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ROYAL COMMISSION: “It’s very much a dictatorship type industry”

The third day of the Perth hearings for the Royal Commission into Aged Care Quality and Safety heard from a panel of allied health professionals and registered nurses about the application of person centred care, and listened to the Age Discrimination Commissioner’s recommendations for what the Royal Commission needs to address.

Patti Houston, Personal Care Worker; Anna Urwin, Physio; and Emma-Kaitlin Murphy, Registered Nurse, all gave evidence on a panel talking about person centred care. [Source: Aged Care Royal Commission]
Patti Houston, Personal Care Worker; Anna Urwin, Physio; and Emma-Kaitlin Murphy, Registered Nurse, all gave evidence on a panel talking about person centred care. [Source: Aged Care Royal Commission]

Four professionals were on the panel including Patti Houston, Personal Care Worker; Gaye Whitford, Registered Nurse and Residential Aged Care Coordinator; Anna Urwin, Physiotherapist; and Emma-Kaitlin Murphy, Registered Nurse.

The topic centred around person centred care, how that is applied and whether it has any barriers to its implementation in aged care facilities.

The general consensus was that the regulations of aged care facilities and the demand for care coupled with a lack of staff, seem to, in many cases, provide difficulties in meeting those person centred care requirements.

Ms Whitford says, “I feel that person centred care is a term that's overused. I think we are not fulfilling that term adequately enough.”

She at one point described aged care facilities as being “very much a dictatorship type industry” since there is little way to pass feedback upwards, to management, to improve care.

Barriers to person centred care

Ms Whitford believes what’s stopping person centred care achieving its full potential is due to limited resources, minimal staffing, small volunteer bases, difficulty accessing allied health and no way to contract alternative therapies because of funding restrictions.

Backing up the claims from Ms Whitford in regards to restrictions was Ms Urwin, who says many physiotherapists are limited in what services they are able to provide to residents.

She states that physiotherapists are on a strict “box ticking” system passed to them from aged care facilities that they have to follow and don’t have any autonomy over the services they provide.

Ms Urwin described physiotherapy work in aged care as “a lot more passive and a lot more pointless than the care that the personal care workers give.”

Under the current Aged Care Funding Instrument (ACFI) model, Ms Urwin feels the ACFI doesn’t allow for person centred care to be provided.

Additionally, her work only handles providing two different pain management treatments rather than actually targeting the chronic issue on a longer basis which would result in better health and function later down the track.

“My frustration is that... the focus is on pain, not physical function. The more that we focus on

somebody having pain, the harder it’s going to be to improve their physical function. And the happiness and satisfaction that you can give someone from such a small input... is so immense,” says Ms Urwin.

She also stressed that this would result in easier care for all staff towards an individual who is again able to physically function well.

Aged care is too regimented

Registered Nurse, Ms Murphy says restrictive restraint policies and sheer volume and demand from other residents are hindering poor person centred care.

One example she gave was about a couple who were split up when they entered an aged care facility together and the husband was only able to see his wife for an allocated one hour, twice a day.

However, sometimes this was less since sometimes staff wouldn’t have time to take him into the dementia ward to see his wife.

“This example, it really displays the challenges we face in delivering person centred care in aged care,” says Ms Murphy.

“I tend to spend a lot of time providing emotional and social support, making them feel like they're actually a person, they're not just a task that I'm completing.”

Ms Murphy also says aged care has become an undesirable career path because it restricts where you can work afterwards, with most hospitals not hiring a nurse if they have a background in aged care.

She admitted the only motivation for her to work in the sector is due to her passion for taking care of older people, knowing she probably won’t have a huge progression in her career.

Ms Murphy says, “There is quite a large staff turnover in aged care because it is such a demanding and stressful industry.”

Care always needs a human touch

Personal Care Worker, Ms Houston suggested there needs to be a more holistic approach to providing person centred care to residents.

Ms Houston says, “One part that I feel that we're failing in, particularly dealing with people with dementia, is not addressing their emotional and personal needs as a person.”

In her job, she had more social time with residents and she says the difference it makes to older people are incredible.

A recent program that has been used by staff around holistic type care has caused a change in the way staff comfort and care for residents, as well as giving residents their choice back.

“While some people worried about the safety of residents, risks involved in letting them do things that they might not have done before. So it’s a complete culture change, because it’s not what we've learnt,” says Ms Houston.

“This is a whole, looking at a person as a whole… We need to be actually filling their needs as human beings.”

Ms Houston recommended to the Royal Commission training for aged care staff in emotional and person care, which can be detrimental to the proper implementation of person centred care.

Older people are stigmatised for their age

Age Discrimination Commissioner, Australian Human Rights Commission, Dr Kay Patterson AO, gave evidence about what her department is addressing in the nation, along with problems of ageism and general stigma towards older Australians.

She explained the issues that many elderly people in Australia face, including elder abuse, and that there is a huge need for education for health professionals and the wider community in care for older people.

“I think that a large number of people value older Australians and respect them, but sadly they're not represented well in the press,” says Dr Patterson.

“We use negative language, and we actually, in fact, not only influence the community in having negative effects, but older people themselves begin to feel that they're worthless and useless.”

Dr Patterson outlined the importance of re-educating, or educating, medical practitioners about how to provide better care to elderly people, and the need for a culture shift among other Australians about elderly people.

Especially since old age is something that affects everyone during the last stages of their lives.

Dr Patterson reminds people constantly that, “The culture they set now is the culture they will inherit.”

During her testimony, Dr Patterson gave many examples of older people not knowing their rights, including power of attorneys thinking they have the right to stop anyone from visiting their family member or cases of families stealing money from their relatives.

She believes that if a group of people are considered a certain way, like weak, they become an easier target for others to take advantage of.

In her finishing statement, Dr Patterson says she wants the Royal Commission to focus on a few specific areas to support our elderly, including aged care training and culture change within the community and the workforce.

“I would like to see the Royal Commission focus on best practice. There are some, many, aged care facilities which are giving world class care to their residents. How can they do it on the same funding as another one which isn’t? And I believe that we should have a ranking for best practice,” says Dr Kay Patterson.

“The aged care standards provide a minimum. We saw Oakden meet all of those old 44 standards and were failing. You can have the rights on the wall, but if they're not in the hearts and minds of the staff, you may as well not have them.”

Hearings will continue tomorrow, Thursday, June 27, at 9.30am AWST in Perth, WA.

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