvious reasons must remain nameless.
Click Here to read "People Farming in Australia"
As I have indicated elsewhere on these pages a dysfunctional market system selects for the sort of people who will do what is required of them to make money regardless of the human consequences. It then promotes them. The most glaring example of this is the US company Tenet Healthcare which promoted and supported staff who would exploit and misuse children for profit and 10 years later supported and promoted a poorly trained doctor doing unnecessary heart surgery.
Exactly the same sort of thing can be seen in Australian aged care. Nurses who will pressure staff into doing what management requires are promoted into senior positions. Some lack human skills and humanitarian motivation, are bullies and are ruthless and uncaring. Bullying and intimidation have been ongoing and recurrent complaints. Quite obviously these nurse managers are not going to employ nurses who buck the system and challenge what is happening.
There are many extracts in the pages on this site describing the experiences of nurses.
Riverside, where staff were bullied into giving kerosene baths was a good example. A nurse who worked there briefly explains.
Adelaide Ericksen, a registered nurse who was assigned casual shifts at Riverside through a nursing agency, said the home was "old, damp and dirty" and nurses worked in a climate of fear.
Mar 2000 intimidation and bullying
"The nurses there were terrified Ms, Ericksen said yesterday. "The morale there was terrible."
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She told The Australian she had been disturbed by the overcrowding of residents in one small day room and the sense of panic among patients that they might not receive their medication.
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But what most dismayed her was an incident where a patient almost choked to death after eating a pancake in an unsupervised room.
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Ms Ericksen revived the woman after she was brought to her "blue and limp" by two junior nurses.But she was then forbidden from administering oxygen to the patient - standard medical procedure following asphyxiation - by a senior nursing staff member.
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"While I was waiting, one nurse came up to me and seemed absolutely terrified and asked me not to make her (the senior nurse) angry."While Ms Ericksen subsequently submitted a written complaint detailing the fact that the patient had been denied oxygen, she was unaware if any action was taken.
"It was dreadful, disgusting," she said. "I felt sorry for the patients but I just won't go back. I'll never go back to any nursing home again."
Riverside choke case denied oxygen - nurse. The Australian March 1, 2000
THE nursing home scandal has been re-ignited in Brisbane with claims residents in a northside home spend hours on the floor after falling out of bed because no nurses work the night shift. One resident was found at 5am in a pool of blood after falling and hitting her head during the night, and another died several days after a similar fall from delayed shock, staff say. The nursing home is awaiting full accreditation from the Federal Government's new aged care accreditation agency. But complaints over staff levels were made last year to the Government's complaints resolution scheme and Opposition checks show the facility received no "surprise visits" from the Government's standards monitoring unit in the past three years.
Sep 2000 Nurses experiences
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The alarming claims concerning the Brisbane home were made on Tuesday in the Queensland Industrial Commission by an enrolled nurse who has worked at the home for 10 years. She said they were not isolated incidents. The commission is hearing an application from the Queensland Nurses Union for more qualified nursing staff in aged care facilities around the state.Teresa Adams, an enrolled nurse with 33 years' experience, described workloads at the home as unsustainable and intolerable. The commission has banned the publication of the nursing home's name after representatives of nursing home operators and the Australian Workers Union argued it was not in the public interest. The unusual action has been challenged by the Queensland Nurses Union, which claims the suppression order was favoured by the operators because identification would prove "embarrassing" and that naming the nursing home was in the public interest.
Lonely wait for patients - Nightly neglect of elderly Courier Mail September 15, 2000
The threat comes as staff at some homes claim elderly residents are living in substandard conditions.
Jan 2004 A disintegrating system
Authorities have threatened to close up to 30 Victorian homes in the past four years.
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CLAIMS that lives are put at risk with untrained staff performing the tasks of nurses, including dispensing medicine.
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DOCTORS and nurses abandoning the system.
Breaches endanger elderly Herald-Sun January 6, 2004
ONE fifth of an aged-care nurse's time is spent on administration, depriving north Brisbane's elderly of extra care. Jim Toohey, chief executive officer of Tricare, which has aged-care facilities at Aspley, Stafford and Chermside, said documentation overkill needed addressing immediately."I would estimate 20 per cent of a registered nurse's time is spent telling us what they are doing (through accreditation documentation),'' Mr Toohey said.
Sep 2004 Excess paperwork and process take staff away from care
Aged Care Queensland chief executive officer David Angell said few people would support the imposition of unnecessary paperwork and administrative requirements that diverted the time of nursing staff from care. "Yet in every residential aged-care facility and community care service across Queensland, valuable resources are being devoured meeting burdensome requirements and wading through complex mazes of programs, funding rules and duplications,'' Mr Angell said. "The industry strongly supports the need for appropriate regulation to protect the interests of those being cared for.''
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An Opposition spokeswoman said relieving the paperwork burden on nurses was a top priority. "There are better ways to regulate aged-care facilities without endless hours of paperwork,'' the spokeswoman said. "We also want to see minimum staffing levels, not rigid staff-resident ratios.''
Paperwork diverts nurses Northside Chronicle September 22, 2004
AGED CARE WORKER: In the facility, in this particular facility, it was starting to happen before I left more and more and you feel you have - you can't do anything. You have no recourse to say anything. Because if you do say anything, you are then bullied by management, from right up, the head office right the way down. You have no recourse. There is nowhere - you put in reports and say that this is happening. Nothing is ever done. It disappears never to be seen again.
Feb 2006 A lack of care
REPORTER: What's the key problem in the facilities?
AGED CARE WORKER: The lack of care, care encompasses a lot. Care of staff, care of residents, care of property, that a company that prides itself on caring for people and valuing people is not. These people, these residents deserve better than what they are getting and to be put to bed early for no reason - when I mean early, five o'clock in the afternoon, laying in bed all night, not moving literally.
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REPORTER: Why do they have to go to bed so early?AGED CARE WORKER: They don't, but so the staff don't have to care for them.
Allegations of abuse at aged care facility Lateline ABC TV February 20, 2006
HSU state secretary Jeff Jackson said bullying, intimidation and abuse of aged care workers meant that carers were often terrified of reporting.
Feb 2006 Bullying and intimidating
New laws loom on nursing home rape The Age February 22, 2006
Dysfunctional staffing, bullying, disillusionment and apathy in this market system have reached the stage in Australia where staff caring for residents can watch one of their charges being raped and do nothing about it. A nurse manager also did not see it as her role to report incidents of sexual abuse. These are not isolated disturbed people but a system in serious decay, and a culture of care in disarray.
I am reminded of the dissolution of the hierarchical African culture under the destructive effects of western civilisation and then apartheid. The loss of the emotional community controls exerted by the values and norms of that society resulted in increased random violence, rape and the sexual abuse of children.
MARGOT O'NEILL (daughter): Even more shocking, the witness did not report the alleged assault (rape of 90 year old) for about two months, and Anna's family wants to know why.
Feb 2006 Rape not reported
Claims of sexual abuse at Vic nursing home Lateline ABC TV February 20, 2006
Individual nurses may be admired and highly regarded by those they care for but they have little power. In the sort of situation we have in aged care they turn to their unions, the only body giving them some power.
In a society dominated by economic rationalist thinking unions are seen as part of the loony left, self interested and out of touch with the realities of economic life. They have little credibility and can be ignored.
In the USA and in Australia the unions have been the organizations that have most consistently stood up to the political and market powers. They have pressed the financial interest of their members but have also exposed what is happening in health and aged care, and advocated more sensible policies.
Even though the weight of events and evidence has validated their position and forced change this has done little to improve their credibility in the eyes of the ideologically persuaded.
The unions used the February 2000 Riverside scandal to drive the issues but with little success.
The Australian Nursing Federation federal office said aged care laws were in need of major surgery and called for an immediate Senate inquiry into the incident. ANF federal secretary Jill Iliffe said accountability for conditions had been seriously compromised when the new laws downgraded the role of registered and enrolled nurses who work in nursing homes. "On the basis of removing business red tape, the Federal Government has put elderly Australians at risk," she said.
Feb 2000 calling for a senate inquiry
Bishop silent on delay over aged-care scandal Courier Mail February 26, 2000
The Australian Nursing Federation last night said the Government must change the Aged Care Act to restore day-to-day accountability at nursing homes.
Feb 2000 Must change the act
The federation's federal secretary, Ms Jill Iliffe, said existing rules allowed nursing home proprietors to make their own decisions about expenditure. The only formal accountability was an occasional inspection for accreditation purposes. ``This has led to massive cuts in nursing hours, the employment of more unlicensed staff and the redirection of care funds to goodness knows where,'' she said.
Probe Widened Into Aged Care The Age February 28, 2000
"The (monitoring) system that the government put in place in October `97 just isn't working," federation federal secretary Jill Iliffe told ABC Radio today.
Mar 2000 Accreditation system faulty
"You can't rely on accreditation every three years to keep substandard nursing homes and aged care facilities up to scratch.
"You need more than that."
Ms Iliffe said the Riverside facility was not the only one where standards were being let slip.
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Ms Iliffe said the Aged Care Standards and Acredition Agency did not have the resources to investigate allegations of substandard care, so the federation had asked its members in all states and territories to report them.
Nursing Union members to report substandard nursing Australian Associated Press March 1, 2000
AGED care workers have called on the Federal Government to set employee quotas to force nursing home operators to hire more staff.
Jun 2002 Pressing for staffing and other reforms
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Health Services Union state president Jeff Jackson said Victorian nursing homes were in crisis."Our people try their hardest but quite simply, there's not enough hands to do the work," Mr Jackson said.
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These included minimum qualifications for personal care workers, relaxation of task restrictions for division two nurses and a new system to reduce paperwork in nursing homes.
Staff demand for homes. Herald-Sun June 25, 2002
Health Services Union of Australia (HSUA) national secretary Craig Thomson said the union was not satisfied the federal government was doing an adequate job of maintaining aged care standards.
May 2003 Another campaign about standards
"Last week we broke the story in NSW about the Collaroy Nursing Home which had maggots crawling across the floor of the staffroom, had four scabies outbreaks in three years and had staph infections" Mr Thomson said.
"That is a nursing home that passed accreditation. That is the reason why we are embarking on this campaign."
Fed - Union to conduct snap aged care inspections. Australian Associated Press General News May 27, 2003
" Assistant secretary Jan Brownrigg said the Tangerine Lodge debacle had occurred because there were no regulations in place to compel aged-care proprietors to provide safe levels of care.
Jun 2003 Using Tangerine scandal to emphasise importance of staffing
As a very basic minimum and as a matter of urgency the federal government must legislate to compel aged-care proprietors to employ appropriate numbers of registered qualified nurses 24 hours a day," she said.
Ms Brownrigg also said the federal government should reinstate the legislative requirement for aged-care providers to account for the money they spend on nursing care.
Union seeks security for Tangerine jobs Australian Associated Press General News June 6, 2003
In a functioning system where the objectives of the system and the primary focus of those in positions of power coincide the exposure of problems is more likely to be welcomed and corrective action taken. When the objectives of the system and its primary focus are in conflict as in an aged care market then the exposure of failures in meeting humanitarian objectives becomes a threat and a challenge to those who have built their lives using a conflicting paradigm. The response is very different.
One of the most important lessons from the USA is that regulatory oversight and on site inspections are singularly ineffective. Regulators are seldom there when they are needed and fail to identify what is happening. Detection and prosecution of problems is largely dependent on whistle blowers. The reason why so much fraud is exposed in the USA is because their whistle blowers get much more protection. The Qui Tam laws provide them with a vehicle for action and their efforts are rewarded and recognised.
In Australia a once every three years inspection by the accreditation agency was not designed to work and in spite of all the hype we should not expect this. Whistle blowing in Australia is very different. Whistle blowers are discouraged by a secretive government and have to endure all of the criticism, intimidation (eg Milstern) and economic privations to which they are subjected without any hope of recognition and reward, and often with little hope of success. It is remarkable that so many continue to speak out.
Governments continue to pretend that legislation to protect whistle blowers and handle complaints aggressively would result in a flood of vindictive and unsubstantiated complaints. Experience shows that this is not so as a majority of those who complain have solid reasons for this.
In health and aged care nurses have the least stake in the system whether they are employed by the market or by government . They consequently identify less with management’s objectives and are not bound to its thinking. They are closest to the coalface and the patients so most traumatised by what happens there. The important part they play in exposing problems is well illustrated by the exposure of poor care in hospitals in NSW and Queensland hospitals over the last few years.
In aged care it is the nurses who have spoken out about what is happening. The recurrent scandals in nursing homes have been because nurses or the relatives of patients have acted to expose the failures. In most instances nurses have been fired. Even when they have been vindicated they have lost their jobs when the homes were closed. Riverside is a classical example. Without them this scandal would not have happened.
Nurses who have blown the whistle are much less likely to be employed by other homes. There is very little incentive for others to speak out. In most nursing homes there are only a small number of staff and it is usually obvious who has spoken out. They can be victimised.
The not for profit sector is caught up in the competitive market system and responds similarly. One home fired a nurse who had been with them for 5 years when she responded to an invitation to comment by doing so. When 8 nurses lodged a complaint about the dreadful conditions at Emerald Glades Nursing Home they were all fired. I do not know what happened to them after they were vindicated.
A nurse believes she was sacked today for criticising conditions at the church-owned nursing home where she worked.
Apr 2000 Nurse at not for profit home sacked
Mary Hutchinson was suspended from duties on March 10 after having been a registered nurse at the Church Nursing Home, run by Baptist Community Care in Brunswick, since 1995.
A day earlier, senior management at the home invited staff to comment on an article in The Age which alleged the home had holes in its walls and that residents were left wet in their beds for hours because of staff shortages.
The home denied the newspaper allegations.
But Ms Hutchinson spoke out, agreeing with some of the allegations, and saying the standard of care at the home had declined after staff numbers were reduced in February.
The following day she was suspended.
After a series of letters between the Australian Nursing Federation (ANF), on Ms Hutchinson's behalf, and Baptist Community Care, Ms Hutchinson was sacked at a meeting today.
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"You could not not complain," she said."I have a duty of care to meet ... if anything was to happen (to the patients) we'd be the first ones to get the blame."
Nurse says she was sacked for complaints about nursing home. Australian Associated Press April 20, 2000
The breach of medication management guidelines was uncovered two weeks ago at the Girrawheen Community Hostel in the beachside suburb of Brighton, after a complaint was made to the Department of Health and Ageing.
Jan 2003 A complaint initiated inspection
Hostel loses funding over breaches The Australian January 30, 2003
The mother-of-three believes management sacked her because she was not prepared to tolerate residents being abused any longer.
Jan 2004 Trouble getting another job
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The director of nursing at Lionsville, Susan Gilbert, said Mrs Toperosa's position was made redundant because the hostel needed more experienced staff.
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"I'm not even sure I want to remain in aged care," she said. "The fact I am speaking out means I may have trouble getting a job elsewhere, but the treatment of elderly residents is too important not to tell the truth."
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But Mrs Toperosa does not doubt she is out of a job because she was determined to blow the whistle on shoddy practices that included, she says, 210 medication errors in one month last year.In a separate letter in September, Ms Gilbert told Mrs Toperosa in a letter that she would receive a 10 per cent pay rise for her excellent work. And "Gail, overall, I congratulate you on behalf of the board of management for your tireless efforts to raise the standard of service at Lionsville . . .".
Whistleblower nurse sacked Sunday Herald Sun January 18, 2004
Nine personal-care attendants wrote a letter to authorities last month alleging breaches of commonwealth care standards.
Oct 2004 Speaking out
Hygiene `horrors' in nursing home The Australian October 8, 2004
ANF Assistant Secretary Jan Brownrigg said staff had been reporting concerns about practices at the home for six months, before they were sacked last month.
Oct 2004 Vindicated
She said they wrote to Victorian Health Minister Bronwyn Pike, WorkSafe, the Department of Health and Ageing, as well as the Nurses Board of Victoria.
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Sacked staff now hope to get their jobs back."We are hoping that they will be able to because let's face it these people have been incredibly brave to stand up for the residents the way they have at the expense of their jobs," she said.
"They very much want to return to this place because all they've ever wanted is for residents to be given adequate care."
Vic: Aged care residents put at risk nursing home sanctioned Australian Associated Press General News October 8, 2004
The Daily Telegraph understands the neglect (at Missionholme nursing home) only came to light because a former employee blew the whistle before quitting in disgust.
Mar 20005 A not for profit home
Nursing home shut down over health fear Daily Telegraph March 2, 2005
TONY JONES: That is, of course, if the allegations are true - they are untested at this stage. And as we've heard, the Health Department is saying the allegations were investigated. Why are these women protecting their identity? Are they prepared to come forward at some point and reveal who they are and make these allegations publicly?
Feb 2006 Carers hide their identities to protect themselves
AGED CARE WORKER: I'm not sure about that, sir. That, of course, would be on their own shoulders. They still work in age care. They plan to continue their careers in age care and I would hope that they would stay in aged care, because they're the types of careers that we need, not the ones that mistreat or abuse or harass or threaten.
Allegations of abuse at aged care facility Lateline ABC TV February 20, 2006
TONY JONES: - - - - - - We've heard from a whistleblower, they can't come forward, they are afraid of losing their jobs and losing their ability to work in the industry, but they have really damaging things to say about what's happening inside Victorian facilities?
Feb 2006 Intimidated
Aged care debate LATELINE ABC TV February 21, 2006
AGED CARE WORKER: When this error was discovered the words that were told to me by the acting manager at the time that came in to deal with this incident was, "This will not be discussed with anybody."
Feb 2006 A culture of covering up
Aged care abuse reporting scrutinised Lateline ABC TV February 21, 2006
MATT PEACOCK: - - - - Last year's Senate report called for whistleblower legislation to protect people like assistant-in-nursing Karen Smith, who complained about patient abuse at Brisbane's Eventide Nursing Home and is still suffering the consequences. One night, an elderly resident slipped to the shower floor. Karen Smith claims she and another assistant were ordered to leave her there as punishment.
Mar 2006 Whistle blower protection needed
KAREN SMITH, ASSISTANT-IN-NURSING: I was busy trying to pick this naked, wet lady up and basically in the end she realised, I said to her, "This is criminal. I'm not going to do this." Eventually, she helped me stand her up.
MATT PEACOCK: Karen Smith also reported other incidents. The nurse in question was later suspended but meanwhile, the whistleblower was transferred and placed on lower-paid shifts.
KAREN SMITH: To be removed like that, knowing that I had done nothing, almost destroyed me. I really cared about those residents that I worked with. I had made an attempt to understand mental illness and how I could help these people and I felt that I was contributing a great deal at night to the feeling of safety that they need in their rooms in their beds.
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SENATOR SANTO SANTORO: Is there going to be an improvement in terms of whistleblower laws, improvement from the people seeking information? I think that's also in the mix. I'm not ruling that out because there's still a lot of discussion to be held, including in particular with state governments.MATT PEACOCK: Until these words become action, Jean Duncan (daughter of a misused resident) remains apprehensive.
Elderly abuse prompts Govt measures ABC 7.30 Report MARCH 15, 2006
For Updates:- A good way to check for recent developments in aged care is to go to the aged care crisis group's search page and enter the name of the company, nursing home or key words relating to any other matter in the search box. Most significant press reports are flagged there. The aged care crisis web site has recently been restructured and some of the older links used from this site may not work.
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This page created Sept 2006 by
Michael
Wynne
