Premature deaths of nursing home residents: an epidemiological analysis

To the Editor:

Ibrahim and colleagues1 are to be congratulated for finding a source of information that throws some light on what is happening in Australian aged care facilities, because there is so much positive rhetoric and so little reliable data about aged care coming from the sector itself. The study by Ibrahim and colleagues1 reveals an increase in deaths from external causes, including falls and choking, but we need context. In his 1993–94 report, Gregory2 indicated that in the proposed market-driven aged care system “neither the current standards monitoring system, nor any alternatives considered, would be able to prevent the diversion of funding from nursing and personal care to profit”. However, the government policy is driving consolidation and corporatisation using a competitive profit-driven model. International data indicate that an increased focus on profitability in aged care is associated with poorer staffing and increased failures in care.3

Studies in Australia and the United States over the past 35 years indicate that, on average, 4 hours or more per person per day of nursing care are required for safe care. Available data indicate that, in Australia, only 2.8 hours are provided. As acuity has increased, the proportion of trained staff has fallen. Our residents receive less than half the nursing time from registered and trained nurses compared with the US and an hour less of total nursing care each day.3 Safe care cannot be provided with these staffing levels; yet, over 95% of facilities are accredited by the Australian Aged Care Quality Agency. Braithwaite and colleagues,4 who have studied the regulation of aged care, conclude that aged care regulation has been captured by the market and is ineffective and warn that “the community should be concerned”.

While politicians and the industry talk up our system, it is becoming increasingly clear that the many failures (often in recently accredited facilities) reported in the press are red flags to systemic problems that a succession of captured inquiries into a system that is anything but world class have avoided addressing. With some exceptions, our profession seems to have disengaged from the sector and one wonders if they have been captured too.