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Interview — Bronwyn Pike: The future we want for our elders

The big test for any governance professional overseeing an aged care facility is to ask: ‘Would I come here myself?’ If you can’t look yourself in the mirror and say yes, you need to start changing things, says Bronwyn Pike.

As chair of UnitingCare Australia and Western Heath, and as a former aged care minister for Victoria, Pike is well-placed to provide insights into some of the abuses exposed by the Royal Commission into Aged Care Quality and Safety.

She says aged care deals with some of the most vulnerable people in our community and those working in the system can find it very challenging.

‘Sometimes, circumstances get beyond people and they aren’t equipped to behave appropriately. Whether they are profoundly neglectful, lazy, frustrated or under resourced, they can’t provide the standard of care the community expects.’

But rather than getting angry with individuals, Pike believes it’s more meaningful to look at what we are asking people to do and how we are supporting, training and remunerating them.

Pike points to a big disparity between how we treat healthcare compared to aged care.

‘We pour the lion’s share of our resources into the healthcare system and have far greater regulation and scrutiny over the care in a hospital environment.

‘While we want to create a very home-like environment in aged care, the truth is that many of the people in aged care have pretty profound needs, whether that’s for physical care or specialised care in the case of dementia. But we don’t give the same level of resourcing to aged care as we do to healthcare.’

A lack of resources means that aged care also has much lower ratio of qualified nurses to patients than healthcare. Aged care workers have also traditionally received less remuneration and support.

‘Sometimes, the staff are more transient in aged care and it’s harder to find a permanent workforce so there is a greater use of casual workers.’

That said, Pike stresses that many people working in aged care are enormously dedicated, professional and do the very best they can.

‘The system is stretched. I also think people are older and sicker than they ever were before by the time they come into the system. This means demands on staff are much greater than they might have been in the past.

‘Often, when people go into aged care, it’s really palliative care. Palliative care requires a kind of clinical support and we have to adequately resource that.’

Pike notes that in some cultures, there’s no such thing as aged care; there’s only intergenerational family care.

‘In Australia, we have a strong emphasis on the primacy of the nuclear family. This can mean that people who don’t fit the mould are awkward for us. And, sometimes people end up in institutions because there’s nowhere else for them to go.’

Nonetheless, Pike supports a move away from big institutions.

‘There are only a few institutions left in our society — prisons, aged care and some forms of child care. Whether it was the old mental health asylums, disability institutions or orphanages, large institutions can create an environment that is a bit dehumanising. People lose their individuality and become part of big group of congregate care.

‘The only way we’ve been able to tackle institutionalised neglect and abuse is by breaking down those institutions into smaller places on a much more one-on-one human scale.’

Pike would like to see people kept in their own homes or in a less institutional environment for as long as possible. However, she says that would require a greater proportion of the home care packages being allocated at the more acute end. At present, there’s a limited number of high-end packages.

I am hoping that the royal commission doesn’t just try and ‘nice up’ what we have, but actually has the courage to ask some of those big fundamental questions.

There are 125,000 people on a waiting list for all categories of these packages and Pike believes more funding here would be in everyone’s interest.

‘Every day a person lies down in a bed in a hospital costs about $1,200-$1,500. That’s the most expensive part of our healthcare system. The more we can keep people healthy for as long as we can in the least institutional setting, the more we are responding to their individual needs and keeping them out of the costliest and most inappropriate end of the system.’

Pike believes there’s also room to build deeper relationships between carers and people being cared for.

‘We should also resist going down the pathway of providing ‘oldie only’ environments. Society is a lot healthier when we have a bigger intergenerational mix,’ she says.

‘But to do this, we will have to work harder. It requires some compromises and better planning. But in the end, there’s nothing more delightful than seeing the interaction between children from the local childcare centre visiting older people at an aged care facility.’

To avoid the types of abuses making headlines, Pike says governance professionals in aged care need to keep a sharp focus on their organisations’ performance

‘If you think about nursing homes, there are basic indicators that can tell you really important things about the quality of care, like the number of pressure injuries or falls, the use of chemical restraints, the number of other incidents, the complaint system and staff turnover.

In addition to getting very regular information on these indicators, she says boards should also have a system of benchmarking their organisation’s performance against other similar organisations.

‘They also need to ensure that they have well documented policies and practices that are clinically proven to be providing the best care. They can’t just appoint the CEO and hope that these things will happen.’

Further to that, Pike says boards must ensure they are hearing the voices of their consumers and their families so that they have an appreciation of what’s important to them consumers. Plus, they have to set the culture.

‘Nursing homes can become the most paternalistic places where the voice of the consumer is silenced. Sometimes, people see older people as just old and frail or even treat them in an infantile kind of way and without dignity. The board has to be strongly in tune with their organisation so they don’t allow this to happen.’

Pike says every complaint should be considered a gift and not a problem. ‘Complaints are an opportunity to look at systems and structures to ensure that mistakes made, often not intentionally, don’t happen again.’

Meanwhile, the royal commission into aged care has a way to go and hasn’t yet focused much on governance. Nonetheless, Pike expects this to soon change.

‘It’s only right and proper that the scrutiny is on the performance of boards because they do have overall governance responsibilities and if they aren’t happy with the performance of the administration, they have the ultimate sanction of removing it,’ she says.

‘There’s no point in having boards if they are just filled with sandwich eaters. Directors must be cognisant and serious about the tasks they are being asked to perform and be given the appropriate level of training to be able to fulfil those tasks.

‘I am hoping that the royal commission doesn’t just try and ‘nice up’ what we have, but actually has the courage to ask some of those big fundamental questions — for example, about what kind of future we want for our elder relatives and ultimately for ourselves in Australia.’

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