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From Schwartz Media, I’m Ange McCormack. This is 7am.

If someone in an aged care home is hurt or mistreated, there’s a system in place that’s supposed to make sure incidents are flagged and followed up on.

But the people in charge of doing that, have instead been “bulk closing” cases in the thousands. Sometimes, without even the most basic assessment.

Staff say this is leading to further neglect, abuse and even preventable deaths, as major risks go unnoticed.

Today, senior reporter for The Saturday Paper Rick Morton, on why the aged care regulator hasn’t been doing its job properly, and the people suffering because of it.

It’s Tuesday, August 22.

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ANGE:

Rick, you’ve been reporting on how serious incidents that happen in aged care homes are being handled. Can you tell me, how did you start looking into this?

RICK:

So recently, I heard about a case of someone in an aged care facility whose wounds weren't being cared for properly. This is pretty much, like, aged care 101, is wound care. The resident’s wounds were not being looked after properly. They developed sepsis because of an infection, and that led to the death of this elderly person. Now, as they are required to do by law, the aged care provider notified what we call the aged care regulator, which is the Aged Care Quality and Safety Commission, about this incident. And it wasn't followed up. There was no proper assessment done, there was no proper investigation done. It just sat there collecting dust. And the only reason we now know about this previous issue is because there was another incident at the same nursing home, the same aged care provider, with a different resident, who also had issues with their wound care. And that person also died. So, what we're talking about here is, we’ve missed a pattern of behaviour at this particular provider and, as one staff member at the Aged Care Quality and Safety Commission said to me, we're talking about a death that was preventable. If someone had acted on that first report, we might have been able to intervene and talk to this provider and go, what the hell is going on here, because we've got a problem. That didn't happen, and two people died, and we're just scratching the surface of the problem here.

ANGE:

Right. And so obviously, an incident like that, improper wound care, shouldn't just be ignored. Can you tell me how this information should be handled when it's filed? What's the ideal process meant to look like?

RICK:

It's a really good question, because prior to April 2021, there used to be this system of compulsory reporting in aged care, where if there was an unexplained death or, you know, a serious absence, if someone went wandering and missing from a nursing home, you kind of had to report that. But it wasn't a particularly large system and stuff fell through the cracks. And of course, once the Aged Care Quality and Safety Royal Commission was announced in late 2018, and then it began in 2019. And so, in response to that royal commission, a serious incident response scheme was set up and it massively broadened the categories of, you know, incidents that had to be reported to the aged care watchdog. And these were split into two priorities. We've got priority one, being the most serious that had to be notified within 24 hours. So we're talking death, hospitalisation or any kind of medical care that's warranted because of a lapse in care, people who've gone missing, any type of neglect or abuse, you know, sexual, physical or other. We're talking the big things, right? They have to be notified within 24 hours. Priority two is a second tier notification. It has to be made within 30 days. And it helpfully, or unhelpfully, I would say, the definition for anything that's priority two literally is, anything that's not priority one. And legislatively, both of those have to be assessed and triaged by the Aged Care Quality and Safety Commission, the regulator. Now, what we had was a phased introduction. So, priority one began in April 2021, for the most serious reports, and then from October, priority two notifications began. Now what happened was, there were already priority two notifications being made to the Commission, before October. And they included really serious incidents. And so we're getting bunches, thousands, of priority two assessments being made. And the aged care regulator says, well, we’re legislatively not required to look at those yet. So, they closed them. They just bulk closed them.

ANGE:

Right. So there's this very large backlog of cases and staff, instead of dealing with them properly, as they should with this, you know, quite clearly defined triaging system. Instead of doing that and looking at them one by one, they've just batch closed thousands of them instead. How did this all come to light?

RICK:

So staff started spotting undealt with priority two notifications and they were going, why is this being closed? It should have been followed up on, it should have been actioned, there should have been something more than this cursory assessment. In some cases, no assessment was done at all. And so one staff member in particular decided to go looking. And they divvied up all of the old incidents between April 2021 and the end of 2022, and they found 15,500 bulk closures of complaints or incident reports. And so all of these cases had, you know, this copy and pasted generic description. The assessment dropdowns that would ordinarily have been completed to indicate the standard 45 minute investigation, wasn't completed. And so it looked like many of these matters just had no human giving them, even a little bit, of consideration. So this staff member is thinking… and they're an assessor, this is their job, right? They're thinking, that's not right, something weird is going on here. But after this, they go back to do more searches and they find that the search function that allows them to look for this particular type of closed matter, the search function has been disabled. So, as they said to me, they said, I thought, right, well, they know we're looking, and they're trying to cover their ass. And by they, they mean the leadership at the Aged Care Quality and Safety Commission.

So not only was there a mass closure of incidents, but management was clearly aware, and they were clearly trying to stop staff from sounding the alarm about it, by blocking them from being even able to identify what had happened in the past.

And staff were wanting to do their jobs, but they were being stopped by the very people who should have been making this a priority.

ANGE:

After the break, why thousands of serious cases in the aged care sector were ignored, and covered up.

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ANGE:

Rick, you've revealed this cover up and batch closure of serious incidents in the aged care sector. What was going on, and what is going on, inside the aged care regulator to lead to this error?

RICK:

Now, there's an extraordinary amount of stress, especially for the assessors who are responding to this stuff, because they are seeing what's being written and what's being reported. And in some cases, they're being stopped or hamstrung in their response. And they see that from, you know, some team leaders, some directors above them, where there's this pressure to close cases without proper investigation. The staff are worried that people might die, and they're worried that it'll be because of something they've been unable to do, because of the structure and the leadership at the Aged Care Quality and Safety Commission. And the real problem here is the commission. Now, I don't want to use the word commission too many times, but the Royal Commission into Aged Care, when it reported, it found that the aged care regulator should be completely dismantled. It had no faith in the Commission whatsoever. You know, it recommended this capability review of the organisation to be carried out, which has now been handed to the Aged Care Minister, Anika Wells, and released publicly, finally. And that review is scathing. It said that the entire serious incidents response scheme, and complaints handling, is subject to significant concern and should be completely overhauled.

ANGE:

Right. So the Minister and the Government is obviously aware that there's issues in this regulator. So what, if anything, is being done to address it?

RICK:

The Commission, to its credit, has started doing some of the things that it should have done a long time ago. So in May, they appointed the new Aged Care Complaints Commissioner. In fact, it's the first complaints commissioner we've had in aged care. And the woman they appointed to that job is Louise McLeod. You may remember Louise McLeod from her former role as an assistant ombudsman with the Commonwealth Ombudsman and who gave evidence, quite emotional evidence, during the Robo-debt Royal Commission where she had tried to warn her bosses that something was wrong with this program, that she was talking to both DHS and social services about, the departments. But her bosses weren't quite so keen on hearing that either. And of course, we know in hindsight that the Ombudsman was misled, and also lacked the curiosity and the teeth, really, to pursue what it knew were problems. And so Louise McLeod… staff at the Commission, the aged care regulator, are hoping Louise McLeod has some of that fire in her belly still to fix some of these problems. In fact, I've heard good things about her from staff who’ve met her. But again, they're worried that she's going to be swallowed by this culture at the aged care regulator and that one Louise McLeod is not enough, to break what is a pretty systemic issue of bad practice at the watchdog.

ANGE:

And Rick, when a complaint isn't read or handled appropriately, there's obviously an impact on an individual or a family. But when you have incidents not being dealt with at this really large scale, what's the risk of that, and what can that lead to?

RICK:

So we talk all the time, right, about resources pressure, and there's… you will never be able to put enough staff, in any regulator, to pay attention 24 seven, to every single nursing home provider, every single worker in a nursing home, every home care worker. It's physically impossible, right, no matter how well-intentioned you are. So the whole point of being a regulator that has access to this kind of information, is to use that information to target your activity. It’s to use that data to ration your resources, to point them where the most risk is. In one case, a staff member found 17 closed priority two notifications that involved the same subject of allegation. So in this case, it could have been an abusive nursing home worker, it could have been an abusive family member, or an abusive visitor. But the same subject of that allegation, in all of these closed priority two notifications, as they were investigating in their priority one. Now, that is valuable intelligence that was not used. And we heard about the wound care incident at the top of the episode, where prior indications of poor behaviour could have been followed up on, and maybe even prevented more ill health and in this case, as a staff member says, possibly even the death of another nursing home resident. And so we're looking at patterns analysis. It’s what human beings are very good at, right? If you've got enough information, we see patterns everywhere, even when there are none. But the regulator's job is to make sure they're looking. And they're not looking. And the reason they're not looking is because they say they don't have enough staff, and that's probably true. And I think there needs to be a budget allocation. But you don't get to make it an internal assessment saying, we don't have enough staff, so therefore, we're not going to tell anyone that we're not looking at this stuff.

ANGE:

Rick, over the years, there's been no shortage of stories about issues in aged care going unnoticed or unchecked. And that could partly be the fault of the operators or the regulators, but it could go to something bigger, right. You know, of how we do, or don't, see elderly Australians and how we potentially forget about them in society.

RICK:

I mean, that is the critical cultural issue, right? I mean, the whole point of having the Royal Commission into aged care in the first place, ostensibly, was to draw attention to the shameful treatment of older Australians. Most right thinking Australians, especially as they get older, say, put a bullet in me before… my mum does, she says, put a bullet in me instead of putting me in a nursing home. They don't want to go in there. Now, it doesn't have to be like that. But we had a royal commission. We exposed just voluminous stories of wrongdoing and people who just didn't seem to care. And after that royal commission, which recommended this aged care regulator be abolished, we still have the aged care regulator, and we still have the aged care regulator's leadership putting in place processes that, essentially, repeat their mistakes of the past. I mean, if you actually cared about any single person in an aged care home or in a home care setting, you would come out publicly and say, look, we can't look at every single serious incident report we're getting. There’s tens of thousands of them. We do about 50,000 a year. And they're just the ones that the aged care homes report. You know, it's self-reporting and self-assessment. So, you know, there are probably 150,000 out there that we just don't know about. But we can't even get to the ones that we're told about. And that makes us feel nervous.

This is the kind of conversation you can have with an intelligent, mature public. But we're not getting that. We're getting secrecy and we're getting, close these cases, don't look at them. You’re tricking your own staff, it's leading to burnout. The turnover rate is astonishing, and it's almost entirely driven by this culture at the regulator. Which, if they're willing to treat their own staff in these ways, and they're willing to turn a blind eye, it seems, to older Australians, then who anywhere has faith in what they're doing?

ANGE:

Rick, thanks so much for your time today.

RICK:

Thanks for having me again, Ange.

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ANGE:

Also in the news today…

Australia will lose its triple-A credit rating in the next seven years because of climate change, according to a new study.

Researchers from Oxford, Cambridge, Yale and East Anglia say Australian taxpayers and businesses will be among the 20
worst-affected in the world, even if we manage to limit warming to two degrees.

And,

Qantas has been hit with a class action lawsuit seeking millions of dollars in refunds and compensation for customers who had flights cancelled due to the COVID pandemic.

Echo Law is alleging the airline misled customers about refund options, withheld money, and engaged in a “pattern of unconscionable conduct”.

Qantas rejects the allegations.

I’m Ange McCormack, this is 7am. Tomorrow, we’ll explore the new far-right media network backed by Australia’s rich and famous. See you then.

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