.

  • Written by Joachim Sturmberg, Conjoint Associate Professor of General Practice, University of Newcastle
The aged care royal commission has looked at regulation in aged care. From shutterstock.com

Last week’s hearings at the aged care royal commission in Brisbane looked at regulation in aged care. While rules and regulations are designed to safeguard residents, bureaucratic “red tape” also contributes to the failings in aged care.

The fear among nursing home staff of failing a review visit by an Aged Care Quality and Safety Commission surveyor has been known to shift the focus from care for residents to meeting paper trail requirements.

The best outcome for aged care residents and their families would be new reporting requirements centred on outcomes rather than processes. Their primary focus should be on the mediation of critical incidents – that is, looking at what caused them and how they could be prevented in future – and the maintenance of health.


Read more: Our ailing aged care system shows you can't skimp on nursing care


How did we get here?

The crisis in the aged care sector has emerged over time. At least in part, systemic problems in organisations arise from interactions among its key players. These interactions must be aligned to achieve its common goals.

But the key players in the aged care system pursue divergent agendas. Regulators focus on process adherence, while staff struggle with their limited capacity to manage the complex needs of residents. Meanwhile, proprietors focus on economic viability.

The prevailing approach of dealing with the problem of a particular key player in isolation will not solve the problems of aged care as a whole.

Governance and accountability

Our research suggests the need for a major culture shift in the aged care system.

Around the world, governments are being urged to put less emphasis on process measurement and more on outcome transparency.


Read more: We've had 20 aged care reviews in 20 years – will the royal commission be any different?


Peter Drucker, a well-known management consultant, educator and author, once said “management is doing things right; leadership is doing the right things”.

Ticking the boxes of a protocol to demonstrate “regulatory compliance” – that is, doing things right – is no longer an option on its own. Residents and their families expect staff to be attentive to residents’ changing physical, emotional, social and cognitive needs; that is, doing the right things.

These insights tell us the aged care system needs to be redesigned.


Read more: Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis


What would this look like in practice?

Let’s consider two common aged care problems – falls and diabetes – whose management is significantly influenced by the chosen accountability framework. The differences between an outcomes-based approach (that is, adapting care to problems in their context) and a process-based approach (adhering to a protocol) are stark.

The extent to which staff in aged care are required to focus on documentation may detract from their capacity to care for residents. From shutterstock.com

The first example: a resident has a fall. Rather than only assessing her for injuries and vital signs (as per protocol), staff would also assess potential reasons for the fall – for example, lack of mobility, pain, low blood pressure, or polypharmacy (taking multiple prescription medications at once) – and involve allied health professionals in preventive and rehabilitative care. This could include muscle strengthening exercises, gait and balance retraining, pain management and medication review. These are measures that could reduce the likelihood of the patient falling again, thereby improving her outcomes.

And let’s take a resident with normally stable diabetes, who one day records an elevated blood sugar reading. Rather than just giving him more insulin, staff would also assess potential underlying reasons for the elevated reading. These could include loss of appetite, an infection, or an episode of delirium.

The royal commission should do many things, but adding red tape isn’t one of them

Increasing frailty and/or significant memory decline are the main reasons for admission to an aged care facility. These people are particularly vulnerable as their health changes frequently and rapidly.

Being bogged down by regulatory ritualism reduces the time staff have available to spend on residents’ physical, social, emotional and cognitive needs.


Read more: Don't wait for a crisis – start planning your aged care now


True accountability in aged care is achieved by demonstrating how the provided care has impacted a resident’s well-being. In that regard, the Aged Care Quality and Safety Commission should provide leadership and primarily act as an educator, helping facilities to become learning organisations. If an aged care facility fails to “learn and improve”, then sanctions and penalties become necessary.

More bureaucracy would only serve to perpetuate the current crisis, and would fail those residents and families who have suffered from the current failings in the sector.

Len Gainsford, a former adjunct research fellow in accounting & governance at Swinburne University of Technology, contributed to this article.

Joachim Sturmberg is Foundation President of the International Society for Systems and Complexity Sciences for Health (ISSCSH).

Authors: Joachim Sturmberg, Conjoint Associate Professor of General Practice, University of Newcastle

Read more http://theconversation.com/red-tape-in-aged-care-shouldnt-force-staff-to-prioritise-ticking-boxes-over-residents-outcomes-121561

Private health premium increases might be the lowest in years, but that doesn't mean they're justified

Those facing large price increases might drop or downgrade their cover. Wayhome studio/ShutterstockEvery year private health insurers raise premiums and every year we rue the hit to our hip pocket. Th...

Nathan Kettlewell, Chancellor's Postdoctoral Research Fellow, Economics Discipline Group, University of Technology Sydney - avatar Nathan Kettlewell, Chancellor's Postdoctoral Research Fellow, Economics Discipline Group, University of Technology Sydney

So your kid's finished their first year of school. Here's what they should have learnt

Every child progresses at different levels, just like everyone learns to talk and walk at different times. from shutterstock.comIt’s the end of the first year of school for many children and pro...

Jenny Johnston, Lecturer in Primary Education, Southern Cross University - avatar Jenny Johnston, Lecturer in Primary Education, Southern Cross University

5 human rights issues that defined 2019

One of this year’s most refreshing developments was the youth-led action on climate change. AAP Image/Dan PeledAs we approach the last days of the decade, it’s important to reflect on the ...

Elaine Pearson, Adjunct Lecturer in Law, UNSW - avatar Elaine Pearson, Adjunct Lecturer in Law, UNSW

As heat strikes, here's one way to help fight disease-carrying and nuisance mosquitoes

Although yellow fever does not currently exist in Australia, the species Aedes aegypti - which can transmit the disease - is found widely across northern Queensland. The virus remains a global health ...

Cameron Webb, Clinical Lecturer and Principal Hospital Scientist, University of Sydney - avatar Cameron Webb, Clinical Lecturer and Principal Hospital Scientist, University of Sydney

Don't blame the Murray-Darling Basin Plan. It's climate and economic change driving farmers out

For the thousand or so farmers in Canberra in the past week venting their anger at the federal government, it’s the Murray-Darling Basin Plan to blame for destroying their livelihoods and forcin...

Sarah Ann Wheeler, Professor in Water Economics, University of Adelaide - avatar Sarah Ann Wheeler, Professor in Water Economics, University of Adelaide

Expect family talks about climate change this Christmas? Take tips from Greta Thunberg

Swedish climate activist Greta Thunberg is a master of staying on topic. AAP/Julian SmithAs bushfires rage and our cities lie shrouded in smoke, climate change is shaping as a likely topic of conversa...

Peter Ellerton, Lecturer in Critical Thinking; Curriculum Director, UQ Critical Thinking Project, The University of Queensland - avatar Peter Ellerton, Lecturer in Critical Thinking; Curriculum Director, UQ Critical Thinking Project, The University of Queensland

Climate explained: seven reasons to be wary of waste-to-energy proposals

Many developed countries already have significant waste-to-energy operations and therefore less material going to landfill. CC BY-ND Climate Explained is a collaboration bet...

Jeff Seadon, Senior Lecturer, Auckland University of Technology - avatar Jeff Seadon, Senior Lecturer, Auckland University of Technology

In our time of climate crisis, the exhibition Water is a subtly crafted plea

Olafur Eliasson, Denmark, b.1967 Riverbed 2014 (detail) Site specific installation. Pictured: The Louisiana Museum of Modern Art, Humlebæk, DenmarkCourtesy of the artist; neugerriemschneider, B...

Chari Larsson, Lecturer of art history, Griffith University - avatar Chari Larsson, Lecturer of art history, Griffith University

We're still fighting city freeways after half a century

Demonstrations against freeway construction in Melbourne included a street barricade erected in protest at the F19 extension of the Eastern Freeway. Barricade! – the resident fight against the...

Andrew Butt, Associate Professor in Sustainability and Urban Planning, RMIT University - avatar Andrew Butt, Associate Professor in Sustainability and Urban Planning, RMIT University

Why were tourists allowed on White Island?

The volcanic alert level on Whakaari/White Island remains at three, one rung higher than it was when the eruption took place. AAP/GNS Science, CC BY-NDThe official death toll remains at six, and eight...

Michael Lueck, Professor of Tourism, Auckland University of Technology - avatar Michael Lueck, Professor of Tourism, Auckland University of Technology

Curious Kids: why do we get bruises?

From red, to blue, to purple, to yellow and even green – why do our bruises change colour? From shutterstock.com How and why do we get bruises? – Francesca, aged 8. Hi Francesca, thank...

Abishek Santhakumar, Senior Lecturer in Haematology, Charles Sturt University - avatar Abishek Santhakumar, Senior Lecturer in Haematology, Charles Sturt University

To save koalas from fire, we need to start putting their genetic material on ice

Over the coming months, koalas will depend on wildlife hospitals to recover from the effects of unprecedented bushfires. Lachlan G. Howell , Author providedThousands of koalas may have died in fires ...

Ryan R. Witt, Conjoint Lecturer | Conservation Biology Research Group, University of Newcastle - avatar Ryan R. Witt, Conjoint Lecturer | Conservation Biology Research Group, University of Newcastle

(Almost) everyone's a winner? Art is meant to break rules and prizes must adapt

British artists (L-R) Oscar Murillo, Lawrence Abu Hamdan, Helen Cammock and Tai Shani celebrate after being announced as the joint winners of Turner Prize 2019. Vickie Flores/EPALast week Britain&rsq...

Lachlan Warner, Australian Catholic University - avatar Lachlan Warner, Australian Catholic University

Unlawful metadata access is easy when we’re flogging a dead law

After watching this year’s media raids and the prosecution of lawyers and whistleblowers, it’s not hard to see why Australians wonder about excessive police power and dwindling journalisti...

Genna Churches, PhD Candidate, UNSW - avatar Genna Churches, PhD Candidate, UNSW

Why the profit motive fails in education

The disastrous experience of vocational education and training in Australia holds many lessons about trying to fit education into a for-profit market model. www.shutterstock.comThe Morrison government...

John Quiggin, Professor, School of Economics, The University of Queensland - avatar John Quiggin, Professor, School of Economics, The University of Queensland

The X17 factor: a particle new to physics might solve the dark matter mystery

Anomalies in nuclear physics experiments may show signs of a new force. ShutterstockA team of scientists in Hungary recently published a paper that hints at the existence of a previously unknown subat...

Celine Boehm, Head of School for Physics, University of Sydney - avatar Celine Boehm, Head of School for Physics, University of Sydney

The water crisis has plunged the Nats into a world of pain. But they reap what they sow

Angry farmers are pressuring the Nationals to tear up the Murray Darling Basin Plan. Lukas Coch/AAPWhen farmers descended on Parliament House in Canberra this month to demand the Murray Darling Basin ...

Daniel Connell, Research Fellow, Crawford School of Public Policy, Australian National University - avatar Daniel Connell, Research Fellow, Crawford School of Public Policy, Australian National University

8 Factors to Consider When Buying a Standby Diesel Generator

Diesel generators play a vital role in different home and business applications. However, they are commonly known for providing backup power, especially during the mains outage or blackout. Though...

News Company - avatar News Company

2019 was a year of global unrest, spurred by anger at rising inequality – and 2020 is likely to be worse

2019 may well go down as the most disrupted year in global politics since the fall of the Berlin wall in 1989 and the subsequent implosion of the former Soviet Union. However, the likelihood is that ...

Tony Walker, Adjunct Professor, School of Communications, La Trobe University - avatar Tony Walker, Adjunct Professor, School of Communications, La Trobe University

Sick and Tired of Your Dead End Job? Try Teaching!

Tired of the same old grind at the office? Want an opportunity to impact lives both in your community and around the world? Do you love to travel and have new experiences? Teaching English is the perfect job for you! All you need is a willingness to ...

News Company - avatar News Company

The Impact of an Aging Population in Australia

There’s an issue on the horizon that Australia needs to prepare for. The portion of elderly citizens that make up the country’s overall population is increasing, and we might not have the infrastructure in place to support this. Australians h...

News Company - avatar News Company

LifeStyle

Latest Wednesday Lotto Results

Wednesday Lotto draw 3917 Lucky numbers for this draw were 43 followed by 25. The rest of the...

Ways Love and Relationships Benefit Body and Mind

Being in a happy relationship is great. You always have someone to greet you when you come home ...

The Importance of Smiling: How You Can Smile More

Happiness is something we all strive for and is often just out of reach. Of course, it’s impos...

5 Things to Do On Your Wedding Morning

After months of meticulous planning, wedding mornings usually find the bride excited but stressed ...