Understanding key issues and insights
Lack of consumer knowledge
Perhaps the biggest issue when researching aged care services is that, currently, there are no official ratings or consumer-driven evaluation to compare, praise or expose service providers. In the absence of such a system, consumers are at a serious disadvantage.
This point has been consistently raised by aged care professionals and advocates like Alzheimer's Australia and the NSW Nurses and Midwives Association (NSWNMA), both of which spoke to CHOICE to alert consumers to some serious considerations when selecting care.
Alzheimer's Australia CEO Carol Bennett warns "there is not a single measure of quality in aged care in place. Consequently, there is a lack of information available to consumers. The current standards and accreditation model is focused on safety and needs to shift to ensure that aged care delivers high-quality services, particularly as the ageing population with dementia increases."
When selecting residential aged care, a smart approach involves talking to other consumers about their experiences and having a checklist that includes:
- a resident-centred care approach
- measures to cater for people with dementia
- culturally appropriate care
- involvement of relatives and friends
- effective pain management
- minimal use of restraint
- use of specialist supports
- end-of-life care options
The NSWNMA agrees on the issue of a lack of transparency, warning that "people need to know what they are paying for to allow greater consumer power". They also caution consumers against being too impressed by things like resort-style leisure facilities. "Advertising bars, club rooms, pools and fancy ensuites is common. It's great if people can use them but we know that 80% have high care needs and could not access a small ensuite, or make use of a bar and pool. Focus should be on creating therapeutic environments in building design and staffing structure.
Staffing ratios of residential facilities
Be aware that currently in Australia there is no federally mandated staff ratio or minimum skills level for residential aged care workers. Lynette Dickens, a specialist palliative care nurse with more than 20 years' experience in aged care, says that despite marketing messages of smiling nurses and attentive health care professionals, the real staffing situation might consist of a few low- or no-skilled staff and very poor carer-to-client ratios.
Since staffing accounts for the main expenditure in running an aged-care facility, Dickens says consumers should be extremely cautious when evaluating staff rosters, especially because some larger, private providers focus more on profits than quality of care.
Echoing these concerns, the NSWNMA warns that providers don't routinely advertise their true staffing and skills mix, and cautions consumers that "staffing should be a major determining factor for those choosing an aged care home. Consumers need to know if the home doesn't provide an RN (Registered Nurse) 24/7 or if there's only one AIN (Assistant in Nursing) to 30 residents or one RN to 130 residents".
Another thing to be aware of is the combination of the low wage/low skills aspect of a carer's job, which Dickens says compromises care quality. Over two decades in aged care Dickens says she's witnessed some alarming things and has spoken out both in the media and to her superiors but feels nothing has come of it except personal rebuke.
"There exists a very real fear against nurses speaking out, especially when employed by the big companies. I've reported cases of serious misconduct by staff and I've been told I was lying," says Dickens, adding that some previous employers even went so far as to remove case notes and other evidence of mistreatment in order to escape detection.
Despite this, she acknowledges that there are many good residential homes and staff. Asking a prospective facility about staff turnover could help you gauge staff satisfaction.
In-home care versus residential care
Despite the lack of any industry ratings data, anecdotal evidence suggests and many health care professionals agree that when compared to residential aged care, in-home care is the better option. "Alzheimer's Australia has heard from our consumers that there are higher levels of satisfaction with home care services than with residential care," says Bennett.
In 2010, the NSW Department of Ageing, Disability and Home Care surveyed 565 home care clients and found that 95% were satisfied, with 61% of these respondents reporting a very high level of consumer satisfaction for in-home care. This was put down to the quality and reliability of staff, the standard of services provided and the level of care received.
In-home care also has the advantage of allowing people to stay at home in familiar surroundings for as long as possible. This should be a consideration when evaluating which care plan is best for you or a loved one.
Tips for choosing a service provider
With a better idea of the key concerns we've outlined above, you might find yourself ready to begin selecting and evaluating providers. Here are some tips.
1. Weigh up in-home care versus residential care
Talk to friends and family, your doctor and other community health professionals before contacting the ACAT team for their recommendation. Together you can best determine your level of need whether it be in-home help or residential aged care.
2. Compare a selection of care providers
When evaluating care options, especially residential aged care options, contact a wide selection of providers for a greater sense of comparison. Try to talk to current clients and their families for some consumer evaluation. Do not rely on the marketing literature alone.
3. Do your research and use a checklist
When visiting aged-care homes arrive prepared with a series of questions. See our Residential Care Checklist.
4. Check staffing arrangements carefully
Given there are no minimum staff or skills ratios, check staffing arrangements carefully. If you're quoted staff numbers, check to see that the number of staff providing direct care do not include laundry or kitchen staff. In a site visit, take time to notice staff and their demeanour and ask about staff turnover.
5. Check staff training for special care services (Alzheimer's care for example)
If specialist care is required for conditions such as Alzheimer's or Parkinson's disease or for clients who may be blind or deaf, ask about staff training and qualifications as well as day-to-day practices.
6. Check frequency of access to doctors and other medical specialists
Ask about the frequency of visits from nurses, doctors and other specialists.
7. Seek consumer feedback on services
There is no feedback more valuable than that from current consumers. Ask to be put in touch with a family who already use the service and talk to them about their experience. In addition, engage in some investigation at the facility, for example, ask to visit at meal times to observe the environment and sample the meals (offer to pay if necessary).
8. Ensure you know your rights and responsibilities
Those using aged care have the right to be looked after properly, treated well and be provided with high-quality care and services. Understanding your rights and responsibilities as well as those of the service provider will help you make an informed decision and get the best quality care to suit your needs.