I've been away from my blog for a few weeks as I've been caring for my elderly mother. She has been in and out of hospital and her health continues to deteriorate increasingly.
I am seeing my mother become more frail and more dependent upon outside services and as her power of attorney, I must ensure that she has access to whatever she needs to remain independent for as long as possible.
My mother has heart failure and weakened lungs from a bout of pneumonia some years ago. She is a prime candidate for infection and is currently in lock down until they can stabilise her on various medications.
Mum's biggest issue is her independence and wanting to keep that independence for as long as possible. Her biggest fear is a nursing home. I can't blame her, considering what has come to light in recent times regarding the Royal Commission into Aged Care and the cracks exposed by Covid-19 that were never addressed by the government.
We would need to go back to the Howard government to look to where the "turning point" was in aged care in Australia. This was when private investment in aged care increased and the real damage began in a system where our elders had no real control over their circumstances.
In 1997, the Aged Care Act was drafted by the Howard government. It was then that "private equity firms, new foreign investors, superannuation and property real estate investment trusts entered the residential aged care market". There was also no legal obligation on the part of these private facilities to "take proactive measures to promote the mental health and wellbeing of their residents". Unbelievably, there was also an insufficient number of staff-to-patient/resident ratios and not mandatory in this country that ratios be met.
As well as introducing the Aged Care Act in 1997, the Howard government also slashed over $1 billion from aged care funding in its 1996-1997 budget. The government claimed that the "higher fees and bonds would "provide the incentive for investors to expand and improve the industry". In spite of this, or rather, because of this, conditions did not improve in nursing homes and waiting times blew out significantly.
While the situation under the Aged Care Act continued to deteriorate rapidly for the elderly and the staff who cared for them, it improved significantly for nursing home operators. Operators no longer had to allocate a set proportion of government subsidies to patient care. Funding links to the number of qualified staff employed were removed and the requirement for a registered nurse to be on duty was scrapped. In my opinion, the Howard government designed this act initially as the basis to the lead-up to privatisation of the aged care industry and to increase the profits and benefits of investors in the private sector. This would have required a lengthy amount of preplanning beforehand.
According to the Aged Care Act, a certain amount of audit reviews on homes and hostels were meant to be carried out on a regular basis but they were never implemented due to insufficient funding. In fact, in 1999, "a list rating nursing homes was removed from the Aged Care Standards and Accreditation Agency's website in order not to put 'undue pressure' on homes, which may be rapidly moving to improve their situations".
From my point of view, the increased privatisation, decreased funding, decreased transparency and accountability was the beginning of the end for our elders in regards to their welfare and, indeed, their mental health and dignity. The Howard government had opened the doors to a massive bonanza for private investors to skim the taxpayer via unsupervised subsidisation and exploit the elderly without scrutiny. Moreover, it was at this point that big corporations moved into the industry to capitalise on this new growth sector. The Sydney Morning Herald reported on 2 March 2000 that "nursing homes are big business with handsome profits for some". Managing Director, Kevin Moss said "Once you are in the business you have a guaranteed government income. It's a very good business. It's a cottage industry in Australia.. and some have milked the cow".
Unfortunately, as we now know, the people who suffered the most during this epic government cash grab were the elderly. Of course, the more wealthy who could afford a more luxurious retirement lifestyle continued on unimpeded but for the lower classes, the working classes who had little in the way of retirement investment, the system became unbearable. Corporations were making enormous amounts of profit and not reinvesting the money that they had initially made back into the industry. There were no more regulations to protect the elderly and they were increasingly discarded like so much unwanted rubbish.
The abuse that was no doubt ongoing increased exponentially under these draconian parameters. In fact, it became systemic. We may never know how many of our elders suffered in aged care or how many were neglected and abused to the point of death.
In 2016, several complaints were made to government authorities regarding the abuse of an elderly relative at Oakden Elder Persons Mental Health Service. In 2018, at a Senate inquiry "it was revealed that several incidents at the home were referred to police and a coronial inquiry into the deaths of residents was initiated". There were findings of maladministration against no less than five individuals and Oakden. "Oakden closed in 2017 after it was revealed that a resident with Parkinsons disease was beaten by another resident at least 13 times at the home and did not receive any recorded medical care".
Most of us are also familiar with the shocking footage from a hidden camera on ABC's 7.30 of an incident at Mitcham Residential Care Facility where a staff member attempted to suffocate an 89-year-old resident - which "prompted calls for the legalisation of the installation of cameras in the private rooms of aged care facilities".
In 2018, just before the ABC broadcast a special series into the abuse and neglect in the aged care sector, Scott Morrison announced that a Royal Commission into aged care be established. If I were a cynical person, I would imagine that it was only increasing public pressure and outrage at the ongoing systematic and unchallenged abuse our elderly were suffering every single day in nursing homes that pressured our pompous, pretentious PM into finally conceding to pressure.
The Royal Commission findings were an eye opener but not surprising. It's title in the interim report "Neglect" and in the forward before the first paragraph "A Shocking Tale of Neglect" is self-explanatory - so I will only touch on it briefly here. It speaks of the many failings in the aged care system that had long been known about before coming to the attention of the Royal Commission but nothing was done. Nothing was even implemented. Increased funding is needed desperately to supply what is necessary for our elderly. Implementation to structure an environment of essential loving care is needed as well as transparency rather than hiding from the spotlight to do what they please. This current system was described as "cruel and harmful".
Nothing is being done to address the obvious failings. The system is confronting and difficult to navigate for the elderly and their families. My Aged Care does not sufficiently address the issues. It is not easy to navigate an Internet- and telephone-based system which is confusing for the elderly and more often than not, unsatisfactory. The system is inflexible and "useful information is often the exception, not the rule". Waiting times for home care are impossibly long and even when they are deemed eligible there are far longer wait times than would be acceptable in any other system.
The transition into residential care is traumatic enough for the elderly without the added difficulties faced, including the lack of helpful information from My Aged Care. There is no acknowledgement from providers regarding the fears of the elderly who have few alternatives but to enter residential care.
I found myself in tears while reading through the information in the articles on the failing of the aged care sector and the endless abuses on people who can, for the most part, not defend themselves. I find myself angry at a system that has been so corrupted in its very essence that the elderly no longer matter at all. It is now largely about how much can be squeezed out of each life in terms of profit and subsidies from the government. The elderly have a use by date and are not seen as human beings with thoughts, feelings and lives that matter. Government and corporations forget that most of these frail 'shadows' in nursing homes have contributed, paid taxes, had families and built this country. They are merely commodities to be exploited for as much and as long as possible for minimal input.
Continued cost cutting by nursing homes has not only led to short-staffing, but a decrease in nutritious meals offered to the elderly. In 2016, the amount of money provided to a resident for meals per day was $6.08. I can't think of a single meal I can provide for my mother for $6.08, other than a basic sandwich or a few vegetables. The weekly ration of approximately $42 is surely not enough to provide twenty-one nutritional and interesting meals for one person. During 2016, the government also announced measures in the budget for aged care that saved them $2 billion over four years. While the government were not cutting at that point, they were not spending - and looking for savings in the sector. The average aged care facility was half a million dollars worse off a year. Residents' meals shrunk to save costs and staff were told to ration out supplies like sanitary pads to residents to save money and only change when absolutely full.
With increasing frequency, staff are cut and there will be often less than one staff member to care for 10 or more residents. This is not conducive for effective and essential care for each and every person. Often residents are left in urine-soaked beds - or worse - and unattended for hours because the staff simply can't get to them. As somebody who has had personal experience in nursing homes during my training before my own health restricted my career, I felt the guilt of not being able to attend to each resident on my roster, not being able to chat with them or attend to their needs. Staff are on the clock and are underpaid. It is a recipe for entrenched and often accepted neglect. I would not have lasted in the long term. While I found spending time with the elderly wonderfully enriching, I very often wasn't able to connect with them in ways that would have been socially and emotionally beneficial for them because of time-poor restraints.
Some of the major quality and safety issues in aged care which were brought to the attention of the Royal Commission are as follows:
Inadequate prevention and management of wounds, sometimes leading to septicaemia or death.
Poor continence management - many aged care residences don't encourage toilet use or strictly ration continence pads, often leaving distressed residents sitting or lying in urine or faeces.
Dreadful food, nutrition and hydration and insufficient attention to oral health, leading to widespread malnutrition, excruciating dental and other pain, and secondary conditions.
A high incident of assaults by staff on residents and by residents on other residents and on staff.
Common use of physical restraint on residents, not so much for their safety or wellbeing but to make them easier to manage.
Widespread over-prescribing, often without clear consent, of drugs which sedate residents, rendering them drowsy and unresponsive to visiting family and removing their ability to interact with people.
Patchy and fragmented palliative care for residents who are dying, creating unnecessary distress for both the dying person and their family.
The above points are just the tip of the iceberg. This is not care. This is neglect. And the many failings of aged care have been continuously swept under the carpet for a decade or more. As more and more problems have emerged, less has been done to rectify them and it has snowballed.
There have been many inquiries, reports and reviews into aged care in the last decade, and so far we have seen little change. The most recent Royal Commission into aged care has yet to see any action from the government. In 2020, the stark reality of the failings of reform in aged care emerged painfully during the pandemic, where Australia's aged care death rate from Covid-19 was among the highest in the world.
Senator Richard Colbeck, Aged Care Minister, said he was 'shocked' at the findings of the Aged Care Royal Commission's Interim report. The report was a surprise to nobody - everybody knew what was going on, including regulatory and peak bodies, the government and senior members of the sector. I find it hard to believe that Colbeck had no idea. Colbeck's incompetence for his role as Aged Care Minister became more apparent at a parliamentary hearing when he came unprepared with little knowledge of what was going on in the aged care sector at the time and had no idea of the number of residents in aged care who had passed away from Covid-19.
As the federal government is responsible for funding and regulating private aged care, I would expect more from the Minister for Aged Care. And as Colbeck is responsible for the 'if and when' there is to be mobilisation of an Aged Care Emergency Response Operations Centre - I would expect him to be able to implement this effectively and decisively. A task in which he failed miserably. The responsibility of this has apparently now been shifted to the Health Minister, Greg Hunt.
The difficulties and impossibilities of the current aged care system have been laid bare by the pandemic. Beneath it all are people. People who work in the aged care system and are witnessing what the lack of funding, lack of resources, lack of time and the lack of adequate regulation and transparency can do to our elderly population. While the aged care industry are in desperate straits there are still people who try their best and do what they can for the elderly. While there are many stories of elder abuse there are also a few stories of people in nursing homes who want change in the industry. These are the people who need to be listened to.
It is time to let go of the bottom line and inject more funding into the industry. It is time for more transparency and change to try to transform a sector and bring it back from the brink. I hesitate to use the word "industry" when I think of the aged care sector - as this is what many people see it as, and that is the problem. It's about people, and people should count. When we reach the end of our lives we don't want to approach it fearfully based on the frightening things we have seen and heard regarding aged care. We want to have confidence that we will be nurtured and loved until the end.
That is what I want for my mother. And until the aged care sector changes I can't imagine anything other than using every resource at my disposal to make her feel comfortable. I would rather care for my mother in my home and remember the times shared with love rather than feel her fear of an unknown finality in a nursing home.