This is likely a longer piece than usual, but I think important as we all consider the place of leadership mid-way through the term of appointment of the Royal Commission into Aged Care Quality and Safety.
I have been asked many times over the years I have served as a CEO, to define leadership. There are of course quotes such as “It is an art, rather than a science”. Or “You can tell if you are a leader when there is someone following behind you”. What seems to be true is that you are not born to be a leader, and leadership is not achieved from a one day development training session. However, we can grow as leaders every day – and indeed we must. And leadership is about people, whilst management is about tasks and things.
But even those small truisms above do not do justice to this
thing called leadership. Most of us can
likely recall our own examples of where we have experienced poor, or
ineffective leadership. We may even now
be wincing as we read, recognising our own lack of skills in a leadership role
at some time in the past. We can also
likely recall and acknowledge some fine experience of leadership that was such
a joy to be party to.
Good leadership is a thing of beauty to experience. Much like a diamond. A diamond has so many qualities and when cut well, is a thing of beauty to behold. It is hardly surprising that “diamonds are a girl’s best friend”. As the following picture shows, even a so called six sided diamond has much more to offer than the “simple” six sided cuts.
So it is with leadership.
I provide below just six sides, or attributes, of leadership that I believe if practiced (well) every day will not only assist us to be better performing leaders but will drive better performance in our organisations. I am certain we can all accept that leadership is more complex than these six, but these are a sound foundation. The attributes are provided in alphabetical order only for convenience:
The following link points to the substantive comments I made in a recent submission to the Royal Commission on Aged Care Quality and Safety. As a very recently retired Chief Executive in the aged care sector, with some 37 years of continual involvement in aged care related matters, I feel I can comfortably comment upon my own research into matters around minimum levels of staff. Additionally, and importantly how, I believe, the aged care sector has been left in a quandary as to how best to navigate through these troubled times due to funding constraints placed on (at least) the residential aged care.
I have read with interest late last week the very freshly released Royal Commission research paper (1) into aged care staffing requirements, and the shortfall in funding needed to raise the staffing mix and levels to appropriately care for the average residential aged care service consumer.
The following excerpt from the recommendations paints a picture of what residents, families, advocates, and indeed some providers have been saying for some time – the level of service provision (staffing) in residential aged care in Australia is substandard.
My conclusion is that because that level of provision is so strongly associated with the operating funding mechanism, the funding mechanism for care is equally substandard:
“more than half (57.6%) of Australian residents receive care in aged care homes that have unacceptable levels of staffing (1 and 2 stars).
To bring staffing levels up to 3 stars would require an increase of 37.3% more staff hours in those facilities. This translates into an additional of 20% in total care staff hours across Australia.
We have not limited our analysis to determining the additional resources required to bring facilities up to an acceptable level. We have also provided an indication of the additional resource requirements that are required to deliver staffing levels consistent with good practice and best practice care.
For all residents to receive at least 4 stars (what we consider good practice) requires an overall increase of 37.2% in total care staffing while 5 stars (best practice) care would require an overall increase of 49.4% in total care staffing.” (2)
As you are probably well aware, I am the CEO of Braemar Presbyterian Care (“Braemar”). To put our services into perspective, since I joined Braemar in March 2017 we have been increasing hours per resident per day to a level that is close to the current national average as recorded by the StewartBrown benchmarking service (3) reporting. And, as far as is reasonable, we have been improving our subsidy income to match the staffing. But that recurrent income is not enough.
According to this research paper, prepared for the Royal Commission into Aged Care Quality and Safety, less than 3 star level of staffing is unacceptable, while a 4 star staffing is good practice, and 5 star staffing is best practice. Yet 57.6% of residents receive less than 3 star (unacceptable) staffing and only 1.4% receive best practice staffing.
How is this translated into the care of our elders?
Over the past several years I have written often on how much funding I believe the aged care sector has been short-changed by a range of political and bureaucratic decisions over. Aged care funding is not adequate to meet the health care needs of Australia’s frail elderly, vulnerable, care recipients. My comments apply across residential aged care funding and home/community care package funding alike. You can review some of my previous articles in the footnotes below.  
Patricia Sparrow, Chief Executive of the not-profit aged care peak body Aged and Community Services Australia (ACSA), commentating recently on home care packages, lamented the lack of preparedness and capability of our aged care system, saying “Until we see adequate long-term planning for the structural and funding issues, Australia won’t be able to fully address the needs of older Australians”. Sean Rooney, Chief Executive of Leading Aged Services Australia, similarly recently commented that the “aged care system needs adequate funding to be sustainable and meet the needs of seniors” and called for an additional $3 billion to “improve the viability of the sector”.
Just this week I was briefed about the outcomes of a very recent Faster Horses Inside Aged Care Report (2019) of perceptions around aged care in Australia. I recommend this review to all readers of this blog. Reviewing response from over 1,500 people from a cross section of metropolitan centres, the response to two specific questions piqued my interest.
I am going to assume that most people reading this article will be aware that there is currently a Royal Commission reviewing matters of Quality and Safety in Aged Care. Among other things, that Commission is inquiring into matters where poor and substandard care have been provided to residents in residential aged care and to care recipients in home and community-based care.
Where there have been findings of substandard care, all providers in the aged care sector should stand resolutely with care recipients and be highly critical of the events that took place to permit such poor care being delivered. However, without wanting to escape from the responsibility of being a provider of aged care I do want to highlight again the dilemma that providers find themselves in desiring to provide the best care that they can.
One of the threads arising through the Royal Commission Hearings, and for some time prior to the Commission commencing has been a call for a higher staff ratio in care services being delivered.
Braemar Presbyterian Care is
offering a free community event for local people of Perth, who are interested
in learning more about palliative care.
The team have developed a Living
with Dignity, Dying in Comfort information evening, which
will take place on 22 May from 5:30PM at Braemar House, located at 10 Windsor
Road, East Fremantle.
spoke recently with our Professional Standards, Quality and Risk Specialist,
Bernadette Samura, who has a lot of experience in this area – having previously
managed Braemar House.
Bernadette was quick to point out
that palliative care is far more than just end-of-life care, and that it is
essential to challenge the myths and stigmas around palliative care. ‘We want
people to openly discuss it as a normal part of their future planning,’ she
told me. It is Braemar’s desire to ensure everyone involved in this quality of
life process is very much part of the care and friendship philosophy that can
add so much to quality of life.
evening involves a keynote presentation from Bethesda Hospital’s Clinical Nurse
Manager, Ed Gaudion, as well as exhibits showcasing various care approaches. It
is a free event, and is open to members of the community, their families with
loved ones in care facilities, those planning to relocate to residential aged
care, as well as anyone keen to learn more about palliative care.
Hope to see you there,
Note: The Living with Dignity, Dying in Comfort information
evening will take place on Wednesday 22 May at Braemar House in East Fremantle,
from 5:30-7PM. Coffee and light refreshments will be provided. Anyone
interested in attending this session can find out more details by contacting 08
A former Australian of the Year recently said, “The standard
you walk by is the standard you accept”. In aged care, we are entrusted to care
for and support some of the most vulnerable in our community. It is my belief
that in this industry, we must only accept the highest standard.
While I am proud of the quality of care we deliver at
Braemar, I am a strong believer in creating an environment that encourages
constant improvement. We want to be open and accountable in all we do.
To ensure that everyone associated with our organisation is
able to have their voice heard; about any issues that cause them concern; we
have introduced a new service called Your Call.
Your Call is an independent, third-party reporting service
which allows residents, family members and staff to report any matters of
concern in relation to the care and services we provide.
Sometimes, for various reasons, we might feel uncertain or
uncomfortable about directly raising an issue or reporting something we have
It is my hope that this new service will provide those
living in care, as well as their families, friends and staff, with an
environment in which to raise any concern – no matter how big or small.
Reports to Your Call can be made anonymously. Those lodging
a report can do so by phone or online – 24 hours a day. All reports are
forwarded directly to me for immediate consideration and action.
Contact details for Your Call have been distributed
throughout Braemar’s facilities. This has been done via the installation of
large posters; while printed information and updates are being made available.
This service is available to all our staff, residents and
family members and friends. It is essential that as aged care providers we
ensure we are transparent in all we do.
I want to ensure we hear from you if you have any concerns.
I am excited to see Braemar lead by example in this area.
These days I only read the newspaper on the weekend. My favourite is still The Weekend Australian. It often has thought provoking articles, and occasionally some fodder upon which one can reflect from an aged care sector perspective.
The December 8-9, 2018 edition is just one of those occasions.
On page 2, there is an article bemoaning the recent year upon year increase in private health insurance premium rates. The article reports that ‘Health Minister Greg Hunt … expected to approve an industry average below 3.95 per cent … the lowest since 2001.’ It also includes commentary about the anticipated significantly lower rate increase out to 2022 promised by the current Federal Opposition.
According to Australian Prudential Regulation Authority (APRA) figures cited by The Weekend Australian, the industry weighted average premium increases approved by the Minister for Health since 2015 are as follows:
I understand the impact of high levels of private health insurance premiums, that seem reachable by those who for whatever reason determine them to be affordable. What is more, in contrast to aged care funding, the payment of insurance premiums does not come from the Government purse, but rather from individuals who have determined their affordability.
I find this article useful, if only because for almost the past twenty years I have been monitoring Health Ministers making similar approvals for health insurance premium increases yet at the same time, as the senior Minister over the aged care portfolio, makingstarkly lower indexation for payments for recipients of care or, more indirectly, to the providers of care to aged care recipients.
The comparison of funding increases made to aged care providers through the various indexations against several alternate indicia is shown below:
The chart above clearly shows that whilst aged care funding indexation has indeed kept fairly much in line with CPI, it has failed to keep close to Work Price Index (“WPI”), Average Weekly Earnings (“AWE”), and the greatest gap is between aged care funding and private health insurance premiums.
I will be among the first to say that additional funds are not always the determinant of better quality. Yet the absence of an equitable funding methodology in residential aged care since 1997, and growing concern about insufficient supply of places in community based aged care since February 2017, seems obvious.
Inclusive of some $1.7 billion removed from forward funds in 2015 and 2016, there is a clear pattern of diminishing Government expenditure in aged care over the past twenty years to a point where it is highly unlikely that even courageous and good providers of care will be able to sustain their service provision without a sizeable injection of funding.
It has been just three days since the Federal Standing Committee on Health, Aged Care and Sport recommended support for the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018.
I support the recommendation that aged care providers disclose their staffing ratios. However, it would be unreasonable to expect that providers will be able to achieve a reasonable staff ratio without an immediate and substantial injection of funds – albeit with reporting requirements.
Perhaps the Royal Commission can consider this matter in their review processes into the whole aged care sector quality and safety funding and performance?
House of Representatives Standing Committee on Health Aged Care and Sport, ‘Advisory Report on the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018’ (Commonwealth of Australia, Canberra), December 2018
Sean Parnell, ‘Rise in health premiums likely lowest in decades’, The Australian (Sydney, NSW), 8 December 2018
I gathered these thoughts together the day the Royal Commission into Aged Care Quality and Safety was announced – Sunday 16 September 2018 if my memory serves me well.
This information gathering was in response to the first question of the Prime Minister when making the announcement. The question was around the alleged $1.2 billion cuts to aged care.
Folks, I get it – there have been many cuts from both major sides of our Australian Government over a number of years. And there has been continuing growth in aged care funding based on population related indices etc. But what is galling around these discussions is that the major political parties and the bureaucrats seem unwilling to give simple, transparent responses to questions about these matters.
The recent Federal Senate Community Affairs Committee Hansard from 24 October 2018 make for mind numbing obfuscation around this very issue, with Opposition asking relevant questions, and Government, and Officers, all putting in their opinions, without any direct answer to what should be a simple question. This of course happens regularly at such Committees and is not confined to Aged Care. But this Australian is over it!
Why cannot our elected leaders and paid Officers answer simple questions and be held accountable for the policy and funding interventions they create into valued human service provision? We are projecting tens of thousands shortfall of residential aged care places by 2025 (ref 1) and now some 121,000 not provided with an appropriate level of community care packages short for older Australians already assessed by Government as needing community delivered aged care services. (ref 2).
Of that number, almost 57,000 had no package allocated. A discussion around the residential care funding issues can be found below. Parliamentarians prefer to support their side of the debate, but the Department of Health and Federal Parliamentary Library advice really does paint a helpful and insightful picture into this matter of “funding cuts”.
I shall leave it to you to decide. But if you were to ask me, a return to the residential aged care sector of the $1.2 billion in ACFI funding cuts, along with a requirement for providers to sign off on their direct care staff ratios, would provide, on average, an immediate return to a ratio of 3.2 Hours per Resident per Day (“HRPD”), and begin a move to the 4.3 (or from my research, 4.2) HRPD as soon as possible.
ACFI – December 2015 MYEFO (might be a repeat of the May 2015 budget papers) – https://manad.com.au/aged-care-cut-in-mid-year-economic-and-fiscal-outlook-myefo/ The following is on an Australian Parliamentary Library page and really cannot be disputed. The page is at – https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Librar y/FlagPost/2017/March/Residential_aged_care_funding
ACFI subsidy expenditure has been growing more quickly than expected. The Australian Government believes the unexpected growth in claims cannot be explained by an increase in the frailty of residents, although many in the industry disagree. In order to rein in expenditure, around $1.7 billion in savings over four years were included in the Mid-Year Economic and Fiscal Outlook 2015–16 (MYEFO) and the 2016–17 Budget, to be achieved through changes to ACFI scoring and subsidy indexation. Despite these savings, residential aged care expenditure was still forecast to grow at around 5.1 per cent per annum.” A summary of the impact of these two difficult measures can be found below – https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Librar y/pubs/rp/BudgetReview201617/AgedCare
“Rein in expenditure.” Is that not just a euphemism for a cut to funding?
You decide. Nice chatting!
Ref 1- Aged Care Financing Authority, ‘Sixth report on the Funding and Financing of the Aged Care Sector’ (Aged Care Financing Authority, 2018), 36.
Ref 2 – Department of Health, ‘HOME CARE PACKAGES PROGRAM Data Report 4th Quarter 2017 – 18’ (Department of Health, 2018), Table 7, 11.