Lynda Saltarelli is fighting for the human rights of older Australians in nursing homes. Her account, backed up by studies, shows that most families are ill-equipped when it comes to aged-care issues and mistreatment can easily occur - and regrettably often happens. Saltarelli outlines specific reforms that should be embraced in Australia. She argues that vulnerable older persons often lack capacity to act in their own best interest. Therefore, she says governments must erect 'solid perimeters' around the nursing care system.
SEVERAL years ago my father suffered a debilitating stroke and was admitted to hospital. No longer classified as needing acute care by the hospital, we were told that dad should be moved to a nursing home. The hospital began to pressure my emotionally and physically exhausted family to do the impossible and find him a bed.
Fourteen weeks after entering hospital, my father contracted bedsores and died as a result of septicaemia.
Our grief was unnecessarily prolonged by the circumstances in which my father died. I wondered how often my father's experience was being repeated around Australia. That's how I became an aged-care advocate.
My father's experience taught me just how ill-equipped most families are when it comes to aged-care issues, having to make tough decisions with little or no knowledge easily available. Our Government boasts about the "booming" economy, but many frail Australians live in totally unacceptable conditions. Not even reasonably wealthy baby boomers will be able to lobby for good aged-care when they themselves are frail.
A recent report by the Australian Institute of Health and Welfare highlights the fact that the age and number of residents requiring high-level care is increasing. The time when people make the greatest use of health and aged-care services is during the last two years of life — regardless of age.
There is evidence that residents of aged-care facilities regularly go without proper pain relief and palliative care. Failures include poor infection control, inadequate clinical care, failure to provide safe medication management, and inappropriate use of physical and chemical restraints.
A recent report For Their Sake - which surveyed staff from 371 nursing homes - was commissioned by the Aged Care Association Australia, following complaints from staff about poor hospital treatment.
It found nursing home residents suffered "severe weight loss" in hospitals because of "inappropriate food and food preparation", "no feeding assistance for people with a disability" and "no monitoring of food eaten or left by patients".
Some patients, who were previously without skin conditions, were returned to their nursing homes with skin tears, bed sores and bruising from rough handling.
On the other hand, hospital specialists openly report that they see residents admitted suffering from malnutrition. For example, Royal Perth Hospital aged-care services physician Roger Warne has said the "revolving door" of malnourished elderly patients was partly because of inadequate staffing and training in nursing homes.
Melbourne's Austin Health Hospital aged-care director, Michael Woodward, states "people were dying of malnutrition in nursing homes across Australia".
In aged care, people are generally unable to act in their own best interest. Therefore, we need solid perimeters built around the system - ones we know and trust and that do not short-change vulnerable people.
Little surprise, then, that residents and relatives are the ones most likely to expose deficiencies in aged care. They have neither business nor political interests at stake, and they suffer most when it fails. They are outraged by breaches in care when these reflect a failure to serve the community's values. Too often the bureaucratic complaints procedures fail and justice is denied.
The term "care" implies there is a person-to-person relationship between the carer and the one being cared for. There is a limit to how many people can be cared for at the same time, so at some point spreading care over more people reduces quality. This has a significant impact on our vulnerable in care.
The devil is certainly in the detail - political parties have yet to respond with policies that tackle many of the following unresolved issues in Australia's aged-care system:
Greater accountability for the treatment and care of older and frail citizens in aged-care facilities.
Many homes simply fail to employ enough staff to sufficiently feed, clean and care for the elderly.
Increase the level of transparency within the accreditation system for consumers - accreditation measures what providers say they do and not the standard of care they actually deliver.
Families often feel frustrated by their inability to obtain the latest reports from the Aged Care Standards and Accreditation Agency website when seeking aged-care placement for family. They can sometimes take months, with older reports no longer made available. (Older reports can also highlight repeat offenders - case in point, recently sanctioned and closed Belvedere Nursing Home.)
Spot checks should occur at varying hours of the day and night.
Fear of retribution is one of the biggest and unaddressed reasons for the failure of all the reinvented complaints schemes. Staff fear for their jobs, and relatives are reluctant to complain fearing the care of their loved ones may be compromised.
You can judge a society by how it treats its elderly. Health and aged care is a "social structure" — a system of ideas and people working for society. What it does and how it works is something that has been developed by people providing care and those receiving it. It is how a civil society works.
Politicians, the representatives of the people, have an interest in aged care and a responsibility to the community.
Our parents deserve better. Australia deserves better.
Lynda Saltarelli is an independent aged-care advocate.
Source: The Age, Opinion article by Lynda Saltarelli, 19 November, 2007