Countless Australians visit older relatives in nursing homes — but how many of us still hesitate before we walk through the door, ready to recoil?
The pungent smell of humanity, the antecedents of death — so often associated with nursing homes — offer a grim truth: facilities built for the gradual decline into old age cannot be retrofitted to manage the clinical care needs of an older population with increasingly compressed morbidity.
Aged care, nursing homes and residential care are all synonymous in the eyes of the community, the sector and the government. This could be because residential care receives 60% of all aged care funding. It could also be because it presents the highest operational (and reputational) risk.
Without change, residential aged care will morph into a substandard backstop for the nation’s acute care system. And either we, or the people we care for, will have a system no longer fit for purpose.
The level of complex and clinical care needs for nursing home residents will continue to rise, driven by the ever-tightening entry criteria for aged care and the desire of people to stay in their homes longer. Over the next decade, residential facilities will be compelled to move closer towards pseudo-hospital settings as demand increases. Proper ventilation will be the least of the federal government’s worries.
We’ve had the horror of our grandparents’ fate reflected back at us, publicly, indisputably. And yet there is nothing to demonstrate their fate will not be ours.
If we are going to demand better, then integrating residential care with hospital services and elevating clinical governance, safety standards and infection control are desperately needed.
Better aligning residential care with hospital systems, and home care with primary health, could save $21.2 billion over four years, according to the Australian Medical Association, which estimates these savings would only increase from 2025 as the population ages.
One of the first policy positions NSW Premier Dominic Perrottet eagerly pursued was his desire for the federal government to cede its responsibility for early childhood education to state governments to make the early education system more accessible and affordable. If Perrottet is willing to take such radical steps for the nation’s youngest citizens, is he willing to do the same for the oldest?
In the necessity-based environment of modern politics, the temptation has been to look for a quick solution to specific problems. In this environment, “health reforms” have been more likely to involve marginal change because of the pressure for an expeditious resolution.
Bounded by the traditions of our Westminster system of government, healthcare policies often give little consideration to how best to facilitate local resource-pooling, improve service coordination and navigation, and simplify local decision-making — which leads to an inefficient allocation of resources.
Policies narrowly constructed within one part of a portfolio — such as aged care — cannot meet the needs of every older person and nor should they be expected to. It would be cost-prohibitive. But when Australians can’t get the care they need, when and where they need it, in their local community, the elderly in particular end up in emergency departments, placing even more pressure on a stressed hospital system.
As national cabinet commences a year-long discussion on how to address problems plaguing the health system, the question remains: are our nation’s leaders bold enough to construct a square deal for better public health?
When Health and Aged Care Minister Mark Butler said, “We can’t just add more money to existing systems … It’s about getting the settings right; it’s about getting the policy right,” last Friday, that must include addressing the fragmentation within his portfolio.
Aged care programs initiated without deep consideration as to how they fit into the existing pattern of health and disability care (at a minimum) will continue to adversely affect the quality, cost and outcomes across all care service systems.
To counter the impact of our ageing population on the health system, we will need to elevate comprehensive primary healthcare (endorsed by the World Health Organization) as an equal partner to the dominant biomedical model, so that all citizens and healthcare organisations can be engaged in a collective and collaborative effort to improve population health outcomes.
Much has been said and much has been promised in healthcare reform, and while transformation takes time (and additional effort), only time will tell whether national cabinet is willing to properly ventilate the current intergovernmental dichotomy on healthcare, or whether we will just be expected to breathe in more hot air.
Given our rapidly ageing population, more time is not something we all have.
I am 80 and my partner is a couple of months off 90. We live in a small country town, population less than 300. While there is a nursing home no more than fifty kilometres away, we fear the inevitable move; indeed it terrifies us! We would love to be carted out of our comfortable and cosy home in boxes. It won’t happen, of course; modern health care will keep us alive long past our use-by date, regardless of our super-healthy diet (no factory-processed food at all), the slayers of mind and body are lurking around every corner. Stroke, heart attack, dementia, breaks to major supporting bones and straight-out bacterial or viral disease. One of them will get us. or we will have a road accident on the way to shop or to see a health professional. It is a dilemma, a constantly recurring worry that we try our best to ignore. But it is not going to go away. Perhaps the ancient Greek solution may be the best, “Those whom the gods wish to destroy, they first make mad!”
Well I think some respite now would be worth considering, OK you’ll meet people in that nursing home that aren’t traveling that well but there will be others that are like minded who could easily become good company. There is a certain inevitability about this and you 2 clearly have a lot to offer if well enough when the time comes. Respite is available free 35 days a year in Vic I’m not sure if its federal. There’s some good stories in aged care and they come from the residents.. Giving up driving is a huge hump for anyone I reckon you could wax lyrical on, may you drive till you drop. regards
Banging away like a drum on this as ever, but the first key to recalibrating Aged Care for a sustainable future is not simply to avoid compartmentalisation within the policy and political-executive professional sectors, but to wrench it away from them. To reverse the professionalisation of looking after our oldies; to re-instate it as a collective tribal obligation. And I don’t mean a tax-and-outsource one. I mean…a hands-on, pitch in and pull your weight in looking after our aging tribal members.
The only solution that is going to get close to working is a year’s mandatory ‘National Service’ in the care sectors, for every citizen bewteen the ages of 18 and 55, say. You can do aged care, child care, disability care, palliative care. Those who want to do some entry level training, can: a Cert 3 or even 4, say, or a community Bus driver’s license, a basic cooking degree. Those willing to do hands-on ADL and even clinical assistant care, can. Thoise who find poo, wee, pus and pain a bit icky? Relax, there’s heps you can do, with marginal gtraining, to take the pressure of the RN’s, Allied Health pros and Carers. You pay everyone a basic living wage for that year. Pitch in a range of sweeteners – free public transport, said-training/education opps, subsidised housing, even. Exemptions only rarely granted; being in a wheelchair wouldn’t automatically give you a pass. Nor being a billionaire, or a politician, or trans man.
Even a ventilated quad can read a book to an oldie once a week. Everyone can – should, must – start pitching in again on caring for those in our tribe who need it.
You would likely need to nationalise aged care again to sidestep the usual gouging of public assets/resources for profit by the private sector. It’s a loss-leader sector that is soon going to bankrupt its future capacity for easy profits soon enough anyway, so we may find us lumped as taxpayers with the ‘oldies problem’ again, whether we like it or not. Quite beyond the sheer practical and material impact of an ‘all hands on deck’ approach, the flow-on civic benefitsare hard to overstate. Not least wouldbe the egalitarian and collective-obligation rejuvenation. For young men in particular, a formative year spent using their boundless strength and stamina to help frail oldies…would be life-changing, down many generations.
It’s utterly counter-productive to keep throwing money and ‘the next new clever idea’ at what is actually a very simple, deeply human problem, with an achingly obvious solution. We all get old (unless we die young). Most of us need some help when we do. Some of us have kids who provide the bulk of it. For those who don’t, the village – all of us – need to step up and share the burden. So that when our turn comes…and so on. It’s not hard. It just demands a re-embrace of what all know we truly value, deep down, as humans. Which is…caring for other people.
I have done my share. I don’t want the government meddling and messing with my families’ obligations and solutions. I do want a system that doesn’t pay the profit to international companies.
Some good thoughts here, but I see the main problem is the more complex needs of Aged
care residents as described in the article. I know from first-hand experience that carers are not being educated properly. It seems that on-line learning has replaced actual practical experience. So how does learning on-line teach you how to lift a person with a fractured pelvis, to give a very simple example. I worked in aged care for a good many years and know that the older and more experienced carers are mostly dedicated, overworked, underpaid and undervalued. So now carers do crash courses mainly on line and are not able to do the job properly, through no fault of .their own. And where are the regulators and what are they doing?
If we had a surfeit of manpower in situ then repetitive, supervised hands-on training would be viable again. You’re right that this is the only way to learn the variety of clinical assistance and ADL techniques that make care effective. But it’s really a matter of numbers and time/ratios more than education and training. Everyone in the sector has a vested interest in over-complicating the ‘complexity’ of aged care, because credentialism is a key part of territorial advocacy (and often financial interest).
I’ve done care work for over a decade in a wide variety of contexts and with varying degrees of clinical complexity. I’ve got a few basic quals and had a few months of formal OTJ supervised training, But overwhelmingly I’ve figured it out myself or/and learned working with experienced caters, nurses, allied health staff and doctors, I’ve known very, very few people in 58 years who would not be perfectly useful and capable carers if matched to any one of dozen different suitable roles/circumstances.
The resort to arguments about the ‘complexity’ often come from those who…just don’t want to have to pitch in. Not everyone needs to administer complicated dementia medications, supervise therapeutic activities or mobilise broken limbs and joints. Nor even wipe bums, help shower and feed, or other ‘icky’ stuff. There always heaps to be fine that can free up trained/clinical staff, and just generally make dependant old age infinitely more joyful, productive and beautiful – for all generations.
Why is aged care too often so horrible? Because not enough of us are prepared to do our bit to make it not horrible. These endless debates about systemic change are mostly about outsourcing our collective guilt. That’s the blunt truth, IMO. Never makes me too popular with those outside the sector, but that’s what I think. I don’t do care work because I’m noble and wonderful and have a ‘vocation’ for it (though I’m a conscientious and loving carer). I do it for the same reason mums in the home do most of the housework, still.
Someone has to. Is all. It’d be brilliant if more of our tribal family did their share, too. Warmest regards Mary.
As for the regulators….ha. It’s all tick and flick phone self-audits now. Pure bum-plating. The sector is crippled by pass-the-parcel accountability moral hazard.
At the beginning of a shift everyone needs to know what challenges are critical for individuals in that area , anyone who doesn’t know or doesn’t understand would be helping in other ways . Ratios of having company you like and choice are greatly improved with help.
The problem with poorly trained carers is more about how agencies are the preferred method of holding permanent employees to task. Understaffing is about poor wages but no large facilities have broken ranks so unless it’s industry corruption it is cheaper to pay agency workers who earn more and have free accommodation. Which is just legislated and legal corruption and therefore a business opportunity, a cost saving measure.
There is a fair bit of wishing hat in the elderly they have great instinctive insight into people often, a great help for people requiring steady company they know a lot about people ,themselves and living in general.
I’m in my 70’s female. Recall about 40 years ago at a Xmas gathering with friends, that one revered guest was elderly semi blind lady. I had met her once or twice before her sight deteriorated.
At the lunch, she wanted to go to the toilet. Someone took her in and assisted with getting her on toilet seat. Then came out and said she could not do anything else. No one wanted to “wipe her bum”. I went to toilet and did the job. One simply had to look at what needed to be done at that moment.
I could never understand if this person was loved by the others why were they so finicky about the assistance?
Couple days ago some report on suicides increasing in the over 65 age group and mainly males. Don’t know details but poverty and loneliness may have some part in those events.
I’m praying to go in my sleep.
It doesn’t have to be National service Jack although I like the idea. There are other ways of disentangling people and creating incentives that benefits the community in a wholesome way.
Employer tax incentives, pension allowance , substitute and alternative for actively looking for work and showing the jobs you applied for., and yes a UBS for the effort. A good take and some really good ideas floated good stuff.
Yes, likewise Stuart. The Nasho idea is probably an anachronistic pie-in-the-sky notion. But your lateral, creative incentive approach seems a no-brainer. You’re spot on too earlier, about the problems arising from Agency middlemen having become the default ‘SEP’ solution. (Someone else’s problem). I think people outside the industry don’t realise quite how lucrative Aged Care (and post-NDIS, disability too) can now be. I would even say ‘profit-driven to an often-corrupt, unsustainable and regressive extent’.
Resistance to closing the giant taxpayer-underwritten care sector ATM doesn’t just come from the big fish, either. Plenty of small biz. and even savvier single care/provider agent ‘sole traders’ are minting it, too. At the moment care workers are hard to get due to Covid’s lingering international worker shortage impact, so individual carers can get done trickle down. It won’t last once the government fast tracks the return of battalions of easily-exploited, dirt-cheap Philippino, Indonesian and Sri Lankan workers.
I would add African, Nepalese, and Indian/often Sikh lately which has been interesting meeting them, carers are generally nice people.
A voluntary national service that supports refugees in purpose built Life pod housing that minimises waste and maximises comfort in a community that can be nomadic would be a wonderful caring/learning environment that is exportable knowledge.
But thats another story so I’ll wait for the appropriate article, regards.
Oh Jack! What a huge difference your ideas would make to unpaid carers! Home care is indisputably the neglected side of aged care because there isn’t as much money to be made in it. Look at respite: no such thing as overnight respite care INSIDE the home. Oh no! It has to be in a facility! Even though carers and the elderly have been begging for in home respite for something like 40 years. Everything’s geared to ultimately wearing down carers so your loved one ends up in a bloody profit making facility. It’s like a funnel. Or a mincer.
Yes, see the above: the vice-like grip the profiteers have on the sector. (They would oppose my Carer Nasho idea as bitterly and viciously as the ANA tried to kill Medicare.). It’s also interesting to note how much resistance to volunteer involvement at their places the for-profit sector is. There are some mildly legitimate liability and regulatory grounds but the real reason for this quarantining of any ‘society obligations’ input is, of course, to ring-fence them privatised, taxpayer-underwritten monetisation of what should be a directly-funded, nationalised BFP sector.
Home care is indeed one hugely neglected area where we can all pitch in easily. I always tell people who are keen to ‘get involved’ in doing their bit in tribal care to a) do whatever they can to help keep their parents at home for as long as possible, and b) yep, find someone in a care sitch they know who can desperately use all the respite time they can get, and get hands on. Not just a few hours here and there (though that, too). But get to know the care needs well enough to give them a day, an overnight, even a few days break at a time, untroubled and decompressing, knowing that even though they’re away from their loved one, they’re in safe and caring hands.
PS. People don’t now what they’re missing out on, btw. Even just writing those last few sentences made me tear up. The flow-on collective benefits for us all of getting just a ‘little bit’ more involved in care work would be vast.
This article seems to say that aged care should be better integrated with other care. If it says anything more, I’ve missed it.
I don’t think you missed anything, it’s just that stopping bad practice and making a better community is so much more interesting and it could be extrapolated that this article is discussing the beginning of the process….possibly.
Online courses are a scam. You get pressured to do them all in no time flat so you scan them and pass the test then onto the next one. You dont learn anything but the powers that be get what they want which is to transfer responsibility for any stuff ups to you. A bit more clasroom or OTJ training would produce better resukts.
Residential Aged care has to feel like a village, it has to showcase what the elderly offer to the rest of us and it has to work at making ageing and death feel approachable.
The Aged care for 4 year olds program showed what is possible, particularly how people identify with each other without preconceptions, it is a higher conscious state in that way.
We require a dramatic change in the accessibility of funding so that it is affordable for people to visit, employer incentives , the equivalent of looking for work for a job seeker to satisfy search requirements, age pension incentives.
It will still be possible for the private sector to operate in a better environment but profits will be modest competing with well run public entities.