Staff in Victoria’s mental health and disability support homes lack adequate training, and many of the houses have no active night support, meaning that residents are at risk, according to a report by the Office of the Public Advocate.
The report on the Community Visitors program, which is overseen by the Office of the Public Advocate, contains a litany of evidence suggesting gross neglect by government and failure of regulation.
It contains many case studies detailing abuse, miserly neglect and lack of freedom of choice for residents in supported accommodation and institutions.
The report states that the dignity and rights of people are “constantly under threat” in the state’s residential health services. This is particularly true for the disabled and mentally ill.
The report also suggests that the Department of Human Services provided inaccurate lists of residential homes to the Office of the Public Advocate, leading to concerns that some homes that should be visited were not being included.
The report says: “Glaring discrepancies have come to light. Some houses have the wrong service provider listed, one has been bulldozed, but is listed as operating, while another is listed as closed, but is open.”
Requests for better training for staff in homes had “disappointingly” led to the Department of Human Services denying the need for such training.
Abuses brought to attention by the community visitors included wrongly dispensed medication, inappropriate use of restraint, violent behaviour and under-qualified staff.
One case study in the report concerns an elderly resident with dementia, who was being restrained in a chair for 11 hours a day by staff who were not appropriately trained. Intervention by the community visitor resulted in other strategies being used and an end to the use of restraints.
Another case study concerns a home with five residents, all with extreme disabilities or health issues, including epilepsy. All had nocturnal seizures, some of them life-threatening, and two women residents required turning to relieve bed sores.
Despite this, there was no night support in the house and one resident was found soaked in urine in the morning, due to having had seizures during the night. These residents remain at risk of having life-threatening seizures at night, with no one to protect them from harm.
“Safety and security are fundamental to dignity and rights, but for too many people in residential services, home is not, and does not feel like, a safe place,” the report says.
People with mental health issues and complex care needs are rotated through privately run supported homes, and are at risk of homelessness because the proprietors are ill equipped to care for them, the report says.
The report accuses the state Government of taking advantage of the goodwill and dedication of voluntary community visitors, allowing them to subsidise operating costs in the absence of adequate funding. The community visitors program was not funded well enough to meet its legislative mandate “negotiations have not resolved the problem. The situation is now at crisis point with the viability and integrity of the program at serious risk”, the report said.
Meanwhile, the report contains many instances of the Government failing to adequately maintain homes or address needs for staff training or more funding.
Key concerns brought to light by community visitors include understaffing, under-qualified staff and a lack of community access for residents. Many homes were dirty, smelt of urine and had rotting flooring, broken shower screens and worn floor coverings.
The report recommends the state Government address the chronic lack of funding to the Community Visitors Program, under which 335 volunteers visit vulnerable people in residential health, disability and mental health homes and institutions, to care for and safeguard their interests. The report describes community visitors as the “eyes and ears of the community”. Last year, the report says visitors donated 84,942 hours of time, which was equivalent to $3.6 million.
Of the issues identified in the 2009-2010 report on the Community Visitors Program, nearly 35% related to healthcare needs not being met and nearly 20% concerned personal safety being jeopardised. Problems arose mostly due to a lack of a co-ordinated and comprehensive approach to residents’ complex health needs, the report said.
There were also 13 reports of abuse and neglect. Of all the issues identified statewide, only 45% had been addressed by the time of the release of the reports.
Despite the fact that many residents have trouble communicating, speech therapy plans are rare, as are alternative communications strategies, the report says. In cases where a resident can’t speak, they are often given no other opportunity to communicate. This means some residents can’t communicate that they are in pain or requiring medical attention. Communication Competency Checklists are rarely acted on and speech pathologists are consulted for eating and swallowing issues but not communication issues.
The report says this goes against Department of Human Services policies and practices, and negatively affects residents’ freedom, behaviour and quality of life.
The report says residential care staff are often extremely dedicated and devoted, but low staff numbers mean they are able to provide only basic care. Staff reported that they received little response from regional management to requests for more support.
A lack of activities or access to the community, combined with a lack of non-verbal or alternative communication options, leaves many residents feeling socially isolated and unable to express themselves or make choices regarding their life, which in turn can lead to challenging or concerning behaviour.
Due to the shortage of staff and inadequate staff-training, these behaviours are routinely dealt with by the use of restrictive practices, such as chemical, mechanical and physical restraints or seclusion, the report says.
Aside from community visitors’ issues reports, there is no systematic review process to monitor the use of restrictive practices by service providers, despite this being a requirement of the Disability Services Act. When the OPA raised the issue of restraints not being a substitute for inadequate staffing or an unsuitable environment, the Department of Health responded by saying that the laws were only “guidelines”, the report claims.
The report contains 20 recommendations, including more support for proprietors of residential care services, and ensuring that proprietors understand their obligation to have well-documented care plans for residents. Restraining residents should be prohibited unless legally authorised and supervised by qualified staff, the report says.
New laws on private supported residential services were passed by Parliament in August this year, and come into effect by 2012. The new laws require that all new staff be subjected to police checks and be required to have current first-aid training. Other aspects of the new laws include a requirement for proprietors to keep centralised records and notify the Department of Health of any serious incident.
A spokesman for the Department of Human Services said that before the report had been tabled, the Government had agreed to more funding for the community visitors. Since the report was released, the state Government has committed an extra $200,000 in recurrent funding, bringing the annual total to $800,000 for the Community Visitors Program — but this is still less than a quarter of the community visitors’ in kind contributions. The department’s spokesman said this was “an increase of about $340,000 since 2006-07”.
The spokesman told Crikey that the department had strengthened protection for the disabled establishing the office of the senior practitioner to protect individuals’ rights and the creation of the Disability Services Commissioner as an independent statutory complaints officer.
He also said the Brumby Government had provided “historic levels of investment” in disability services, with $1.4 billion this year representing an increase of 140% since 1999.
The spokesman said that all staff who work directly with clients must have a Certificate IV as a minimum qualification. He said that in 2009-2010, 97% of all full-time staff had this qualification.
However, this claim is put in perspective by figures obtained by Crikey from the Australian Bureau of Statistics, which show that the great majority of community service and disability support staff are permanent part-time or casual. The national figures show that in 2008-2009, full-time staff made up less than a third of those employed in community services.
The spokesman said that the department is “… increasing the training for disability staff”, and that “all new DHS disability support workers must do an induction program to ensure they understand the legislation, policy and practical requirements of their jobs”. Other training included leadership and management, behaviour support and first aid.
The spokesman said the department “does not tolerate any behaviour that jeopardises the health and safety of people with a disability in its services … any issue or concern raised is investigated and responded to”. He said that in department-managed group homes, an internal practice review process had been introduced and all registered disability service providers were subject to independent monitoring.