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ROYAL COMMISSION: Care loopholes and Government empathy

Day 7 into the third series hearings of the Royal Commission into Aged Care Quality and Safety had a research academic take to the stand, bringing humour to an otherwise very shocking takedown of the current social and parliamentary opinion of people in aged care.

Professor Joseph Ibrahim gave a scathing statement about the current issues in aged care. [Source: Aged Care Royal Commission].
Professor Joseph Ibrahim gave a scathing statement about the current issues in aged care. [Source: Aged Care Royal Commission].

Professor Joseph Ibrahim, Head of Health Law and Ageing Research Unit, Monash University, was the witness for the day, explaining his research into premature deaths of elderly people in Australia, as well as issues in aged care including suicide, mental health, aggression and sexual assault.

He also briefly touched on an opinion that respite care in Australia is dangerous compared to permanent residents in residential aged care facilities (RACF).

After the first witness’ statement, Commission Richard Tracey said, “Professor, you have enormous learning and empathy in relation to the care of the elderly.

“Given the demographics we are confronting in this country, we are going to need dozens if not hundreds, of people with your skills and knowledge to care for them.”

Research of deaths in aged care facilities

Professor Ibrahim’s research team used coroner death reports because death is not contested and is easily available.

The team identified 230,000 deaths potentially occurring in residential care between 2000 to 2014 from coroner death report data.

There were 22,000 resident deaths and of these 3,289 were caused by injury.

Professor Ibrahim said his team didn’t have the resources to investigate the 18,000 natural caused deaths. He added he is curious about the number of those deaths reported to the coroner because coroner reports usually mean there was some unusual circumstances to the death.

The 3,289 data reports was divided into categories, intentional deaths like suicide, resident-to-resident assault, and homicide; and unintentional deaths, like falls, choking, burns, asphyxiation, and complications of clinical care.

“What I want to highlight from [the research] was the incredibly small number of deaths from complications of clinal care. Only 39 deaths reported to the coroner for complications of clinical care over 14 years, which beggars belief,” says Professor Ibrahim.

He believes the under-reporting of clinical care complications are due to failure to recognise misdiagnosis, mistreatment, and inappropriate treatment. Adding, that clinical care complications may be listed as falls or naturally caused deaths.

Professor Ibrahim was also concerned about the obvious lack of legislation in the industry which is shown through a 14 year stagnant statistic in the external case death “other” category.

Natural caused deaths reduced due to legislation changes for reporting which external cause death around falls had significant increases because of reporting requirements in Victoria.

“We are left with the conclusion that nothing has changed in 14 years in Australia in reducing harm for injury, that is clear and obvious to all as a cause of premature death,” says Professor Ibrahim.

In regards to RACF, he said there is internal inconsistencies throughout the country on what the purpose of aged care is for.

“In terms of measurement, you can’t measure something if you can’t define it. The beauty for the parliament and the Government and the Health Department is if it’s not defined, then you can’t do anything wrong. You can switch your definition or what you think the role it,” says Professor Ibrahim.

“What you have seen in aged care, on one hand, it's a palliative care unit when you want it to be, and then the next minute it's a brokerage or concierge service for people to go skydiving. What is it? No one knows.

“We can’t call people to task if we can’t measure it. Death from an injury is a premature death, which means someone has died before their time... We accept people dying prematurely because we believe they are old and have no benefit to society, and that is just wrong.”

Professor Ibrahim believes one big problem is the fact that simple solutions are being implemented for complicated problems, which means things worsen when denying the complexity of an issue.

Suicide and mental health not addressed

In regards to suicide in RACF, there was around 146 cases the research identified and getting data around depression diagnosis is difficult.

Professor Ibrahim says that even getting data on depression medication prescription wouldn’t help because that would depend on whether it was appropriately used.

The third series of Royal Commission into Aged Care hearings have shown that prescription of antipsychotic medication isn’t always applied for the right reasons.

Professor Ibrahim’s research shows around one in four people in RACFs are depressed from the suicide data they have available.

Males who had recently entered aged care and were still "cognitively intact" represented majority of the suicide victims.

General suicide prevention plans in Australian never took into account or considered issues in RACFs.

Resident aggression and sexual assault is hidden

Similar to previous comments Professor Ibrahim made on the stand, he says interpretation of aggression differs at RACFs which is why it's difficult to measure or may not be reported.

He estimates one in five residents would have experienced aggression in aged care.

However, he has been waiting two years for research on sexual and physical assaults in RACFs from the Government Health Department, with no account of what the Department is doing with the data.

In relation to sexual assault, he said it's even more challenging because even if it is witnessed by someone, police won’t do anything.

“Sexual assault is hidden generally within the community. It is hidden in institutions and it’s invisible in RAC,” says Professor Ibrahim.

Over 10 years, there were only 30 cases reported, which he doesn’t believe is correct or accurate.

Physical restraints have no place in aged care

The Professor expressed disgust at the use of physical restraints in RACFs, adding that interpretation is again key to whether restraints are used or not.

Professor Ibrahim says, “[There is] no evidence, I am aware of, that physical restraints improve your life and keep you safe.”

“Only possible justification is if there is an imminent threat to life that you might restrain someone.

“The protections around restraint is so dismal, that it allows people to be restrained for prolonged people of time, they get forgotten. It beggars belief it still goes on in aged care.”

Respite classified as dangerous

Professor Ibrahim affirmed his belief that respite care was more dangerous than normal residential aged care, since they receive different types of care.

“Respite is try before you buy. Respite care residents were treated differently to permanent residents. People in respite fall more than those in permanent care,” says Professor Ibrahim.

Research undertaken by Professor Ibrahim’s team showed respite was for the carer, rather than the person going into respite.

It also shows that more support needs to be given to carers, since 50 percent of carers either have physical or mental health issues due to the “burden of caring”.

“Government don’t care”

To see proper change aged care in the country, Professor Ibrahim suggests more legislation, better definition of what aged care needs to achieve and Government action to result in better aged care in the future.

“Residents are stateless. Parliament does not care about people in RAC. If they did, they would have done something. There have been 20 plus reports on the sector and we now have the Royal Commission,” says Professor Ibrahim.

“No one seems to give a toss. A person with a disability in aged care still have rights and are a person, they don’t have to justify their own decisions to anyone.”

After Professor Ibrahim’s strong statement, Senior Counsel Assisting Mr Peter Gray QC returned to question second witness Christina Bolger, Executive Director, Regulatory Policy and Performance, Aged Care Quality and Safety Commission.

Ms Bolger says in her position she has seen non-compliance by aged care facilities increase since unannounced audits and visits were introduced.

Compliance monitoring by assessors from the Aged Care Quality and Safety Commission will determine whether an unannounced audit needs to be implemented at a facility.

Mr Gray also read out communication from Ms Bolger around the new amending principles on restrictive practices.

Ms Bolger accepted and admitted that her requests for stronger language around restrictive practices were not adopted by the Department of Health.

The hearings will recommence on Friday, May 17.

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