Dear Minister,

I see that you have created yet another committee. I note that it is called the 'Advisory Panel on Positive Ageing' and it comprises 'a range of eminent Australians with strong expertise in issues facing seniors'.

Could you also create one on 'Negative Ageing'? Because that is what a lot of people in this country are experiencing - especially those who must spend their final years in our residential care facilities where undervalued and hard-pressed staff struggle to respond to the needs of the residents for whom they care?

You see, your government like those before you, has not had the courage to mandate safe staffing levels in aged-care homes.

Many of us therefore think that you must be more concerned about the providers' powerful lobby groups than the vulnerable, frail citizens for whom you are responsible.

I know your Government is fond of 'Panels of Eminent Persons' when there are difficult problems to be solved.

It recently asked one such Panel to solve the hard question of where to process the asylum seekers who reach our shores seeking our protection from corrupt and violent regimes.  So perhaps it is not too much to ask for a similar Panel of Famous People to work out how to ensure that all older Australians in residential care receive nourishing meals - rather than a diet of processed food.  They might even realise that this could well be their fate in future years.

Such a Panel might be influential enough to remove all the obfuscation around aged care and ensure that there is openness and transparency within the sector so that people can choose a home on the basis of fulsome information about the ownership of the home and with full knowledge of the care that will be provided.

Minister, I note that you have the admirable aim of wishing to 'ensure that the ageing of the population is seen as an asset'. You want to 'harness the economic and social opportunities presented by an older population'.

While I agree that it is very wrong to portray the ageing demographic as a population of tiresome old people who are a burden on the tax payer there are some things about old age that cannot be wished away - such things as the loss of energy and vigour and various conditions which often occur towards the end of life.

You see, the thing is that older people, like any other group, do not want to be defined by either their good health or their disability. And the notion that the key values which define old age are, or should be, fitness and success, is just as ageist as those images of useless, decaying old people that you seek to counteract.

Minister, I wish your 'Advisory Panel on Positive Ageing' every success. But first, could you please put the 'care' back into aged care. You could start by bringing in, and enforcing, decent resident/staff ratios. That should not be too difficult. It would only take a little courage – not even a Panel of Experts!

Imagine Alice - single woman, no children, getting older, some health issues. Alice decides to take steps to provide for her own care. She has been an independently-minded person all her life and does not wish to be a burden to her extended family.

With some help and following an ACAT assessment, she chooses a low-care home. The facility she finally decides on has great promotional material showing many happy faces. The building is pleasant and one of the features promised by the home is AGEING-IN-PLACE.

This seems like a good idea. Alice doesn’t want another difficult move at her stage of life...

Five years after the event, Victorian State Coroner, Judge Helen Coate, has released the findings of the inquest into the deaths of four residents of the aged-care home, Broughton Hall.

Most of us can remember very well the Broughton Hall gastro outbreak. Not only did four residents die but many other residents became very ill. The outbreak occurred on the weekend. The written guidelines for managing infections were locked in a cupboard and no-one notified health authorities for several days.

There are three groups of people whom are regularly incarcerated in this world. We lock up people convicted of criminal acts; people who have mental health issues and are assessed as being a threat to themselves or to others and old people who live with dementia – for their own safety. In the first two instances, there are protective processes and procedures in place. Individuals can take their case all the way to the Supreme Court. Perhaps it might be said that old people too, under the principles of Habeas Corpus, also have the right to have their case heard before a judge.

Last week the federal government finally got around to announcing its long-promised, aged-care reform agenda. Yet the stunning thing about the announcement was not the package itself but the tenor of the resulting talk-back and commentary.

Radio presenters took call after call from individuals expressing great fear and dread of nursing homes. Stories of distressing neglect were recounted. The public clearly has little confidence in the current system of residential care. It is therefore hard to understand why such negative public comment is not seen as a major disaster in public policy?

Here we have a major policy announcement by the government of the day - outlining structural and funding changes in aged care which will affect almost all of us. And yet, the very heart of the issue, the bit that worries everyone, has been largely ignored.

Certainly, structural and funding issues are critical. And no one is going to argue with having more community care available. More support for those experiencing dementia is long overdue. A single gateway into aged care should greatly assist families when it is time for a loved one to move into residential care and, just maybe, a 'My Aged Care' website will provide some much-needed transparency within the sector.

However, it is patently clear that Minister Butler has not been able to withstand the forces of the powerful provider lobby group which insists on 'flexibility' in staffing. Generally 'flexibility' in aged care and nursing is code for the minimum possible staff on duty to care for large numbers of ill or frail people. That is why nurses in the acute sector take such a firm stand against state governments which regularly attempt to reduce staffing levels.

One can only wonder why mandated staff/client ratios is considered a requirement for those who run child-care centres, hospitals, schools and other places which care for vulnerable people but is an unaffordable luxury for frail, older people.

Yes, there is a section in the new aged-care package that relates to the prevailing problems within the aged-care workforce.

Here is how it starts.....

'An appropriately skilled and well qualified workforce is fundamental to the delivery of quality aged care across both the residential and home care sectors.'

And this is the problem. These words are almost the same as those in the Aged Care Act 1997 which determines the current system of care.

They are the words that have allowed dangerously low levels of staffing to prevail in many homes. They are the words that have seen homes operate without a registered nurse on site.

'Appropriate' staffing can clearly mean different things to different people.

To some providers it means leaving one carer on duty at night to look after fifty residents or more. To residents and their families it means having enough staff on the floor so that care needs are managed in a timely manner.

The test of the package that has just been announced is whether aged-care homes of the future will generally be providing better care than they are now.

And, quite frankly, it is hard to see anything that was announced last week which will make that happen.

People are usually stunned to learn that there are no set staff/resident ratios in aged-care homes.  They simply assume that frail people in care will be treated like other vulnerable individuals – for example like those in hospital or very young children in kindergarten and day-care who receive the protection of mandated levels of staffing.

Then tell them that some homes have only one or two staff members on duty at night to care for - perhaps 100 residents - and the shock is magnified many times over.

Let us put ourselves in the position of an 'average' nursing home resident. You are largely confined to a chair and/or a bed.

The only way you can voice your needs is to press your buzzer (if you can reach it and it works) or to tell (if you can speak) those who come to your room to assist in toileting, bathing or dressing.

In some cases, these mostly well-meaning staff members have limited ability to understand or converse with you because English is not their, or perhaps your, first language.

In almost all cases they are under enormous pressure to finish with you as quickly as possible and move on to the next resident.

Who then can speak on your behalf with any authenticity? Very few people really. Being old and frail is a place where most of us have never been and many of us prefer not to think about.

Yet there are many who think that they can. But how well they do is another matter. Just look at the comment from Richard Gray, of Catholic Health Australia, and author of the insensitive email about kerosene baths:

Imagine waking from deep sleep to see a strange, expressionless face staring right down at you. Then imagine that this happens many times a week and that you are aged 96 with limited mobility.

This is life for a friend of mine who lives in a high-care residential facility. It also happened to my mother in similar circumstances – and to many others.

The faces of grieving family members at the memorial service for the residents of the Quakers Hill Nursing Home speak a thousand words. How to even imagine what it might be like to be frail, bedbound and to be caught up in a maelstrom of fire! 

At the time of writing nine residents have died, more are still in critical care and many more have suffered the trauma of relocation.  Quakers Hill was home to 88 residents at the time of the fire.

The police are still conducting investigations, a Quakers Hill staff member has been arrested and charged and Premier O'Farrell has called for a review of the state’s aged-care system.   Presumably there will be a coronial inquiry into these deaths – as occurred with the deaths of people at the Victorian Kew Cottages in 1996 and the Childers Backpacker Hostel in 2000.  We all hope that these investigations will be far-reaching and will provide both answers and solutions.

How is it possible that a man who has been unable to move any part of his body and is unable to speak is labelled as verbally abusing and physically threatening? Yet this is how he was described in an Aged Care Funding Instrument (ACFI) document.  

His daughter, shocked when discovering this assessment, states, 'He cannot do anything for himself, he can’t even call out for help, he pretty much just sits there'.

A further resident who suffers multiple sclerosis, and who can only move one hand, was described as being 'physically abusive'.

A Victorian coroner has said that the recent nursing home toilet death should not be allowed to happen again.  "If it’s happening here, it might have happened elsewhere, it might be happening elsewhere," Coroner Olle said. 

Of course it is. That is because many staff in aged-care homes regularly take short cuts in order to get the job done. And they will continue to do so until something is done about the appalling staff/resident ratios in many of our aged-care homes.

This Column drew attention to the appalling lack of dental care given to older people right back in 2008. 

The article was written after ABC’s Lateline Program interviewed dentistry lecturer, Dr Clive Rogers, who stated, ‘that the neglect of dental care in nursing homes amounts to abuse’. He showed graphic photographs of ravaged mouths and teeth.

Politicians generally profess much empathy for frail older Australians. They like to visit aged-care homes – usually when making some funding announcement. They front up to homes at election time and seek photo opportunities with happy, smiling, older people.
We hear the rhetoric over and over again - that Australia has the best aged-care system in the world - no matter which side of politics is in government. And yet one always has the feeling that, in spite of the various statements of support, often there is little real understanding of what it might be like to be very old, frail and needing assistance to achieve the most basic of tasks.

The Productivity Commission believes that exposing aged care to further competition and freeing up the market even more - by removing regulatory restrictions on the number of bed licences - will solve many of the problems besetting the sector.

This is the basis of the Draft Report, 'Caring for Older Australians', which was released for public comment last week...

Mark Butler, the new Minister for Mental Health and Ageing, recently commented in the West Australian, ‘ that Australia has one of the best aged care systems in the world’.

Well, he would say that, wouldn’t he? Because that’s what they all say... the various Ministers who have been given the responsibility for the care of Australia’s frail and vulnerable! At least Minister Butler had the grace to qualify his statement with .....‘but the Government was aware it needed reform’.

The Productivity Commission’s Inquiry, Caring for Older Australians is underway. 

The Commissioners are expected to report on their findings by April 2011 with an interim report by December this year. Submissions to the Inquiry were due at the end of July and are still being received now. You can read the submissions here.

Some of us were extremely cynical when the Labor Government announced it was dispatching the fraught issue of aged care off for another review. Surely there have been enough reviews, inquiries, committees etc exposing the many cracks in Australia’s ageing aged-care system in recent times. 

Aged care is one of the few areas where consumer action has been slow in coming. Research has shown us that hospitals are safer and better when the consumer voice is heard. That is why they employ patient advocates and support community advisory committees.

Those who have actually experienced a particular health service often have a fresh perspective to offer. They see things through a different glass.

A new funding arrangement for hospitals looks like happening. Included in the deal are new initiatives affecting the delivery of aged care across the country. The Commonwealth is to be responsible for all aged-care programs and more aged-care beds are to be provided.

One of the announcements that has not received much publicity is that $96 million dollars, over four years, is to be provided to improve access to GP and primary health services in aged care.

The CEO of the peak industry body, Aged and Community Care Victoria, Gerard Mansour, must live on a different planet from most of us.

Just this last week he stated that mandated staff/resident ratios were 'outdated and inappropriate'. He claims that this is because 'staff skills were matched to residents' needs which can vary substantially from one location to the next'.

Tell that to the overstretched and undervalued carers and nurses who feel that they can never get the job done or to the residents who must wait for long periods to receive the care they urgently need.

There are mandated staffing levels in child care centres, kindergartens, schools and hospitals. They, too, cater for people with different levels of  need in different locations.

Why should vulnerable frail, older people miss out on this protection?

The much publicised My School web site goes online today. 

Deputy Prime Minister, Julia Gillard, states that, for the first time, parents across Australia will be able to get accurate information about how their child’s school is performing. The results of each school’s performance in the National Assessment Program tests are published online for all to see. Colour coding shows at a glance whether the school is performing above or below similar schools and how it compares to the national average...

How do they get away with it? Year after year we hear politicians and aged-care bureaucrats waffling on about "appropriate levels of care" – words that mean nothing at all and allow shonky aged-care providers to staff their homes with dangerously low levels of nurses and carers...

A friend of mine, aged 96, died this week. Death is always sad but my friend remained living in her own home until the very day she died and so her friends and family are able to take great comfort in that.  I have heard it said that there are more deaths in nursing homes at Christmas than at other times of the year. It would be interesting to know if this is, in fact, true.

Tuning in to local ABC radio the other night I heard some aged-care guru telling the world how ageing baby boomers would expect chai soy lattes along with their residential aged care. Sure! Along with their blackberries, lap tops and iPhones! At times, you wonder whether some of these experts on aged care have set foot in the door of an aged-care home lately.

Forget the latte and worry about whether you can get someone to help you get to the toilet in time.

The National Health and Hospital Reform Report purports to provide the basis for a series of promised reforms to Australia's system of health care.

It is 'the culmination of 16 months of discussion, debate, consultation, research and deliberation by a team dedicated to the cause of strengthening and improving our health system for this and future generations of Australians'...

Sometimes you see, or read, something that makes your brain just snap. This did it for me today. It is a son's account of the lack of services provided for his mother who is in now in residential care.

'My mother left hospital unable to walk independently. She was placed in transitional care with the promise of intensive physiotherapy.'
Of course, his mother never walked again.

The management at the nursing home I visit has decided that having a registered nurse on duty is a luxury it can no longer afford. 

They now think it is enough to have an RN on call. This one person, who does not need to be on the premises, is responsible for the health and well-being of 30 high care residents and approximately 150 low-care residents.

The much-awaited report from the National Health and Hospitals Reform Commission has just been released.   The Prime Minister and the Minister for Health and Ageing are now engaged in a 6 months consultation process with various health bodies and stakeholders.

There are 123 recommendations.  Some of them pertain to how we care for people at the end of life. One that has received much publicity relates to the possible introduction of bonds for high care – 'that consideration be given to permitting accommodation bonds or alternative approaches as options for payment for accommodation for people entering high care'. This did, of course, immediately send everyone to their entrenched positions. Providers see bonds as the answer to all their problems. Others are worried about people having to sell their homes at a time of crisis and great trauma...

The most disturbing aspect of the recent Four Corners Program featuring four families dissatisfied with aged care was that the complainants’ voices were not heard – by anyone! They were not heard at the home providing care and the Commonwealth complaints investigators did not listen...

The Australian Medical Association (AMA) has called for more nurses to be employed in aged care homes.  They say that this needs to be done to prevent dangerously sub-standard medical care from occurring.

Of course, many of us have known this for years. We have seen our family members sent back and forth in ambulances to emergency departments for minor complaints because there have been no trained health professionals on the premises.

We have sat with our mothers and fathers as they have waited for stressed and harried staff members to attend to them. We have seen the reliance of homes on agency staff who don’t know, or understand, our family member’s care needs and we have noted the increasing dependence on immigrant carers who are unable to communicate adequately with the residents in their care...