Published by David Dupuy - C.E.O. GSO Care Pty Ltd in Aged Care Software · 2 December 2020
Tags: GSO, Care, Aged, Care, Software, And, The, Pathway, Forward
Tags: GSO, Care, Aged, Care, Software, And, The, Pathway, Forward
The Pathway Forward To Better Aged Care
On 31 October 2019, the Australian Royal Commission into Aged Care Quality and Safety submitted their interim report. The report was titled, “Neglect”. The forward is titled, “A Shocking Tale Of Neglect”. Below are some excerpts.
What happens in aged care
.....there is substantial direct evidence about what can happen to older people once they move into residential care. Case studies give invaluable insights into the vulnerability and isolation of older people in care.....
We have been told about people who have walked into an aged care residence, frail but in relatively good spirits and mentally alert, only to die a few months later after suffering from falls, serious pressure injuries and significant pain and distress. We have seen images of people with maggots feeding in open sores and we have seen video and photographic evidence of outright abuse.
We are concerned that there are no measures available to quantify the extent of substandard aged care. However, the combined impact of the evidence, submissions and stories provided to the Royal Commission leads us to conclude that substandard care is much more widespread and more serious than we had anticipated. We consider substandard care to include care that does not meet the relevant quality standards or other legislative obligations, or which otherwise does not meet community expectations.
The often shocking evidence reveals too many unacceptable practices and an aged care sector that is too often failing to satisfy basic community expectations or legislated requirements.
The major quality and safety issues which have been brought to our attention during this Royal Commission are:
• inadequate prevention and management of wounds, sometimes leading to septicaemia and death
• poor continence management—many aged care residences don’t encourage toilet use or strictly ration continence pads, often leaving distressed residents sitting or lying in urine or faeces
• dreadful food, nutrition and hydration, and insufficient attention to oral health, leading to widespread malnutrition, excruciating dental and other pain, and secondary conditions
• a high incidence of assaults by staff on residents and by residents on other residents and on staff
• common use of physical restraint on residents, not so much for their safety or well being but to make them easier to manage
• widespread over prescribing, often without clear consent, of drugs which sedate residents, rendering them drowsy and unresponsive to visiting family and removing their ability to interact with people
• patchy and fragmented palliative care for residents who are dying, creating unnecessary distress for both the dying person and their family.
It is shameful that such a list can be produced in 21st century Australia. At the heart of these problems lies the fundamental fact that our aged care system essentially depersonalises older people.
The aged care system lacks fundamental transparency.
.....it was routine practice for large sections of the reports of accreditation audits of services conducted by the Aged Care Quality and Safety Commission to be generated by computer assisted text. In other words, the same positive words prompted by computers were used over and over again. Computers cannot determine quality; only people can and should do that.
GSO Care Conclusions And Recommended Pathways
The Royal Commission found at the heart of the problem(s) are two fundamental facts, as highlighted above. GSO Care believes that there are some five system fundamentals not being addressed. Briefly, they are:
A resident’s family members should be actively involved with their loved one. Allied health practitioners should have ready access to their patient’s care data. Both should have real time access to all relevant alerts and alert resolution. The number of family member complaints should be reduced accordingly.
All carers and managers should electronically acknowledge their acceptance of shift hand over data at the commencement of every shift.All care plan activities should be scheduled and have delivery time tolerances with real time alerts for early or late delivery. All care plan activities should be customised specifically for each resident.Resident assessments should be scheduled for re-assessment based on two criteria:
All residents should be constantly surveyed as part of general conversation, regarding their level of satisfaction with recent care plan activities, by carers who were not the giver of the service. Manual audits and data sampling become redundant.(a) There has been an apparent change in the resident’s care needs;(b) The assessment validity period has expired.
(a) ResidentsAll carers, nurses, managers, cleaning staff and kitchen staff, be they internal or external agency, must have full knowledge of each resident’s specific requirements, idiosyncracies, culture and life style choices at their fingertips when administering care.(b) FinancialsEach aged care bed should be treated as an individual cost centre.
4. Carer Workloads
The onus of carers remembering the current individual care needs of each resident should be removed completely. It is an encumbrance destined to fail and is completely unnecessary.Reduce carer charting and documentation time. Allow real time capture, and allow the system to flag alerts based on individual resident parameters.Eliminate the maintenance book by automating the notification via an integrated maintenance application.Automate the three items above and negate the carer’s need to leave a room for documentation. Every five minutes saved equates to 5 more minutes of care or around $30,000.00 per annum saved for an average facility (90 beds).Optimise daily activities to spread carer workloads, where acceptable to residents, even across shifts.
It would appear most providers apply annually for increased funding per resident, only if the documentation can be found to support a claim.A system should automatically report, in real time, changes in levels of care needs for each resident, based on the fund cycle. (ACFI = 7 days)Biannual funding increases instead of annual could result in increased funding in excess of $300,000 p.a. for an average facility.
Mandatory AuditsMandatory auditing should become an integral component of daily care, with discrete, polite and appropriate enquiries prompted of carers regarding recent daily activities, and the resident answers recorded in real time. Therefore, any dissatisfaction may be actioned in a timely manor.Shift HandoverShift handover data, relevant to a carer’s role, should be available in real time, and not dependant upon verbal transmission and the availability of supervisors.IncidentsIncidents (such as falls) requiring immediate additional care, should not rely on the availability of an RN, but should automatically inject clinical pathway activities (based on world’s best practice) into a resident’s schedule, pending further investigation.AlertsAny clinical alert (high or low blood pressure, high or low BGLs, skin integrity deterioration, pain, weight loss or gain, urine colour, et al.) should automatically inject clinical pathway activities, based on world’s best practice in the absence of specific MDs directives, pending further investigation.Imagine reducing the cost of obtaining funding and performing mandatory audits down to one employee, irrespective of the number of residents or facilities. The result would be a saving of over $20,000.00 p.a. for an average facility.
What is Needed
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