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Is aged care an ageist institution? opinion

Ever wondered why aged care is full of passionate, good, caring people, yet the care older residents get is often so bad?

That kind staff are working their bums off to do the right thing – but older clients are bored, isolated from whom and what matters to them, malnourished, lonely, depressed, and as the Royal Commission found, neglected and abused – it wouldn’t be unreasonable to conclude that bad care, poor lives, abuse and neglect come from bad people.

But anyone who’s connected with aged care staff at any level, not for profit or commercial, knows they’re not.

Providers said there were just a few bad apples, but the Royal Commission found abuse and neglect was endemic to the sector. Which leads us to assume that providers don’t know that their services actually do this. This blindness to the sad reality of the lives of vulnerable people that providers are paid to care for results from unconscious ageism.

That is prejudice (what you think) and discrimination (what you do) against people simply because they are old, without even realising you are doing it. It’s not just providers who are ageist, the recent UN global report on ageism says most of us are. And it starts much earlier than aged care.

In fact, from the time of voluntary or forced retirement people become quietly less important, less visible, less included, less able to contribute. And all this makes it that much easier to assume older people need less money, less jobs, less opportunity, less welcoming inclusion, less health and dental care, less housing, less purpose and less full lives. Then we become frail and it’s not too hard for aged care providers to assume that what these life-depleted older people most need is a room with care, free from the worries and baggage of their diminished lives.

But this style of care requires us to give up on the very things that older people are most desperate to sustain in their frail lives. The same things that any citizen wouldn’t give up in a fit. Worse still, ageism also impacts on residents’ very ability to stay alive, brought sharply into focus by residential care’s inability to respond safely and decently to the pandemic. This provider requirement has nothing to do with being frail, it’s simply what this style of care “does”, that we’ve all given the nod to.

This style of care doesn’t just require residents to live in a certain way, it also requires staff, volunteers, visitors, boards, accreditors and funders to behave in a certain way. We all become part of this ageist service model, despite our personal values. So, good people end up doing bad things. Since the Royal Commission there has been much talk about good and bad providers. Ridding ourselves of the bad providers is part of the answer we’re told. But all providers offer this residential care which is intensely ageist in its assumptions about what matters to frail older people and how they want to live.

So, are all providers bad? No. But they are all ageist.

Which leads to them running bad services. And they don’t know they are doing it. Strathalbyn aged care set out two years ago to explore what non-ageist residential care might be.

They assumed that older people are citizens like the rest of us and asked these citizens what they would want to change in their lives if they became frail. Basically, people didn’t want to change anything, and wanted care that enabled this. They discovered that people don’t fear their frailty so much as they fear what they know aged care will do to them. They don’t fear being old so much as they fear the impacts of ageism.

The Royal Commission did observe ageism in aged care and stated that we can’t fix aged care without addressing it. So serious is this that they recommended, and Government has accepted, that the rights of older citizens should be explicit in law.

So, this would make it illegal to subject any citizen to the ageist aged care currently on offer from all providers. This is very good news, but law on its own has always struggled to change community attitudes when it comes to vulnerable people.

So, what else could we do to back this up? The answer might look like just keeping everybody out of residential care. But home care is run by the same providers. So, most likely they will make the same assumptions about their home care clients and set up services based on this.

Client experiences are already showing that we’re well down the track to turning peoples’ own homes into 'nursing homes for one'. What we really need is for ageism to be confronted in the whole of Australian society so that older people don’t present to aged care with diminished lives in the first place.

The 'Every Age Counts' research shows that Australians do know about ageism, but don’t think it’s serious. Which is why, like all 'isms', this confronting has got to engage older leaders (elders) themselves, who know it’s serious. The recent National Seniors survey shows elders are stridently up for this. And here lies the opportunity (and duty) for aged care providers in their community leadership role.

To partner with older people to co-invent and provide non-ageist care, using this to engage the whole community in a conversation about ageism. Government could play a role here in opening up this conversation, aligning with their moral and soon to be legal obligation to ensure that the care they pay providers to deliver is not ageist. As the UN report tells us, ageism is a global problem in all of the developed world and sadly growing in the developing nations.

Nowhere is anyone transforming aged care by confronting ageism, which is why our global search for excellence and innovation in aged care always disappoints.

And here lies the opportunity of a lifetime. An Australian aged care system that confronts ageism, and pays good people to do good things, would be a global exemplar and highly exportable.

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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