Ageism (also spelled "agism") is stereotyping and discriminating against individuals or groups on the basis of their age. This may be casual or systematic. The term was coined in 1969 by Robert Neil Butler to describe discrimination against seniors, and patterned on sexism and racism. Butler defined "ageism" as a combination of three connected elements. Among them were prejudicial attitudes towards older people, old age, and the aging process; discriminatory practices against older people; and institutional practices and policies that perpetuate stereotypes about elderly people.
The following article was written after Aged Care Crisis learned about the death of evicted patient Elizabeth Rogers. A version of the article was revised for publishing for the Sydney Morning Herald's Comment section as Aged-care response a true test of society's caring on the 24 August 2015.
Have we lost our way to care?
Eight years ago, I wrote an article titled Vulnerable elderly deserve better care, which explored the problem of pressure-cooker tactics used by hospitals to evict elderly and frail patients from care - sometimes with dire consequences. That's why I started Aged Care Crisis to try and help other family members through a difficult system.
Elderly and frail patients as well as their loved ones can sometimes be unwilling participants of an insensitive aged-care system. There are examples of excellence, but it can seem that sadly there is not enough. Levels of care delivery in hospitals and aged-care homes vary greatly, but there is usually no way of knowing this until things go wrong.
I was recently reminded of our family’s experience when learning about another frail patient admitted to the Prince of Wales (POW) hospital. Elizabeth Rogers, an 89-year-old patient, spent three days in the POWH after suffering a fall at her low care home. She was forced out of the POW hospital with an eviction notice under the “Inclosed Lands Act” - despite protestations from her (low care) home that she needed acute care. Humiliatingly, the notice was read out aloud to the 89-year-old blind patient in a crowded ward.
After returning to the aged care home, her conditioned worsened and within 48 hours staff tried to transfer her back to the Prince of Wales Hospital who refused to readmit her. Thankfully, she was accepted by another hospital.
Once media descended upon the story, the hospital apologised to family members with the reassurance that the eviction notice was not "acceptable practice" and that an investigation was under way. Outrage and condemnation on social media was swift.
One poster on Twitter commented:
'Who signed it? They should be publicly shamed. After that no one will be game to put their name to "get out" notices'
The sad reality is that this scenario is played out regularly and those of us familiar with aged care already knew that this was no 'isolated incident'. Elizabeth's situation brought back vivid memories of our family’s experience eight years ago. But this was much worse - and brutal, in my view.
Unfortunately for 89-year-old Elizabeth, her condition was so frail, she died just nine days later - in another hospital. Surviving family members must now live with the legacy of her last days being marred by hospital eviction, yo-yoed between various destinations, in a system where ageism is pervasive.
It is difficult to have confidence that an apology or investigation would have taken place without involvement of the media. Our ageism is reflected in a culture among administrators responsible for organising care.
Because some of us are both old and sick, then somehow, we become lesser beings, de-personalised and demoted to 'objects' or 'problems to be managed'. This can be reflected in the language used in some facilities where the aged are referred to as - 'bed blockers' (in hospitals), or by using demeaning medical slang terms such as GOMERs (get out of my emergency room). Imagine if we applied the same terminology to babies or young adults presenting themselves to hospitals or emergency?
Instead of supporting those at the end of their lives and their family members, we seem to have lost our way and our ability to empathise. Elizabeth's family acknowledged that she "deteriorated rapidly after being exited from the Prince of Wales Hospital … I don't know how related it was to her experience there but the end came very quickly."
We all struggle with the stresses of these intensely emotional family experiences. When compounded by this sort of treatment, then the likelihood of psychological consequences must increase.
As residents in aged care have become frailer and sicker, nurse numbers and skills have been reduced to save costs. Many aged-care homes are unable to cope with patients who need intense nursing.
According to the Australian Institute of Health and Welfare (2013), over 80 per cent of people who go into aged care now are classified as high care, albeit with varying levels of complexity. This is increasing each year.
NSW is the only state with legislation – currently under review – to ensure registered nurses are in aged-care facilities 24 hours a day, subject to patient classification. Separate federal aged-care legislation has no requirement for safe staffing levels or skills, which can leave those near the end of their lives with little reassurance or choice regarding their care needs.
Whilst many providers of care insist on 'flexible' staffing, overseas studies reveal the close links between staffing and care - and between staffing and profit pressures.
When we became aware of one home operating with no staff rostered on for more than 10 hours per night, we wrote to the then Minister of Ageing (aged care no longer has a dedicated minister) to ask that if government wasn't prepared to regulate safe levels of staffing, then at the very least staffing levels in homes should be disclosed publicly. If the community had access to this information, they could make informed choices for their loved ones and even remove them if they feel the environment is unsafe. This has not occurred.
Eight years ago I wrote that you can judge a society by how it treats its elderly. Health and aged care are community responsibilities and the onus is on us all to ensure the best outcomes for those who are approaching the end of their lives. And politicians, as representatives of the people, have a responsibility to ensure community health and aged-care needs are met. Our thinking has not yet adapted to the intrusion of strong market forces into the sector.
Politicians have an interest in aged care and a responsibility to the community. We do not believe that these issues would have arisen in this case if aged-care management issues had been adequately addressed. Our parents and our elders deserve better.
Lynda Saltarelli, founder of Aged Care Crisis.