RILEY WALTER
CONTINUAL improvement is credited with earning two Barmera aged care facilities re-accreditation, despite failing to meet compliance on several Aged Care Quality Standards.
Reports by the Aged Care Quality and Safety Commission (ACQSC) have highlighted the shortcomings of Bonney Lodge and Hawdon House in Barmera, however, Riverland Mallee Coorong Local Health Network (RMCLHN) chief executive officer, Wayne Champion, believes the facilities are moving in the right direction.
“This re-accreditation outcome is a credit to the progress the Riverland Mallee Coorong Local Health Network has made in improving aged care services in Barmera,” he said.
“It also reflects the Commission’s confidence in the steps that RMCLHN is undertaking to further improve the services.”
Based on site audits of Bonney Lodge and Hawdon House in September 2020, the reports reveal that both facilities were deemed non-compliant in four and seven out of eight Aged Care Quality Standards respectively.
In 2019, the facilities’ accreditation periods were reduced when an audit found that both failed to meet 21 of 44 requirements before site audits were suspended by the ACQSC in light of the coronavirus pandemic.
Following the September audit, Bonney Lodge was deemed to be non-compliant in 10 of 42 requirements, while Hawdon House was found non-compliant in 14 of 42.
In light of the findings, Mr Champion believes the new standards, introduced in July 2019, are harsher than those they replaced, therefore making compliance harder to achieve.
The requirements, rather than the standards, Mr Champion said, are the key focus for the facilities.
“The standards are more tightly defined and therefore harder to achieve…” he said.
“There’s quite a focus on aged care quality and safety so they (the assessors) are very, very rigorous in the way they conduct their assessments.
“It’s quite a detailed process over… three or four days with a couple of assessors.”
The reports are critical of the facilities in several areas.
The Bonney Lodge report cited compliance failures in similar areas to those reported by the Murray Pioneer in 2019, including administration of pain relief medication and management of “high impact or high prevalence risks”, as well as assessing the risk of malnutrition for a particular resident.
The report states that the resident went 15 days without a supplement required as part of their nutritional needs.
However, as the examples outlined in the reports are largely based on the assessment of a singular resident in each scenario, Mr Champion believes they are not indicative of the facilities’ overall care, as residents with more “complicated” care requirements are often interviewed.
“Part of it is just about the luck of who they ask, because they (may) ask someone with complicated dementia who might seem lucid on a particular day…” he said
“I don’t think they specifically target those residents for those sorts of questions; they do specifically target complicated, high-risk residents for some questions about caring for people with high falls risk and people with complex needs.”
Both reports also noted instances of suspected or alleged “abuse” of residents by other residents going unreported, including four at Bonney Lodge.
Despite this, Mr Champion said staff at both facilities were aware of reporting requirements for incidents of abuse or assault.
“Staff have had a lot of education about the Aged Care Standards and reporting requirements and the requirement to report any reportable issue within 24 hours and to keep a register of any incident that’s deemed to be not reportable,” he said.
However, Mr Champion also said that some minor assaults go unreported.
“Often a minor assault of a resident with dementia against another resident with dementia… isn’t necessarily reportable because it hasn’t caused harm and it’s a known behaviour of a resident with dementia that we’re working to manage,” he said.
And according to Mr Champion, all unreported incidents have since been followed up.
“Every time we’ve become aware of those incidents, they’re followed up fully,” he said.
“The incidents that the finding relates to have all been subsequently reported to the Aged Care Quality and Safety Commission…”
Transparency with residents and their families is key for the facilities, according to Mr Champion, who said none of the reports’ information should alarm relatives.
“There won’t be anything in that regard that the family is not already aware of relating to any individual resident,” he said.
“I think families will be surprised by some of the findings because they’re probably not reflective of the family’s own experience of the service, in terms of the customer service orientation they experience.
“I’ve certainly talked to residents and their families and the overwhelming feedback is that most of them are very happy with the service, don’t want to see it change significantly, and are comfortable with the quality of service their loved one’s receiving.
“We’ve got family members that are in there every day… so it’s not like they don’t have complete transparency of what goes on in the facility.”
The Bonney Lodge report also provides several examples of the facility’s response to instances of accident or injury, particularly in the case of a resident who sustained 10 falls in an approximate 10-week period.
“The service did not effectively implement, or review falls prevention strategies to minimise the risk of falls and injury,” the report said.
“Additionally, staff did not complete neurological observations in accordance with the service’s processes to effectively monitor for adverse clinical outcomes following several falls.”
This, Mr Champion said, was a case of staff misinterpreting policy and the appropriate action to take following an incident such as a fall.
“I know it’s been a misunderstanding of the policy,” he said.
Mr Champion said the falls mentioned in the report were, in many instances, from a low bed just a few centimetres from the ground and the number of follow-up tests required was misunderstood by staff.
“It’s staff education and it’s also the wording of the policy or clarity about the policy,” he said.
Despite the compliance issues raised in the report, Mr Champion is confident that both facilities are continually improving their service.
“We have a comprehensive plan for continuous improvement that’s been updated to include all of the findings or recommendations of the report… that’s been shared with the Quality and Safety Commission as part of our response, along with a whole lot of evidence demonstrating the fact that many of the findings of the report have already been addressed…” he said.
“We hear about some of the issues and concerns as the assessment is happening and address them while they’re there.
“They still find their way into the report, of course, despite the fact that they may have been addressed in the moment.
“We have responded, we are improving the service; we are addressing everything that was raised in the report (and) that has led to the satisfaction that has supported their decision to re-accredit us and to do so for a longer period than our previous accreditation period was for.”
The Royal Commission into Aged Care Quality and Safety’s final report was released on Monday, with some 148 recommendations made by the commission.