Preventable deaths quadruple in Australian nursing homes over ten years

By Oscar Grenfell
7 June 2017

A landmark study, published in the Medical Journal of Australia last week, recorded 3,291 premature deaths in aged-care nursing homes from potentially preventable causes between 2000 and 2013. The research found such deaths increased more than four-fold over a decade.

The staggering figures are an indictment of the aged-care and nursing home sector, which is increasingly dominated by profiteering corporations as a result of the policies of successive federal and state governments, Labor and Liberal-National alike.

The study leader, Professor John Ibrahim of Monash University, told the Australian Financial Review: “We have uncovered a ‘systems’ problem, rather than a problem with a few bad nursing homes or individuals.”

The data, the most comprehensive of its kind yet released, provides a statistical snapshot of the experiences of thousands of elderly people and their families, who are forced to pay exorbitant sums for little more than a bed, often substandard care and a poor quality of life.

The study was based on coronial data for 21,672 deaths in accredited nursing homes over the 13-year period.

Some 98.5 percent of incidents which caused premature deaths occurred inside nursing homes, rather than when residents were in hospital or elsewhere. Falls were responsible for 81.5 percent of non-natural fatalities. The other two main causes, non-intentional choking and suicide, accounted for 7.9 percent and 4.4 percent of preventable deaths, respectively.

The high number of suicides tallied with 2015 figures from the Australian Bureau of Statistics, released last week, which found that males over the age of 85 had the highest proportion of suicides, at 39.3 per 100,000 people. That number is more than double the ratio for teenagers, another at-risk demographic.

Commentators noted that the tragic indices were directly related to the growth of poverty among the elderly, along with the rising cost of medical procedures and housing.

Other causes of death documented in the Medical Journal of Australia study included asphyxia and aspiration (23 deaths), thermal injuries or burns (23 deaths), poisoning (18 deaths) and drowning (15 deaths).

The survey noted the sharp rise in the number of nursing home deaths resulting from “external causes,” rather than natural causes, from 1.2 per 1,000 admissions in 2001-02, to 5.3 per 1,000 in 2011-12. It stated that while improved reporting might have contributed to the rise, it was likely that deaths caused by falls and other injuries were still being attributed to natural causes. That would mean the real number of preventable deaths could be far higher.

The report said the increase raises “an important question” about “governance structures” in nursing homes.

A number of recent cases have highlighted the unsafe conditions in some nursing homes.

On Thursday, the federal Department of Health announced there were still “significant and immediate risks” to residents of a nursing home for elderly people with dementia and mental health issues in Oakden, South Australia. The facility, run by the state Labor government, is the subject of a maladministration probe by the Independent Commissioner Against Corruption.

Among the accusations are that residents were sexually assaulted by staff, left in pain for hours because of the use of incorrect catheters and suffered broken bones that were undetected for days. There are also reports that residents were given excessive doses of medication. A 70-year-old resident died in 2008 after being assaulted by another resident who suffered from Alzheimer’s disease and was allegedly known to be violent.

Oakden’s accreditation, which entitles it to federal funding, was suspended for six months in 2007, but nothing appears to have been done to prevent the subsequent mistreatment of residents. The South Australian Labor government reportedly received warnings of a high risk of injuries or deaths at the facility in 2014, but the reports were dismissed.

Last month, the Australian Broadcasting Corporation reported allegations that Kevin Williams, a resident at the Bupa Modbury aged-care facility in Adelaide was mistreated before dying of an infected ulcer on his right hip. Williams’ family claim he was handled roughly and often not showered.

In another case, Shirley Carter, a resident at the Opal Raymond Terrace Gardens nursing home in New South Wales was allegedly found with maggots inside her mouth the day before she died last October. Carter’s daughter claimed she was also not given sufficient medication to alleviate intense pain.

Many other cases of mistreatment and neglect have been alleged in the media and by residents’ relatives. In a number of instances, attempts have been made to scapegoat individual nursing home workers.

As the Medical Journal of Australia notes, however, premature deaths are part of a systemic crisis across the industry. A national report last year found that only 8.2 percent of nursing home workers thought staffing levels were adequate at all times. The average staff ratio at any given time was one worker to more than 38 residents, with one registered nurse for over 59 patients.

Successive governments have cut funding for federally-subsidised placements into nursing homes, reducing the quality of care, especially for the poor, and increasing pressures on over-worked staff.

In its 1994-95 budget, for instance, the federal Labor government of Paul Keating slashed $250 million from the sector, while introducing entry bonds for residential facilities. The Coalition government of John Howard cut $1 billion from aged-care funding in 1996-97.

This agenda was deepened by the Labor governments of Julia Gillard and Kevin Rudd from 2007–13. Labor’s “Living Longer, Living Better” aged-care policy, introduced in 2012, abolished any distinction between “high-care” and “low-care” beds in nursing homes, removing restrictions on charging some prospective residents accommodation bonds.

The measures were aimed at abolishing any government-provided safety net for elderly people requiring care, and transforming the sector ever more into a lucrative, for-profit market. An article in Crickey in 2014, noted that Japara, a nursing home operator, floated on the stock market for $450 million in the wake of the changes. Other providers have also turned to private equity.

A report in April by the right-wing, pro-business think-tank, the Centre of Independent Studies (CIS) lauded the policies introduced by Labor, and the bipartisan support for further changes earlier this year. Under the fraudulent banner of “consumer directed care,” the latest measures create the conditions for the further curtailment, or even abolition, of federal funding to nursing homes. The CIS declared that this “presents an important opportunity to showcase the benefits of market-based reforms.”

In reality, the opening up of aged-care to the market has already created a social disaster, especially for poor and working-class families. In February, the Daily Telegraph reported that federal authorities had exempted 215 nursing homes from the nominal $550,000 cap on nursing home accommodation bonds, thus lifting the average amount that elderly people and their families have to pay. The estimated average bond, or equivalent accommodation fees, is around $370,000.

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