Just this last week, the Vice-Chancellor of Monash University, Richard Larkins, told a conference of the Royal Australasian College of Physicians that health care was being wasted on prolonging the lives of old Australians at the expense of people who sometimes died on hospital waiting lists. Now there's one for the ethicists. When exactly does an individual reach the age that good health care can be considered to be a waste of time and space?...

Vice-Chancellor Larkins goes on to explain, "Old people suffering likely terminal events in nursing homes should not be returned to intensive care units in acute hospitals if their quality of life is already low and their chance of a productive and rewarding future is close to zero."

Now this columnist, not being a member of the Royal Australasian Society of Physicians, did not hear the full address and, in any case, gives full marks to Richard Larkins for opening a long overdue debate on how best to use scarce health resources. And, if what he really meant is that top notch health care should be provided within the nursing home itself, then I am with him all the way.

How sick and tired I am of seeing frail old people bundled off to hospital wards every time there is either a major or minor crisis for which the nursing home does not want to take responsibility. Being transported back and forth from aged-care home to hospital doesn't do anyone any good – least of all the patient. And I, too, do not want frail older people spending their last days in acute hospital beds where treatment is often not appropriate for their age and condition.

But I wonder if Vice-Chancellor Larkins is aware of the appalling staffing arrangements in most of our aged-care facilities?

Low staff/resident ratios, dependence on a low-skilled workforce, the use of agency staff unfamiliar with residents and few registered nurses on deck hardly makes for excellence in health care.

Add to that the increasing difficulty of obtaining the services of medical practitioners, ready and willing to attend aged-care facilities in emergencies, as well as on a regular basis. So perhaps we should address some of those issues – before we close off the hospital option for frail older people.

Now let us consider the 'chance of a productive and rewarding future close to zero' statement. That really is something. A culling of the unproductive in the aged-care homes? We could certainly reduce the health budget if we follow that line:

• Who is going to decide exactly which older person's life is unproductive?
• How many people living in high-care facilities would actually consider their lives 'productive and rewarding'?
• And does this mean that they would reject further health care treatment?
• Should this criterion of 'unproductiveness' also apply to others within our community - those with intellectual and psychiatric disabilities, for example?

Some time ago, a leading Victorian health service decided to forgo life-saving health-care procedures for an older woman who was suffering dementia. The family did not agree with this decision and took the issue to the media. Hospital staff went to air stating that, because the woman lacked cognitive capacity, the treatment was not warranted. The controversy that followed was significant and the hospital back-tracked.

Instead of devaluing people at the end of the life journey, perhaps we should acknowledge being old as an intrinsic part of the human experience – even a time when it is OK not to be 'productive'! Then, maybe, we could get on with the business of providing quality care in the situation which is best for the individual involved. Maybe it might be hospital care. More likely it would be to remain at home or within the aged-care facility that has become home. But wherever it is, we should do it properly.