South Australian nursing homes trial increased autonomy amid reports of lowering standards

Documents released under Freedom of Information show that almost one-in-five new nursing homes failed to meet quality standards last financial year.

The revelation comes as the Federal Government looks to cut red tape in aged care homes, including a reduction of the official aged care complaints system.

The figures are contained in a Freedom of Information (FOI) request on complaints between 1997-98 to 2013-14 submitted to the Australian Government's Department of Social Services.

In 2013-14, 28 nursing homes that started operations that financial year passed accreditation while six failed, a failure rate of nearly 18 per cent.

There was a similar failure rate in 2012-13, when 22 new nursing homes passed, while five failed the accreditation audit.

In 2011/12 none of the 20 nursing homes that opened that year failed the quality audit.

Increase autonomy for aged care facilities trialled

A trial, the South Australia Innovation Hub, is currently underway in 10 nursing homes in the state, one of which was criticised by the state coroner for contributing to the death of a woman who was left unsupervised while smoking.

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Under the proposals, most nursing homes would be accredited every five years instead of every three years.

Heavily redacted documents from the Department of Social Services released under FOI show most complaints would be handled by nursing homes instead of the Government's Aged Care Complaints Scheme, if the pilot is adopted nationwide.

"All complaints about a provider's services that would be typically handled through a full scheme resolution process will be referred to the provider via correspondence for resolution ... except where a major or significant risk to care recipients has been identified," one document said.

The documents outline a proposal of "earned autonomy" for nursing homes considered to be high performers, including a plan to "develop a process to reduce the involvement of the Aged Care Complaints Scheme in the resolution of aged care complaints".

The documents said complainants would still have the right to lodge an appeal with the Aged Care Commissioner and the Aged Care Complaints Scheme would continue to manage anonymous or confidential complaints.

One department document from October 2014 discussed the "risk of decreased regulation on quality of care".

"In the event consumer concerns are identified, normal regulatory processes will apply," the document said.

"Where concerns are not adequately addressed and/or providers no longer meet the performance criteria, the department may withdraw autonomy from providers."

The documents stated that 85 per cent of aged care homes fully meet the required standards as of August 2014, while 1 per cent failed to make the standards.

There was no guarantee a poorly performing facility would have a five-year accreditation period restored even it improved its performance.

Aged care homes would still face unannounced visits by the Australian Aged Care Quality Agency which conducts the checks of nursing homes which includes audits of safety, health and staff development.

Trial does not reduce the standards: Social Services department

The Pensioners and Superannuants Association of NSW said some of the homes included in the SA trial failed accreditation audits in the past.

But Professor John Kelly, chief executive of Aged and Community Services, which represents homes run by charities and churches, defended the choice of the homes by the then social services minister Kevin Andrews.

"Look, one of the benefits of the pilot is that there are a series of facilities that have been picked, both from the church and charitable sector and the private sector, that have not all just been unblemished," he told PM.

"These are good opportunities for learnings for the sector, and it was part of the reason why those particular facilities were chosen as a group; so they could learn from each other."

Assistant Social Services Minister Senator Mitch Fifield was unavailable for an interview.

A spokesman for the Department of Social Services said safety nets continue to apply under the SA pilot, including unannounced site visits and sanctions.

"If a provider no longer meets the performance criteria for participation in the Hub, they will be unable to continue in the trial," the spokesman said.

"Although the trial reduces intervention by the Government's regulatory programs, the trial does not reduce the standard and quality of care that aged care providers are required to provide."

Industry heads divided over deregulation

Every year the Federal Government pumps more than $10 billion in subsidies and grants into the nation's nursing homes.

But Professor Kelly said the regulatory burden imposed on aged care homes hampers the provision of care.

"We are certainly not anti-regulating or monitoring if you like those aspects of the provisions of services that go to quality or to the safety of residents," he told PM.

"A lot of the red tape and paperwork actually is involved in the management administration of the funding and it takes up an enormous amount of time including the time of the carers."

But Charmaine Crowe from the Combined Pensioners and Superannuants Association said the implementation of the SA hub proposals will reduce oversight of nursing homes.

"At a time when we are asking aged care residents to pay more for their care, we are reducing the obligation of providers to ensure that care is of a high standard," she said.

Labor's ageing spokesman Shayne Neumann said the Opposition was prepared to support the trial but did not want consumers to lose the opportunity to make complaints about poor care.

He said he was concerned about the Government's assurances that safeguards would remain in place.

"I think that sounds wonderful in practice but in fact anyone who deals with aged care facilities knows that there is a great difference with aged care facilities in the country," he said.

"We've got to make sure the resident's rights, responsibilities ... we've got to make sure that people get access to the complaints process put in place."

Michael O'Neill, the chief executive of National Seniors, an advocacy group for the over 50s, said there was over regulation in the aged care system but the SA pilot needed rigorous analysis to see whether it should be adopted.

He said National Seniors was unlikely to support the plan for nursing home audits every five years.

"I certainly wouldn't see five years being an almost blanket offering, I think the need for discipline and rigor in the process means that three years from our perspective would be a much more satisfactory point," he said.

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