Risk management and governance in Aged Care and the Royal Commission
Shocking narratives involving the abuse and neglect of elderly people housed in residential aged care facilities made headlines in early 2018. It came as no surprise then that the Royal Commission into Aged Care Quality and Safety was established in September.
The general state of elderly care
There had been reports of substandard care where residents were fed on food worth seven dollars a day. Moreover, there were reported cases of both unintended harm as well as deliberate acts of elder abuse and neglect, and premature death from injury. A few cases of the non-disclosure of details surrounding the death of a resident to family members had also been noted. There were cases of some residents being given the wrong medication or the wrong prescription or dosage as well.
On top of this, the Earle Haven Aged Care incident this year has also indirectly highlighted problems involving manpower and compensation. Many argue that Government-supported elderly care facilities are hugely underfunded while for-profit facilities are unattainable in the long run for those who cannot afford quality aged care. Moreover, there are reports that owners of for-profit aged care facilities sometimes end up underpaying their staff to ensure higher returns and whilst ensuring they comply with minimum aged care standards.
This has a knock-on effect on the standards of hiring elderly care staff. Lower salaries typically mean that such facilities will only be able to hire either under qualified or unskilled individuals, or those who are qualified, but are willing to compromise on remuneration.
Moreover, some aged care facilities are grossly understaffed, employees are stretched thin or close to breaking point, and are therefore unable to give the care needed to residents.
Impact of Royal Commission findings on the Board of Governance
A major challenge for the Board of Governance not only involves the collection of accurate and meaningful data within a limited time frame but also proving that they are engaging clients and their families in the planning process.
The Royal Commission highlights Clinical Governance requiring providers to be able to satisfy client needs and community expectations in measurable ways. This covers all aspects of care, including the medical, clinical, social, emotional, and behavioural elements of service delivery and client satisfaction.
The findings will no doubt increase the responsibility of those charged with governance of the aged care providers. They will need to prioritise organisational culture, consumer engagement, and clinical standards when making decisions.
An article in the Australian Institute of Company Directors also recommends that Boards focus on the following:
1. Understanding of service quality and safety
All efforts must be made to report on organisational performance involving service quality and safety. Incidents of non-compliance, inability to meet standards for accreditation as well as client neglect, harm or abuse must be considered and acted upon. There must be an in-depth look into what type of organisational culture has led to tolerance of non-compliance and the substandard quality of service delivery.
2. Framework for complaints and incident reporting
Boards need to work with management in reviewing how complaints and incidents were handled in the recent past. They need to assess and improve upon their current framework to improve processes of reporting and remediation to make them more proactive and responsive to the needs of clients and their families.
3. Compliance with accreditation and quality standards
Boards must undertake to have independent reviews of management practices and systems in terms of reporting and investigating misconduct. They also need to evaluate their current practices, processes, facilities, and human resources against what is required in the new Aged Care Quality Standards, and seek the counsel of experts or consultants where needed.
4. Engage truthfully with stakeholders
There should be a communications strategy in place to ensure Boards are directly aware of the concerns of all stakeholders. An investigation protocol must be put in place, and accountability must be specific and measurable in order to resolve service issues.