Auditor-general Lyn Provost has blasted the Ministry of Health for its monitoring of the country's 715 rest homes.
About 34,000 people live in rest homes nationwide and they are "some of the most vulnerable in our society", Ms Provost said in an audit of the industry released today.
Since the ministry had become responsible for auditing and certifying rest homes in 2002, there had not been "adequate assurance" the homes had met criteria set out in the Disability Services Standards, Ms Provost said.
The report comes in the wake of a number of complaints, including one about Palmerston North rest home Rose A Lea, which was shut down after an inspection team found a 103-year-old woman tied to her bed with a sheet.
Ms Provost said the ministry used eight designated auditing agencies (DAA) to carry out audits of the homes.
"The ministry has known since 2004 that auditing by DAAs is inconsistent and sometimes of a poor quality. Notwithstanding its recent efforts, and evidence that DAAs are improving some aspects of their work, the ministry did not respond to these problems quickly enough or with enough effect," she said.
"There are examples from 2008 and 2009 where DAAs have failed to find or report instances where rest homes have not met the criteria in the (disability) standards.
"Serious failures in the care of residents have been identified later by other regulatory bodies. The frequency of these events may have been low, but they are significant because the failings are serious."
The ministry's quality assurance of DAAs largely consisted of an evaluation of their audit reports - many of which were not properly completed, Ms Provost said.
"Except in times of crisis, the ministry has given little feedback to DAAs on their performance, and it has never removed a DAA's designation despite evidence of sustained poor performance."
Ms Provost also criticised district health boards which were required to monitor the delivery and performance of services by rest homes for which they held age-related care contracts.
"Although the age-related care contract is the same throughout the country, individual DHBs interpret and monitor the contract differently. I encourage DHBs to achieve consistency in this matter," she said.
Monitoring of rest homes by DHBs had not been well co-ordinated with the work of the ministry. Occasionally, DHB auditors and DAA auditors had audited a rest home within days of each other, or on the same day with the results often being quite different.
Ms Provost said she was "encouraged" by the work the ministry had done with DAAs and DHBs this year.
"However, it is too early to judge whether the changes being made will make the auditing, certification, and monitoring of rest homes more effective and efficient."
Health Minister Tony Ryall said the Government accepted Ms Provost's findings.
"The report will be helpful in our work to address long standing poor performance in rest home auditing.
"We have introduced spot audits of rest homes, started publishing audit results on line, and we are further improving the way rest homes are audited," he said.
Legislation was being drafted, which would require rest home audit agencies to be audited themselves and accredited by an international organisation, he said.
Labour's spokeswoman for aged care, Luamanuvao Winnie Laban said Ms Provost's report was a "wake-up call for those who deny there are problems in the aged care sector".
