Gillard orders probe into dentist's 'abuse' claims
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Blowing the whistle: Dr Clive Rogers (pictured) says neglect of dental care in nursing homes amounts to abuse (ABC TV)
Deputy Prime Minister Julia Gillard says the Government will make sure that reports of dental health neglect in nursing homes are investigated.
A senior dentistry lecturer at the University of Western Australia, Dr Clive Rogers, says nursing homes across Australia are failing to meet Government standards for the daily maintenance of oral and dental hygiene.
He says the neglect of dental care in some nursing homes amounts to abuse.
Ms Gillard told ABC's Lateline she is shocked by the findings and says Minister for Ageing Justine Elliot will give them full consideration.
No-one wants to think of patients in nursing homes being in pain, not being able to eat, obviously having other health problems because of this kind of neglect," she said.
"Anybody who sees those images obviously can conclude we need to do something and Justine Elliot, our Minister, will get the information. She is very keen to deal with these complaints."
Dr Rogers told Lateline that nursing homes are passing accreditation tests even when their residents' mouths and teeth are so ravaged they risk serious illness or premature death.
"The thing that disturbs me most is seeing someone who is in pain. Yes, having pus draining into their mouth, abscesses, they disturb me," he said.
"The whole aspect of the neglect and the whole aspect that this is not widely known amongst the population, Australia at large, is that mouths that I see, these terrible mouths, exist everywhere all over Australia.
"All the nursing homes I see should not be passing their accreditation."
Dr Rogers has put together a library of photos to show the extent of the problem and has also conducted his own national survey of 18 visiting dentists, who all have experienced working in nursing homes across all states and territories.
"Out of those 18 people, 89 per cent of them said that they didn't believe that the standard was being met," he said.
"I will go in and I will look at the in-house dental reports and some reports done by other government bodies. I will totally disagree with what's been written down."
Dr Rogers lodged complaints with the accreditation authorities and the Commonwealth Department of Health and Ageing, who have rejected his claims.
But now Ms Elliot has asked Dr Rogers to send his complaints to her directly.
"I would encourage him to put forward complaints and issues he has to the complaints investigation scheme, or to forward them to me personally because, as I say, if anyone raises any issues in relation to any matter to do with the nursing homes, whether it's about health, safety and wellbeing, these will be investigated," she said.
Ms Elliot has announced a strengthening of 44 legislated standards that govern nursing homes.
"I'm also getting all of those standards assessed and since I've become minister I've looked at ways of strengthening our age care standards and accreditation agency, strengthening their standards as well.
-Adapted from a report by Suzanne Smith for Lateline
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Comments (43)
Comments for this story are closed. No new comments can be added. If you would like to have your say on this issue, you can do so via the Emails section of our Opinion pages.
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Cavity:
05 Dec 2008 9:36:04am
And how about people, old and young, outside nursing homes who depend on public healthcare?
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sharsh:
05 Dec 2008 9:46:21am
Yeah, I would think that at least in an aged care facility the residents would at least have personal carers to monitor their dental health.
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acker:
05 Dec 2008 9:52:11am
Cavity most of those younger people outside nursing homes other than children who are at the mercy of their parents can opt whether they want to spend their money on getting neccesary not extravagent dental work done.
Most older people reliant on nursing homes cannot.
I think it is disgusting that we treat these people after a lifetime of paying taxes that financed most of this nations exsisting infastructure like some kind of terminal unit that's existance needs to be funded at the cheapest possible price to make the balance sheet on a nursing home look good.
Drastic action needed.Agree (1) Alert moderator
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pony:
05 Dec 2008 10:16:24am
acker, most nursing home residents are reliant on the PCs and nurses at a facility to report any dental problems. The money being spent is not an issue as their is usually a POA or Trustee who can release monies to fix the problem.
Reporting procedures and dental waiting times need to be addressed immediately.
To label all nursing homes as bad is disrespectful to the (underpaid) caring, hard-working Personal Care staff throughout the country.Agree (0) Alert moderator
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acker:
05 Dec 2008 10:47:13am
All well and good 'pony'
As long as the nursing homes are instructing the Personal Carers and Nurses to check for dental problems, and giving those staff the appropriate amount of time and resources to do so.
Rather than covering the biggest amount of nursing home patients they can with the smallest amount of Personal Carers and Nurses possible.
Some nursing homes have rate the bottom line profit on their balance sheet as their primary aim, whilst some rate their nursing home patients welfare as their primary aim.
My big concern is that Australia still has too many homes with managers too pre-occupied with profit that are ruthless enough to sacrifice patient nursing and personal care to acheive that goal.
And we have too many employers in the Nursing Home industry that think that is an asset and admirable trait when looking to hire administrative staff and executives.Agree (0) Alert moderator
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chalkie:
05 Dec 2008 10:32:45am
Yes, these people deserve suitable standards of care.
No, they did little to pay for the level of services they now enjoy (or should enjoy). The extent and quantum of medical care that is currently provided (or should be) is a result of a compassionate society doing the right thing, not a society obligated to repay some sort of debt.Agree (0) Alert moderator
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acker:
05 Dec 2008 11:05:44am
How many new hospitals has the real estate (land) been appropriated for, and been built between 1978 - 2008 compared to 1948 - 1978 Chalkie ?
Yes
They have done more than you or I to deserve better than just the miserly level of services they are hardly enjoying now.Agree (0) Alert moderator
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pony:
05 Dec 2008 9:42:03am
Surely this would be reflected during a full three-yearly accreditation of a facility? (and spot-visits) If this is true then what the hell do assessors assess?
If the governmnet wants to focus on the neglect of the the teeth of the elderly, then I would suggest they target problems with the public dental system that has up to a three-year wait for a pensioner to get a new set of dentures.Agree (1) Alert moderator
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shocked:
05 Dec 2008 9:50:07am
This is outrageous! PLEASE do something about this Ms Gillard! Well done Dr Rogers for bringing this to the govt's attention.
If nursing homes don't come up to standard, close them!Agree (0) Alert moderator
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pony:
05 Dec 2008 10:03:27am
And then where do all the residents go?
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Big Yin:
05 Dec 2008 10:11:36am
Where, when you've closed the nursing homes, do you then propose house the reseidents? Get serious!
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Peter D:
05 Dec 2008 10:15:42am
Really??? If you propose to close the nursing homes because they don't meet the 'standard' for some reason where, pray tell, do you think the residents are going to?? Every public park in the nation will be home to the old and frail. If that was to happen, and it certainly won't, at least the problem of the elderly won't be around very long.
Judging by the cases of dental neglect seen on the ABC report last night, I'd say most of the trouble started for these people long before they hit the nursing home bed. You can't blame a nursing home because somebody has got a mouth full of rotten teeth. You can, however, jump on them for not tidying up the problem
Closing nursing homes is just sweeping the dirt under the rug. IIt doesn't fix any problems -- just creates more.Agree (0) Alert moderator
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robbi64:
05 Dec 2008 10:41:12am
There is no excuse for leaving a helpless patient with food particles in their mouth, clinging to the remains of what teeth they have. It should be a normal part of daily hygiene. Or did personal care training standards change in the past 20 years?
I agree that most of the damage was done before the resident got to the nursing home. However, any decently trained carer knows that mouth care is vital for a patient, and it only takes a few minutes to remove obvious food and plaque.
I wonder if the problem is actually caused by not enough staff to provide personal care in nursing homes. They have been saying quite frequently over the past few years that if they did not secure a better funding model, and be able to employ more staff, they would not be able to provide the standard of care expected by the community.Agree (1) Alert moderator
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Peter D:
05 Dec 2008 11:33:56am
True. I got to say you're quite correct. I was looking at the problem from a longer term view. I'm surprised that the staff let these patients be examined on film withourt be checked prior to the occasion. Reflects very poor management and supervision of staff.
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Peter:
05 Dec 2008 12:11:46pm
Unfortunately I missed the Lateline program; however, from the comments made I feel some explanations are needed. As a dentist working with medically compromised patients and the aged for over 30 years I have seen some significant changes in both health management and outcomes. 30 years ago we werent doing solid organ transplants and we didnt know what we do today about auto-immune diseases and many other ailments. A couple of things modern medicine has done. We live longer but take more medications. The down side for many is that these ailments and many of the drugs cause xerostomia (dry mouth) as does getting older. The salivary flow diminishes or even stops completely. Without adequate saliva even well maintained teeth in the elderly and medically compromised group can rot away rapidly in the dry acidic environment of the mouth, especially when juices, sugared drinks and biscuits are part of the staple diet.
If you are able bodied cleaning your teeth twice a day properly should take at least 2-3 minutes each time. If you are elderly or have poor manual skills it may not happen at all. For a Nursing Home of say 150 residents to spend 2 minutes a day on each resident, plus write up the notes, plus get from one resident to another equals a fulltime staff member. It isnt going to happen while Medicare fails to acknowledge that oral health is as important as the health of any other part of the body. If a person can go along to a doctor with a sniffle or a pain and receive a Medicare benefit surely someone with and infection, pain or swelling that may compromise their general health should be able to have that seen to by a dentist.Agree (1) Alert moderator
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Gadget:
05 Dec 2008 10:26:10am
How about we Nationalise them and bring them up to standard instead. That would seem to be a more appropriate and humane path to take.
Health should never be a "For Profit" business. Too many corners get cut when its "For Profit", because the bottom line becomes the motivating factor. And as we've seen in the seeds of the financial crisis, human greed can do great damage.Agree (1) Alert moderator
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mike says it was planned:
05 Dec 2008 10:26:55am
everyone should get subsidised dental care
the nations teeth are in decay
and flouridation is obviously a poison that is clearly not protecting teeth or its enamel
there is no difference between forms of neglect no duty of care abuse and injury at ALL ages
its about time dental nurses were trained to the level of dentistry by experience instead of ridiculous 4 years of university at least let them perform certain procedures based on skill and practical testing... create mobile clinics and deregulate the dentistry industry, free descale free clean free check up and referral surely we can make savings by training more on the job...
teeth are connected to general health including the heart itself
we throw away tens of thousands on often failed bypass or temporary bypass surgery but not a dollar on the teeth that may be linked to the well being of our circulation systemAgree (0) Alert moderator
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Green:
05 Dec 2008 11:03:07am
If it wasn't for fluoridation, the state of our teeth would be poorer. The research clearly shows that the benefits far outweigh any disadvantages.
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Tabby:
05 Dec 2008 10:02:14am
There are other issues, yes, but if someone zeroes in on a particular issue, then there's nothing wrong with that. People are simply getting embarrassed and defensive when yet another problem is found in the aged-care community, and collapse upon any investigations with a 'yeah-but-what-about--' sound. There's many issues needing attention out there, we're all aware of that, but they can't be fixed all at the same time. Its become such a pot of proverbial that no matter what they address first they are going to get howled down. Seniors in nursing homes need care, and so it should be provided. If anyone wants to argue other issues, they should seek the appropriate avenues instead of diving onto it with things that aren't the topic at hand. There's probably seagulls fighting for chips that argue less readily.
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Rolly:
05 Dec 2008 10:05:25am
Usual problem:
Those who should care, don't; and those that do care, or say that they care, do nothing.
'Twas ever thus.Agree (0) Alert moderator
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Justin:
05 Dec 2008 10:28:58am
Speak for yourself.
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Derridian:
05 Dec 2008 10:06:42am
Fix this now! I pay taxes... stop funding useless 'security' initiatives and urgently re-direct funds to age care facilities and hospitals!
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Justin:
05 Dec 2008 10:33:48am
Yes you are right. Make the community and health the focus again rather than chasing shadows, a legacy from a previous government.
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Felix:
05 Dec 2008 11:34:27am
A year on yet still some have to make excuses and continue the blame game......... New leadership a little lacking hey Justin?
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Wendy Greenway:
05 Dec 2008 10:12:14am
Dr Clive Rogers is a very caring person with completely altruistic intentions.
He is not an attention-seeker, but he also is not a shrinking violet when he sees a situation which needs immediate attention.
On behalf of all the elderly people in nursing homes I sincerely hope that the Government pay attention to Dr Rogers findings.Agree (0) Alert moderator
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Robert:
05 Dec 2008 10:15:33am
There is another very serious issue here:
The doctor presented a complaint and supporting evidence to the Commonwealth Dept. of Health and Ageing , and the evidence was 'rejected'. This should now be a matter for the relevant Crime and Misconduct Commission to investigate possible charges of gross misconduct on the part of the public servants who saw, yet ignored, this evidence.
We need to call upon Ms Elliot and Ms Gilliard to hold these public servants accountable for their misconduct in ignoring evidence of mistreatment!Agree (0) Alert moderator
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Fred F:
05 Dec 2008 11:38:08am
Yeh. Seems to me that the issue is much wider than an abusive system not caring for our elderly, but more one of why the good doctor could not apply appropriate feedback.
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Justin:
05 Dec 2008 10:26:45am
The same goes for hospitals and depends if the nurse is empathetic and has time for. The only person that cleaned my mother's teeth was me, otherwise the food is left in them, pathetic.
Accreditation should involve asking the relatives and advocates of the aged what goes on. And coincidentally everything is up to scratch when the 3 yearly inspection arrives.Agree (0) Alert moderator
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pony:
05 Dec 2008 10:46:57am
Assessors do ask relatives of residents and the residents themselves about the care at the facility.
Also, a facility is meant to inform relatives and residents of an accreditation visit to get them the opportunity to talk with the assessors. This should also be checked to see if that has been done during accreditation.Agree (0) Alert moderator
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L:
05 Dec 2008 10:28:48am
Surely a "man of science" such as a debtistry professor knows better than to quote a biased sample of 18 as a statistic.
Having worked in aged care for 8 years, people in nursing homes with pus-spewing abcesses are unfortunately not uncommon. These woulds are more common in pressure areas (hips, heels, back etc) than they are in mouths.
Of the thousands I have seen most occur when a frail person with multiple illnesses deteriorates until they need more care than an aged care facility can offer.
-They get carted off to hospital where they develop pressure sores because of lower nursing standards (because of overcrowding and a stressed system, the staff focus on keeping people alive, not comfortable).
-Their pressure sores get infected with antibiotic resistant bacteria (hospitals are the major habitat for such bugs)
-The medical issue that caused them to be hospitalised is stabilised and they are sent back to the nursing home with suppurating wounds that will never heal.
It's the same with dental health, but not as bad.Agree (0) Alert moderator
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Fang:
05 Dec 2008 10:33:02am
I dont think that anyone who works in the dental sector would be surprised by this story. The elderly in nursing homes are a vulnerable and isolated population and there is little regard for their oral health,as they are often unable to create enough "fuss"to gain attention. The limited resources of the public sector are allocated to those who are more mobile and vocal(able to complain to pollies) and rightly,children. Another group who are probably in the same state are the intellectually/physically handicapped and the group that I have most experience with-remote indigenous children. Residents of the leafy suburbs of our major cities would be horrified at the extent of abuse by neglect in, especially, indigenous children. Our overwhelmed Child Protection agencies take no real action despite mandatory reporting. Unless abuse involves broken bones or actual sexual penetration they are not interested. Maybe our Federal government needs to have a good hard look at the dental health sector and follow up with some action.
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Di:
05 Dec 2008 10:39:54am
My mother is in a very good nursing home, however, if it wasn't for my father being there for her at each meal- feeding her and cleaning her teeth and dentures- I shudder to think how her mouth would be.
Because of the way these institutions are funded there is never really what I would consider an appropriate staff/patient ratio.
Couple this with the "hazards of the occupation" when dealing with aged care at different levels (my mum is high dependency) where there are always things such as natures "little accidents" to clean up etc. on top of all of the routine showering, dressing and feeding etc. The nursing staff are always pushed to the limits. Then of course when "agency nurses" come in on weekends or public holidays this doesn't help either. Generally, they are not involved with the patients long enough to care and so a lot of them don't. It is just good money to them. (some do care)
The bottom line is that more funding and more staff could possibly help improve the situation. At the end of the day it also comes down to individual staff members caring enough to do the right thing by their elderly charges. No doubt there are a good many that do care, but are just run off their feet and can not physically do all that needs to be done.
I see the main issue as lack of staffing levels because of funding.Agree (0) Alert moderator
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sucker:
05 Dec 2008 10:42:38am
If they'd done the study in Qld, where we haven't had fluoride in our water supply, there wouldn't be many old folk with cavities because by that age they'd all have dentures.
But I bet that very few nursing staff in Qld help the poor old people clean their dentures either. New generation nurses (the university-spawned ones) have great management skills and know where they are coming from but are far too arrogant to stoop to menial tasks.Agree (0) Alert moderator
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grumpy grannie:
05 Dec 2008 10:47:46am
When facilities like nursing homes ( and childcare centres too but don't get me started on that !) became investments for big business like insurance companies, retailers etc instead of being run by people who had some interest and expertise in the actual field - and wash my mouth out for mentioning compassion - then the almighty dollar dictated stingy staff hours, minimal qualifications poor care, less interest and cruel games: "what no fresh fruit to eat? - I'm sure it was on the table when the visitors were here" etc etc
Anyone who has ever been inside a nursing home in any capacity can tell a swag of similar stories.
Let's start telling all of these stories out loud instead of sharing shocked whispers.
Good on you Dr Rogers.Agree (0) Alert moderator
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BlzBob:
05 Dec 2008 11:27:26am
Has anyone not considered the fact that many nursing homes are understaffed and carers are overwhelmed by the number of client that they must tend too.
Too many people out bush earning the big bucks for mining companies to have time to look after their own parents, I think.Agree (0) Alert moderator
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BlzBob:
05 Dec 2008 11:34:55am
I might suggest that it is not so much the fault of nursing homes but the fault of the previous government for not ensuring that dental work was kept affordable for people on low income and pensioners.
11 years of dental neglect.Agree (0) Alert moderator
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Felix:
05 Dec 2008 12:04:58pm
Gee Bob, any one else you want to blame? Funny you failed to mention the corrupt and inefficient state labor governments over the years?
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Felix:
05 Dec 2008 11:37:12am
Dump the kids in childcare before they can walk/talk and dump our elderly in homes when they get too hard to handle. So easy to pass responsibilty for their care onto others, all for a fee. Progressive society?
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Roberto:
05 Dec 2008 11:37:33am
Where is Nicola Roxon in all this?
Could somebody please wake up the Minister for Health? She seems to have fallen asleep...Agree (0) Alert moderator
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Di:
05 Dec 2008 11:42:11am
Blzbob-
Not a particularly nice or necessary thing to say at the end of your comment.
Parents go into nursing homes mostly as a last resort. Once their care becomes unpractical to the untrained or once they become a potential danger to themselves not to mention many other reasons- then they go into care. Then the former partner/carer suffers a lot of guilt even though they know it is for the best.Agree (0) Alert moderator
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Audilili:
05 Dec 2008 12:07:40pm
As a registered nurse working in aged care I am moved to respond to these unfair comments. Many nursing home residents suffer dementia and will not permit carers to insert a toothbrush into their mouth . They clamp their jaws shut or bite the brush.They are unable to rinse.They become distressed if we persist as they do not comprehend the purpose of our efforts.
Short of giving them an anesthetic or strong sedative we are unable to examine their teeth properly. We monitor them carefully, and any evidence of pain , refusal to eat or other signs of infection are referred to the doctor then if necessary to a visiting dentist.Agree (0) Alert moderator
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C G Kyle:
05 Dec 2008 12:11:58pm
It is not only the elderly in the nursing homes but the over 40's dental hygiene must be a major problem causing supplemental medical challenges. Extortionate dental costs prohibits all but the super wealthy the benefits of modern day dentistry. Those of us that can ill afford this suffer the pain, embarrassment and subsequent; dietry, and cancer health issues this lack of care and concern is causing.
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nancy:
05 Dec 2008 12:15:33pm
thoroughly agree it is a disgrace.
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