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Staff at the aged-care regulator say complaints are being closed with copy-and-pasted findings, in some cases leading to preventable deaths. By Rick Morton.
Exclusive: Aged-care watchdog closes cases without probe
The aged-care regulator is dismissing thousands of serious incident reports regarding abuse, sexual assault, neglect and even deaths by ordering staff to close second-tier notifications without a proper assessment or, in some cases, any human assessment at all.
Under the Serious Incident Response Scheme (SIRS), care providers are compelled to report all Priority 1 and Priority 2 incidents to the Aged Care Quality and Safety Commission (ACQSC), which is required by law to monitor and assess the reports to protect older Australians from harm.
Alarmed watchdog staff have told The Saturday Paper that pressure to keep up with the volume of incident notifications – the backlog is now more than 5000 cases – has led to serious risks and trends going unnoticed because cases are being closed en masse.
It is especially concerning, employees say, because aged-care providers self-assess the severity of incidents and it is well-known they sometimes get them wrong: matters that should have been given the highest priority, such as the hospitalisation of a resident, are instead rated as a lower priority.
“Providers have obligations to contact the police when there has been a sexual assault and we have had cases coming through where there is a serious sexual assault and they haven’t done that,” an assessor tells The Saturday Paper. “So it’s not picked up, and that’s our job to regulate that, to make sure the provider has called the police and we miss it because the notification has been closed without a proper review.”
One staff member who became suspicious went searching for old reports from between April 2021 and December 2022 and found 15,500 “bulk-closure cases”. These were cases closed without investigation, often with reasons copied and pasted into the file. As a result, the trend data on which the regulator relies is non-existent or not flagged for follow-up.
An example: “So with neglect, I’ve seen a case come through where wounds have not been treated properly by staff in residential care, resulting in sepsis and death,” the employee says.
“That was a recent one. When you check the history on this case, which has come through for further action, you see the same kind of thing where the wound wasn’t treated, also resulting in death, so there is a trend.
“Something is happening at this particular service where they are not managing wounds correctly, not dressing them or following them up, and they are getting infected and if that first notification had not been bulk closed and we had taken action on that one, we could have prevented this further death.”
In another case, a commission staff member found more than 12 closed Priority 2 notifications with the “same subject of allegation as the Priority 1 that I was assessing”. A subject of allegation could be a staff member, another resident or a visitor accused of abuse or negligence, for example, and establishing this kind of trend across multiple notifications is critical to the work of the regulator. Nevertheless, the employee says “most of the P2s did not acknowledge the trend and some even stated ‘no trend’ ”.
Another nursing-home resident, a blind man with significant behavioural issues and unmanaged care, was told to monitor his own blood sugar levels.
“The service had a history of severe non-compliance [with the aged-care standards] and a history of confusing hypo with hyper [low and high blood sugar levels] and lying about numbers,” an assessor says.
A notification involving a nursing home resident who died from a stroke was rated as “no concern, no non-compliance identified”, but it was later discovered the stroke developed as a result of a fall in the facility.
“The consumer… they get assessed on their falls risk and none of that had been done, so the service was non-compliant, but that wasn’t followed up,” an assessor says.
SIRS came into effect in April 2021 for the most serious reports but because the legislative obligation to report Priority 2 incidents didn’t begin until October 1 that year, the commission says “all Priority 2 notifications received prior to that date were deemed out of scope for reporting”.
They were still reviewed, the commission said in a statement, and “all relevant information referred on to appropriate areas of the commission”.
That’s not what staff found when they came across these in the system, however. Workers discovered the “bulk closure” of P2 notifications with a placeholder description that had been copied and pasted across all reports. There was no evidence of the standard 45-minute assessments being done, meaning no one gave the matters more than a cursory consideration.
Not long after assessors trawled through old notifications to find incomplete investigations and premature “closures”, someone at the ACQSC sent a direction for the search functions that would have captured the pro forma categories to be disabled.
“And I thought, Right, they know we’re looking and they’re trying to cover their arse,” a staff member says.
In any case, what employees saw before the ability to search the two categories was removed, was a rationale that claimed notifications were out of scope. This simply wasn’t true.
“These were very much in scope,” an assessor says.
In March this year, the ACQSC established a Priority 2 project team to “improve the timeliness of the assessment of Priority 2 SIRS notifications and their referral for regulatory action or follow-up”. Staff report this has come with verbal instructions to “close” cases and get them off the books.
The team, based in Brisbane, has been given a modified risk-assessment template that removes critical questions from the standard document used by other assessors. The purpose of this, they believe, is to speed up processing.
“This team in Brisbane, the template was modified. A lot of the legislative questions were taken out that they didn’t have to respond to, such as trends and things like that they didn’t have to answer,” an assessor with knowledge of the process says.
“So it was halved. Their template was halved so they could just close that quickly, you know, one after the other. That was the point of that. So it was like a bulk closure in disguise.”
A spokesperson for the commission says it “continues to review the operating model of SIRS-related functions and is engaging with other government agencies that respond to high volume programs of work to learn from their experience and to help us test and strengthen our model”.
They continue: “The operating model continues to be enhanced with changes to structure, roles and responsibilities. There are no performance measures or indicators attached to the closure of SIRS notifications by individual staff or by the team as a whole.”
The Saturday Paper has obtained a psychological risk assessment for the commission’s SIRS team, completed last month, that appears to dispute this, however.
“Performance indicators are based on sample of team members undertaking key activities within a 6-hour period, so breaks and other learning activities are taken into account,” the document says.
“Managers are empowered to adjust performance indicators to account for the experience of the team member or other factors such as, complexity of the workload, other personal circumstances.”
The same document indicates “updated performance measures” were due to be implemented at the start of this month and celebrated a new milestone with the dedicated P2 project team.
“Priority 2 Project Team completed 10,000 assessments – improving safety for consumers and reducing staff work backlogs,” it says.
Beth Vincent-Pietsch, the deputy secretary of the Community and Public Sector Union, tells The Saturday Paper that staff at the ACQSC are particularly concerned about a poor internal culture that has led to bad outcomes for aged-care recipients.
“There has been a lot of stress, a lot of bullying and poor behaviour, but one thing our members desperately want to get across to us is how worried they are that something is going to go seriously wrong with all the pressure to close cases and not investigate thoroughly,” she says.
“Our members have been saying that they’ve been given directions to close cases, or that new systems have been put in place that don’t thoroughly investigate serious incidents, and they’re just really worried that lives are going to be lost.”
When the ACQSC called for the regulator to be dismantled, it did so because it found the agency was “overly concerned with processes and not focused on outcomes, is not responsive to the experiences of older people, has a poor track record of enforcement and has a reactive approach to monitoring and compliance”.
A capability review of the organisation conducted as a result of that recommendation was released by Aged Care Minister Anika Wells last month. It is similarly scathing of the regulator.
“The Commission urgently needs to fix significant problems in its complaints process and Serious Incident Response Scheme (SIRS),” the review says.“This is a huge workload, and the appointment of the new Aged Care Complaints Commissioner must proceed as a high priority.
“There must be regular and more detailed reporting on complaints and SIRS.”
Former senior assistant Commonwealth ombudsman Louise Macleod was appointed to the senior complaints commissioner role at the ACQSC in May, after the capability review had been written but before it was released.
Her appointment has been warmly welcomed by staff who hope she can become a circuit-breaker for systemic bad practice.
As the commission continues to struggle with the volume of cases, a surge workforce has been seconded to the serious incident reporting team. These staff are working at weekends but do not have experience in the assessments they are conducting.
“They are not qualified, they are not SIRS assessors at all in any way, shape or form,” a SIRS assessor says.
“We have found so many cases they have edited, assessed and closed down and just fucked up the assessments on them. They have essentially contradicted and counteracted all of the hard work the assessors do.”
It is not clear why this unrelated workforce is retreading old ground already assessed by the SIRS team, though employees have their suspicions.
“They have been undoing the work of the assessor when they are not qualified to assess or close,” the source says. “As far as I know, they are only dealing with stuff we have already assessed.”
Last month’s capability review found the current leadership structure of the ACQSC is “problematic”, with too much control vested in the commissioner. It recommended four deputy commissioners be appointed, though so far only two deputy commissioner roles have been filled.
“To become a trusted, high performing regulator, the Commission must as a matter of urgency take action to fix its organisational structure, senior leadership, and internal governance,” the review says.
“It needs strategic, visible leadership, and a focus on being engaged right across the sector and community, in an open and transparent way.”
Staff say the approach to serious incidents, arguably the most fundamental responsibility of the ACQSC, is anything but open and accountable.
“The commission was created for this exact purpose yet all they are doing is sweeping things under the rug to make their statistics look good,” a staff member says.
“It’s quantity over quality everywhere you look and we are failing older Australians.”
This article was first published in the print edition of The Saturday Paper on August 19, 2023 as "Exclusive: Aged-care watchdog closes cases without probe".
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