'Something is wrong at the top': how Bupa's aged care homes hit rock bottom
When a tropical fish tank disappeared and guide dog puppies stopped visiting a Bupa nursing home on New South Wales’s north coast, elderly residents were inconsolable.
Amid horror stories of maggots growing in wounds, malnourishment, neglect, medication mismanagement, assault and sex abuse incidents at some of Bupa’s 73 aged care homes, the abrupt end to pet time may seem trivial.
But for Shane Thompson the incidents exemplified what was wrong with the corporate culture at Bupa nursing homes – an obsession with cost cutting which forgets residents are human beings.
“My dad would go down to dinner every night in his wheelchair and would talk about the fish tank the next day. They all had names for the fish. Then all of a sudden it was just gone and nobody was told where it went,” Thompson tells Guardian Australia.
“I said, ‘What’s the deal with the fish tank?’ And they said, ‘Well, it’s in case someone hurts themselves.’ I said: ‘It’s been there forever. Do you know how many people stop and look at the fish tank?’”
Thompson’s father Don died last November aged 95, after spending his last three-and-a-half-years at Bupa Pottsville Beach on the NSW north coast. The home received a notice of noncompliance from the federal health department in October 2018.
Bupa, a health, insurance and nursing home business with headquarters in London, is the 30th largest company in Australia based on income. The company, which looks after an estimated 6,700 elderly residents, has been heavily criticised at the royal commission into the aged care sector.
Analysis of recent audits and notices of sanctions and noncompliance shows nursing homes run by Bupa have a much poorer record than those of other providers.
Guardian Australia analysed data from the Aged Care Quality and Safety Commission’s audit reports and the federal government’s My Aged Care website’s noncompliance checker.
The audits, conducted over the past four years, show conditions in over a third of Bupa’s facilities have been deemed to be a “serious risk” to residents. Nursing homes were rated on 44 benchmarks covering everything from administration and IT issues to clinical care of residents.
Bupa had the lowest average audit score of large providers – 40.38 out of 44.
If an audit results in the facility failing a standard that presents a risk to clients in the facility, the Aged Care Quality and Safety Commissioner will notify the Department of Health and post a notice to that effect on its website.
Twenty-five Bupa facilities have had a serious risk notice in the past four years, representing 34% of Bupa’s facilities. For comparison, the next highest provider was 26% – and the average of all large providers was 6%.Following the risk decision, some facilities have corrected the issues.
Thirteen of its nursing homes were hit with sanctions – two of them twice. Sanctions include funding cuts, bans on taking new residents, man
datory training and the appointment of administrators and advisers to get the home up to scratch at the company’s cost.
The results are not a surprise to Thompson, a business consultant who gave up full-time work so that he could monitor his father’s care for two to three hours each day.
“I was one of the very few people who was there every single day to make sure that his room ran right,” Thompson said.
His said his biggest fear while his father lived at the Bupa nursing home was “incompetence”.
“My dad had three heart attacks and I had to demand an ambulance on two [occasions] yelling my head off at them,” he said.
Thompson pointed to a shortage of staff, lack of handovers between shifts and problems with medication management. There was a turnover of three general managers in three years.
“I just became a grumpy bear by the end of it because you’re pacing around trying to find someone,” Thompson said. “I could walk his whole ward on some days and not find a person in uniform who worked there.”
After his father’s death, Thompson said he felt a huge sense of relief.
“I thought, ‘thank God, I never have to walk into Bupa again.’”
‘They pack them in like sardines’
It’s a feeling Jane Rankin-Reid shares, after her late mother Lee’s time at Bupa South Hobart.
The nicest thing she can say about that Bupa home is that the gardens were “immaculate”.
“You have very attractive gardens that are meant to attract a particular wealth group. My mother would have been much happier beside a compost bin quite frankly,” Rankin-Reid said.
“In the 16-17 months she was there I don’t think she was taken outside more than twice because of staff shortages. The gardens are always empty.”
Rankin-Reid said it took two weeks for someone to clean a chair in the 93year-old’s bedroom following a faeces accident. She said she hired an external cleaner to come regularly at her own expense.
Whenever she made complaints, Rankin-Reid said, she was told she could move her mother if she didn’t like the care she was receiving. She said there was an “endless defensiveness” from management and that she was labelled a troublemaker when issues were brought to their attention.
She alleged her mother’s room had allegedly been robbed multiple times and trinkets and cash were stolen, but Bupa was reluctant to investigate.
“There was a high degree of pilfering but they would say ‘your mother’s got mental difficulties’. The gaslighting. This is a woman who read seven books before she died in the last fortnight. But [staff ] would say she’s losing it,” Rankin-Reid said.
She alleged her mother was also robbed on the night she was dying.
Bupa South Hobart was sanctioned in October 2018, but Rankin-Reid said she saw very little improvement afterwards.
A former Bupa general manager from a nursing home in regional NSW, speaking on condition of anonymity, said penalties generally brought about short-term change in Bupa nursing homes. Long-term sustainable change required getting into “the heads of staff ”.
“You can fix all the paperwork up, anyone can do that,” she said.
“But you’re not necessarily going to fix up how you care for somebody. [Staff] have to be given encouragement that will make them feel that when they get to work they want to do the best for Mrs Jones. You can put a BandAid on it, it will look good, but it will fall over in five minutes.”
She said managers of homes were under pressure to cut costs – including by restricting overtime, curbing the food bill and deploying fewer level-four trained carers on the floor because they are more expensive than inexperienced staff.
“There’s pressure to not spend too much money on activities because there’s no profit in activities,” she said.
She said general managers were constantly under pressure to sell beds.
A former staff member who worked at Bupa Woodend in Victoria, who declined to give her name, said three lounge rooms had been recently converted to make way for extra bedrooms.
“They pack them in like sardines. It’s insane,” she said. That nursing home was hit with sanctions in September 2018 and a noncompliance notice in October the same year.
“As soon as they get their accreditation back all of the things they put in place, to prevent further incidents … they ditch them and it goes back to how it was,” she said.
She described a mass exodus of trained staff when her nursing home was sanctioned.
“They’re happy if they just have numbers on the floor, they don’t care about the mix. As a consequence we got a lot of junior [registered nurses]. Bupa don’t provide the support for them, so you’re sending them in blind,” she said.
“In terms of staffing levels it wasn’t unusual for us most shifts to have up to 10 agency staff members. You have to show them what to do and it’s another risk to the residents.”
For three years, Rod Medew’s late mother Edna was at Bupa Traralgon, which was hit with a sanction in April after a previous sanction from July 2018 was lifted in February. The nursing home also had a notice of noncompliance in August 2018.
“Something is going wrong at the top level,” Medew told Guardian Australia.
Lack of communication, distrust, problems with medication and poor food quality were among the family’s biggest complaints.
“Mum was simply not getting her medication [for Parkinson’s disease that needs to be given at certain times]. My sister was finding it on the floor,” Medew said.
Marie Edwards’ late mother Irene Ashford, 96, and late brother Michael, 56, who had Down syndrome and earlyonset dementia, were cared for at Bupa Echuca in regional Victoria. The nursing home was hit with sanctions in March.
Edwards said her brother developed scabies on two occasions and the staff failed to tell the family the first time it happened.
“I was there every single day and none of the nursing staff bothered to say he had an issue. We were gobsmacked,” she said.
“I nearly fainted when I saw it [on his back with his shirt off].”
Edwards said her brother had gone into the home with the ability to play billiards but ended up in a wheel chair, never walked again, and couldn’t feed himself.
Battle with the tax office
Bupa’s aged care managing director Suzanne Dvorak insisted the company was trying to lift its game.
“We apologise for the failings identified in these homes and are focused on fixing these problems so no resident experiences unsatisfactory care,” she said in a statement.
“Some of this will take time but we are already starting to see genuine progress.”
Dvorak said the company was hiring more nurses and carers, refurbishing homes and trying to improve meal options and training for all employees.
“The vast majority of our homes are working well, passing external audits and providing the care residents should expect from a Bupa home,” she said.
In April, the Australian Competition and Consumer Commission announced it was taking Bupa to the federal court for allegedly making false and misleading claims about the services it provided at 21 nursing homes.
Bupa has also been in trouble with the Australian Taxation Office in recent years.
Documents filed with the corporate regulator show Bupa’s Australian aged care operation has been extremely lucrative, declaring a profit of $90m in 2017, but plunged into the red last year with a loss of $132m after it settled a long-running battle with the tax office.
It paid $122m to settle a tax bill over borrowings from other group companies to finance the purchase of businesses in 2007 and 2008, Bupa ANZ Healthcare Holdings said in its annual report.
Jason Ward from the Tax Justice Network said despite the royal commission and failures to meet care standards, the company continued to cut costs.
He noted in the 2018 calendar year it cut $24m of spending on employees and suppliers, following a $3m cut the year before.
Notes
Guardian Australia scraped every service page on agedcarequality.gov.au to get the most recent audit outcome and most recent serious risk decision.
We also scraped every entry on the myagedcare.gov.au compliance checker pages to get counts of current and archived notices of noncompliance, and current and archived sanction notices.
The datasets were merged based on service name. Provider names were cleaned and matched where possible. Large providers are defined as those with 10 or more audited services.
My dad had three heart attacks and I had to demand an ambulance on two occasions yelling my head off at them
Shane Thompson