Excerpt: Submission - Review of the Aged Care Complaints Investigation Scheme, Dr J.M. Wynne (Section 9, Appendix, Page 31 )
From semantics to doctors
The aged care "reforms" introduced in 1997 introduced a whole new range of words and concepts. These enabled a more impersonal and analytical approach. Parallels could be drawn with other activities and services. Aged care could be positioned in a broader context and its particular attributes ignored. At the same time a number of terms that were more accurate in describing the predicament of the aged had acquired connotations that were seen as depersonalising, medicalising, paternalistic or to reflect ageism. They were dropped.
Distorting real situations
One consequence of these changes has been the (probably unconscious) use of linguistic strategies to remove the legitimacy of the community model. Words with associative meanings that bring out the unique and important humanitarian characteristics of the sector have been replaced with words without specific associations other than those common in commercial enterprises. The unique emotional content intrinsic to the sector has been removed.
Emotional content and humanitarianism has been replaced by broad promotional feel good phrases suitable for public relations.
Aged care has been turned into a commodity that sits comfortably within the market paradigm.
Nursing homes become residential facilities, nursing and medical care becomes a service, and patients become residents.
The good English word "quality" has been overused and misused, when there were better alternatives, because of its positive associated meanings. Any document liberally peppered with "quality" and other positive sounding words favoured by public relation efforts raises the suspicions of cynics about its veracity and of the motives behind it. Broad words such as customer and consumer similarly remove defining characteristics.
More and more TV savvy members of the community are becoming cynics and distrustful of what they perceive as marketing. Red flags go up.
The use of words in this way results in category errors, so that strategies that may be generally applicable to some broad categories are applied to subcategories where the necessary conditions (uniqueness) makes them inapplicable. Aged care has suffered.
Where are the doctors?
In the myriad press reports about failures in care, whether it be paraffin baths, gastroenteritis, gangrenous legs, wrong medication, or missed injuries, there is never any mention of the doctors who should have been there.
They are responsible for diagnosis and care, as well as raising the roof when they are not called in time and when their patients do not get the care that they need. These patients have illnesses and it is their responsibility.
A World Health Organisation Directive imposes an ethical duty on doctors to act when they are aware of situations that place the lives and well being of citizens at risk.
It is exceptional for any of the press reports of adverse events and inappropriate responses to document the involvement of doctors or hold them responsible.
Embracing ideas and words
The problem is not only that the words and ideas expressed project a false image, but that participants in the care process are more prone than anyone else to embrace the words, the ideas and the positive implications. The feel good impact on self realization is very seductive.
This distorts their perceptions and the way they behave. They often simply do not see what is happening.
They are more shocked than anyone else when the house of cards collapses, and they are blamed for what they had come to believe was desirable.
My experience in meeting with the Complaints Scheme causes me to suspect that this may be so.
The vast majority of the occupants of nursing homes do require "nursing", and often highly skilled nursing. The nursing home becomes their "home" and not a facility.
If they are to have a life with sufficient meaning to justify existence then it is critical that they experience it as a "home" with all the emotional bonds that develop there.
Like any other citizens, these "occupants" require "services", but they differ in being frail and vulnerable and in requiring "care". The vast majority of "residents" have illnesses and require ongoing medical care so are "patients".
In our society the word "patient" now has association with medical paternalism, but without a word that adequately reflects the vulnerability and dependence of the elderly, its abandonment has serious consequences.
This juggling with words is well intentioned and an attempt not to stigmatise the elderly and display our ageism. They might approve themselves. Canadian John Ralston Saul has stressed that language is the way that we grasp the real world. He decries the trend to use words to distort and hide the real world in order to escape it, to support ideology, or to distort it for any other purpose. He gives many examples. He calls this being unconscious and that is what has happened to our community in regard to aged care.
The linguistic gymnastics serve to insulate politicians, bureaucrats, businessmen, and even those providing care in nursing homes from the real needs and anguish of the frail elderly. Empathic care and quality of life become the victims.
The same processes sanitize and dehumanise the real lives and problems of the aged for the community by positioning them within comfortable concepts and clothing them in neutral words. The way in which commonly used euphemisms serve to hide the real horror of dying is now well recognized but this insight is not applied to ageing. The community ceases to act as a caring, compassionate and supporting entity - avoiding the discomfort that would ensue.
Demedicalising the ageing process has accentuated the flight of doctors from nursing homes and undervalued their important role there. It is more tedious for them, more time consuming, they are not seen as needed by staff or community and receive little credit or reward.
The elderly are among the most taxing and difficult medical problems yet this is now left to nurses.
Some nurses who may have received complex training and the ability to handle complex nursing problems may believe, like the current minister for health, that they can act as doctors. The training is quite different. The consequence is only too apparent in nursing homes.