Increasing age brings with it a loss of physical and mental ability and in our society this defines perceptions of ageing. But the more physically and mentally active old people are the longer they remain physically healthy, the better their mental faculties are, the less aged care they need and the lower the costs for society. If you don’t use it then you lose it quicker and its much more difficult to get it back than it is when you are younger.
We need to stay well and active to stay alive but will have to overcome a persistent ageism in society. But change is coming and the proposed hub will be well placed to drive that change forward. The sections below, examine these issues.
Staying alive and well
Sustained physical activity, mental stimulation and varied social interaction in the community are as important for the aged, if not more so, than they are for the young, and for addressing the obesity epidemic in our society.
... A new University of Florida study shows daily moderate physical activity may mean the difference between seniors being able to keep up everyday activities or becoming housebound. In fact, moderate physical activity helped aging adults maintain their ability to walk at a rate 18 percent higher than older adults who did not exercise.
What's more, moderate physical activity not only helped older adults maintain mobility but also helped prevent the occurrence of long-term mobility loss. - - - - - - - - there was a 28 percent reduction in people permanently losing the ability to walk easily.
Source: Physical activity helps maintain mobility in older adults - Science Daily, 27 May 2014
In general those who continue to engage in sport, seek out and enjoy mental stimulation, remain engaged with issues, and who are socially active across the breadth of society, are much more likely to live active and fulfilling lives and remain fit and switched on into their '90s. They still have something to offer and don’t require many years of costly care.
Ageism and its consequences
In contrast, the words we use and the images we have are of a slowed down 'retirement'. We create ageing communities sequestered into scenic retirement villages at the edges of our cities where they can live the rest of their lives out of sight in indolence and then go gracefully off into the sunset without the cares and strife of life.
Retirement becomes an opting out from life, instead of a challenging opportunity to change direction and find new areas of involvement and stimulation where contributions can be made. Financial freedom opens windows and creates opportunities to contribute in ways that are not possible during one's working life. Society loses the benefits.
There is a deep and pervasive ageism in our society. At its best it is manifested by a demeaning, sympathetic and kindly paternalism, pushing older citizens gently out of a role in society. At its worse it results in disengagement with the elderly and warehousing in institutions - but with occasional regimented visits and outings as busy citizens do their duty to their parents.
As we age we should aim to recognise when we are not coping in one activity, and be prepared to move on to other activities where we can still contribute.
We bring these community attitudes with us as we age and older citizens often live out these ageist stereotypes, either willingly or in response to social pressures. We might go gracefully into the dark night but we go sooner and with greater suffering and ill health than we would do if we are fighting - screaming and kicking out in the community.
Change is coming
Innovative thinking in aged care is increasingly moving away from the old stereotypes and it is thinkers in the community that are driving the changes. A variety of innovative accommodation arrangements are being tried. Some are being placed centrally in the middle of towns and cities rather than the periphery. Others are co-located with schools. Retirement villages are placed on university campuses.
The buzz words are activity, stimulation and interaction. Australia has been talking and initiating government reports, but so far has not been an active participant in this process.
... Longer lives are the most positive development in the last century of human history. - - - - They offer each of us, on average, 25 extra years of high quality living with new opportunities for productive work, unprecedented leisure, teaching and learning, and fulfilling relationships with family and friends.
- - - ageing only represents a challenge if we choose to see it so. Instead, we could choose to see longer lives as a social and economic good.
- - - our recommendations are based on the idea that ageing is creating opportunities and assets that need to be exploited rather than seen as problems to be overcome ..."
Source: Blueprint for an Ageing Australia (From the think tank "percapita", 3 Sep 2014)
Blueprint for an Ageing Australia: The September 2014 report "Blueprint for an Ageing Australia" and the 2011 report from the treasury "Realising the economic potential of senior Australians: Turning Grey into Gold" cover much the same ground, which is not surprising as the 2011 report is by three of the same six people responsible for that in 2014. Three of the authors of the 2014 report, Everald Compton, Brian Howe and Professor Gill Lewin, addressed the National Press Club on 3rd Sept 2014. It is interesting that the government axed the Bluepring for an Ageing Australia 6 months before it was due to give its report. Think Tank, Per Capita, took on the project. National Seniors also joined and contributed to the study.
The emphasis of these and other reports is on the pluses of our increased longevity, and the benefits for individuals and the community from a program of Active ageing. With 20% of the population projected to be over 65 in a few years, the reports point to the need for a major restructuring and reorientation in thinking and behaving in the whole of our society, to reflect the nature of this change. The rhetoric has not been matched by a response from our politicians and many of those consulted have been economists and industry figures.
While the proposals are of interest and importance, they come from experts rather than the coalface and do not really engage us. In spite of National Seniors late involvement, I am not persuaded that the community has embraced this and participated fully in the process, nor that these reports are having any major impact in local communities. This may be because issues addressed seem to have been generated from government, their appointees and industry, rather than people in the community. This may well reflect the community's current lack of engagement with the issues.
The Hub: The proposed aged care hub would create a network of engaged community members across the country, pressing for change. Not only would they be central to initiating the active ageing program, but they would be an involved and actively debating community, providing feedback, raising issues, instituting innovations, and pressing for further advances.
The current disinterest in something, which will ultimately be very important for everyone, is probably because our communities were pushed aside by the 1997 aged care changes. They have been isolated from and are disengaged from the issues and problems in aged care. Professor Maddocks' proposals recognize this and he sees his re-educated doctors and the community working together to keep aged citizens involved and active in the community.
Encouraging example: In Australia we have had a tendency to expect someone else to fix our problems. Socialism gave us an entitlement mentality and many came to expect government to do everything for them. With economic rationalism we have transferred that expectation to the market and expect to be able to buy everything.
Eva Cox in contrast, in her Boyer lectures, advocated for a Civil Society in which the community worked together to organise and run itself and in doing so build "Social Capital". I argue that this would provide a context for recognising and developing our "social selves" so re-establishing a better balance with our individual (selfish) selves. Our "humanity" resides in the former. The proposed hub is a step in this direction.
It is encouraging to read of a new idea described by journalist Adele Horin on her blog in 2013 and again in 2015. It is being trialled by a community of older people in Waverton, Sydney. They are adapting a community self support idea being tried in Boston to the Australian context. They are forming a group in the local community to organise and run aged care activities and services, contributing funds to the employment of a manager to run the organisation, employ people to provide services and to combat isolation by organising community activities. The object is for each older person to have 6 or 7 others who are in regular close contact and that they help each other out and provide support.
This idea is congruent with and would fit into or work well in cooperation with the proposed hub. They have even called it the "Waverton Hub".
Not everything is broken: There are a few not-for-profit providers that stand out as exceptions to the "broken" description. They maintain and advocate for a true not-for-profit focus, and are pioneers in innovative care. Adele Horin talks about what Feros Care are doing in NSW. Hammondcare has been a pioneer.
Stephen Judd Hammongcare's CEO has written a book about the problems in the not-for-profit sector. He attributes the failures of the not-for-profit system, which owns the large majority of nursing homes, to their loss of identity and loss of the contact with the community that underpins their mission. They lose their sense of mission.
I argue that this is also because they are deeply conflicted by having to compete in a marketplace where their core mission must be subservient to a focus on competition for profits in order to survive. They no longer know who they are and what they are doing here.
The community hub system would work with the groups who retain their identity and learn from them. The hubs would work to spread this sort of culture across Australia, redirecting and supporting the not-for-profits so that they regain identity and a mission.
The not-for-profit providers originated within the community as a result of its Samaritan culture. They depended on the cummunity's support of their mission. That support has been lost. By re-engaging with them the hub would restore and rebuild their Samaritan ethic.
The role of the community hub
One of the primary roles of the community hubs would be to engage citizens across age groups in developing social structures that embrace and include all age groups in community activities.
The aged should be supporting the young and the young the aged. Older citizens are well placed to make significant contributions, particularly into not-for-profit community services and activities, including societies and sport.
If older citizens are to maintain their grasp on life and continue to create meaningful lives they must remain as much a part of society as they once were, and continue to contribute to it. They need to play sport and be physically active for as long as they can. They benefit more than most from medical advances that maintain mobility. Modern eye surgery allows the large numbers who once became blind to read and study, so maintaining their mental abilities.
The thrust of government innovation in Australia at present is to care for people at home in the community and this is a welcome change. But there is a real danger that frail elderly will be warehoused in their homes, where attendants will come to provide basic physical care.
Instead of being part of the community they could find themselves in solitary confinement in isolated prisons from which they cannot escape - worse off than in a nursing home. Different types of independent, integrated group accommodation may be better for them. In some countries communities, or seniors themselves are experimenting.
Contracting commercial entities to provide care for basic needs may not address this problem. It is the community that must reach out to these citizens and help them to stay involved. In doing so they will also be monitoring the service they are getting.
Dr Karen Hitchcock expressed some of the ideas that lie behind this page and the proposal for a hub on ABC 7.30 Report. I agree with her view that we need to decide what sort of society we want and then see how we can fund that. The proposed hub creates a context where we can do that. At present we seem to decide what sort of society will make the market work best and then impose that.