DUTY OF CARE AND SAFETY IN HEALTH AND AGED CARE
By JENNY HAINES
Recent events in the health system report breaches in the expected standard of care from doctors, nurses, allied health professionals and aged care workers that alarm the public and worry the educators. Individual health care professionals do carry a duty of care for their patients and clients that requires them to practice to a standard of care set for their level of knowledge, skill and experience. Registered and enrolled health professionals can face not only the requirements of criminal and civil law but also professional disciplinary law which can see them struck off the register or roll. Unregistered and unlicensed health and aged care workers face only the criminal and civil law and the discipline of the employer,if they choose to exercise it. Most employers do. Aged care workers who are caught assaulting patients face immediate sacking but they can go to a new employer, lie, not have their references checked and gain employment again quite quickly in the aged care sector.
But what of the obligations on the employer to provide a safe place of care for patients and a safe place of work for employees. Common law and statutes place a duty of care on employers to provide patients with a safe place in which to receive care, and for employees to work. But statutes and the law spend pages fussing about buildings, infrastructure, the width of shower entrances, floor coverings and water facilities but very little space is given to the education level, the training, the knowledge skill and experience of the staff. No such space is given to recognising the weight of a workload, or the appropriate ratio of staff to patients and clients. Those considerations are decided on the facilities accountancy sheets. But these are the criteria on which the public assess the quality and value of a service. The public don’t immediately notice that a shower may have a slippery floor but they do notice when a patient is repeatedly ringing a call bell and no one comes as there is insufficient staff to meet patient needs. The public most certainly notice when a patient appears with unexplained bruises inflicted by an undertrained aged or disablility workers frustrated at being unable to manage the care of patients and clients because they have never been taught nursing skills and techniques.
Hospitals and aged care facilities are largely run on the least cost bottom line like most businesses these days. But they are not a business. Never have been a business and never should be treated as though they are a business. The human factors in health services and aged care call for their own method of financing based on the considerations that the service is caring for people at their most vulnerable time in their lives. You cannot put a price on the human factors, communication, care and comfort that is required at this time. Financing of health care needs to focus on the standard of care, the amount of care each patient requires and the number of staff required to provide that care. Of course there needs to be safe facilities, and buildings and showers and floors. But more importantly patients and clients need to be guaranteed a safe level of care from well educated and trained, skilled and experienced staff.
The Aged Care Royal Commission has a mammoth task ahead. As even the Prime Minister Scott Morrison acknowledges we are going to hear some pretty awful stuff. Why? Because the aged care sector providers have been allowed to go too far in deregulating the system. Downskilling of staff, the elimination of registered nurses in aged care facilities, paying workers less than they would receive if they worked elsewhere in the aged and health care sector, being notified in advance of inspections so they can get it all spick and span for inspection and back to normal when inspection is over, minimising the cost of food services and activity workers and programs, have led to widespread community concern about aged care where people express the desire for home based euthanasia rather than enter an aged care facility. Aged care needs a better method of financing based on human factors, not business modelling. The Aged Care Royal Commission needs to lead the way.