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.
