QUEENSLAND nurses tired of inaction on elder neglect have joined forces to conduct a secret, state-wide audit of aged care facilities.
Angered by the ongoing mistreatment of Queensland's elderly - nurses, relatives and community volunteers yesterday formed a civilian army to inspect 70 aged care facilities across 30 federal Queensland electorates.
Queensland Nurses and Midwives' Union (QNMU) Secretary Beth Mohle said the results were damning. The audit, believed to be the first of its kind in any state or territory, uncovered disturbing and dangerous aged care practises as a result of chronic understaffing between Cairns, Cloncurry and Coolangatta.
Ms Mohle said seventy-nine per cent of aged care staff surveyed said their facilities were dangerously understaffed. She said the audit also revealed more than 82 per cent of staff reported residents who called for help were forced to wait.
She said more than two thirds or 68 per cent of staff surveyed said chronic understaffing meant they were unable to properly clean residents.
It has become common practice in some facilities to wash residents just once a week. The findings are preliminary and further analysis will be undertaken.
"The QNMU's secret state-wide audit has revealed aged care residents throughout the state are regularly left without a Registered Nurse on staff overnight,'' Ms Mohle said.
"Today, on Mother's Day, we know there are much loved parents calling for help and not receiving it.
"We know that aged care facilities are dangerously understaffed throughout Queensland and Australia, and that elderly residents are suffering as a result.
"Behind closed doors, in almost every city and town, Registered Nurses are being left to look after up to 200 residents at a time. While nurses and other staff are doing their best, but they simply can't meet the demand for care under those circumstances.
"Our audit of Queensland aged care facilities has revealed almost 80 per cent of staff caring for elderly residents in Queensland are Personal Carers.
"These staff are an important part of the aged care workforce but can be hired with no qualifications.
"Our findings reveal unqualified staff are being allowed to administer dangerous and potentially life-threatening medications, that residents are falling and not being checked, that residents are laying with untreated injuries such as broken hips for days at a time and regularly experienced malnutrition and dehydration.
"This chronic understaffing and elder neglect is occurring in so many facilities.
"Elderly mothers, fathers, retired teachers, firemen, farmers and many others are going unfed, unmedicated, unwashed and left to lie in their own waste for hours at a time.
"We won't stand for it. Queensland and Australian nurses and midwives are taking this matter into their own hands and will not rest until Australian laws are introduced to protect the elderly - and those who care for them.''
Currently, there are no laws that state even a single Registered Nurse (RN) must be on a site at an aged care facility at any time. The audit found some facilities routinely leave residents without a Registered Nurse overnight.
Others use Virtual Nurses, or nurses located at sister facilities hundreds of kilometres away, to provide potentially life-saving medical advice over the phone.
· Qld has 446 privately-run residential aged care facilities
· QNMU's nurse army audited 70 facilities (7am to 11am) on May 12 across Qld's 30 federal electorates
· More than 75 per cent of aged care staff are not nurses and are unqualified
· 82% said understaffing forced residents to wait longer than they should for help
· 79% said staff levels were unsafe at their facility
· 68% said they did not have enough time to properly clean residents. It has become common practice for residents to be showered just once a week due to chronic understaffing
· 58% said residents were not being walked as often as required
· 57% not enough time to turn residents increasing likelihood of bed sores and ulcers. Research shows these wounds account for large numbers of life-threatening infections and hospitalisations
· 57% said staff were not replaced when they couldn't come to work
· 57% said they did not have enough time to properly feed residents
· 53% said dangerous understaffing lead to increased falls. Research shows falls may lead to premature death
· 36% said poor staffing lead to pressure injuries
· Average nursing hours provided by aged care facilities 2.5 hours per resident per day
· Research shows residents should be receiving on average 4.3 hours of nursing per day
· 11% of facilities audited were providing less than 2 hours of care a day.
Audit findings re aged care staff:
· Personal Carers, no qualifications required: 76 per cent (more than three quarters)
· Registered Nurses, degree qualified: 16 per cent
· Enrolled Nurses, TAFE Diploma: 8 per cent
· Some aged care providers, such as Queensland's biggest provider BlueCare, have cut large numbers of Enrolled Nurses and replaced them with unlicensed Personal Carers
· They have also transferred the administration of complex, potentially life-threatening drugs from Registered Nurses to Personal Carers. BlueCare have 126 facilities state-wide.
AGED CARE STORIES INCLUDE:
· Resident left with a broken hip for 48 hours before family visited and an ambulance was called HINKLER
· Aged care staff forced to wash and reuse bandages BRISBANE
· Resident fell overnight while visiting toilet unassisted. Broken arm undiagnosed until family visited 24 hours later HINKLER
· Relatives claim a resident died after contracting sepsis from a Urinary Tract Infection (UTI) that could have been treated with a pill HINKLER
· Families claim a loved one suffered malnutrition while in aged care as a result of inedible food served three times daily. All vegetables frozen, thawed or made from a packet. Staff unable to assist all residents during meal times due to chronic understaffing BRISBANE, FORDE, HINKLER, MARANOA, FISHER, DIXON, LONGMAN, KENNEDY, FAIRFAX, FLYNN, BOWMAN, LILLEY, HERBERT
· Some facilities keep Registered Nurses on site only during office hours. Aged care routinely left without RN overnight STATE-WIDE
· Nurse reported being off site and remotely on call via the phone for six aged care facilities MARANOA
· Residents repeatedly hospitalised after suffering falls at around 2am when the elderly traditionally need to rise and use the bathroom. Understaffing means there are not enough employees rostered on to assist at this hour. Falls occur near nightly, ambulances called frequently as a result STATE-WIDE
· Untrained staff with as little as three hours first aid training forced to give injections and administer dangerous drugs due to lack of staff STATE-WIDE
· Student nurses used as workforce STATE-WIDE
· Lack of staff mean residents are going unfed, unhydrated, getting ulcers and contracting infections from being left in unchanged incontinence pads STATE-WIDE
· Allegations aged care management are receiving bonuses as a result of keeping costs down. Cost-cutting reported included locking up gloves, incontinence pads or refusing to replace items that ran out BRISBANE, HINKLER
· Residents having to toilet other residents because cries for help and buzzer calls went unanswered for so long BRISBANE, FORDE
· Residents breaking one hip because of lack of supervision in secure unit, only to return from hospital and break the other hip, again because of lack of supervision
· Residents having to wait two hours for pain relief overnight because there was only one registered staff member on site for all 140 residents FORDE
· Obese residents are being left for up to 12 hours in bed without being turned, moved or having continence cares attended to because management refuse to employ enough staff FORDE
· Dementia residents in secure unit being completely unsupervised overnight with not even one staff member present in the unit for up to one hour at a time because staff are needed in other wings of the facility FORDE
· Residents receiving regular medications including pain medications up to two hours later than when the medication is charted to be given because one nurse is expected to give out medications (not just tablets but puffers, eye drops, insulin, nebulisers, medicated creams, high calorie drinks) to all residents in the facility at the same time FORDE, BRISBANE, LONGMAN, DIXON, MARANOA, FISHER, FAIRFAX
· Two PC's being expected to feed 12 bed-bound residents all with swallowing deficits and on a pureed diet within an hour. Because of the resident's frail condition, it would regularly take between 30-45 minutes to feed just one resident. Staff must stop feeding after 15 minutes and move on to next resident so that everyone gets something to eat. Residents end up dehydrated and malnourished FORDE
· Permission for drugs like Endone and Morphine being given to unqualified staff including over the phone by staff who are qualified but work at other facilities within the organisation. Staff members giving the permission for drugs has never laid eyes on the resident and is not present to conduct any kind of assessment prior to giving permission for medications. All this is a cost cutting method so that the organisation does not have to pay for even one registered nurse to work at the facility overnight. Extremely dangerous and puts residents at high risk of being subject to medication error BRISBANE, FORDE, HINKLER, MARANOA, FISHER, DIXON, LONGMAN, KENNEDY, FAIRFAX
· Residents being given party pies, sausage rolls and pizza for evening meals because food budgets are being slashed. Meal choice has been taken away from residents and they regularly complain they cannot chew the food they are given because it is too hard for them to chew with dentures FORDE, BRISBANE, FISHER, HINKLER, MARANOA, LONGMAN, DIXON
· Bed-bound residents being showered once weekly (this is a regular practice) because there are not enough staff on the floor to assist with showering daily or even second daily BRISBANE, FORDE, HINKLER, MARANOA, FISHER, DIXON, LONGMAN, KENNEDY, FAIRFAX, FLYNN, BOWMAN, LILLEY, HERBERT
· Residents being left in agony with fractures (hip, arm) for over 24 hours because there was no RN on site to assess or treat injuries HINKLER, FORDE, FISHER, LONGMAN
· Residents being left for long periods of time (hours) after falling and sustaining an injury because only one RN is on staff. Physically impossible for that staff member to be everywhere at once BRISBANE, FORDE, HINKLER, MARANOA, FISHER, DIXON, LONGMAN, KENNEDY, FAIRFAX, FLYNN, BOWMAN, LILLEY, HERBERT, FLYNN, CAPRICORNIA, MORETON.
The names and locations of individual facilities have been withheld to protect the residents, families and staff who completed the audit. In some circumstances, staff levels are so low those who reported would instantly be known to management.
The audit highlights the poor conditions elderly Queenslanders are exposed to every day of the year.
"We know aged care facilities in almost every community are dangerously and chronically understaffed,'' Ms Mohle said.
"We know for a fact Australia's elderly are suffering unnecessary pain, suffering and premature death due to dangerously low staff numbers.
"We also know there is a truly toxic culture in Australian aged care where providers who fail to safely staff their facilities blame their employees for the tragic incidents that occur.
"The Federal Government are aware of the dangers and the culture of fear facing the elderly and those who care for them. Yet politicians continue to fail to act.''
Ms Mohle said it was time for change.
"Each and every federal politician that does nothing about staffing in aged care should be held to account for the elder neglect occurring in their electorate,'' Ms Mohle said.
"We are tired of the lack of action by our federal politicians and that's why nurses, midwives and volunteers have come together on International Nurse's Day to conduct this aged care audit.''
Ms Mohle said Australia's 260,000 nurses and midwives - including 68,000 in Queensland – would not rest until safe staffing laws were introduced in Australia's 2400-plus privately run aged care facilities.
On May 7, the Australian Nursing and Midwifery Federation's (ANMF) launched a national Ratios for Aged Care – Make Them Law Now campaign.
The campaign aims to put pressure on federal politicians to introduce legislation to make safe staff levels law in aged care. Similar laws exist for other Australian industries.
She said Queensland and Australian taxpayers would be outraged to learn aged care providers receive billions of taxpayer dollars in federal funding every financial year – on top of deposits of up to $550,000 and 80 per cent of pensions they receive from residents.
"To get a bed in even a basic aged care facility, the majority of Queensland pensioners must pay a deposit of up to $550,000,'' Ms Mohle said.
"They then pay up to 80 per cent of their pension or up to $800 a fortnight.
"In addition, in the 2015/16 financial year, Australian aged care providers received $16.2 billion in federal funding or Australian taxpayer dollars.
"In exchange, aged care providers fail to properly staff their facilities because they simply do not have to under the laws as they currently exist. They also do not have to report how they spend a single cent of the Commonwealth funds they receive.
"A great number of these providers are profiting at the expense of the elderly. We will not rest until the laws are changed.''
Ms Mohle said it was important to note some aged care facilities provided safe staff numbers and quality care for their residents. However, it is impossible to know which facilities are safely staffed as there is currently no online reporting of staffing numbers or outcomes in Australian aged care facilities.
The QNMU wants to see nurse to resident ratios and the public reporting of staff numbers and resident outcomes for each individual facility made law.
The ANMF's Make Ratios Law To join the campaign to protect Australia's elderly please http://anmf.org.au/campaign/entry/ratios-for-aged-care
- The QNMU and ANMF want to see nurse to resident ratios made law for Australia's 2400-plus aged care facilities
- In May 2016, Queensland Premier Annastacia Palaszczuk committed to the introduction of aged care ratios in Queensland's 16 state-run aged care facilities
- In addition to ratios, Queensland nurses wanted aged care providers forced to publicly report causes of death, incidents resulting in death and staff numbers at each facility
- Public reporting of causes of death and other health-related indicators will hold aged care providers to account and help Queenslanders decide which facilities were safest
- Public reporting would also put pressure on aged care providers to safely staff their facilities
- In some parts of America, hospitals must legally report patient mortality rates and staff numbers online. Hospital research has shown, an increase in a nurse's workload by one patient increased the likelihood of an inpatient dying by 7 per cent
- Staff numbers in aged care facilities impact resident outcomes
- At present, public reporting of incidents in aged care is near non-existent. Unlike the hospital sector, there are no robust, system-level mechanisms that identify trends or issues related to events that result in temporary harm, permanent harm or death in aged care
- There are no robust, system-level processes to investigate why harmful events occur or to stop them reoccurring
- Australian aged care agencies focus on individual complaints and facilities after incidents have occurred, rather than looking at the systems in place.
Ms Mohle said Minister for Aged Care Ken Wyatt recently announcement another agency to report elder neglect after it had occurred.
"Minister Wyatt's recent announcement of another agency to report on elder neglect is akin to parking an ambulance at the bottom of a cliff – rather than erecting a fence at the top,'' she said.
"Queensland and Australian nurses are deeply worried for the nation's elderly and extremely tired of being blamed for the systemic problems in Australian aged care. We are fighting back in order to protect Australia's elderly and those who care for them.
"We aim to make politicians from all parties responsible for care provided to elderly residents in their electorates.''
Almost routinely, staff numbers linked to a death or any incidents resulting in the death of an elderly person go undetailed or unexamined.
- Australian aged care facilities are not legally required to have even one Registered Nurse on site at any time
- It is not uncommon for a single nurse to be left with up to 200 residents at a time
- Many aged care facilities use Virtual Nurses, or nurses located at sister facilities up to 400km away, to provide medical advice over the phone
- Elderly Queenslanders pay a deposit of up to $550,000 to secure a bed in a basic aged care facility
- Aged care residents pay up to 80 percent of their pensions or around $800 a fortnight, to receive care. It is not charity
- Aged care providers received more than $16.2 billion in Federal funding or tax payer dollars in the 2015/16 financial year
- Aged care providers are not required by law to report how a single cent was spent
- In the same financial year, Australian aged care providers reported profits of more than $1.1 billion. https://agedcare.health.gov.au/reform/aged-care-financing-authority/2017-report-on-the-funding-and-financing-of-the-aged-care-industry
- In 2015-16 aged care providers recorded an average net profit of more than $5,900 per resident, per annum. (Page 102, Aged Care Financing Authority Report July 2017 for financial year 2015-16)
- Nurses and midwives in every state and territory have launched a national aged care campaign as part of the Australian Nursing and Midwifery Federation (ANMF)
- The national campaign is calling for the introduction of nurse to resident ratios in aged care. Introducing safe staffing laws to aged care would bring it into line with other industries in Australia such as child care
- More Queenslanders have joined the campaign than any other state or territory with 3148 community members joining the campaign
- To support the ANMF campaign, please join thousands of supporters across Australia by Liking the campaign on Facebook https://www.facebook.com/MoreStaffForAgedCare
- Or visit www.MoreStaffForAgedCare.org.au to sign up and join the campaign.