Good Things Often Come in Small Packages

Big is not necessarily better.

Neither is an increase in the numbers of care providers who may have entered the industry driven by the lure of profit. This is something that is becoming evident from reports in the media lately, especially when it comes to aged care facilities and services.

For many years we’ve been hearing finance and business ‘experts’ advocate for the amalgamation of smaller facilities and services. They say it's better, organisations are more accountable, and services are more viable. But we have to ask ourselves, are they? Have we lost the essence of what quality care is in the process of developing mega services and/or in commercialising care?

I think back to the time I was the coordinator of a small service, catering to the needs of 28 clients. I knew every one of the clients using the service, I knew their family, their likes and dislikes, what meals and other services each of them needed and how they wanted it delivered.

We were responsive; if they wanted to go on a bush outing, I’d check with the on-site CEO that morning, arrange the fuel and food for the trip, do our pre-activity checks and load everyone up for a morning of fun. Now however, that service is part of a larger organisation, created to improve economies of scale. It is just one of a number of programs operated by the organisation.

It’s an often repeated scenario among providers where aged care is not their ‘core business’.

The simpler community management structure has been replaced with layers of management. All these people, of course, need to be paid and their services accounted for. But has it actually made a difference where it counts? Does the end user get a better service? I don’t think so – the administration burden now consumes a greater percentage of the budget and it is the client who misses out.

This is why it’s important for small, independent services, and those who support niche client groups or deliver an alternative model of care and support, to be recognised and valued. These types of services can often teach the big guys something about responsive, quality care.

We have been working recently with a small, rural residential service that would put some larger organisations to shame. This facility runs on a tight budget, but with efficiency and without compromising the quality of care. Residents receive personalised care from an adequate number of staff, sourced from the local community. The staff are devoted, diligent and caring. Staff are supported by management to maintain competency, to upskill and to aspire to work towards gaining higher qualifications in the industry. The centre doesn’t feel like an institution, it feels like home. It feels like a home I would be happy for my mother to live in. It exists for the people who live there, not to make a profit.

This is in contrast to facilities such as Earle Haven, where monetary considerations overrode the need to provide ongoing, quality care to a group of vulnerable residents. It was disheartening to read that the group providing the direct care and support to the residents lacked aged care experience and had a history of non-compliance.

This week, the Australian Newspaper ran an article on a large not-for-profit Approved Provider operating aged care in Tasmania, whose CEO noted that “he read monthly and quarterly reports that detailed the amount of commonwealth government funding to which the organisation was entitled to,” but admitted he didn’t read or receive the monthly and quarterly reports about the quality of clinical care being provided. This is concerning and demonstrates the disconnect that some Executive management of larger providers have. These are situations we don’t want to see repeated. It also highlights that where profit is put before people, we can fail the most vulnerable in our society.

Of course, if you are a small facility or boutique service, viability can be an issue and we’ve seen a number of smaller services close in recent times.

I hope that the Royal Commission will highlight the value of smaller, personalised services and facilities and that the Commonwealth Government will find a way to support them appropriately into the future.

For providers who put profit before people, this is a wakeup call. Aged care should not merely be seen as a program that is set up to pay shareholders, prop up other programs or be an employment target opportunity. Personalised care is what our seniors need from capable, caring staff, and that is what they are more likely to receive from organisations who put people first.

If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources to keep your service or organisation compliant, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.