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care marketplace and the material available to me.
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Aged Care Introductory
The many extracts on these pages are from copyright material. They are owned by the reference given or its owner. They are reproduced here for educational purposes and to stimulate public debate about the provision of health and aged care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes.
Entry to Privatisation
Pathology & Radiology
Gen. Pract. Corporatisation
Story of corporatisation
Breadth health corporat.
Ret. Villages a to c
Aus. Ret. Hm. & FKP
This corporate web site addresses the issues of corporate health care within a broad framework. A web page describing this broad context should be considered as an introduction to each page on the web site. If you have not yet read it then CLICK HERE to open it in another tab or web page.
This is a Queensland nursing home and retirement village operator which has developed relationships with banks in order to expand rapidly. There have been two disturbing but unproven allegations about its services.
Nursing Homes and Retirement Villages
LINKS CORPORATE MEDICINE WEB SITE
Every attempt is made to provide accurate and well written material. Your contributions, suggestions, additional information and advice sent to the web address at the foot of the page are welcome. Where possible they will be included in revised pages.
The intention is to show the general thrust of corporate practices as well as the nature and extent of any allegations made. Material contained here represents my views based on my study of the operation of the health care marketplace and the material available to me. It should not be assumed to represent the views of any other individual or organisation.
Links to Site
Tricare is a privately owned Queensland nursing home and retirement village company expanding rapidly in partnership with banks. While it makes claims to a tradition of high standards of care the critical report from a nurse who spoke out is disturbing. Its apparent willingness to house and restrain a patient against her wishes and that of her family is even more worrying and reminiscent of practices in the USA.
Ticare's complaint about this page:- Tricare has written to the University of Wollonong where these pages reside requesting that the page be modified or removed. I believe that they have not clearly understood the points I am making or the overall thrust and intention of the web site. I acknowledge that the page could have been worded more clearly and I apologise if, in trying to keep the page small and not repeat material on other pages, I have given the wrong impression. I apologise too if the the discussion of the pros and cons of larger nursing homes looked like a direct attack on Tricare's new venture on the Gold Coast. This was not intended.
I have made changes to make the points clear and ensure that no one can misinterpret the page or its intent. This has meant repeating context and arguments which have been discussed add nauseum on other pages. I have been criticised for this by those who explore the site and have to wade through the same arguments on multiple occasions but there seems to be no other way!
I am not claiming that Tricare has indulged in any of the matters raised on this page. It has denied them. Tricare is a leading Australian company which claims to provide a very high standard of care. I am simply documenting what has been said about it. I have commented to place it within the wider context of what is happening in the industry.
Australian aged care has been placed under increased market pressures and that these allegation have been made about a company with such a reputation is a matter of concern. The allegations are significant when seen within the wider context of developments in the industry and Tricare's partnership with Macquarie bank. Tricare is expanding rapidly in Australia. Macquarie is strongly focussed commercially. There is a rush to exploit the commerical opportunities offered by aging baby boomers. Companies are looking for capital to do so and loans must be serviced by profits from the homes.
The additional comments I make here indicate what the broader context is and what has happened there. Most readers would not have read widely enough to appreciate the significance of the allegations made.
This web site places the blame for much of the dysfunction in nursing homes on the marketplace paradigm rather than on the malign intention of any individual or company. Unfortunately the criticisms cannot be made without criticisng what happens in the companies. The allegations made about Tricare homes in the press extracts mirror similar allegations made by others about market operated nursing homes. Although they may be isolated they deserve attention.
Tricare has indicated a willingness to contribute to this page and address the concerns. I would welcome this and would be grateful if at the same time they would address my criticsms of marketplace aged care on these pages. I have offered an explanation for what is happening in my paper "Belief versus Reality in Health care" (pdf file). The industry needs an advocate willing to debate the issues. Tricare's input would improve the site and give it greater breadth.
Tricare is a private nursing home and retirement village company founded over 30 years ago by Paul OShea. He has become a millionaire many times over on the proceeds. Nursing home companies cry poor and call for more government support - to add to their wealth? So much for altruism!
Health care, retirement villages. Brisbane. 60. Married, children. O'Shea and his family own nursing homes, a growth market in Queensland, where southerners have been flocking in retirement for many years.
May 1994 PAUL O'SHEA - $65 million
It (Tricare) has 11 nursing homes, two sets of serviced apartments and a retirement village; it claims to be Queensland's largest provider of private nursing home care. The company employs more than 1000 people and is rumored to be preparing to open 12 more centres in the next two years.
UNDER $100 MILLION Business Review Weekly May 23, 1994
But the balance sheets of two private firms that operate nursing homes tell a different story. (they have been crying poor)
Sep 2004 Money in nursing homes
TriCare is a Queensland-based company owned by the O'Shea family, whose patriarch is one of the richest men in Australia.
Paul O'Shea bought the company's first nursing home in Sydney after leaving his accountancy practice. He is listed among the country's richest 200 people by Business Review Weekly, which compiles assets of the very wealthy.
The report said Mr O'Shea was worth $75 million in 1998.
Evidence of enormous wealth for some in aged-care industry The Courier-Mail September 2, 2004
TriCares CEO, Jim Toohey, is a prominent figure in the aged care industry in Australia. He has been a Director of peak aged care industry bodies, worked with various Governments on the development of aged care policy, advocated for better standards of care for residents and a more informed public debate about the financing of aged care. He has provided advice to the Reserve Bank of Australia about the sector.
Jun 2006 JIM TOOHEY
Mr Toohey has been at the head of TriCare since 1999 leading the companys growth, development of industry standards and provision of services.
Prior to his appointment as CEO of TriCare, Mr Toohey served for 9 years with Westpac / AGC in a number of roles including auditor, credit management and Regional Sales Manager.
- * Industry representative - Retirement Villages legislative review
- * Deputy President - Aged Care Queensland
- * Chair - Workplace Relations Committee ACQI
- * Industry Representative - CAP and Prudential Arrangements Committee
- * Industry representative - Queensland Health Aged Care Liaison Committee
- * Industry Representative - AMA Queensland Aged Care Working Group
- * Industry Representative - Workforce Review Committee (Commonwealth
- Mr Toohey will act as the official spokesman for RCA in Australia.
TRICARE WEB PAGE ABOUT TRICARE Accessed June 26, 2006
In the past Tricare has targeted the wealthy section of the population with luxury villages and nursing homes. It has been particularly successful in Queensland. More recently it has started running homes for the poorer sections of the community - those previously run by the Salvation Army.
It has also entered the home-care business and hopes that this will bring the residents to their nursing home facilities. A similar strategy in the USA proved unprofitable. Home care was dumped by the big corporations when they came under pressure - leaving the citizens served in limbo.
The company has 16 nursing homes and hostels in southeast Queensland, five retirement villages in Brisbane and the Gold Coast and a food and catering service, NutriFresh, that supplies cook-chill food to aged-care residents.
Sep 2004 Scope of operations
Evidence of enormous wealth for some in aged-care industry The Courier-Mail September 2, 2004
Mr Toohey said Tricare planned to utilise the (700 bed Coomera) centre as a base for the introduction of home-care to the Gold Coast, a move that would see the company provide services such as shopping, helping with showers, cooking and cleaning to meet client needs.
Sep 2005 Home care
Tricare plans $200m Coomera care centre The Gold Coast Bulletin September 2, 2005
In late 2004 Tricare formed an alliance with Macquarie Bank which has moved aggressively into aged care in Australia, New Zealand and Canada. Tricare owns 5% of Retirement Care Australia (RCA), the 95% owned vehicle used by Macquarie bank to buy and own the homes. Tricare is contracted to run them. Tricare is consequently poised to become a major provider of services across Australia.
Tricare will be running the more basic Salvation Army nursing homes purchased by RCA. This is a change in direction for a company which built its name providing luxury facilities for the wealthy. It may find it more challenging. RCA has also bought 12 homes from the Moran group as well as 49% of Zigge Inge. It seems likely that RCA is acting as a REIT and that these facilities will be run by the previous owners and not by Tricare.
The Salvation Army is finalising the sale of 15 aged-care facilities to a private equity group, packaged by Macquarie Bank and to be managed by Queensland operator TriCare.
Oct 2004 Salvation army purchase
If signed, the deal will point to the way the fragmented aged-care sector is about to be rationalised.
Key elements in the decision were the emergence of new private-sector providers, the new care standards requiring more day-to-day income and capital investment and a desire to focus attention on the most disadvantaged in society.
The 15 properties for sale involve close to 2400 beds in Victoria, South Australia, Western Australia, Tasmania and the Northern Territory .
Salvos close to selling to MacBank group Australian Financial Review October 28, 2004
News of the Coomera project comes just weeks after Tricare joined with the Macquarie Bank-linked Macquarie Capital Alliance Group to form Retirement Care Australia, which aims to establish extensive aged-care facilities throughout Australia to be managed by Tricare.
Sep 2005 Stake in RCA
Tricare plans $200m Coomera care centre The Gold Coast Bulletin September 2, 2005
Tricare also reflects another change in nursing home care as the drive for efficiency, economies of size and profits is developed. It is building much larger facilities. In small intimate personal nursing homes of 20 to 50 beds the staff form a caring community around the patients whom they come to know and talk to. This is the residents home and the people there become part of a caring family. They provide intimate and personal care which would be acutely embarassing with a stranger. The small groups relate to one another and the patients. This small group is critical for the mentally confused. Potentially dysfunctional staff are more readily detected and pressured by their peers who soon know them well. It is difficult and more costly to provide more sophisticated services in small homes. The current market in aging places these homes under acute pressure and they cease to be viable.
The business community is talking about nursing homes of a 100 beds being the optimal commercial size. This allows them to spread their resources and so reduce costs. They are more economical. Tricare is carrying this much further by building an integrated 700 bed giant on the Gold Coast. This will provide home care, retirement accommodation, hostel and high level nursing home care. This certainly has appeal and provides continuity for residents.
Small homes certainly have their problems and disadvantages. There are some advantages for patients in larger homes and in integrated services. A wider range of expert services can be provided and more activities organised. There are however more diffficulties in organising intimacy and a homely atmosphere. In a small home residents who may be confused have ongoing contact and intimate services provided by people they know well. In a larger home staff can be moved from one area to another where there is greater need. It is more "efficient". It is almost inevitable that management will do so to keep costs down and maximise the use of resources. This alters the relationships and the intimacy which older humans need. Socially staff form cliques with soulmates and the close pattern of personal relationships between groups of staff on the floor is lost. Management in the home is less able to maintain a close personal relationships with staff. Dysfunctional people who might abuse or even rape residents are less likely to be detected.
The problem is compounded when larger homes are created for purely commercial reasons and when there is strong pressure for profitability. Here the pressures to reduce staff, use less equipment, and reduce recreational activities to increase profitability have resulted in what has variously been described as wrinkle ranching. warehousing and even more challegingly as people farming. Examine the many allegations made in the USA where disgruntled relatives have placed video cameras to document what happens as stressed and overworked staff rush through the patients to provide some semblance of care. There is no time to listen or for even a few words of comfort or concern. The French giant GSI was accused of using a factory approach in the United Kingdom. Similar experience are described by nurses in Australia. This practice is given impact on this site in a confronting allegory by a nurse aid working at the the coalface. The nurse compares commercialised aged care with a chicken farm. This is an important and challenging problem and it should be confronted.
The strong pressures placed on care by commercial forces is summarised in a 600 word opinion piece I was asked to write and on a web page in which the pressure placed on care by the drive for profit is discussed. The people involved are not criminals. They are simply human's unwittingly trapped in a situation with which they have come to identify. These are normal business practices and the people involved in these practices are often successful, experienced and well trained businessmen. Like many other aged care CEOs Tricare's CEO (see resume of his curriculum vitae above) is a highly trained businessman.
I do appreciate the need for an economically viable sized complex and for integration. My concern is that profit pressure has and probably will continue to foster warehousing. Larger homes focused on profit rather than care can do this more readily and more profitably.
I am not claiming that Tricare has done or plans to do anything like this but that the market is likely at some stage to put pressure on them to do so. Bankers and financiers giving advice and lending money can press for staff cuts and other efficiencies. They have little understanding of the consequences. Businessmen steeped in marketplace practices think along similar paths and are more likely to comply. There are no powerful doctors to exert economic leverage as they did with Mayne Health. Everyone is deaf to the nurses who have little economic power.
Tricare may well be as exemplary as it claims in its practices but it is a commercial enterprise. It could be acquired by a more profit driven entity. It could go under and its facilities be sold to another, even (like DCA) to a disturbing foreign financier like Citigroup. Worse still it might end inn the hands of a multinational from the US markeplace like Sun Healthcare. If Tricare were threatened by bankruptcy would they in their desperation follow Markalinga by selling to a multinational under investigation for fraud and misusing residents.
These are real concerns and market advocates should confront them. Tricare has built a new 700 bed integrated facility on the Gold Coast, Tricare is well placed to explain how this will work and be protected. How will the stable small intimate communities which physically and mentally impaired elderly can call home be recreated in such a large complex.
TRICARE, a leading Queensland-based aged-care provider with extensive facilities on the Gold Coast, is poised to develop a $200-million-plus centre at Coomera.
Sep 2005 "State of the art" centre
The company is laying plans to build a state-of-the-art centre for up to 700 residents as well as infrastructure to enable it to introduce home-care services to the Gold Coast.
The new facilities will include independent-living units, serviced apartments, as well as a nursing home and hostel that will be equipped to meet intensive care needs.
"We plan to provide about 700 beds in a range of state-of-the-art facilities offering different levels of care.
"There is a clear need on the Gold Coast for such (home care) services which also serve to provide an introduction to the company and its aged-care facilities," he said.
Tricare plans $200m Coomera care centre The Gold Coast Bulletin September 2, 2005
The Divide:- I have written at length elewhere about the large divide in perceptions between corporate managers and those at the coal face. Dave Lindorff in his book "Marketplace Medicine" first described this in the US hospital sector in the 1980s before the scandals in that country were exposed. He found the corporate icons of the time to be plausible, genuine and likeable yet those at the coal face told a very different story.
This phenomenon is readily apparent in what has happened since then and is well illustrated by internal document's from the market's worst offender Tenet Healthcare. Staff and management in this company identified enthsiastically with practices which were considered normal and desirable in the marketplace but totally unacceptable in the health sector and to the public. Their economic success was used to give their practices legitimacy. The uncritical acceptance of their marketing by the business community and indirectly the public allowed them to internalise these and accept them as valid. Sociologists talk about "objectivising" an image of ourselves before others and then "internalising" that objective image. This I believe is what occurs across the industry. I have observed a similar phenomena among staff at my hospital when they were exposed to their own hospital's advertisements (eg. on the hospital telephone system during delays). They accepted this positive projection and became desensitised to the hospitals problems. They did not criticise.
In 1993 I met and spoke to a number of those who blew the whistle on Tenet Healthcare (then called NME). The most insightful comment came from one of them. When asked how this could possibly have happened. He simply said "thats the way they think".
Some health policy experts like Uwe Reinhardt, an economics professor at Princeton University, see the situation as "brutal and inhumane." But, Professor Reinhardt said, doctors and hospitals are trapped in it.
Apr 2001 Writing about managed care in the USA
Mark Pauly, a professor of health care systems at the Wharton School of the University of Pennsylvania, said there was no real villain. "I don't think it's exactly good versus evil," he said, "it's just business." Medical Fees Are Often Higher for Patients Without Insurance New York Times April 2, 2001
These differences in perspective are readily apparent when one examines the aged care system in the USA, in Australia and in Canada. Different perspectives and understandings by businessmen, politicians, nurses and patients in Australia are well illustrated by what happened at Riverside.
In general corporate spokemen have denied the allegations made, accused assessors of bias or inaccuracy and attempted to destroy the messenger. Success within their own frames of reference gives them legitimacy in their own eyes, in the corporate sector and often in the community. Examples of similar behaviour can be found in Australia. Companies have denied dysfunction in the face of evidence, of criminal convictions and costly settlements. Even after a criminal conviction Tenet never accepted that its business practices were at fault. It reverted to the same practices as soon as it could.
The people:- I have never argued that these people are deliberately malign. What I have argued is that people who are highly focussed are successful in the marketplace and are highly valued. They are promoted. This focus is all too often associated with an inability to see from the other persons perspective. There is a very human tendency to respond by being suspicious of those who challenge what to them is self evident and to rationalise their own position. This emphasis on focus draws very unsuitable one eyed people into the sector and they do well initially. The consequences for citizens and employees caught up in the health and aged care sectors are often unfortunate.
I have examined the social dynamics and tried to suggest an explanation for this phenomenon. I have summarised this in a published paper "Belief vs Reality in Health Care" (pdf file) and explored the psychology of it on a separate web page. To emphasise the issues and underline the adverse consequences I have used the words sociopathy and successful sociopath to broadly describe the phenomenon and stress the consequences.
People who might fit this pattern in various ways were the now discredited leaders of Tenet Healthcare (Richard Eamer and Geoffrey Barbakow), HCA (Scott and Frist), HealthSouth (Scrushy), Citigroup (Sandy Weill) and particularly Sun Healthcare (Turner). I have devoted pages to some of these people so that the reader can assess their characters as revealed by available reports and set it against what I have said. In Australia we can look for similar characteristics in the leaders of Gribbles (Cameron), Macquarie Health (Wenckart), Mayne (Smedley A and Smedley B) and the McGoldrick businesses. In aged care in Australia we should examine Ted Sent from Primelife as well as Martyniuk on the Riverside scandal page and Graham Menere on the Saitta and Neviskia page. These people came to grief earlier than their counterparts in the USA so did less damage. The market paradigm and dominance of marketplace thinking in Australia is not as advanced as in the USA so that they were less credible and so more readily challenged. The medical profession have not been captured by the market in the same way and are in a better position to act.
All of these people have left a human trail behind them whether these were investors who lost money or patients who were misused. The market in vulnerable people has left a trail of misfortune behind it yet credible and responsible people continue to promote it. People believe them. Proponents of marketplace health and aged care should be challenged to confront the history of the sector.
Contrary experiences:- I do not believe that we should make the mistake of discounting alternate opinions simply because they come from diffferent and less credible sections of the population or because they have had adverse experiences which have drawn their attention to the problems. Their experience motivates them to act. People who speak out do so because this is the way in which they experience their situations. Nurses who speak out are usually fired and others will not employ them. It requires a lot of courage, disgust and determination for them to do so. Their complaints usually have substance and they have often been the first to speak out about companies whose scandalous conduct is then exposed. We ignore them at our peril.
Tricare:- The press reports about Tricare reveal a company which is proud of its track record in providing outstanding care. We have no reason to doubt their sincerity. On the other hand the reports by a patient and by a nurse paint a totally different picture and their are no grounds for doubting their sincerity and conviction either. They see the situation from a different perspective.
I am not claiming that Tricare executives are insincere or exploitative. I am saying that the pattern of the material available reveals very different understandings of what happens in Tricare homes and that this should be noted and confronted to be sure that the situation I have described does not exist.
Tricare has recently adopted a far more aggressive commercial focus and has aligned itself with one of the most aggresssive and financially successful profit focussed banks in the world. It has also moved away from the luxury marketplace where there is economic room to manouvre and into a government funded more basic sector where there is less latitude in providing both care and profit. Tricare's comments about this situation would be welcomed.
Tricare has had many glowing accounts (advertorials) in the Queensland press and they come with conviction. Here are some examples made during the same period that the criticisms were made.
TRICARE now offers even more choice within their nursing centres and hostels.
Mar 2004 Claims to excellence
Over the past 31 years, they have learned that excellence is a combination of resident focus, home-like environment, genuine caring, professionalism and experience.
Quality care assured in aged nursing centres Sunday Mail March 21, 2004
FOR more than 35 years, TriCare has been Queens-land's largest provider of nursing home care and is a recognised industry leader.
May 2004 Recognises industry leader
TriCare owns and operates 13 nursing centres and three hostels in southeast Queensland that offer quality nursing care in attractive surroundings.
TriCare also offers extra services to its range which mean superior accommodation, more privacy and additional services.
Residents dignity and identity is respected Sunday Mail May 2004
FOR almost 35 years, TriCare has been one of Queensland's largest private providers of aged care facilities and is a recognised industry leader.
Jul 2004 Queensland's largest
Aged care provider The Courier-Mail July 29, 2004
A RECOGNISED leader in aged care in Australia, TriCare has earned a solid reputation for ownership, development and management of facilities throughout southeast Queensland.
Feb 2006 Solid reputation
Established for more than 35 years, TriCare is a name recognised by most Queenslanders as a soundly-based, quality-driven provider of excellence in aged care facilities and services.
As a privately owned company with a reputable track record, TriCare employs more than 1600 professional staff dedicated to providing the highest standard of service to residents of its 23 facilities. The TriCare philosophy for its retirement villages is that they should be much more than just a real estate development -- they are communities specifically designed to meet their residents' needs.
TriCare a trusted name in aged care Sunday Mail February 19, 2006
The nurses:- Nurse managers have participated in these advertorials and praised the company.
AGED care nursing is a rewarding and, at times, complex job, requiring well-developed organisational and practical skills, according to Farrah Thomson of TriCare Annerley Nursing Centre.
Feb 2006 Nurse praises the company
Since March 2004, she has been working as TriCare's resident classification scale co-ordinator where part of her role is to provide information to the Department of Health and Ageing for appropriate funding for residents.
"Real satisfaction comes from learning about each resident's care needs and understanding the needs of the family so that you are able to give holistic care to both."
Ms Thomson said that, through working at TriCare, she had been able to maintain a good work/life balance, arranging shifts to suit her lifestyle and family commitments.
Not only does TriCare ensure good care for residents, they also look after their staff," she said.
Providing care to the aged The Courier-Mail February 23, 2006
In sharp contrast is a damning criticism of staffing and care by a nurse who claims she resigned in disgust. When nurses speak out like this experience shows that they are seldom wrong. In this case the nurse's claims are congruent with what nurses and their unions are saying about other nursing homes. Do we believe the occasional nurse who has sacrificed her career in order to expose what she considers abhorrent or do we believe the nurse who has been promoted by the company. Experience indicates that we ignore the former at our peril.
Company executives see things very differently. They are genuinely incredulous when this happens and often ascribe a variety of unsavoury motives to the person who speaks out. We must remember that these managers live in a very different world and for them it seems to be the real world.
When Mrs Horniak resigned recently, it wasn't because she quit loving her clients. She just couldn't stand being part of a system she said valued money and paperwork over people.
Sep 2004 Nurse tells another story
Over the past several years, Mrs Horniak said she witnessed a spiralling decline in care at her private TriCare nursing home at Stafford Heights in Brisbane. Management deny the claim.
To save money, juice and milk were watered down, resident activities were curtailed and paperwork and useless meetings cut into nursing time, she said. Residents' calls for help went unheeded.
"Staff were not replaced. The workload got even bigger and more stressful," she said.
Chief executive Jim Toohey "absolutely, categorically" denied cutting staff, hours or resident activities. Drinks were only diluted to meet the care plans of residents, he said, "but that happens anywhere".
Money matters more, says carer The Courier-Mail September 1, 2004
The press has continued to praise Tricare's virtues in a warm fuzzy way and these are best characterised as advertorials. In the last several months there have been four in Queensland papers and three were in the Courier Mail or Sunday Mail. We are entitled to ask whether the serious complaints were openly addressed; what was found and whether anything was done about it? Claiming that the accreditation agency found no problems is not a convincing answer. It is clear that homes in large companies with extensive resources are readily tidied up prior to inspections and many allegations that some groups regularly do so.
A Tricare home has also been a wiilling or unwilling party to the worrying imprisonment of a resident against her will and the will of her family. The guardianship laws were used in a draconian manner to keep her there and to muzzle those who took her position - preventing them from appealing to the public.
It wasn't until the matter was raised under privilege in the parliament that the issues could be publicly exposed.
Although the matter was raised in parliament on 8 Feb 2006 nothing was done. The unhappy lady died 3 months later. The report suggests that in part this was consequent on her refusal of treatment from a system which she had come to distrust.
The sons comment about the Tricare home is worth noting ""It was a hostile environment. She absolutely hated it." The son was relieved that she did not die there. A hostile response is what people all too often get when they challenge establishment patterns of conduct. The content of the Hansard report suggests that Tricare, if not an active participant in the detention may have been willing to go along with it. It would be reassuring if we could be assured that Tricare took up the issue for their resident and suported the family in their efforts.
In the situation in which this family found itself anyone could become difficult and suspicious and this is common in the elderly. Experienced staff and management should be trained to deal with this and adebt at resolving the hostility. I find the comments worrying and am not persuaded by the argument that personal difficulties automatically compromise objectivity, although they occasionally do.
Most of us are capable of assessing the situation and drawing reasonable conclusions even when we are personally involved and are stressed by loss. After a personal loss I was attacked for not being objective, as being vengeful, as being a crusader and as lacking credibility when I challenged and exposed Tenet Healthcare (then NME) between 1991 and 1996. I faced two unprosecuted libel actions. I believe that almost every assertion I made has been validated including my assessment of the company's culture. I suggested that because of this culture and the general denial it was likely to reoffend. It did so in spectacular style less than 10 years later.
Because of the restrictive Guardianship legislation in Australia the press could not publish anything about this failure in care other than the parliamentary statement until after the Tricare residant died. The public could not come to the family's asssistance. These are critical social and ethical issues where public accountability is essential. I have taken the liberty of reproducing most of the last article. It would be nice to know that Tricare had recognised the problems and joined with the Courier Mail in pressing for reform. It was the only resource the family had. The newspaper does not mention this.
One of the consequences of the marketplace model of democracy is that it is understood in terms of rights rather than responsibilities to others. The balance between our rights, and our responsibilities for the rights and well being of others, intrinsic to true Democracy, is lost. I addressed this in the latter part of a long background paper (pdf file) which I prepared for a visit to Canada. I was invited to address interested doctors and citizens in Alberta in 2004 to discuss the corporatisation of health and aged care.
The issue is relevant and important because there have been similar imprisonments in the market driven USA - including allegations that Electroconvulsive Therapy was given without the patient or family's consent. Social workers and some staff working for government and the courts have been seen as too closely associated with aggressively profit focused nursing home and psychiatric companies when advising unwelcome government guardians to institutionalise their charges.
One glaring example occurred in the psychiatric scandals in the USA some years ago. Court staff were paid kickbacks for directing delinquent children, whom they had assessed, for admission to company psychiatric hospitals. They were kept in hospital needlessly for long periods of time while the system was fleeced. Business creativity recognised no barriers in their search for profitable patients.
I am not claiming that Tricare did anything like this or ever would. These things have happened in the marketplace. Unless we raise and consider these issues whenever there is innappropriate incarceration of a resistant citizen we will sooner or later have this happen in Australia.
As indicated a socially responsible corporation would be expected to take up the issue on behalf of their helpless and vulnerable resident. It would be good to hear Tricare's version of what happened and to know that they did not stand idly by.
Dr Flegg (state MP in parliament) said a "comprehensive and independent" report prepared by a respected occupational therapist, concluded: "Prompt intervention is required. (Mrs Sokal) is suffering emotionally, physically and cognitively in her present accommodation at TriCare Nursing Home, Jindalee".
Mar 2006 Raised in parliament
State keeps woman as a 'prisoner' The Courier-Mail March 1, 2006
Dr FLEGG (Moggill--Lib) (8.58 pm): I rise to speak about the case of Mr Henry Sokal and his mother, Hanna Sokal. Mrs Sokal suffered a stroke which left her with a physical disability affecting her speech and mobility.
Feb 2006 The story told in parliament
Mrs Sokal clearly has full understanding and was able to, in an impassioned way, ask my help to have her released from a nursing home into the care of her son. They are a close-knit Jewish family and her son, Henry, is her only kin here in Queensland. She was excited that someone was willing to try to help her and her son.
Control of Mrs Sokal was handed to the Adult Guardian by the guardianship tribunal and permission has been repeatedly refused for her to return home with her son despite the fact that she clearly understands and can express her wishes.
Overnight visits to her sons home were banned and repeated appeals to release Mrs Sokal in accordance with her clear wishes have been refused. Essentially, here in Queensland we are holding an elderly disabled person of perfectly sound mind against her will as a prisoner in a nursing home similar to the way abuse occurred in institutions in Soviet Russia.
Prompt intervention is required now. The client is suffering emotionally, physically and cognitively in her present accommodation at TriCare Nursing Home, Jindalee, Queensland.
Her son and the media have been prevented from speaking out against this abuse of an elderly disabled persons human rights by section 112 of the Guardianship and Administration Act, which prevents the reporting of any proceedings that have appeared before a guardianship tribunal.
It is unbelievable that a persons express wishes could be trampled on by a government agency and that by law we prevent even their closest family from raising this serious infringement of her human rights.
It has never been asserted that Mrs Sokal is not of sound mind. She clearly expresses her wish to return home to her family. Independent reports indicate this is not only practical but, with some minor modifications to the home, absolutely essential for the mental wellbeing of Mrs Sokal.
It is unconscionable in Queensland to imprison her in an institution without adequate reason. Parliament is the only avenue in which this matter can be openly discussed. I will be referring the Hansard of this speech to the Attorney-General for action.
Personally, I found it distressing to interview Mrs Sokal and Henry, a normal loving mother and son who just want to be together and are being prohibited by bureaucracy that is subject to zero accountability.
Sokal, Mrs H Queensland Parliament speech at 8:58pm Hansard at pages 357-8 February 28, 2006
LAST Wednesday evening a woman called Hana Sokal died. The Queensland Law Reform Commission can learn much about the shortcomings of Queensland's guardianship regime and the legislation underpinning it which it is currently reviewing, from the circumstances leading up to Sokal's death.
May 2006 The story after she died
She died having been forced to live in a nursing home for three years where she was unhappy. The Courier-Mail published a feature on the plight of Sokal and her son Henry last October. But it was an emasculated article -- rendered so by the restrictive confidentiality provisions of the Guardianship and Administration Act.
At the time of her death, Sokal still had not been permitted to move home. The Sokals' nightmare began when Hana Sokal was on the verge of leaving hospital after a stroke in 2002.
Henry has said he was told by the hospital he should apply for formal guardianship of her and did so after contacting the tribunal. He said tribunal staff told him not to bother bringing a lawyer to the hearing because it was an informal process.
But when he got there "everyone was quoting sections of the Act".
"My mother conveyed she wanted me to be her guardian, but no one would listen," he said.
After the appointment of the Office of the Adult Guardian, Henry arrived for one of his daily visits to the hospital to find his mother's bed empty and her personal effects gone. No one at the Office of the Adult Guardian had had the decency to tell him his mother was being moved to a nursing home.
Henry appealed to the OAG to let his mother return to her home. He made plans for home renovations, plotted out community care support services and had training for the care he would have to provide.
His appeals fell on deaf ears and so he turned to Carers Queensland, The Courier-Mail and Flegg for help.
In a letter dated March 27, Attorney-General Linda Lavarch responded to Flegg's speech in Parliament. She said Henry could have re-applied to the tribunal to, in effect, challenge the OAG's guardianship.
But this begs the questions: why should he have had to do this and what faith would he be expected to have in the process, given the outcome of the original hearing?
Lavarch went on to say she understood meetings had taken place between the OAG, Henry and Carers Queensland to "put plans in place as an initial step for Mrs Sokal to return to her home."
"When all these are in place the OAG will give consideration to Mrs Sokal residing in her home," she said.
But it's a case of too late, too late, too late, Ms Lavarch.
And here's another rub that the tribunal, the OAG and the Law Reform Commission might like to consider. When Sokal died it was in a Brisbane private hospital where she was admitted for a diabetes-related ulcerous toe. Throughout her stay in the nursing home, Sokal had refused to take medication dispensed by staff, including for her diabetes. It was because, Henry said, she did not trust anyone. Complications developed from the initial surgery and Sokal wound up having her leg amputated.
Henry has also said his attempts to be involved in the decision-making about the surgery were rebuffed on the grounds he was not his mother's official guardian.
His mother died after a heart attack.
When Henry rang The Courier-Mail to impart the sad news, he also expressed relief that his mother hadn't died in the nursing home.
"I didn't want her to finish her life there," he said. "It was a hostile environment. She absolutely hated it."
It was a small mercy and one by no means attributable to those in charge of the Guardianship and Administration Tribunal and the Adult Guardian.
Postscript: The Courier-Mail is able to publish details of the Sokal case including identifying Hana Sokal because under the Guardianship and Administration Act a guardianship order ends upon the death of the person under the order.
Death, denial and the law The Courier-Mail May 15, 2006
The December 2004 Newsletter of the Association of Residents of Queensland Retirement Villages is critical of the way in which Tricare set up its resident committeee in its Runaway Bay Village.
Tricare www site is http://www.tricare.com.au/www/index.cfm
For Updates:- A good way to check for recent developments in aged care is to go to the aged care crisis group's search page and enter the name of the company, nursing home or key words relating to any other matter in the search box. Most significant press reports are flagged there. The aged care crisis web site has recently been restructured and some of the older links used from this site may not work.
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This page created Sept 2006 by Michael Wynne
Modified Jan 2007, May 2007