Australia's tsunami of the aged

Today in Australia, many elderly people are being moved out of their homes into aged care facilities. With 14.7% of Australia's population over the age of 65, which is expected to be 24% by 2056, a crisis in aged care is occurring, as life expectancies are at an all time high. Australia has one of the highest elderly dependency ratios in the world at 21.5%, which brings up a multitude of issues relating to the principals behind palliative care, patient rights, and the right to be released from pain and suffering. There is such a wide spectrum of elderly with different needs, ranging from people who are just naturally aging, to those in need of high levels of palliative care due to physical and/or mental disabilities, the situation is extremely complex and requires multiple approaches. The issue of aged care also has mammoth economic and fiscal consequences, and such a discussion also requires a frank and honest examination of Australian social values in relation to aging.

Aged care was largely ignored as an issue in the last federal election. Without being somehow exposed to the aged care system, it is very easy to dismiss the issue as something unimportant and of little direct concern.

However nothing could be further from the truth from both human and socio-economic perspectives.

An ABC Lateline report by Margot O'Neil after a one year investigation, aired mid last year, found that many residents were left for long periods of time in faeces and urine, were dehydrated, subject to arbitrary and oppressive practices like restrictive diets, verbal abuse and rough treatment, had inadequate pain relief, and even suffered from undiagnosed bone fractures and infections from falls. Many suffer bedsores from not being properly dried, which causes great pain. In addition, 20-50% of residents in aged care facilities were undernourished. There are not enough doctors around Australia to call on all residents, where doctors are reluctant to take on new residents as patients.

According to Margot O'Neil, Palliative Care Australia claims that only one in five residents receive adequate palliative care, where powerful anti-psychotic medicines are used to both sedate and restrain residents. Up to 60% of residents in aged care facilities are on some type of anti-psychotic medicine.

Interviews with residents, family, and workers by the author confirmed this bleak picture of the human side of aged care. Antibiotics are so frequently used in some aged care facilities, that there is a great risk that many bacteria will become resistant to antibiotics, leading to the breeding of superbugs.

Boredom is the greatest problem for many. Some cannot accept they are in an aged care facility, and still believe their life should be as before. This often prompts family members to treat their parents like children and stop listening to them, especially when talking to their parent becomes like talking to a stranger. A number of residents have no visitors.

Many with dementia develop anger, and continually try to escape, while others mentally return to happier times in their lives, some even forgetting how to speak English, returning to their native tongue. 

More than 2250 residents in aged care facilities were allegedly assaulted during 2011-12. Many of these assaults against women were of a sexual nature. According to a Federal Government report these assaults are on the increase. Issues of sexuality for the elderly are almost completely ignored leading to some emotional problems with residents.

Even more astounding was the regularity of cover-ups in aged care facilities over assaults, neglect, and even deaths.

According to a palliative care worker interviewed, depression and fear can almost be "felt" within some aged care facilities where she has worked. She went on to say that "although there are some humorous aspects to the job, some residents would say each day, 'I hope I die today'." Many are embarrassed in the helpless predicament they find themselves in, where they rely on others to do simple things like go to the toilet. This leads to great depression, loss of self esteem, dignity, and will to live on.

According to the accounts of those who spoke to the author, some residents are just left to die by various means, particularly if there are no next of kin. One worker told the story of a lady who was in deep fear pleading to get out of the facility, when later on that night she passed away.

Many palliative care workers fear feeding incapacitated residents because of the risk a resident may choke, where legal consequences could make a worker responsible to some degree for negligence. Some residents as a consequence are left only to suck on a piece of ice and slowly starve to death.

There are almost 350,000 people involved in some way with aged care in Australia today. From the care worker point of view, great shortages of qualified staff exist. This is leading to high levels of stress on workers, and even bouts of depression in some. In many facilities the sheer number of residents and pressure on workers to complete their daily quota, leads to rough handling and neglect. This leads to 'burn-out' and worker turnovers as high as 90% in some facilities.

Care workers may be able to provide the physical care, but have little time or training to assist in looking after the psychological needs of residents. Personal care assistants (PCA) are not trained to detect any mental illness in residents. The certificate III in Aged Care from TAFE, the qualification PCAs are expected to have, primarily deals with bathing and handling of residents. There is only three 6 hour sessions on issues involving mental health and dementia within the course. Registered Nurses (RN) handle most of the medical issues in regards to residents, but due to much lower pay rates in aged care facilities verses hospitals, there are large shortages of these trained and experienced workers.

For the spouses and families of those requiring care in an aged facility, the process is also traumatic. The process signifies a change in relationship from being a spouse or children to becoming a guardian. This most often changes the dynamics of the relationship dramatically.

The process starts with a person undergoing an aged care assessment by the Aged Care Assessment Team (ACAT) (ACAS in Victoria) to determine what level of care the person requires.  The evaluation is based on a review of physical and mental competence, current family situation and/or ability to cope at home by themselves, needs, and medical history. A person may be then placed into a transition centre for up to 12 weeks so the resident's financial affairs can be arranged and a permanent aged care facility found by the spouse or family.

Aged care facility charged are in four basic parts. A capital component exists of a bond ranging between $300-1.5 Mil. lodged with the facility for the duration of the resident's stay, or the equivalent in interest paid. A daily charge of around $47 is levied for basic services with an additional means tested component paid, where the resident's assets are above $2 million. Finally families may also opt to pay up to $60 per day for extra services, with all charges subject to the GST. People with no assets or income will have the payments taken out of their pension. The house that the resident was living in prior to entry into the aged care facility is exempt from the means test for two years. However in many cases, families are forced to sell the house to lower the level of assets for means test purposes and use the funds for the bond.

The Department of Social Security through the VCAT recommendation basically controls the destiny of the person assessed as recommendations are binding and can only be challenged through going through an internal procedure, or if not satisfied the costly Administrative Appeals Tribunal. 

The legal situation can become very complex if the resident has made no power of attorney, doesn't have a will, or any next of kin. In such cases the resident will most probably become the ward of the state, where decisions about the future will be in the hands of a bureaucrat within the department of Social Security. Under such a scenario these people lose control over their assets and have very few rights being at almost total mercy of the state system, except for the potential intervention of an overworked and underfunded aged care advocacy service. People in this situation within an aged care facility have little recourse against any cruel and unjust practices and are generally left to suffer within the system.

This group constitute what could be called the 'forgotten Australians' languishing alone in aged care facilities, and dying by themselves. An aged care worker told the author that up to 10% of people in facilities fit this category.

The trauma in having a parent moved into an aged care facility also seems to bring out the ugly side in many families. Often family members cannot agree on what care arrangements should be made for the parent leading to bitter disagreements, and even costly court proceedings. In addition, many with the sudden authority over their parent's assets through an activated enduring power of attorney, often mismanage or inappropriately utilize the assets, leading in some cases to grave financial consequences. 

Australia's aged population is going to become an even greater burden on the economy in coming decades. This will decrease the size of the available workforce and tax base, while dramatically raising the number of people dependent on aged care. In addition, with the expected increase in the incidence of dementia within the Australian population, industry experts believe that between 500 to 1,000 new beds are required every month for the next 40 years, indicating that massive capital investment is required in this sector.

As a consequence the Australian economy will be hard pressed to grow sufficiently to compensate this large change in demographics. This is of particular importance where Australia's mineral boom is slowing down due to lower rates of Chinese economic growth. Without drastic structural changes to Australia's economy and radical policy changes, there will be chronic labor and skill shortages, and scarce public funding with many demands upon it over the next few decades.

This requires urgent public discussion and debate about social values, the human issues, and how aged care should be approached in the future under the above circumstances.

The Australian Government has responded to the aged care crisis by commissioning a host of inquiries over the last decade and a half, of which only snippets of the recommendations have been implemented.

Australiathe land of the young is a myth. Australia shares the reality as most of the post industrial societies do. The demographic of a rapidly aging population.

Yet the aged in Australia have little dignity. Instead, they live in fear that the end stage of their lives will be a painful one, where they have no control.

The aged are becoming Australia's new dispossessed. Politicians seem unwilling to discuss the important issues of palliative care and the right to die in dignity, preferring to let so many citizens go through painful and lonely deaths.

Society needs to take a stand against the loss of dignity and suffering, and allow the elderly take control of their own destinies and choice of palliative care, when it only keeps them alive in pain and a terrible state. The state must also see that no one suffers due to neglect.

The above requires attitudinal changes. However any debate on such issues is likely to lead to massive polarization in community views, and consequent lack of decision and action by government.

The aged lack the alternative of non-drug therapies, where drug administration supports the institutionalized factory environment most aged care facilities have developed. Financial resource allocations have been so utilitarian that relaxation therapies, meditation, personalized music therapy, group narrative sessions, and one-to-one counseling are considered marginally beneficial.

Funding will have to be orientated towards user-pays with some form of national aged care insurance, although it will be very expensive due to the large proportion of people over 65 and small population base. Family values will have to accommodate parents living at home and being cared for, following some successful European examples. Massive skilled migration will be needed to have sufficient workers in the aged care sector. More aged care facilities need to be built, especially in rural Australia, which is lagging behind urban the centres of Australia.

We know the problems, but are there any better solutions?

Governments of both persuasions have failed, now it's up to the community to start the debate. Successive Governments have listened too much to vested interests within the aged care industry, which has been plagued with scandals over the years.

If there are to be reforms, legislators must know the community is demanding them.

As elderly rights are being eroded with little safeguards, that are very expensive to exercise available, one must make a stand to prevent the aged care system becoming the 'brave new world' where people with 'expired use-by dates' are helplessly locked up in with no rights and dignity. Becoming aged now leads to dispossession in regards to the stripping of rights and property. The elderly can no longer be considered citizens with rights.

Putting people away to suffer hardship and pain is a form of torture. Civilization is judged upon how it treats its weakest members. Aged care has become people farming where a crop of people produce profits all year round for facility operators. Putting the aged into socially isolated people farms is a national disgrace of which all must take responsibility.