WENDY CARLISLE: The image of Australia's nursing homes might be peaceful and serene, kicking up your heels in god's waiting room.
But the brutal reality for many of us, is that as we make our final journey we'll be frailer and sicker than our parents and grandparents before us.
One hundred and seventy thousand Australians are currently in nursing homes, in 30 years time there will be two and a half times more.
The strain is already showing.
CHERYL DUNN, AGED CARE WORKER: Sometimes you've got to split yourself in lots of different directions and it's very, very hard on night duty to get anyone to help because we're very low on staff at night, very low.
WENDY CARLISLE: Patient care is being compromised.
CRAIG EASTWOOD: And the nurse came around. And I said you know my mum's not well, we need to get a doctor, and her comment to me was, "Isn't she always like that?" That's what she said to me. And I said "no, she's not, near dying."
MARK: And the doctor and the nurses at the emergency room they said basically this is definitely wrong and ah we're looking at this stage, just by looking at it that there may be an amputation. And I thought "my god this can't be, this can't happen".
WENDY CARLISLE: It's not just the residents who suffer, but all those who love and care for them.
CLARE HUGHES: There was a lady in Mum's room one day they come in and they said "oh it's smelly in here" and they said "oh she's soaked", but they left her, they didn't change her.
CRAIG EASTWOOD: I can't sleep at night knowing those things happen.
WENDY CARLISLE: Tonight on Four Corners, the story of four families' struggle to find out what happened to their loved ones in nursing homes.
(On Screen Text: End of the Line, Reporter: Wendy Carlisle)
WENDY CARLISLE: The frail elderly are the most vulnerable in our community. We'd all like to believe that the institutions set up to look after them can do just that, look after them.
But the real picture is often very different.
Two years ago, Eric Novak made the hard decision to put his father Eddy into Aged Care.
Eddy Novak had developed severe dementia and diabetes after a long life lived on two continents.
Born in Poland in 1919, he survived the Krakow Ghetto in World War II, and moved to Australia with his young family in 1950.
ERIC NOVAK: He was a very good father, and he was caring. He looked after me. He looked after mum. Um he worked hard. He was in a concentration camp. He went through the war. He um, he was a loving man.
WENDY CARLISLE: At 87 years of age, Eddy Novak could no longer be cared for at home. He took up a place at Redland Residential Care a nursing home run by the Queensland Department of Health.
Over the first year, he slowly declined. Then on the 6th of October last year, Eddy Novak fell over while trying to get out of his chair in the dining room.
ERIC NOVAK: They rang me up the afternoon and they said to me "your dad had a fall", like and I says "what do you mean a fall?" "Oh he, he fell down, that's the word, he fell he fell." I said "where is he?" "He's at the hospital at Cleveland."
WENDY CARLISLE: Unknown to his son Eric, another visitor at the nursing home had witnessed his father's accident.
AMBER O'CONNOR, WITNESS TO INCIDENT: The RN was calling out to him "shut up Eddie, shut up Eddie, shut up" and that's the bit that got got me shocked. That isn't the sort of words that I expected to hear. What I expected to see after a fall was certainly that, that sound that still I can hear in my mind was for him to be patted down for breaks, to be checked, but there wasn't the, what shocked me was there were no observations taken.
He was rolled over onto his stomach and both of them grabbed an arm under, under his arm and his and his elbow and they tilted him upright and they marched him back to his seat.
WENDY CARLISLE: That night Amber O'Connor lay awake, concerned that Eddy Novak had been injured and not given proper medical attention, and upset at the way he had been spoken to.
AMBER O'CONNOR, WITNESS TO INCIDENT: When I woke up the next morning I said to my husband "I've got to ring someone, I don't know who I've got to ring", but I had to find out and I rang this other the CIS or the Complaints Investigations Scheme.
WENDY CARLISLE: Eric Novak had never met Amber O'Connor and was unaware there had been a witness or a complaint.
Eddy had fractured his hip, it was discovered later that afternoon.
He was admitted to hospital that night.
After two weeks, he returned to the nursing home, and was bed-ridden for another six weeks.
This, combined with his diabetes and vascular disease, helped cause terrible ulcers on his legs and feet.
Eric Novak wanted to know what was wrong. He asked a nurse.
ERIC NOVAK: I says to her "what's wrong with dad's legs, why are they wrapped up?" "Oh they're just like a like a bit of bed sore, there's nothing much worry about."
WENDY CARLISLE: On the 2nd of December Eddy was again admitted to hospital, his wounds had worsened.
Eric was there with his camera.
(Excerpt of footage of Eric Novak showing Wendy Carlisle photos of his father in hospital)
ERIC NOVAK: This one's up here, at the hospital.
(End of Excerpt)
WENDY CARLISLE: By this stage, the ulcers had been necrotic for a month. The wounds stunk. The staff at the nursing home had put teabags in the dressing to combat the stench.
And then there was the shock of the wounds themselves.
(Excerpt continued)
ERIC NOVAK: This is what they called bed sores, this is how they started to deteriorate all that black is just dead skin.
(End of Excerpt)
WENDY CARLISLE: Three case conferences were held to discuss Eddy's worsening condition in November, December and January. Amputation was decided against because of the threat it posed to his life.
Eddy's health deteriorated further. On March the 3rd, he died.
His son was deeply distressed, and has been on a mission ever since to try and understand what happened.
Redland Residential Care says Eddy Novak's ulcers were not caused or compounded by any lack of care at the nursing home.
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: Once he had the fall and he was confined to bed, it became more challenging and we needed to prevent ulceration like this if we could. Ah we had many mechanisms for that ah,
WENDY CARLISLE: What did you do?
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: Well, air mattresses are, are probably the mainstay of it. Boots that protect the ankles and we've got quite a, I can give you a list of the interventions that we used to try to prevent this outcome.
WENDY CARLISLE: It is possible that Eddy Novak received appropriate care, but Eric is not convinced. Last month he went to Redland hospital to get copies of his father's medical records. In spite of holding power of attorney and being executor of his father's will, the hospital would only give him admission and discharge dates.
(Excerpt of footage of Eric Novak showing a paper with admission and discharge dates)
ERIC NOVAK: There it is, there.
(End of Excerpt)
WENDY CARLISLE: For the rest he was told to fill out an FOI (Freedom of Information) application.
WENDY CARLISLE (to David Thiele): Why does a family like Eddy Novak's family have to use FOI to get their father's medical records?
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: Um we can't freely disperse private information about any individual unless it is deemed to be in the interests either of the person that we're revealing it about or of public interest.
WENDY CARLISLE: But Mr Eddy Novak um, Eric Novak clearly thinks it's in his interest to see those documents and you're deciding that it's not.
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: He is able to apply for FOI and judgements are made about that. That's not my judgement but judgements are made.
WENDY CARLISLE: Having now met Amber O'Connor, Eric Novak called the Complaints Investigation Scheme to find out the result of her complaint. The CIS is the body set up by the Federal Government to investigate all complaints about nursing homes.
(Excerpt of footage of Eric Novak calling the Complaints Investigation Scheme)
ERIC NOVAK: I'm ringing you back to let you know my dad was at the Redlands Care centre.
(End of Excerpt)
WENDY CARLISLE: Two weeks ago he got his answer. The investigator had gone to the nursing home, spoken to staff, looked at Mr Novak's progress notes and a fall report.
In what will become a familiar theme the nursing home's paperwork was checked, and because there was no evidence available to support the allegation that staff spoke rudely to Eddy Novak, it was dismissed.
Amber O'Connor's eyewitness report was ignored.
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: The evidence when it was looked at by the review, accepted that there was no yelling involved.
WENDY CARLISLE: But nurses are hardly likely to admit that are they?
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: Um we have a, an accountability in our workplace and ah, one person in the workplace observes another and if they observe adverse behaviour, they report it.
WENDY CARLISLE: Report on each other?
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: Yes.
WENDY CARLISLE: And that happens?
DAVID THEILE, QUEENSLAND HEALTH DISTRICT CEO: Yes.
ERIC NOVAK: I trusted people. Like you trust you know. You, you, ah. You trust people, you, you say all right, that the Governments pays. They pay but you're hard just saying well you can go to sleep peacefully, I know you're getting looked after and this is the sort of look after I'm getting?
WENDY CARLISLE: Clare Hughes and Alice Barrett are sisters, living in the foothills of NSW's Blue Mountains. On February the 11th their 86-year-old mother, Thelma McSpadden was admitted to Jamison Gardens nursing home in nearby Penrith.
(Excerpt of footage from home video of Thelma McSpadden's birthday)
WENDY CARLISLE: The McSpadden's are a huge clan. Thelma has 74 great grandchildren. With such a large brood, life for Thelma McSpadden had been pretty full.
(End of Excerpt)
WENDY CARLISLE: But later in life she became severely depressed, was diabetic, and had lung disease. She needed to be given full assistance with a range of basic needs like feeding. It wasn't long before the family started to worry about the care she was receiving at Jamison Gardens.
CLARE HUGHES: I think everything was done cheaply, like there wasn't enough linen. One time she um, was sick on a Sunday, um and they had washed up well there was no towels to dry her, they did it with chux clothes and um. Another time there was all faeces on her sheets, wasn't there Alice?
ALICE BARRETT: Mm mm.
CLARE HUGHES: Yeah. Alice went to put her to bed in the afternoon and so her bed had been made in the morning and there was all faeces on the sheets.
ALICE BARRETT: I went looking for somebody after I discovered this and couldn't find anybody to complain to and I actually had to ask one of the cleaners could she get me a clean sheet and when she opened the door I got the last sheet that was in the cupboard.
WENDY CARLISLE: Within a week of admission, their mother was in decline.
CLARE HUGHES: You know we were saying she's really having trouble breathing, you know she's breathless and do you think you know you could have it checked out and they would sort of, you know, "oh okay", you know, but that would be it, you know I mean that.
WENDY CARLISLE: No no follow up?
CLARE HUGHES: No follow up.
WENDY CARLISLE: For several days the sisters asked for a doctor to be called. The nursing home said they were trying and there would be one there first thing on Saturday morning.
At 8am on Saturday, Clare Hughes drove to Jamison Gardens, she was anxious and expecting to see the doctor.
CLARE HUGHES: It took me 15 minutes before I could get her to open her eyes and I just said how are you feeling today and she said terrible. And you know I could tell that she was just so sick, you know that's when I you know went looking for staff to get the doctor there, because actually the Friday night before they told us they would have a doctor there first thing for her because she was unwell on the Friday.
WENDY CARLISLE: Did they get a Doctor?
CLARE HUGHES: No and that's what I said "have you got the doctor coming" and they said no, and I said "well I want a doctor here now, I want, could you call her Doctor now".
And um she come back in about 10 minutes and said no he was unavailable, so then I asked for the ambulance to come.
WENDY CARLISLE: Thelma McSpadden's doctor was Lala Kumar, following advice from his insurer, he has declined to talk on this program.
But he has told Four Corners emphatically that he was not called by the nursing home on the occasions they claimed. Instead, a fax was sent to his practice late on Friday afternoon asking him to review Thelma McSpadden as soon as possible.
Dr Kumar told Four Corners his surgery is always closed on Friday afternoons, and the nursing home knows this well.
WENDY CARLISLE: And to your knowledge how many times did the Doctor turn up?
ALICE BARRETT: He didn't turn up at all when we'd asked them to call him because they would tell us he wasn't available.
WENDY CARLISLE: But he told you his mobile was on the whole time?
ALICE BARRETT: Exactly, yes.
CLARE HUGHES: And we actually met him in the car park one day when we were going home and he had just been to see another patient and we talked to him about Mum and said how unhappy we were that you know we didn't think she was getting looked after and he said "the care here is no good, get her out".
WENDY CARLISLE: The ambulance drivers realised the situation was urgent.
CLARE HUGHES: And they listened to her chest and then the one that was checking her chest said to the other one you know, "come and have a listen to this" and um and I said "what is it" and they said Pneumonia.
WENDY CARLISLE: Nineteen days after she went into Jamison Gardens, on Monday the 2nd of March, Thelma McSpadden died of a pneumonia at Nepean Hospital. It was at this point, the McSpadden clan joined the Aged Care complaints queue.
(Excerpt of footage of Cheryl Dunn receiving mail)
CLARE HUGHES: We got the letter from Aged Care"
ALICE BARRETT: Oh at last.
WENDY CARLISLE: Twelve days ago the sisters got the decision.
ALICE BARRETT: The details of the breaches are, the approved provider failed to recognise that a care recipient's health condition had deteriorated.
(End of Excerpt)
WENDY CARLISLE: The complaints investigation scheme found that Jamison gardens had not noticed their mother had pneumonia or diabetes, and not given her oxygen or adequate fluids. But the CIS accepted the nursing homes' assurances that they had tried to contact Thelma McSpadden's doctor.
Dr Kumar has told Four Corners he was not called by the CIS.
WENDY CARLISLE: Professor Alan Pearson was a panel chair in the old Aged Care Complaints Resolution Scheme, replaced two years ago by the CIS. He has concerns about the current scheme.
ALAN PEARSON, UNIVERSITY OF ADELAIDE: Well it isn't an investigation scheme. It is a scheme that goes in and checks the degree to which the facility is complying with the Aged Care standards in terms of its systems and processes.
They're not going in and investigating the complaint, they're going in and investigating compliance with standards.
WENDY CARLISLE: They're investigating paperwork?
ALAN PEARSON, UNIVERSITY OF ADELAIDE: Yeah.
WENDY CARLISLE: As for the sisters, the decision is cold comfort.
ALICE BARRETT: The facility has actually been there for some years and it makes you wonder how often has this happened to other people?
WENDY CARLISLE: That's an answer many people would like know, but can't, because complaints are not publicly disclosed, nor will they be on the Government's new nursing home website.
WENDY CARLISLE: When a family goes to that website they can't find out how many complaints have been made against a nursing home.
They can't find out the result of those complaints against a nursing home.
Should, if you're a minister who says you're committed to transparency and openness shouldn't they be able to see those things?
JUSTINE ELLIOTT, MINISTER FOR AGEING: Well this new website will start from the 1st of July and people will be able to access information, particularly in relation to sanctions that maybe in place in relation to a nursing home.
WENDY CARLISLE: But not in relation to complaints or the outcome of those complaints.
JUSTINE ELLIOTT, MINISTER FOR AGEING: There will be ah some instances where they will be able to see if there has been a breach that has occurred, they can access some of that information.
WENDY CARLISLE: Last year, Jamison Gardens passed its accreditation audit with flying colours, and was last spot checked three months before Thelma McSpadden was admitted. Nothing amiss was found.
The representatives of Jamison Gardens declined to appear on this program, however they sent us a statement claiming the CIS investigation was flawed.
Nurses who choose to work in Aged Care are some of the most caring of the caring profession.
This group of Melbourne nurses are training in how to look after our elderly.
(Excerpt of footage of nurses in training)
TRAINEE NURSE: Okay Donald, up you go.
DONALD, RESIDENT: Be careful I'm very frail.
TRAINEE NURSE: It's alright we're nurses, we know what we're doing.
(End of Excerpt)
WENDY CARLISLE: But as the typical nursing home resident becomes older and frailer, the nurse's job becomes more demanding.
(Excerpt continued)
NURSE INSTRUCTOR: So Gabby, if you just want to put the feet peddles down and just make sure his feet are off the ground, so we get a total weight.
(End of Excerpt)
WENDY CARLISLE: Since 1997, there have been no minimum nurse-patient ratios, and the number of registered nurses working in nursing homes has fallen.
(Excerpt continued)
NURSE INSTRUCTOR: So you can see the stable weight, 75.25 kilograms.
(End of Excerpt)
WENDY CARLISLE: Staffing in some nursing homes has reached a critical point and nurses themselves are starting to speak out. Tanya Dave has worked as a nurse's aide and a manager in Aged Care.
TANYA DAVE, AGED CARE WORKER: There's a lot of residents at risk, ah for example when it comes to staffing levels, as the AMA has pointed out, I mean you've got 120 residents with one RN responsible for them. You're putting those residents at risk.
WENDY CARLISLE: This directly impacts on care.
TANYA DAVE, AGED CARE WORKER: For example when it comes to toileting residents, there are certain practices that have to be in place, for example the hygiene practices which are sometimes missed because you're rushing to get things done.
WENDY CARLISLE: Like what?
TANYA DAVE, AGED CARE WORKER: Like wiping residents down, you know after they, they use their bowels. Um.
WENDY CARLISLE: And that wouldn't get done sometimes?
TANYA DAVE, AGED CARE WORKER: Some, yeah because residents, I mean staff are rushing. When it comes to mealtimes, you're rushing to meet, meet allocated time frames, so in that respect you won't finish feeding the residents.
CHERYL DUNN, AGED CARE WORKER: What it will lead to is residents, pressure areas, breakdowns, wet beds being left. Maybe someone dying and not knowing that they're dead for several hours because the workload is too huge.
WENDY CARLISLE: Cheryl Dunn has worked as a nurse and nurse's aide in a number of nursing homes. On average, nurses in aged care earn about 20 per cent less than in public hospitals.
CHERYL DUNN, AGED CARE WORKER: If we're not willing to pay nurses or even enough nurses to care for our elderly, isn't that saying that we don't want to know about our elderly, let's lock them away and all forget about it.
Because to me if we value them, we would value our nurses and put more people on the floor and give them at least a good pay that would match you know like night fill at Woolworths (laughs).
WENDY CARLISLE: Clare Hughes and Alice Barrett believe a lack of nurses directly impacted the care provided to their mother Thelma McSpadden at Jamison Gardens.
CLARE HUGHES: That's the big thing, not enough nurses. You know at any one time, whenever you needed a nurse there you had to walk the corridors looking in every room to find one, they were they were just nonexistent.
WENDY CARLISLE: In child care centres there are ratios of staff to children. Why aren't there ratios in nursing homes of registered nurses to residents?
JUSTINE ELLIOTT, MINISTER FOR AGEING: Well that's a very, ah important issue that particularly the Australian Nursing Federation has raised with me.
WENDY CARLISLE: Well why aren't there?
JUSTINE ELLIOTT, MINISTER FOR AGEING: Well we've previously committed to looking at the issue of the staffing mix through our Aged Care funding review that's underway at the moment. We committed to that previously. Because I think there is a basis to be looking at the staffing mix in our nursing homes.
WENDY CARLISLE: Three years ago Rhonda Button and Craig Eastwood's mother Hilda moved into the Waverley Gardens nursing home east of Melbourne. Like over half of the residents in Australia's nursing homes, their mother had dementia.
(Excerpt of footage from home video of Hilda Eastwood and family at Christmas time)
(End of Excerpt)
WENDY CARLISLE: Waverley Gardens is one of the many nursing homes in the Regis group, now co-owned by Macquarie Capital.
CRAIG EASTWOOD: She couldn't even understand that she couldn't look after herself. You know and she thought she could.
RHONDA BUTTON: She still believed she could look after herself, and it mainly affected probably myself and my dad and we were virtually we were attacked by her when, and it was, it was, it was a terrible time and you didn't want to go and visit, did you?
CRAIG EASTWOOD: It made it very difficult.
WENDY CARLISLE: Hilda Eastwood was prescribed Risperidone to relieve the agitation. Such is the short half life of the drug that it had to be given at exactly the same time every day.
RHONDA BUTTON: I was in there visiting and it was actually one of the personal carers that said "has your mother had her medication?" And I said 'I don't really know" and anyway so I questioned the person in charge. "Oh yes, she's had it" and next thing we know, know the person in charge is bringing in the medication, she had not. She had not had it.
WENDY CARLISLE: Rhonda complained to the CIS that this happened frequently and she also complained that her mother's dentures were filthy.
RHONDA BUTTON: Anyway I take her teeth out and having dentures, um under the denture just food, that had been there, you can tell how long the food's been there and they would smell foul and that is how I described it to the, to the department.
WENDY CARLISLE: It was early December, four months after the complaint about Waverley Gardens that Rhonda Button received word of the official outcome of the investigation.
Waverley Gardens had been cleared, the complaints had been dismissed.
RHONDA BUTTON: They replied that there were measures in place that people get their medication on time and that was obviously it was registered documentation that said there were measures in place.
WENDY CARLISLE: So the process was they're relying on the paperwork to show that she did it.
RHONDA BUTTON: Yes, that's exactly right. And the paperwork looks good.
WENDY CARLISLE: Alan Pearson has looked at the CIS decision, and he believes it is yet another example of investigating paperwork, not the facts.
ALAN PEARSON, UNIVERSITY OF ADELAIDE: There was no investigation of whether that event occurred or not. There was simply a report about what the current policies and systems are and an assumption that because such policies and systems are in place, this event did not occur and the complainant is telling a lie.
WENDY CARLISLE: Well what kind of investigation scheme is that?
ALAN PEARSON, UNIVERSITY OF ADELAIDE: Well it isn't an investigation scheme.
WENDY CARLISLE: And the investigation finding on the teeth was even shoddier.
WENDY CARLISLE (to Rhonda Button): And what did they do? Did they investigate that complaint?
RHONDA BUTTON: Their reply to that was on the day they were there, her dentures looked clean.
WENDY CARLISLE: Did they take her dentures out?
RHONDA BUTTON: No, they did not take her dentures out?
WENDY CARLISLE: How do you know that?
RHONDA BUTTON: Well, it doesn't say that but they looked clean, and I did, I did actually question the investigating officer on the telephone, "well, did you take them out?" "Oh well no we didn't. They looked clean." I said "well you can't tell just by just by looking at them." You cannot tell whether they are clean or not.
WENDY CARLISLE: But the family's problems with Waverley gardens did not end there.
CRAIG EASTWOOD: It was a hot day. I think it was the start of the heatwave, the lead up to Black Saturday, it was, there was a couple of days before that it was very hot.
I went in there and I found her in a semi-conscious state, she was sitting half upright, she couldn't verbalise anything to me, she was very, extremely weak, she couldn't even move, move, she could barely move her head, you know sort of her eyes.
And the nurse came round. And I said you know, "my mum's not well, we need to get a doctor." And her comment to me was, "isn't she always like that?" That's what she said to me. And I said, "No she's not near dying. She's normally coherent. I can't get a word out of her, she's not speaking to me."
WENDY CARLISLE: Craig eventually got his mother into Dandenong hospital.
CRAIG EASTWOOD: They said that she, she was dehydrated. And that she had pneumonia in her left lung but they could virtually get no reading from her left lung. Um and her blood pressure was very low and the likelihood that she would survive was sketchy.
WENDY CARLISLE: Did they make any comment about how long she must have been in that state?
CRAIG EASTWOOD: Um we asked the question, we just said you know "would this have happened you know, overnight? You know could she have got this pneumonia, this dehydration, overnight." "No, no, this would happen, have to have happened over a few days at least."
WENDY CARLISLE: Hilda Eastwood spent next five days in hospital. Shortly after discharge the family found her a bed in another nursing home. The family have now lodged a second complaint.
CRAIG EASTWOOD: Of course mum having the dementia you can't ask her the question did you have tea today? What did you have for lunch today? What did you have for breakfast? Did you get this on time? Did you have that? Did they shower you today? Did they brush your teeth today?
Well mum can't answer those questions. So it's these, these people, these silent, silent yeah, aged people that can't speak out, you know, that can't look after themselves that they're the ones that are slipping through the cracks, yeah.
WENDY CARLISLE: For people unhappy with a departmental finding on their complaint, there is the Aged Care Commissioner, a statutory body who can review CIS decisions. Last year, the Commissioner found serious deficiencies in the department's investigations. Of the 139 cases that were appealed to her, she found half of them were flawed.
RHONDA PARKER, AGED CARE COMMISSIONER: If they're not happy with either how they were treated or the decision that was made, they can appeal to this office.
WENDY CARLISLE: And in 50 per cent of the cases you recommend a variation.
RHONDA PARKER, AGED CARE COMMISSIONER: Sure.
WENDY CARLISLE: Or a set-aside.
RHONDA PARKER, AGED CARE COMMISSIONER: Sure.
WENDY CARLISLE: That looks like you're not happy with the way in which the department is handling those complaints?
RHONDA PARKER, AGED CARE COMMISSIONER: I think we'll certainly we on examination on an independent review we do, and on 50 per cent of occasions we recommended some sort of a change.
WENDY CARLISLE: So half the time the department is getting it wrong?
RHONDA PARKER, AGED CARE COMMISSIONER: On those that come to us.
WENDY CARLISLE: How can the public be confident the Department is able to conduct a review, a proper investigation, when the Commissioner herself says the Department gets it wrong in half the cases?
JUSTINE ELLIOTT, MINISTER FOR AGEING: Well we do have a very robust system that includes the agency, the Complaints Investigation Scheme and the Aged Care Commissioner. As I said, initially I've already brought in a whole range of measures in terms of strengthening that system and ah including last year looking at reviewing the Accreditation Agency.
And I'm also committed to ensuring there's a review of the Complaints Investigation Scheme. This scheme has been in place for two years, I think it's very timely that we do have a look at ways to continuously improve upon it.
WENDY CARLISLE: However, the Minister is not looking at the real flaw in the system, the fact that the Aged Care Commissioner's decisions are unenforceable. The department can, and sometimes does, simply ignore her.
RHONDA PARKER, AGED CARE COMMISSIONER: Well that's the legislation and that's what I have to work with. As I said, I've been on the record it goes back to this toothless tiger debate that was had right at the beginning.
WENDY CARLISLE: It makes you sound like a toothless tiger then, in those instances.
RHONDA PARKER, AGED CARE COMMISSIONER: I don't feel like it, well, because those instances are very, you know they're not, they're not the overwhelming example or experience.
WENDY CARLISLE: For Alan Pearson the idea that the department has the final word on any complaint is a conflict of interest.
ALAN PEARSON, UNIVERSITY OF ADELAIDE: Well of course it is because the Commonwealth Government is the funder of aged care. The Commonwealth, The Department of Health and Ageing with the Minister for Health, the Minister for Ageing are always held to account by the Australian population when things go wrong. So the role of the public service is to avert as far as is possible any likelihood of things going wrong. So they are in conflict.
WENDY CARLISLE (to Justine Elliott): How can you describe the Complaints Investigation Scheme as independent when it's run by the Department?
JUSTINE ELLIOTT, MINISTER FOR AGEING: Well what I'm saying is we have bodies that are independent of one another, we look at the whole entity of our aged care sector in terms of the Accreditation Agency, in terms of the CIS, in terms of the Commissioner. We have the three separate entities in terms of the regulation and the compliance that occurs.
MARK: He was a very good dad. A very private person, a very proud person and to see what happened to him at the latter part of his life was um very, very painful.
WENDY CARLISLE: Mark doesn't want us to name or show his father's face, to respect his mother's wishes. In 2005 Mark placed his father, a former policeman, into the care of the Sandgate nursing home in Brisbane, a Masonic Care facility.
MARK: Although he wasn't incontinent because he was paralysed down the left side he had to wear the pads and he was told basically just go in bed. And ah which he did, he didn't like. Um as I said he was a very proud man. To do that sort of thing was just beyond belief, but anyway.
The reason I contacted the complaints department if you like was basically because of what happened with dad's leg.
Down one portion of his thigh there was a bit of ooze if you like, um a bit of muck ah dribbling down his inside of his leg. And on closer inspection I had a hell of a shock. There's literally a hole the size of a 50 cent piece.
Anyway after being fobbed off, if you like, by the RN at that time, I used my camera phone and I thought I'll sort this these people out, I'd take photos of it.
WENDY CARLISLE: Over the next month Mark was assured his father's leg wound was healing. But then he got a phone call from the nursing home.
MARK: It was night time. Anyway um she rang me and she said "the wound doesn't look good at all, it looks very, very messy", which surprised the hell out of me because we had only just been in to see dad that earlier that day.
WENDY CARLISLE: Mark got his father to hospital straight away.
MARK: And I had a look at the wound, ye gods. It was an absolute mess. At this stage it was the size of a tennis ball and ah, well you could've put a tennis ball in the back of his knee.
The back of his knee joint was exposed. Um the sinews or the main tendons in the back were all exposed.
Well the doctor and the nurses at the emergency room they said basically this is, this is definitely wrong and we're looking at this stage, um just by looking at it that there may be an amputation. And I thought my God ah this can't be, this can't happen.
WENDY CARLISLE: Mark filed a complaint with the CIS. But the investigators didn't contact him, or ask to see his photographs. Instead they found in the nursing homes' favour, saying the home had taken adequate care of the wound.
MARK: I had the photographs. I had um, the complaints, the written documentation. I had all of that. And how the hell do you decide what's wrong and what's right if you don't listen to both sides of the story?
WENDY CARLISLE: In your initial complaint, in your written complaint, did you say in that letter I've got more evidence?
MARK: Yes most definitely, most definitely. And I said that that I was quite welcome to share that with them. But ah the next thing I got was a letter saying that there was no case to be answered by the nursing home, everything was Kosher.
WENDY CARLISLE: Mark decided to take the next step. He appealed to the Aged Care Commissioner.
MARK: And the appeal was lodged I suppose and it came back that yes there was a definitely a case to answer and all the rest of it.
WENDY CARLISLE: The Commissioner found that the department had failed to conduct an adequate investigation. And that Sandgate Nursing home failed to provide adequate wound care.
WENDY CARLISLE (to Mark): What did you think was going to happen then?
MARK: Um I'm not quite sure what I thought was going to happen.
WENDY CARLISLE: What happened was that the Department rejected the Commissioner's findings, and confirmed the Sandgate Nursing home was not in breach of its responsibilities.
WENDY CARLISLE: Now, who's right? You, as the independent commissioner, or the department?
RHONDA PARKER, AGED CARE COMMISSIONER: Well, I have my own view.
WENDY CARLISLE: Well what is that?
RHONDA PARKER, AGED CARE COMMISSIONER: Well we found that when we investigated the matter that we didn't think there had been a sufficient investigation.
WENDY CARLISLE: The Commissioner said that Sandgate did not meet its responsibilities to provide adequate care.
ROBERT GORE, CEO MASONIC CARE QUEENSLAND: Mm mm.
WENDY CARLISLE: That's a fairly damning statement isn't it?
ROBERT GORE, CEO MASONIC CARE QUEENSLAND: If you accept it and the final authority in this matter did not accept that. And the final authority's views was the same as ours and I'm quite confident under the Act our responsibility is in a very condensed sense, is to provide sufficient numbers of appropriately trained staff or contracted personnel to provide a level of care that the Resident might reasonably expect.
ALAN PEARSON, UNIVERSITY OF ADELAIDE: The delegate simply says, well thank you for the comments from the Commissioner, but in light of the investigating officer's report, which they restate, we still confirm the decision to not uphold the complaint. There's no reasoning behind that judgment.
WENDY CARLISLE: So it's not possible to really understand why the Department decided to veto the Commissioner's recommendation?
ALAN PEARSON, UNIVERSITY OF ADELAIDE: No.
WENDY CARLISLE: The Minister describes this as a robust system. What would you describe it as?
ALAN PEARSON, UNIVERSITY OF ADELAIDE: I would think it, I would describe it as a very flawed system.
WENDY CARLISLE: These older Australians are not yet in nursing homes but the chances are many of them will be. They'd like to think they could find a place where they will be well treated, but the evidence is, that is not assured.
MARK: I have no wish to go into any nursing home with the situation at the present time. I would much prefer to go out in a blaze of glory, an accident, bang, gone. To go into a nursing home and see what actually happened to my father was absolutely horrendous.
WENDY CARLISLE (to Cheryl Dunn): What are your thoughts about ending up in a Nursing Home?
CHERYL DUNN, AGED CARE WORKER; (Laughs) I know what you've been told. I don't think I know a nurse that wants to.
CLARE HUGHES: I hate the thought of it and I'd hate any of my loved ones to have to go to a nursing home, it would be just something that would you know, I couldn't, couldn't do it. You know I'd just rather find some other way out.
CRAIG EASTWOOD: You know these are people that obviously built the, built society to what it is today and it's really sad to see that these people you know, that had a meal in front of them and they're not helped, you know. They're not helped to be fed, you know.
There's a meal and it, it's taken away from them after they're, you know taken away from it, and then I can't sleep at night knowing that those things happen, you know.
WENDY CARLISLE: Three weeks ago, the Eastwood and Button families visited Hilda in her new nursing home to celebrate mother's day. They feel, this time their mother will get the care she deserves.
Placing a spouse or parent into care is one of the most emotionally fraught decisions any of us will need to face.
What we need, but don't yet have, is a system where at least we know they're safe.