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Royal Commission… just give us Recommendation 55(d)

Not surprising that the aged care mandarins are arguing about who should run the aged care show. Because there is no obvious winner that could take these 124 Royal Commission recommendations and turn them into something that will improve the lives of frail modern elders. And that’s what we’re after.

We don’t mind the lofty ideals in the first few recommendations. But mostly it’s the dozens of recommendations after that has us despairing for today’s and tomorrow’s modern elders.

Problem is they are all about fixing a broken system. And it’s hard to imagine that, even fixed, the current system would actually improve people’s lives.

Don’t try and tell us that small institutions will be that much better than big ones, and that tougher oversight will make home care packages imagine better lives for people. And, there are so many recommendations covering so many areas, that we are left feeling like whoever’s running the show will never pull it off, and what they do pull off will be way too complicated and expensive… and maybe not even that different.

Let’s not fall for the providers’ rhetoric either, that it’s all about more staff and more money… when it’s my dog and my daughter who used to cook a special lunch once a week and the familiarities all around me that I’m missing. And if I’m bored, lonely and disoriented that doesn’t mean I want to spend my day with more staff.

Our favourite recommendation… in fact the only one we think is likely to take us somewhere remotely in the direction of really improving modern elders’ lives is Recommendation 55(d), “prioritise research that involves co-design with older people, their families and the aged care workforce”.

This would have to be real co-design, not consultation after older people and their families have been socialised into aged care thinking. Co-design that first asks about people’s lives, interrogates what they want to keep or change, invents solutions with older people and clever product developers, tests these with older people, and insists on a range of new prototypes that we can all learn from.

Let’s not assume that we can imagine what a new co-designed aged care system will be. With a leadership with no lived experience it will be no better that what we have now.

Remember the wounding of older people started 20 years earlier in people’s lives, and every bad thing done to them makes it more acceptable to do the next. If you want to stop the abuse, stop the process that makes them abusable.

We know aged care has to be sustainable but not by screwing efficiencies out of a strained system, rather by building capacities of communities and older people, by offering them products and services they like and want to learn to use and pay for, by hunting for efficiencies of approach not just the hopelessly over-sold efficiencies of scale.

So, Royal Commission, keep it simple. Ditch the lot and give us Recommendation 55(d). Resource the building of co-design capacity locally all over Australia. Fund new prototypes. Grow us all in the co-design culture. Start tomorrow. Let us have some fun for a change. And join a broader movement towards productive ageing and against ageism, accepting that current aged care might be kind, but it’s also ageist and will never get us there.

Mike Rungie specialises in the intersection between good lives and aged care. He is a member of a number of boards and committees including ACFA, Every Age Counts, Global Centre for Modern Ageing and GAP Productive Ageing Committee.

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7 comments

  1. Firstly, if you want aged care to be funded or supplemented by the government, you cannot expect to get 6 start service by paying youth hostel prices. Second there will never be a one size fits all approach to this, but if this year has shown us anything, it has shown us that aged care needs to be under health ( and ergo under the state’s jurisdiction) not the federal arrangement we currently have. This lovely “pie in the sky” approach to aged care has seen the pendulum swing so far over to the resident’s rights and wants, that the basic care is now missing as the carer’s are so busy keeping all the layers of red tape and control happy instead of the resident. I have never in my 45 years of nursing seen so much compliance and butt covering as I now see, that I want the pendulum to swing back to basics, ie. good care, love and chicken soup, instead of glossy articulate brochures and glib nods to the ” extra special features ” the home has for those who cannot use them. Poor overworked , undervalued , underpaid, abused carers and some private organisations making money ( don’t see how) in a service that should not be For Profit at all.

  2. Great article Mike, absolutely spot on! I always say, no one is asking me how to do things better!

    This is from the very start of aged care, “MY AGED CARE” website….dreadful!!! complicated!!! Centrelink, don’t get me started.

    Mountains of paperwork to fill in, assets to nominate, if you own your own home you are at a disadvantage…

    My mum is in an aged care facility, so so so wrong! It’s a facility not a home!!!! Keep saying this, but no one will listen, Australia needs to turn the aged care system on its head, NOT THESE LARGE FACILITIES, more community based structures, “homes”, actual houses NOT LARGE BUILDINGS..

    Dementia is one of the largest killers in Australia and it is so misunderstood by the so called providers!! They have no idea how people should be looked after what sort of environment they should be living in. My mum’s unit is an example of this…AWFUL!! And yet I still pay a lot of money for the privilege..

    My question is WILL THINGS CHANGE PER YOUR RECOMMENDATION????? OUR VOICES SHOULD BE HEARD AND CHANGES SHOULD BE MADE..

    BRILLIANT ARTICLE

  3. You will never see any changes until you legislate to ensure ALL care workers have at least a Certificate 3 qualification before they work in aged care, they are undervalued, underpaid and often work under stressful conditions often with not enough staff to provide the required “person centred care” to the residents. Aged care workers are the staff that spend the majority of time with the residents, they know their likes and dislikes, they know their background, they have formed strong rapports, they work with older people that have very complex health and medical conditions, sensory and cognitive impairments, yet we treat these workers appallingly by paying them low wages, not offering permanent shifts and generally not appreciating the incredibly hard work they do. Its all well and good to recommend nurses have a better presence in aged care facilities, but it’s the carers who bear the responsibility to provide the bulk of care, we need legal ratios for care workers, too many times I have seen care workers pushed to the brink because service providers do not have enough staff to provide care and it never changes, some providers think their great because they offer training for staff, but they don’t want to pay staff a days wage to attend training, paying for staff to attend training should be compulsory, most times, staff don’t engage in training, because they can’t afford to lose a day’ pay.

  4. Linda’s comments (2 November) raise some valid points but miss others. The issues needing to be addressed in Aged Care are many-faceted. Community Care’s lengthy waiting lists for assistance in the home often puts intolerable strain on unpaid carers/family and this can lead to elder neglect and abuse. Informal carers are not always well informed on coping with complex care needs including significant cognitive impairment which may or may not have been accurately diagnosed and treated. Professional carers in Residential Aged Care Facilities (RACF’s) are usually motivated to do their job well but labour under staff shortages and unrealistic shift expectations which predispose them to “cut corners” in order to appear to have fulfilled their duties. Inadequate numbers of registered/enrolled nurses to resident ratios on every shift does not allow for competent supervision of care staff or adequate time to balance documentation requirements with nursing care. Staff shortages can be due, in part, to the revolving door of international students taking casual work until their degrees are finished. Pay rates are also a factor – when people with no qualifications and little responsibility can earn as much packing supermarket shelves, where is the encouragement for Carers to take a job which is hard work and very stressful for similar pay rates.
    In addition, Boards of Aged Care organisations insist on profits because they are running a business which needs to be profitable for sustainability. However, I believe transparency and accuracy in financial reporting to an independent body is essential for the mix of meeting staffing requirements and residents’ complex care needs with a fair profit margin. In addition, the majority of RACF’s have had to renovate or re-build to meet current and future residents’ expectations for single rooms with ensuites and the latest technology. The increased incidence of dementia adds a further dimension with specific accommodation and staff skills required for these people. I believe all of the abovementioned issues should be addressed urgently.

  5. I so enjoyed reading Mike’s refreshing perspective. Such a vision of sensible unreality is exactly what we need to hear…visions that are different and seemingly hard to do, but entirely necessary. All we hear from the Inquiry is how to prop up a failed and failing arrangement. Central to the whole capacity to bring a meaningful day to people entering the latter parts of their life is how should they be served? What we know is that large numbers composed of people with very different urgent needs is a recipe that no amount of staff can fix. The problem I believe rests in the poor practice of grouping large numbers of diverse people together that it is impossible for even good staff to provide anything beyond basic care. Both groups (residents and staff) miss out on having their needs met and with few exceptions the arrangement is miserable and soul destroying. We need a decent vision that allows us to move forward and progress the interests of older Australians. Thank you Mike for igniting the conversation.

  6. You just cant contract out community services to private enterprise…it’s never succeeded…anywhere.

    And we really need to stop pretending RACFs are homes…they’re not and never will be. If folks could be at home, they would.

    The high acuity of contemporary residential clients requires well-staff and highly skilled nurses, not just ‘carers’ who might mean well, but just dont know what they dont know. Its time we stopped pretending these old models can deliver the care people need.

    This level of aged care has to be part of the state healthcare system…operated professionally with real clinical governance (not the amateurish ACQSC pretend standards) and medical professionals.

    Or are we all happy leaving it up to churches and accountants?

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