Opinion Article – Community expects high quality aged care

Traffic warning sign - frail or older people

This article was originally written and published on World Elder Abuse Awareness Day, 15 June 2016

Aged care policy has changed a lot in the past 20 years. But what about care quality? Many in the industry would argue that it has improved, but what about people living in nursing homes? Would they agree?

Back in 1997, the Howard Government removed a requirement for nursing home operators to account for the funding they received and specifically show how much was spent on staffing. While the system wasn’t perfect, it implemented some accountability into a model where private operators receive public money to provide care to a vulnerable and generally voiceless group of people.

Since then, we have seen a substantial decline in registered nurses working in nursing homes and a substantial increase in lower skilled and lower paid personal care workers. Latest data show that registered nurse numbers are actually lower than what they were in 2003, despite there being 40,000 more high-needs residents in the aged care system. If care need has risen since 2003, why are there fewer registered nurses?

The nursing home industry has admitted that it stands to profit when it reduces the number of registered nurses, whose high-level skills and professional judgement come at a price. RNs have slowly been replaced by lesser-skilled Enrolled Nurses and Assistants in Nursing. The upshot is that we have nursing homes full of high-needs older people but fewer skilled people on the floor to look after them.

There are many homes that do a fantastic job caring for people. There are also homes that don’t. The problem with the current system of regulation is that it’s hard to tell the difference – 95% of homes are fully accredited with no mark against their name.

As repeated examples have shown, accreditation doesn’t equal good care. In 2010, a woman died in an accredited NSW nursing home because she fell from her bed and strangled herself on a bed pole. There were 45 residents in the home at the time but only one care worker rostered on to do the entire nightshift, with another worker on cleaning duties. The woman wasn’t discovered in time to be saved. The Coroner investigating the case found that one care worker to 45 residents was insufficient, even if it satisfied legislative requirements.

This is not an isolated case. Monash University and the Victorian Institute of Forensic Medicine released a report in 2015 that found over 100 Victorian nursing home residents die prematurely each year from preventable causes.

Most of the residents studied died from falls, but choking, being given the wrong medication and assault from other residents comprised the remaining deaths.

The report barely got noticed. What would be the public’s reaction if these figures applied to childcare centres?

Just because someone is old doesn’t mean their life doesn’t matter.

According to the latest Aged Care Financing Authority report, the average nursing home is making a profit of just over $9,000 per resident per annum. The top 25% of homes are making twice that. The 2014 Living Longer Living Better reforms are broadly expected to have injected billions into the industry as it opened up accommodation pricing allowing providers to charge more for the nursing home rooms.

Government, and the public, need to recognise that nursing home residents are more than just numbers on a profit ledger.

It is World Elder Abuse Awareness Day today, and I believe we need to reform regulation of aged care to protect our vulnerable older citizens. An obvious place to start is implementing minimum staffing requirements. A NSW Parliamentary Inquiry I chaired last year found that facilities looking after residents with high needs should have at least one registered nurse on duty at all times. Unfortunately, the NSW Government looks to be removing the last piece of regulation in the country that implements such a requirement.

Older people recently identified health as their number one concern when deciding who to vote for in this upcoming election. Yet, neither Labor nor Liberal has committed to reforming aged care regulation to improve care quality.

The community expects high quality care, particularly for older, vulnerable people. Aged care policy needs reform so that we can actually achieve what the community expects and show that we as a community value older people’s lives.

NSW Government fails leadership test on care for frail older people

“The NSW Government has not supported an inquiry recommendation to retain the requirement for nursing homes to have at least one registered nurse on duty at all times, putting at risk the needs of frail older people”, said Ms Jan Barham, Greens NSW spokesperson on Ageing and chair of the inquiry.

“I am greatly disappointed the Government has completely ignored the Parliamentary Inquiry recommendation, supported by its own members, for nursing homes with high-needs residents to have one registered nurse on duty 24/7.”

“Some of these facilities have over 300 residents. Now there’s no guarantee they’ll have a registered nurse on site during the day, overnight or on weekends.”

The Inquiry found that NSW should require 24/7 registered nursing as current federal regulation fails to ensure safe staffing levels and registered nurse care for residents.

“Doctors, nurses, gerontologists, academics, health professionals, older people and their families were unanimous in their call for 24/7 registered nursing.”

“Even NSW Health opposed removing the regulation .”

“There are many tasks that only a registered nurse can do. Without 24/7 registered nursing, residents can wait for hours or days for pain relief or to have a catheter changed or have the specialised care that recognises symptoms of an emerging condition.”

“Older people in NSW deserve the very best care. They should not be sent to an emergency department in the middle of the night because there is no registered nurse on duty to provide the expert care they need. Sadly, that is going to be a reality for more nursing home residents in NSW, which comes at cost not only to them, but also the NSW Health system” said Ms Barham.

For further comment, please contact Jan Barham directly on 0447 853 891

Inquiry report: https://www.parliament.nsw.gov.au/committees/inquiries/Pages/inquiry-details.aspx?pk=2275

Tragic death highlights need for 24/7 registered nursing in nursing homes

Traffic warning sign - frail or older people

A Victorian Coroner has found that a 76 year-old woman should have been sent straight to hospital after a fall in a nursing home. The home had no registered nurse on duty at the time and the Coroner described the initial assessments she received by enrolled nurses as “inadequate” and “deficient”.

 

Mrs Ena Vickers suffered a fall at midday on Monday 30 July 2012 and was not seen by a registered nurse until some four hours later. She was then transferred to hospital, where it was found she had suffered fractures and bleeding around her brain. Mrs Vickers died on 4 August 2012.

 

“This is a tragic case that sadly shows what can happen when there is no registered nurse on duty at all times”, said Ms Jan Barham, NSW Greens spokesperson on Ageing.

 

“Although an immediate assessment by a registered nurse and transfer to hospital may not have changed the outcome, it may have reduced any suffering experienced by Mrs Vickers after the fall.”

 

“Because there was no registered nurse on duty at the time of her fall, Mrs Vickers was attended to by personal care assistants and enrolled nurses. I don’t want to downplay the skills of these employees, but the Coroner found that Mrs Vickers should have been examined by a registered nurse or medical practitioner straight after her fall because of the seriousness of the situation.”

 

“Last year I chaired an inquiry into registered nurses in NSW nursing homes, which found that a registered nurse should be on duty at all times so that they can respond to incidents like this one.”

 

“I understand that Mrs Vickers had high-care needs and a history of Parkinson’s and dementia. Our inquiry found that registered nurses are critical in the care of such residents because they can exercise their professional judgement about their clinical care needs.”

 

The NSW Government is currently reviewing its state regulation for nursing homes to have a registered nurse on duty at all times. There is no similar Commonwealth requirement, despite it being the primary regulator of aged care.

 

“I call on the NSW Government to adopt the recommendation made by the NSW Inquiry to have a registered nurse on duty at all times in nursing homes where people have high care needs.”

 

“I also extend my condolences to the family of Mrs Vickers.”

 

For further comment, please contact Jan Barham directly on 0447 853 891

 

Victorian Coroner’s findings into the death of Mrs Ena Edith Vickers: http://bit.ly/1TcuRH5

NSW Inquiry into Registered nurses in New South Wales nursing homes:
http://bit.ly/1WY8LpS

Commonwealth must follow NSW’s lead on registered nurse staffing in nursing homes

NSW Greens spokesperson on Ageing Jan Barham has called on the public to support a Commonwealth Senate inquiry into the aged care workforce.

“Last year I chaired a NSW Upper House Inquiry into registered nurses in nursing homes, which received unanimous support for regulation requiring nursing homes to have at least one registered nurse on duty at all times” said Ms Barham.

“Now the Commonwealth Senate is inquiring into the aged care workforce, led by Greens Senator Rachel Siewert.[i] I encourage the Senate Committee to review staffing standards in nursing homes, which our inquiry found were inadequate to ensure elderly, frail nursing home residents had access to registered nurse care around the clock.”[ii]

“The NSW Inquiry received overwhelming evidence from experts in the field including the Australian and New Zealand Society for Geriatric Medicine, the NSW Nurses and Midwives’ Association, Alzheimer’s Australia NSW, Council on the Ageing and Combined Pensioners and Superannuants Association that nursing homes need a registered nurse on duty at all times to ensure that residents receive high quality care.”

Ms Barham expressed concern about the lack of robust Commonwealth regulation governing staffing in an industry that is making record profits.

“Reports of some nursing homes recording a 40% surge in profits while face-to-face care hours dropped by 7% are cause for alarm. In 2014, research showed that residents received an average of just 5.2 hours of care from a registered nurse per fortnight.”[iii]

“We know that many nursing homes have replaced registered nurses with lower-skilled Assistants in Nursing and care workers even though resident care need is the highest it has ever been. This is placing residents at risk in cases where an emergency arises or the particular needs of high care residents are reliant on registered nurse care and supervision.”

Ms Barham said that while the NSW Inquiry found that nursing homes caring for high needs residents must have a registered nurse on duty at all times, exemptions could apply to small remote and rural nursing homes where it’s difficult to attract registered nurses.

“Some nursing home operators in remote and rural areas told our inquiry that it would be difficult to comply with a 24/7 registered nurse requirement. That’s why we recommended there be an exemption clause, which recognises the unique challenges facing such facilities.”

“But our inquiry was clear: Government must ensure nursing homes caring for high-needs residents have a registered nurse on duty 24/7 in the interests of resident safety.”

Submissions to the Commonwealth Senate inquiry close 4 March 2016.

For Further Comment, please contact Jan Barham directly on 0447 853 891

Jan-Barham. RN 247 CAMPAIGN

Background

[i] Senate Community Affairs References Committee inquiry into the Future of Australia’s Aged Care Sector Workforce http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Aged_Care_Workforce

[ii] Nursing homes are largely regulated by the Commonwealth under the Aged Care Act 1997. The Act does not require nursing homes to have a registered nurse on duty at all times. NSW mandates under the Public Health Act 2010 that nursing homes formerly known as ‘high care’ facilities be staffed by a registered nurse 24/7. This State requirement came under review after changes to the Aged Care Act removed the distinction between ‘high’ and ‘low’ care facilities, thus rendering the NSW requirement inoperable. The NSW Government is still reviewing its registered nurse requirement under the Public Health Act.

[iii] Paddy Manning ‘Profits rise, quality called into question in aged-care industry’ Crikey 15 January 2015, http://www.crikey.com.au/2015/01/15/profits-rise-quality-called-into-question-in-aged-care-industry/ & Tom Allard ‘Nursing home profits soar as patient care declines’ Sydney Morning Herald 1 January 2016 http://www.smh.com.au/federal-politics/political-news/nursing-home-profits-soar-as-patient-care-declines-20151224-glupug.html

NSW Legislative Council inquiry into registered nurses in New South Wales nursing homes: http://www.parliament.nsw.gov.au/prod/parlment/committee.nsf/0/D7A6228FCC493975CA257E6F0024A87D

Productivity Commission report a wake-up call for the NSW Government to improve affordable housing for older people

The Productivity Commission’s report on the Housing Decisions of Older Australians released today is a wake-up call for the NSW Government to improve housing affordability for older people.

“The Productivity Commission highlights that older people are constrained in their housing choices because of a lack of age-appropriate housing, and, to some degree, inefficient taxes such as stamp duty”, said Greens spokesperson for Housing and Ageing Jan Barham.

“There is a lack of age-appropriate housing in NSW, which discourages downsizing and sees some older people prematurely enter nursing homes because their home is inaccessible. This issue was identified by both the inquiry into Social, public and affordable housing and the inquiry into Registered nurses in NSW nursing homes.”

“Stamp duty presents another barrier to downsizing and the NSW Government should explore ways of removing this inefficient tax to facilitate smarter use of housing supply.”

“Of great concern is the increasing number of older people who live in private rental, with 220,000 older Australians renting privately. Up to 45% of older private renters are in housing stress, where they pay more than 30% of their income in rent alone. Older renters in New South Wales face insecure tenure, which can have a huge detrimental impact on their health and wellbeing.”

Ms Barham said this report highlights a disconnect between housing and aged care policies as well as a lack of planning at a state level in preparing for an ageing population.

“The NSW Government must invest in a range of affordable and age-appropriate housing options for both older homeowners and private renters so that they can age in place. NSW must increase social housing supply, targeting areas of highest demand, but also explore other options such as increasing supply of independent living units and improving consumer protections in, and affordability of, retirement villages.”

For Further Comment, please contact Jan Barham directly on 0447 853 891

The Productivity Commission Report on the Housing Decisions of Older Australians

Inquiry into Social, Public and Affordable Housing Recommendations and Final Report

Inquiry into Registered nurses in New South Wales nursing homes

Renters Rights – Jenny Leong, Greens MP and Rental Tenancies Spokesperson

Incoming Government must support a fairer and more caring society

Jan Barham, the Greens’ spokesperson for the North Coast, Aboriginal Affairs, Housing, Ageing, Disabilty and Community Services, has called on the re-elected Coalition Government to adopt a more caring and strategic approach with a priority focus on housing and community services for areas of high vulnerability and disadvantage such as the North Coast.

“The high levels of people who are unemployed, aged, have a disability and receiving income and parenting support payments is an indication of the disadvantage and vulnerability in our region. The risk is that if priorities don’t change with the next government we will see a continuation of vulnerability that can result in intergenerational disadvantage. Without changes there could be more people living in poverty and excluded from full participation in society,” said Ms Barham.

“There must be a focus on investing in communities to deliver fairness and improved opportunity to participate in all aspects of life. It’s time to look at the needs of this community and prepare for the future, with a more caring and compassionate approach.

“In this election campaign the Greens prioritised a boost in social housing with funding of $4.5 billion to build 20,000 homes over 4 years. With some of the longest waiting lists in NSW, there should be a significant increase on the north coast. The lack of affordable housing is threatening the health and wellbeing of the community and putting many at risk of homelessness, especially the young, the elderly and Aboriginal community members.

“Many older people living in caravan parks are facing unaffordable rent increases or eviction, with no other options available. NSW needs new legislation to provide the security and affordability required for our valued older citizens living in parks and villages.”

The Greens are also calling for secondary dwellings grants to assist property owners to build for the aged and disabled.

“We need to deliver appropriately designed and dedicated housing to allow people to stay living in community rather than being forced to move away from their neighbours and families. Funding support at a local level would grow the stock of housing needed and retain community cohesion,” said Ms Barham.

Ms Barham noted that with an ageing population, the NDIS, domestic violence, child protection concerns and a significant Aboriginal population, the region needs additional workers in the community services area to address and prevent risk for the most vulnerable in our community.

“Some of the disadvantage experienced in the region could be overcome with a greater investment in early intervention services and additional workers. The community service sector is in need of additional staff and the Greens are calling for a training financial assistance scheme to encourage and support more people entering the caring workforce. The need for increased Aboriginal specialist services is crucial and would create much needed employment opportunities as well as culturally appropriate services,” said Ms Barham.

Taxis are the main form of transport for some residents who have significant disabilities to allow them to access medical, health and work opportunities.

“The Taxi Transport Subsidy Scheme has not been increased for 16 years and this is grossly unfair. An increase in this vital service would benefit inclusion for those who are otherwise disadvantaged, especially in the regions,” Ms Barham said.

Ms Barham also warned that recent funding cuts by the Federal Government to parent and youth services have shown a lack of foresight and investment in the future, which the NSW Government must work to rectify.

“The Greens call on the State Government to lobby against the Federal Government funding cuts to important programs that support young people at risk and that provide skills for the transition to adulthood and independent living, and to make up for any shortfall in federal funding as they have done for pensioner concessions. The funding cuts to important programs that support new parents are a dangerous move that puts child welfare at risk, and which will end up creating additional social harms and put pressure on state services in child protection, juvenile justice and other sectors,” said Ms Barham.

“It’s time to overcome the history of the major parties ignoring the needs of the regions. While North Coast seats were a major focus in this election and coal seam gas was an especially crucial issue, the wellbeing of North Coast communities has been off the radar for too long.

“Without a commitment to social infrastructure investment for the region, there will be continuing disadvantage. The true test of a progressive society is how well we care for those in need and plan for the future wellbeing of all of our residents.

“The Greens are committed to caring for the most vulnerable in our society. I will be focusing on these issues when Parliament resumes, hopefully with two new North Coast Greens members in the Legislative Assembly to echo the focus for the region’s communities,” Ms Barham concluded.

For further comment, contact Jan Barham directly on 0447 853 891

Planning for a more caring community

  1. Investment in social housing – announced $4.5 billion to deliver 20,000 new homes in NSW over 4 years
  2. Financial grants for the delivery of appropriately designed secondary dwellings for older and disabled people – $20,000 per property
  3. Care Workforce Strategy – grants to assist people in training in the community sector – aged, disability and child protection and Aboriginal and Torres Strait Islander
  4. Residential Parks protection – legislation to secure the rights of people living in residential parks against high fees and eviction
  5. Taxi Transport Subsidy Scheme – increase funding that has been stagnant for 16 years
  6. Youth programs – return funding to crucial youth programs that have been cut by federal government eg. Links to Learning, Youth Connections and REALskills – approx. $700,000 for region

Premier Baird must stand up for the vulnerable harmed by a cruel Federal Budget

Premier Mike Baird must use Sunday’s meeting of chief ministers to raise the harms the Federal Budget would cause for disadvantaged groups and the pressures it would place on NSW services and programs, says Greens MP Jan Barham.

“The Federal Budget has cut enormous holes in this country’s safety net and is set to put already vulnerable people at risk of poverty, homelessness and deep disadvantage.

“The biggest impacts in this budget will be felt by the people who are least equipped to deal with further challenges,” warned Ms Barham, the Greens NSW spokesperson for Ageing, Disability Services, Aboriginal Affairs, Housing, and Family and Community Services.

Ms Barham’s call comes ahead of Sunday’s meeting of state and territory government leaders in Sydney to discuss how they will deal with cuts to Commonwealth funding.

“The cost-shifting in health and education are obvious concerns for the state and territory governments, including NSW. But the cuts and changes to programs that support younger people, older people, people with disabilities, Aboriginal communities, the homeless and those at risk of homelessness will see the state government faced with increasing numbers of people in crisis,” said Ms Barham.

“Changes to pension eligibility and indexation will push people deeper into poverty. Removal of housing investment and support will drive people further into housing stress. The withdrawal of funding to Aboriginal services and programs will widen the gap. This is a budget that promotes inequality, and the unfair burden will fall on those who can least withstand it,” Ms Barham said.

“Instead of providing people with support and opportunity, this Budget is going to leave vulnerable people under greater pressure to overcome the challenges they face, while they receive far less assistance and support.

“The Premier needs to make the case that investment in that support is crucial to securing people’s wellbeing and preventing them from suffering harm,” Ms Barham concluded.

Adjournment speech on the Federal Budget from the NSW Legislative Council, 14 May 2014:

For Further Comment, please contact Jan Barham directly on 0447 853 891

AGEING, DISABILITY SERVICES—THE QUALITY AND SAFETY FRAMEWORK AND THE QUALITY ASSURANCE IMPROVEMENT PROGRAM QoN

Ms Barham to the Minister for Finance and Services, and Minister for the Illawarra representing the Minister for Ageing, and Minister for Disability Services—

    1. What are the functions and processes of the Quality and Safety Framework (QSF) and the Quality Assurance Improvement Program (QAIP) within the Department of Ageing, Disability and Home Care?
    2. What type of data do the programs collect?
    3. How is the data managed?
    1. Do these programs generate reports on the data collected?
    2. If so,
      1. How often are these reports generated?
      2. Which officers in the Department are provided with reports generated from data collected as part of these programs?
    1. Do the programs make recommendations to improve services based upon data collection and analysis?
    2. If so, will the Minister provide the details of any recommendations made by the QSF and the QAIP?

 

Answer—

  1.  
    1. The Quality Assurance and Improvement Program (QAIP) is a collection of processes that monitors quality and identifies areas for improvement in Ageing, Disability and Home Care (ADHC) operated accommodation support and centre-based respite services. 
      The Quality and Safety Framework (QSF) is a component of the QAIP. It is a monitoring tool used to measure compliance with key policy and procedures. The QSF is completed quarterly.
    2. The QSF comprises 24 Key Performance Indicators, to monitor the development and review of client care plans, levels of incident reporting, completion of health and safety inspections and levels of staff and service usage. Other data that informs quality improvement areas include feedback from clients and families, Ombudsman reports and investigations, Community Visitor reports and internal audits.
    3. For the QSF, at the unit level (group home, centre based respite and large residential units) data is collected on a quarterly basis and reported both regionally and centrally. Other data collected as part of the QAIP is stored in a number of corporate record management and information systems.
  2.  
    1. The unit level data is collated into a regional report. Regional results are aggregated into a state-wide report that is reported to the agency’s Audit and Risk Committee. In addition, a regular report is submitted to the ADHC Executive regarding the operation of ADHC operated accommodation support and centre based respite services.
    2.  
      1. The regional and state wide reports are generated on a quarterly basis. Reports to the Audit and Risk Committee occur quarterly or as required and the reports to the Operational Performance Committee (OPC) occur on an annual basis or as required.
      2. Regional Directors receive reports relating to quality in the services in their region. Regional Improvement Teams have carriage of action plans for quality improvement. The ADHC Executive (Chief Executive and Deputy Directors-General) receive regular reports through the Audit and Risk Committee and the OPC.
  3.  
    1. Results from the QAIP, including QSF, are used to inform service delivery improvement and reform, including training and management of client support plans, and improvements to policies and procedures.
    2. The tools are not used to make recommendations rather each region uses results to inform local action plans. Current state-wide areas for improvement in ADHC operated accommodation services include implementation of the Lifestyle Planning Policy and Guidelines and the commencement of a review of all health-related policies and procedures.

COMPLAINTS UNDER THE COMMUNITY SERVICES (COMPLAINTS, REVIEW AND MONITORING) ACT 1993 QoN

Ms Barham to the Minister for Finance and Services, and Minister for the Illawarra representing the Minister for Ageing, and Minister for Disability Services—

  1. How many people or service providers have been found guilty of an offence under Section 47 of the Community Services (Complaints, Review and Monitoring) Act 1993?
  2. What action has Ageing, Disability and Home Care (ADHC), under the Department of Family and Community Services, taken to make clients of ADHC and non-government service providers aware of their right to be free from threats of retribution?
    1. Has ADHC through its internal complaints handling mechanism received allegations of threats of retaliation?
    2. If so, what course of action is ADHC required to take?

 

Answer—

  1. Ageing, Disability and Home Care (ADHC) is not aware of any people or service providers who have been found guilty of an offence under Section 47 of the Community Services (Complaints, Review and Monitoring) Act 1993.
  2. ADHC’s current Feedback and Complaint Handling Principles and Guidelines (2005) indicates that “all parties to a complaint should have the opportunity to have his or her say, without fear of a negative reaction or victimisation”. 
    In addition, ADHC’s publication, ‘Standards in Action – Practice requirements and Guidelines for services funded under the Disability Service Act’ provides in its minimum practice requirements a similar standard for practice. 
    ADHC’s revised Community Complaints Policy will strengthen the principles regarding threats and retribution such that: 
    “ADHC will treat complainants with respect and will ensure that complainants (and other parties to the complaint) are not subject to harassment or discrimination, are free from threats of retribution or disadvantaged as a result of having made a complaint.” 
    The policy statement and principles will be included on the complaints section of ADHC’s internet site, within revised brochures for clients, non–government service providers and other stakeholders. A communication strategy will be developed to promulgate the revised policy in the second half of 2011.
  3.  
    1. No
    2. Allegations of threats of retaliation would be treated as a breach of policy ⁄ Code of Conduct under Chapter 9 of the ‘Public Sector Employment and Management Act’ 2002 and action would be taken in accordance with ADHC’s processes for dealing with these matters. In addition if may be referred to the Law and Justice Directorate for prosecutorial consideration as an offence under the Act.

BOARDING HOUSE REFORM PROGRAM OFFICERS

Ms Barham to the Minister for Finance and Services, and Minister for the Illawarra representing the Minister for Ageing, and Minister for Disability Services—

  1. Are the Department of Family and Community Services’ Ageing, Disability and Home Care (ADHC) Boarding House Reform Program Case Managers and Licensing Officers separated?
  2. Are there clear protocols established for referrals to be made between Boarding House Reform Program Case Managers and Licensing Officers?
    1. Has ADHC implemented all recommendations of the NSW Ombudsman outlined in ‘DADHC Monitoring Standards in Boarding Houses. A special report to Parliament under s31 of the Ombudsman Act’?
    2. If not:
      1. Which recommendations has ADHC not implemented?
      2. What is the reason for ADHC not implementing the NSW Ombudsman’s recommendations?

 

Answer—

  1. AHDC Regions allocate resources according to local priorities and circumstances. Where the roles have been combined and performed by the same officers, this has been to allow for a flexible approach to situations such as boarding house closures. It also takes into account that licensing issues can have an effect on the well-being of the resident, and at times there can be an overlap between the two functions.
  2. Where different officers perform the licensing and casework functions they are still part of the same team and report to the same manager, and frequently work together. Whether the roles are separated or combined, in each region serious issues of non-compliance with the Regulation or Licence Conditions are escalated to management for resolution.
  3.  
    1. The Ombudsman’s Report made a number of findings as opposed to specific recommendations. All of these findings have been addressed, specifically:
      • The 2005 Regulation under the Youth and Community Services Act 1973 (YACS Act) was amended in May 2010, and remade in September as the 2010 Regulation, with new provisions including requirements for one staff member on duty to have a first aid certificate, and for safe medication administration and record keeping. The Regulation has clarified the obligations of proprietors. Further reform of the boarding house sector, including boarding houses not currently licensed under the YACS Act, is currently under consideration.
      • Licensed boarding houses are monitored on a six to eight weekly basis and Full Service Reviews of each premises occur once every three years. Ageing, Disability and Home Care’s (ADHC) Central Office monitors data from regions regarding this.
      • Caseworkers specifically for licensed boarding houses are employed to plan and co-ordinate services for residents.
      • Training for regional staff involved in licensed boarding houses occurred in November 2009 and June 2011. Formal training did not occur in 2010 as the focus was on revising the Regulation as well as updating and revising the relevant policies and procedures to support that. In addition to formal training, quarterly meetings occur between the relevant ADHC Central Office policy team and regional staff involved in licensed boarding houses.
      • The Licensing and Monitoring Policy was revised and updated in April 2011 and is available on the ADHC website with a range of supplementary documentation.
    2. See answer to 3 (a) – all findings have been addressed.
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