Some aged care homes ‘run like a factory’, industry expert claims

‘Frankly, there are some places … I wouldn't go anywhere near,’ says professor.

aged care run like a factory

“The way policies are framed around running these [aged care facilities], it is as if they are running a factory.”

That’s the disturbing assessment by University of NSW emeritus professor Richard Hugman, a social worker who specialises in the caring professions.

Prof. Hugman says that when the government responds to the current aged care royal commission, which is due to report in February, it must go beyond providing a significant injection of funds and ensure older people are treated with dignity and care rather than regarded as objects.

“[The government needs to] focus on improvements to the aged care sector that are not reflective of a sense that older people needing care are a burden on society,” he says.

“[Instead, they need to focus on the fact] that older people are part of society and that a good society is one that values all its members.”

Prof. Hugman says there must be an emphasis on positive values and our elderly people must be treated as human beings.

“Frankly, there are some places I've visited in the last few years, either because I've had friends or relatives who are living in them or I've gone to visit for professional reasons,” he says, “[that] I wouldn't go anywhere near.”

The dramatic increase in COVID-19 deaths in Australia’s aged care homes – more than 580 – lays bare the ethics around our treatment of people in such places, says Prof. Hugman.

“To use a similar ethos in caring for human beings that you would use in producing physical things for sale, I think is an unfortunate way to think about the world.

“… it is as if they are running a factory. I understand good management techniques are transferable across settings, but you also need to understand the content of what you're managing.”

COVID outbreaks in care facilities have been blamed on a lack of available staff and insufficient training in the use of personal protective equipment (PPE), plus staff working across multiple facilities to earn enough to survive on.

Melbourne’s aged care homes have been the worst hit, with all but five of the 115 aged care homes affected by the virus. St Basil’s recorded 44 deaths, Epping Gardens 36 and Twin Parks Aged Care in Reservoir 21. In Sydney, Newmarch House recorded the state’s highest death toll in aged care with 19 cases.

Prof. Hugman says the alarming death toll at Newmarch and St Basil’s was due to a decision not to transfer patients to hospital – a decision exacerbated by the fact that there are now very few qualified nurses in nursing homes.

“Some nursing homes don't even actually have a nurse on duty at all times. If they’re looking after 100 people and they’ve got one nurse on duty to supervise other people, then they might have somebody who has a certificate from TAFE administering drugs and medications.

“In a hospital, someone would actually have to be a qualified nurse to be doing that.”

Prof. Hugman says that while the royal commission creates an opportunity for people to speak up, the real challenge will be in how the government responds and whether that produces a positive change in society generally.

Regarding funding, he says there is a lack of transparency in how government funding is spent by management in aged care facilities in comparison to community-based social services where monitoring is stringent.

Claims by some aged care homes, particularly those from the for-profit sector, that they have to spend less on staff relative to residents in order to cover their costs, just don’t stack up.

“And those claims about non-profitability do not explain how or why the [aged care] for-profit sector remains [in operation].”

For-profit aged care homes have reported more cases of COVID-19 than facilities operating on a not-for-profit framework, heightening concerns about staff numbers, training and supplies.

Do you believe a sense of humanity is missing in some aged care facilities? Is it profit first and people second? Do you believe the royal commission will initiate meaningful change?

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    Ted Wards
    25th Sep 2020
    Yes it would be the last place I would ever put an aging parent. Its all about profit at the cost of lives. Enough talk and more action is needed!
    25th Sep 2020
    Same here and for that matter personally would not even consider entering one, appreciate argument re impact on those around you if you elect to stay in your home but anything better than the poor attention, food and medical support some of these so called Aged Care facilities offer. The whole Aged Care Industry needs urgent review and in most cases correction.
    25th Sep 2020
    As a frontline carer the biggest obstacle is everyone above you! Management has to answer to head office. Government gives money in a situation calledACFI. Basically facilities get money from government on top of Basic from client. Things like giving medication To toileting assisting with personal care. So ultimately they take away your ability to be independent For cash.
    They feed them rubbish fish fingers party pies... I saw no summer fruits just apples oranges bananas. They offer independent living....That’s also a crock!
    The place I worked there was rampant bullying by management.
    I really hope it gets changed because the young ones don’t stay young forever!!!
    25th Sep 2020
    MJM you are right about the independence. My folks moved into aged care with physical difficulties yet they were very with it and had been coping well in their own home till heart issues forced them to seek help with day to day living. They were treated as cash cows. The food was as you say party pies and frankfurts on the weekends when there was no cook on site and during the week when they had proper meals the portions were tightly rationed to come under budget. The worse thing though was the loss of dignity. Staff entered rooms without simply knocking and they went through residents drawers frequently. They wouldn't let mum keep even a panadol in case of need when staff were unavailable and this is a woman who until she moved in was handling all her own medications. The facility was two years old and on the surface looked great but was what I would describe as all fur coat and no knickers. I fought them tooth and nail and won some but got empty promises for most issues. I offered to move the folks out but they had friends there and didnt want to leave. Under staffed because most of the wages budget went on the excessive tiers of management. Your last point is well made. The people able to effect change now are the people who will eventually benefit from that change.
    25th Sep 2020
    The bottom line is, of course, money. Everyone wants to spend as little of it as possible. It's why our manufacturing industries died - consumers wanted cheap cheap cheap, so manufacturing moved offshore and a lot of consumers lost their jobs in manufacturing. Go figure. Now, of course, the same people want to put nan and pop into a nursing home because they are too busy working three jobs to pay for the next cruise to care for them themselves. But they don't want to pay much for the nursing home, so the home employs cheap labour, most of whom are barely qualified to breathe. And then everyone complains when it doesn't work out. But yes, in the end, everyone wants everything as cheap as possible so they have more to spend on the fun stuff. Aged care isn't fun or sexy so it will never attract serious funds. I don't have answers to any of this, but please now, tear my argument apart. tell me where I'm wrong!
    25th Sep 2020
    The problem is the Federal Government supply taxpayers funds to aged care facilities but do not exercise proper controls on that funding.
    The State Government aged care homes in Victoria had very few covid cases but they have proper staffing levels whereas the privately owned ones have no mandatory staffing levels, as the article said.
    The Federal Government have responsibility for aged care and all they think needs to be done is throw more money at it without oversight of where that money is being spent.
    The families of the aged people are not the ones responsible for the care provided.
    25th Sep 2020
    Thanks for that, Tanker. Question for you: if state-owned homes provide better staffing, why do people opt for private ones? Just not enough state places available?
    25th Sep 2020
    No need to tear you apart. There are different stages of growing old, the last one is where professional nursing is really needed, this cannot be done in many family's, if you are 80, your kids could be 60 and not physically capable of doing the work for a multitude of reasons, handling a dementure patient requires training and is a constant job of living your life and someone else's, some can do it but not many and not for long therefor a nursing home really is required.
    Far too many are placed in care when with help from a carer they could live on at home for many years, homes can be modified to help the ageing, bathrooms, bedrooms, kitchens and ramps and best of all the Government helps with this.
    I live in a village where many in their 80's and 90's live happily with professional caregivers, they have a quality of life that is happy, they enjoy living with neighbours that they have known for years, they listen to each others medical news, share the daily paper and importantly care for each other.
    My advice is that as soon as your home becomes a chore move to a village, you will make friends with people of a similar age and with similar interests, you dont have to be old and failing, many ride bikes, go walking, play cards and cook. As they age meals on wheels come in, as do carers who clean, wash and do the tasks that are becoming too hard,
    Villages offer different levels of accomodation and facilities, seek out people who are livng in villages, ask questions, find out about body corporates, there is plenty to learn.
    Lastly dont put it off if your home is unsuitable for living as an older citizen, my experience is that I am the healthiest Ive been for 20 years, have caring friends in the village, no maintenance problems, family come and go, life is great
    25th Sep 2020
    Thanks for a very detailed outline, Tarzan - lots of good ideas there!
    Fair Dinkum
    25th Sep 2020
    My mum was in Goodwin Monash aged care and the care was excellent. Every little misshap i was notified immediatly. There of coure were a few small things that could have been done better but overall the care was excellent. I am a retired nurse so feel i have the knowledge to make this accessment. Before entering the full care mum was one of the first into the village about 25 years ago and except for a short period when they had a currupt uncaring CEO who left unders supisicous circumstances the village has returned to its once good record.
    Karl Marx
    25th Sep 2020
    Told my children years ago to never put me in an aged care facility as it's a death sentence & not necessarily for me.
    25th Sep 2020
    I'm with you, Karl Marx (good name that!)... but if your kids won't/can't care for you, what are the options?
    25th Sep 2020
    Good one, Karl Marx
    Karl Marx
    25th Sep 2020
    Options, live at home as long as possible or jail maybe. better treatment, better food, better medical care, better everything & not means tested
    25th Sep 2020
    Good point, Karl Marx, perhaps aged care homes should be run like a jail and not a factory.
    Pass the Ductape
    28th Sep 2020
    Ending up in jail is not such a bad idea and the way prisoners get attention and the things they need, is to simply smash the place up.
    Get all they want in the end! Perhaps nursing home residents ought to try the same methods.
    25th Sep 2020
    I am familiar with aged care homes having worked in them, as a nurse in the 1980's 90's. Nothing has changed from then to now. The three major problems are government funding being inadequate, Private 'run' aged facilities where excessive profit comes first and care of residents comes last, and staff training non-existent. Anyone can get a job in a nursing home with no qualifications at all. I could tell you stories of what I have seen in nursing homes that would make you sick. All nursing homes should be government run by professional caring and trained management and staff trained for for one year both in nursing school and 'on the job' before being certified and then getting decent pay. But how to get a competent government to organize this is the problem. Our governments still have their ideology locked into the 19th century. But government run they should be but never by Church or private companies never, never, never. By a public non-profit company under strict regulation and overseen by a government minister and responsible for reporting complaints by the public - absolute transparency at all times. Too long has this situation has been ignored by both State and Federal Governments. They are a disgrace and should be ashamed of their failure in the care of our elderly citizens
    25th Sep 2020
    spot on
    Horace Cope
    25th Sep 2020
    Individual aged care facilities are legally responsible for the safety of their residents, but the Federal Government is responsible for the aged care system as a whole.
    The Government's primary role is to fund and regulate facilities to ensure they adhere to agreed safety standards. These standards include preventing infectious disease outbreaks.
    Aged care facilities are also subject to the public health laws of their host state or territory, so state governments retain some responsibility for residents.
    However, a state's involvement only comes after an outbreak takes hold. Under powers not specific to aged care, it can, if necessary, take over facilities.
    In preparation for COVID-19, both levels of government agreed on their roles and responsibilities for helping residential care facilities respond to outbreaks.
    These largely reflected existing legislative arrangements, but they made clear the Federal Government would, in addition to its regulatory role, manage the supply of personal protective equipment and help address staff shortages. State governments were tasked with, among other things, testing, contact tracing and working with hospitals to free up hospital beds.
    25th Sep 2020
    Why should I comment as it would only be for venting my spleen as I can only see the government will only have talk fests as at present, to make us suckers believe that they are doing something. Don't hold your breath to see any improvement.
    25th Sep 2020
    This government sees the aged as a burden on the economy they did not listen to the last royal commission and they wont listen to the next one. So many have died needlessly the only way to make them listen is at the ballot box this government is corrupt and incompetent paying 10 times the value for land belonging to liberal party dondors and ignoring the aged is criminal.
    25th Sep 2020
    Another political rant, why do you bother, no one really takes you seriously.
    25th Sep 2020
    Tarzan Its not a political rant its fact
    Horace Cope
    25th Sep 2020
    The vendors also donated to the Labor party.
    25th Sep 2020
    Horace I am not denying the fact that they donate to both parties my issue is corruption and that`s what it is. A royal commission found last October that aged care residents under their watch were neglected undernourished and were left lying in their faeces and they did nothing they should be held accountable
    25th Sep 2020
    You probably watch the A B C suggest you take a nap.
    26th Sep 2020
    Tarzan what do you trolls get out of personal attacks on other commenters? Two insults in one thread a bit over the top. You may not agree with someone's comment but they have as much right as you to state their opinion.
    Ollie is correct about nothing being done since the aged care inquiry began.
    26th Sep 2020
    diamond, this whole site has a left wing bias, state your opinion, but don't try and stop others whose political opinion you don't agree with.
    The Aged Care inquiry has been ongoing so don't expect anything for a couple of years, get on with your life and don't expect someone else to look after you and yours or you will be very disappointed, we have to look after ourselves, take a walk, enjoy a sunset , life is good f you allow it to be
    Pass the Ductape
    28th Sep 2020
    'State your opinion and don't stop others from doing so'....quite right Tarzan....but it seems from what you say, this doesn't apply to everyone.
    Up front lady
    25th Sep 2020
    Who has ever heard of someone saying that they can't wait to get into an aged care place?
    Once people are in there they can't wait to leave, even though there's only one way to do that.
    People must be treated with dignity and respect but they should not be kept alive to keep putting money into drug companies coffers. Most medication should cease to be given and nature allowed to take its course. Covid has destroyed the lives of so many in aged care, not by killing them, but by policies that deprive people of seeing their loved ones. That's about all people have to look forward to and it's been taken away because governments are afraid that old people may die. Old people do die, so let them be happy.
    25th Sep 2020
    I find your suggestion that medication be withdrawn from the people who go into aged care totally repugnant and horribly unkind and nothing short of euthanasia. If their medications are keeping them alive, withdrawing those medications will kill them. That is murder.
    The idea of assisted dying is by far preferable for those who have had enough, but the instinct to hang onto life is strong and should be respected.
    26th Sep 2020
    Am I missing something?. On reading the blurbs above, I get the impression all aged care facilities are bad, especially private for profit run homes. Well, I'm sorry to say that's crap! Yes, some are and some aren't.

    In my experience, one that appeared cheap in comparison to other Aged care homes in the area (private ones) was terrible, another further from home that wasn't cheap was and is still excellent. The first one set you back $550,000 RAD plus $2,800/month, the second $800,000 RAD and $3,750/month.

    For those arguing the government pays these private aged care homes taxpayer funded allowances is absolute rubbish! The government does not fund these places (private) at all, what it does the cunning bastards, is to allow these homes to charge an additional fee of up to (or more) of $2,400/month odd, paid for by the resident or the resident's relatives. So the government has control, but costs it nothing, the aged care home gets a good wack at the available funding and makes a healthy or reasonable profit. The resident misses out.

    Having said that, the care in the second facility is excellent, staff to resident ratios 1:6 or better, professional nurses, carers, cleaners, 5 star cooks, activity managers, and maximum 40 residents. Thank God, there have been no Covid 19 outbreaks or infections this year in this facility This is because they are strict on hygiene and proper care of residents.

    I would rather see my wife in this aged care facility than anywhere else, even if they were free. You get what you pay for. In my view there are three basic types, Public and Not for Profit and Private. Each of these have the good and the bad care. Each home, regardless of funding, has to pay for it's costs, and the emphasis should be on resident's care as first priority, and secondly maintaining it's stated goals. Profit, a dirty word these days is important as well, seeing if you want to run an aged care business, you have to put up a facility worth at least $1,000,000 per resident, that's $40,000,000 in my own case. So the private good homes need to recoup these costs, and also maintain a running budget. I my case, I had to sell my former house of 48 years and buy a small unit near my wife's home, so I could walk there if necessary to visit her. Big changes in lifestyle and accommodation on my part.
    Karl Marx
    26th Sep 2020
    Would rather die at home or Jail than in any aged care facility. I'd be happier, live longer & still have some money left at the end of the day to leave for my cat.
    26th Sep 2020
    Agree with you JoJozep. All the points you've made are correct & valid. I hope you have many wonderful years ahead of you to drive &/or walk to visit your beautiful wife. Best wishes. You have made a great decision for yourself & your wife.
    26th Sep 2020
    Your A good man
    Red Robin
    27th Sep 2020
    Take the 'profiteers' out of the aged care industry and you will get the correct care, ratios of staff, decent food and more respect for the residents. Residents pay a lot of money for the care they do not get!
    Pass the Ductape
    28th Sep 2020
    Running a factory - might as well be - and of course it's profit first!

    The operators of these homes are in it for no-ones health but their own, otherwise why outlay the funds in the first instance to set one up! The real object of the whole exercise is to work out how to make the most money by spending the least amount.....this is the crux of the whole matter.

    The less they spend on servicing - the more they make and their are a myriad ways to do it. None of the operators of these homes would ever allow any of their own parents to end up in one.

    My wife (a compassionate person and a damned hard worker) used to work in one.....the pay was pathetic and the workload was horrendous.....robots wouldn't have been able to do what was expected of her and it got to a point where she ended up spending her own money to purchase items for patient health care which weren't supplied by the operators of the home because of - 'budgetary restraints'.

    It was a disgusting situation and the government should feel thoroughly ashamed to keep letting these pathetic, greedy care home owners operating - and don't let anyone tell you they don't know who they are.

    Sense of humanity gone.... IT WAS NEVER THERE IN THE FIRST PLACE!
    Will a royal commission solve the problem? NO!

    Complete waste of bloody time like everything else - just more money down the drain!
    28th Sep 2020
    I hear what you say. Yes the private for profit homes do make profit, but it's a question of degree. Some are very greedy yes and follow the get rich schemes as a maxim. Others try to provide a good service and maintain the business for many years. Any that rort the system don't last long, they soon run out of residents. Once a home gets a bad name, it goes around very quickly.

    I still wonder if I did the right thing! It was a huge life changer. Then I thought, well, it's time I thought about our future. My wife's condition is incurable, but just manageable with the right help and professional care. I tried to manage our situation for about 2 years, tried home help, tried everything I could, letting her stay quiet or in bed but this had it's limits. The home help wasn't the answer because it needed to be 24 hours per day seven days a week. A large home has it's drawbacks. Fine for a young couple starting a family, terrible as you get older and cleaning and maintenance became a chore that filled the day. Even going out presented problems, especially operating a wheelchair. Proximity to my daughter was also paramount, as she could do cheering up her mum amongst other small favours. The problem of falling didn't diminish, it increased. Fracture/broken bones and bad bruising was out of control. Something had to be done.

    Having spent my life sorting out problems in the building industry, I had to sort this life problem once and for all. I could start to feel my own mental health was at risk. What then were my choices?

    1. I woke up to my self that we were not getting any younger.

    2. Our bucket list was just that; chucked the plans in the bucket and into the rubbish bin.

    3. Weigh up selling our long standing home. Finding a good Aged Care Nursing Home and buying a small unit nearby. (needed to be within walking distance to the ACNH and my daughter).

    4. As soon as a decent unit became available, my decision was finalized. I bought and sold my residences.

    5. I was finding living alone in a big house a big chore. Marinating an acre of land with mowing, weeding and house maintenance was getting beyond me and of no benefit.

    5. As if the planets had aligned, my only problem was finance. This was gradually overcome.

    6. Although my parents brought me up in a religious environment, I wandered away from the Church, but the good Lord was still looking after us, because the events fell into place and I discovered her happiness increased, her condition improved, my well being improved and I could now see myself lasting some more years without too much hassle. These events ticked the right boxes. I am now much happier than I was 2 years ago.

    I hope these experiences of our later lifestyle will encourage others to think deeply about options, and make the right choices. I'm happy to discuss the matters privately with any one facing the same situation.
    ex PS
    30th Sep 2020
    Not a factory, a warehouse, factories produce something, these places are mostley somewhere to put people out of sight to die.
    Any government money goes to investors in the form of dividends and bonuses for the board.
    Pass the Ductape
    1st Oct 2020
    And that, dear friends, is what's it's all about....right on ex PS. No need for an expensive royal commission to tell us that!