Solutions through evidence and dialogue
Registered and enrolled nurses now account for less than 27% of this workforce, while personal care attendants (PCAs) make up 68%. Much of the hands-on care that registered and enrolled nurses once provided is now being provided by PCAs.
To read more https://theconversation.com/heres-why-we-need-nurse-resident-ratios-in-aged-care-homes-59682
Published in Courier Mail on 27 March 2017
Last month the Courier Mail reported yet another heart breaking story about aged care homes (Aged care nightmare: man’s scrotum ‘left bleeding’, 20th February). Many of us were shocked because we assume elderly Australians receive high quality care in aged care homes.
The Federal Government is promoting its reforms in the aged care sector as supporting a consumer driven and market-based system. However, the “consumers” in aged care homes are often frail, elderly people, many with dementia. How can they demand a high quality service on the free market?
There are around 2,600 aged care homes in Australia. Although some are excellent, many aged care homes operate without enough staff. Managers who are under pressure to meet their profit targets do so by reducing staff, placing vulnerable residents at risk.
Staff in aged care homes are often hard-working, dedicated people doing a very difficult job for not much pay. When an aged-care home has insufficient staff, there may not be time for staff to walk residents to the toilet or even help them out of bed. All too often relatives feed, shower and dress residents because staff are too busy.
A key to quality healthcare is a good staff-patient ratio. However, unlike hospitals, there is no federal legislative requirement for aged-care homes to have mandated staff-to-resident ratios or skill prerequisites. The decision whether to have a registered nurse on duty is at the discretion of the provider.
When registered nurses are on duty in aged care homes, residents have better health outcomes, a higher quality of life and fewer hospital admissions. However, registered nurses now account for less than 27% of this workforce, while personal care attendants make up 68%.
Some personal-care attendants gained their qualification to work in an aged care home after completing a five-week course. It is inconceivable that someone with only five weeks of training is qualified to provide competent care, particularly when there is no registered nurse on duty to supervise them. Is it any wonder relatives’ submissions to recent inquiries into aged care have highlighted inadequate personal care, neglect, and negligence?
Relatives complain because residents’ needs are unmet – when incontinence pads are not changed regularly, when bruises appear or skin tears, and when pressure sores are not treated appropriately, in some cases turning gangrenous. Complaints are also made when residents suffer from malnutrition and/or dehydration and are chemically restrained. The list goes on.
The accreditation process should play an important part in monitoring the standards of care in all aged-care homes, including whether adequate numbers of skilled staff are employed. The current accreditation standards are woefully inadequate.
Coronial inquests into separate deaths at two aged care homes in Melbourne, BUPA Kempsey and Arcare Hampstead, exposed inadequate care. Yet both BUPA Kempsey and Arcare Hampstead were fully accredited by the regulator, the Aged Care Quality Agency, with perfect scores of 100 per cent in all criteria. This suggests something is wrong with the accreditation processes.
Following the coronial inquiries, the Aged Care Quality Agency did not change the accreditation processes. Vague phrases such as “sufficient staff” continue to be used. In some cases, sufficient staff means no registered nurse on duty. It may also mean an inadequate number of personal-care attendants.
When taxpayers are subsidising the care of elderly people, the public’s investment needs to be protected in the form of regulation, mandated staff ratios and a rigorous accreditation system. The care of vulnerable older people is too important to be left to the whims of the free market.
Published in Courier Mail on 27 March 2017
What would make a man eulogise about his dead father at his mother’s funeral and then propose a toast to his “mother and father”?
This eulogy was more than your garden-variety misogyny. It was misogyny on steroids.
Listening to the eulogy, I was transported back to the to the Victorian era. In those days, a wife lost her personal identity when she acquired her husband’s name. A wife became her husband’s property, his chattel.
Victorian marriage and property laws stipulated that a married woman did not have a separate legal existence from her husband. A married woman was a dependent, like an underage child or a slave, and could not own property in her own name or control her own money.
The laws changed over a hundred years ago. Thankfully so too did attitudes towards married women. Older women may be the last bastion of Victorian traditions.
Some older women are treated like an underage child after their husband dies. They are encouraged to appoint a financial power of attorney because older women, particularly those who have not been the family’s breadwinner, are assumed to be incapable of managing their own financial affairs. Not only is this patronising but also it disempowers older women.
The ultimate act of disempowerment is when an older woman is declared legally incapable. According to the Office of the Public Advocate, older women are more likely to be declared legally incapable than older men. This may be due to the fact that women live longer than men. It may also suggest that older men are revered while older women are infantilised.
Once an older woman is declared legally incapable, an enduring power of attorney, both financial and medical, is appointed. The financial powers of attorney take complete control of their mother’s financial affairs. The older woman is then transported back to the Victorian era. She loses control of her own money, just like a young child.
Financial powers of attorney are required to act in the older woman’s best interest. If they don’t, it is financial elder abuse.
There is little reliable data on the extent of financial elder abuse. State Trustees Victoria found that women over the age of 80 are most at risk of financial elder abuse. They found that adult sons were the most common perpetrators of financial elder abuse.
Financial elder abuse may begin with the best intentions – with children acting as their mother’s financial power of attorney thereby managing her finances. This can quickly progress to a sense of entitlement, particularly when adult children have mortgages or debts.
In some families, children are not willing to wait for their inheritance until after their mother dies. They assume what was once ‘Mum and Dad’s money’ is now their money, not their mothers’ money. They may even curtail the amount of money their mother spends.
There have been several high-profile trust fund disputes in which sons have sued their mothers. In one case, a former pupil of a private boys school in Sydney sued his mother after the family estate was left to his mother rather than to him. This “old boy” was castigated by the judge for having a “highly developed and unhealthy sense of entitlement“.
Financial elder abuse is currently not a criminal offence in Australia. It is treated as a private issue, like family violence was treated during the Victorian era – before the work feminists did to make it a public issue. For financial elder abuse to become a criminal offence, attitudes towards older people, particularly older women, need to change.
Published in Women’s Agenda 19 November 2015
A month ago, the Aged Care Guild began a campaign called “Protect Aussie aged care”. It launched a petition asking for signatures in a bid to pressure the government into providing more funding. How many people signed the petition not realising they were supporting some of the most profitable providers in the aged care industry? The Aged Care Guild represents the largest nine aged-care companies: BUPA, Japara, Regis, Estia, Allity, Arcare, McKenzie, Blue Cross and Opal. These companies are now the fastest-growing owners of aged care homes in Australia. According to their annual reports (2015-16), Japara made a profit of $30 million – up 5.6 per cent; and Estia $51.8 million – up 16 per cent. These large profits depend on substantial government subsidies.
This campaign resembled “astroturfing” – although the campaign mimicked a grassroots movement, it was run by a highly paid lobby group.
With the recent horror stories about the quality of care in residential aged care homes, including maggots being found in a resident’s mouth at an Opal aged care home, we need to feel reassured that government subsidies are used to improve the quality of life of residents, not go into the pockets of providers.
Sarah Russell, Aged Care Matters
by Ian Anderson and Sarah Russell
Another Australia Day has been and gone demonstrating that our history provokes a range of emotional responses – pride, sorrow, happiness, anger and guilt. The large number of non-Indigenous Australians who attended Invasion/Survival Day rallies around Australia suggests guilt is a common emotional response of non-Indigenous Australians when recalling Australia’s colonial treatment of Aboriginal people.
If you accept – as I do – that the Australian frontier was a violent place and many Aboriginal lives were lost in this violence. Also that Aboriginal Australian suffered because of the loss of livelihood, disease and poverty. Then there is much to provoke a sense of guilt. However, guilt prevents constructive dialogue.
Instead I want an honest conversation between Indigenous and non-Indigenous Australians about our shared past and its consequences. I want to have this conversation in ways that enable us all to address the legacy of the past and create a shared future.
Guilt can be a crippling and paralysing emotion. Guilt doesn’t create the basis for reframing our relationships or enabling us to see new alternative futures together. For some, the fear of guilt becomes a reason to avoid thinking about these confronting truths about Australia’s past.
For those Australians who do not have any historical connection to Australian frontier– such as more recent migrants – guilt seems an even less appropriate response.
Hobart Lord Mayor Sue Hickey brought herself to national attention when she raised concerns about The Museum of Old and New Art’s (MONA) proposal for a Truth and Reconciliation Park. MONA has a long-term vision to transform an industrial site into a cultural precinct at Macquarie point. This proposal includes a precinct that acknowledges Tasmania’s colonial conflict with Indigenous people as well as a Tasmanian Aboriginal history centre. It has the potential to become a national building project with an innovative cultural space that creates new ways for Australians of all backgrounds to reconcile our colonial past.
Sue Hickey said a Truth and Reconciliation Park would create “a guilt ridden” place adding that she “didn’t kill Aborigines”. She received public opprobrium for her comments, particularly from Indigenous Australians. Although her initial comments were clumsy and caused offence, subsequent discussions between Sue Hickey and Tasmania’s Palawa (Aboriginal) were positive. However, the incident illustrates how the fear of guilt can get in the way of conversations about our colonial past.
I am not promoting a naïve dewy-eyed nationalism that glosses over the confronting aspects of our history. If we are going to have a shared future, we need to collectively remember our colonial history. But there may be more productive ways to set the tone for our engagement with our colonial past.
A dialogue about our colonial history underpinned by generosity, empathy, respect and compassion has greater potential for constructive engagement with our colonial history and its legacy. This approach may allow us to acknowledge past suffering whilst at the same time opening up new ways for us to relate to each other and build a shared future. This is a future in which we all belong but in different ways.
Every year we have difficult conversations about the problems associated with choice of the 26th of January to celebrate our Australian nationhood. This year was no different. Australia day honours, BBQs, citizenship ceremonies and invasion day/survival day marches were all held concurrently. Once again, Australia Day – a national day that should bring Indigenous and non-Indigenous together – divided our nation.
A poll published in the Guardian found most Indigenous Australians want the date changed. 26 January is the anniversary of the date in which the First Fleet raised the Union Jack in Sydney Cover in 1788. It is a date that by virtue of its historical symbolism causes pain to Indigenous Australians.
26 January became a public holiday uniformly across all Australian states only in 1994. For many Indigenous Australians it is symbolic of the act of dispossession. Yet we seem unable to have a frank and honest conversation about changing the date. Being dismissive and responding that this is a silly conversation – or that it is “political correctness gone mad” – is not a generous way to bring all Australians into a celebration of our shared collective future. A generous approach to dialogue based on empathy, respect and compassion would seek to find a date to celebrate our nationhood that is inclusive of all Australians.
We need a way to talk about our past that is honest that acknowledges harm both intended and not intended to Indigenous Australians. Perhaps this would be more productive if we were able to move from one based on guilt to one based on emotional engagement that is enabling. That might require us all to shift our approach to each other and acknowledge the multiple cultural traditions. Whoever we are – Indigenous, descendants of settler Australians, migrants or refugees – we all have a stake in our nations future.
Aged-care homes require a highly skilled workforce plus robust regulation.
To read more http://www.smh.com.au/comment/were-ignoring-the-needs-of-our-ageing-population-20160416-go80kr.html
