The future of aged care
If there is one thing that aged-care policymakers can agree on, it is that something has to change — fast. But precisely what and how has remained the subject of a hot-button debate for quite some time — a debate which has inflamed in recent months amid COVID-19 and the ongoing Royal Commission.
At the crux of it, a collective desire to improve quality of life within residential aged-care facilities (RACF) may have struck a harmonious chord. But drill down into the specifics of how this can and should be achieved and the tune quickly becomes unmelodic.
Improve RACF health care through better nurse-to-resident ratios and funds will dry up — at the expense of other aged-care priorities — some have argued. Enact a market-based system — whereby people with means pay more — and residents will expect better care for their investment, others have warned.
Although a veil of fog may be obscuring our vision of future aged-care delivery, the existing facts are clear. Around 70% of RACF residents live with trauma, yet few have routine access to a psychologist within their facilities. Up to 40% receive no visitors, yet staff are often too stretched to provide any regular or meaningful psychosocial engagement. And approximately 52% have dementia, yet zero mandates are in place for staff to have any specialised dementia training.
Those are the ‘luckier’ ones. Around 100,000 senior Australians are still waiting for a place in an RACF or the right care package — a considerable overspill from the 20,000 new places recently announced in the federal Budget.
While it may be easy to recognise what quality of life isn’t in the context of aged care, merely doing the opposite of these things doesn’t equal a solution. So, where do we start?
Funding, plus compassion, plus rights
Stephen Duckett, of the Grattan Institute, says the aged-care conversation must begin with compassion, focus on rights, and end with the requisite government pay cheque.
“At the moment, the emphasis is on saving money and rationalising the number of aged-care places. The way I see it, we all have a right to health care in this country and would never be denied access to a GP if we needed one. Yet we are not seeing the same rights-based mentality within the aged-care system,” Duckett said.
“In my view, it is unacceptable that an elderly person in Australia today still cannot guarantee a care package to support them with their daily activities, like taking a shower, when they need it. Additionally, that many are denied liberties or have unmet psychosocial needs when entering facilities,” he added.
As baby boomers enter aged care, most want to minimise the change in their lives, retaining their sense of choice and independence. Instead, many face the opposite experience: limited freedoms and an environment that often does not resemble a home.
In recent years, the Australian Government has sought to address this, investing billions in the aged-care sector and working hard to establish standards and assessment frameworks.
One key positive development has been the revised Aged Care Quality and Safety Commission (ACQSC) standards and the introduction of the ‘dignity of risk’ principle, which permits residents to undertake activities of enjoyment — despite any (reasonable) risk they may involve.
However, staff shortfalls can make enacting a resident’s dignity of risk a challenge. A morning walk to the shops, for example, often requires assistance and time — a commodity most aged-care staff don’t have in surplus. Hence, a compassion and rights-based formula that does not include the requisite funding is inadequate.
Despite former claims by some politicians that the Budget could not permit sweeping change within the aged-care system, Duckett believes funding can always be found if it is looked for.
“Throughout the COVID-19 pandemic, the government has coughed up billions for the construction sector, where the average wage is considerably higher than that for aged care. The debate is no longer about ‘can we find the money’ — it’s about prioritisation and what conditions we are willing to tolerate for our elders. Society has to say, ‘will we tolerate the poor quality and the death rate we have seen over the last six months?’” he said.
Duckett says that while some facilities pose an urgent risk, the systemic change needed to enhance aged-care delivery does not need to happen by tomorrow.
“Even if it were to take, say, three years, then so be it. Providing we are on the right track and acting with the appropriate sentiment, then, in my view, that’s a positive development.
“We have a large task ahead of us to reform our aged-care system. But one thing is for sure: we cannot continue on as we are. We owe it to our elders to ensure their final years are quality ones,” he concluded.
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