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


#5 Michael Wynne 2015-11-30 13:06
Great to have someone in the industry looking at the problems so many are experiencing and then developing solutions. I hope you will find time to make a summary for the Contributions page in our solving aged care section and put references or links there so that those of us who are interested can follow up on it.
#4 Tuly 2015-11-28 23:28
oh and by the way I think it is worthwhile noting that since 2007 things have changed considerably. The demographics are more compelling than ever ... and they are only increasingly so. The economics are similarly compelling. The productivity reports of several years ago clearly point to the need to do things differently. We need a new paradigm so that we can respond. Throwing more resources at an old and ineffective system will not achieve the results we need.
#3 Tuly 2015-11-28 23:23
Thanks for your return comments. I have bene in the 'industry' for some time (probably over 30 years now) and it is clear that older people are not gaining sufficient benefit from what we have learned. Much activity and money has resulted in not as much benefit for older people as should have occurred by now. The proliferation of residential care and care services hasn't matched what older people often want and need. Indeed those who most need services receive the misdirected services or miss out altogether. The result is to fall into emergency departments or nursing home care usually in crisis. We need to do more to preempt crises and plan care while at the same time give older people and their carers the right information with which to make better and more informed choices. I have been working on systems to do this for some time and I believe have designed a number of sustainable and affordable solutions. Certainly more affordable than piling money into a residential care system in which many (most?) older people don't want to be in.
#2 Michael Wynne 2015-11-28 22:36
Lynda wrote this in 2007 after she started ACC and as you note it has not changed. I argue that the main reason for this is that politicians and the market are trapped in a political dead end. The political pressures and policy commitments prevent them from even considering the things that need to be done –a situation known as “paradigm paralysis. They are not going to do anything until they are forced to.

There is much more about this in the section Solving Aged Care where we are asking the community to come up with solutions and then, if enough of us can agree, we can press for them to be implemented.

That section explores all these issues, proposes a possible solution to start people debating and then goes on to look at what is happening in politics and in other countries. It looks at multiple issues and at innovative ideas in Australia and overseas. This is to encourage people to reflect and come up with ideas.

Have a look, see what makes sense for you, make some comments or even submit a page indicating how you think this can be sorted out. If you agree with proposals, please indicate that so that we know what you are thinking. Simply complaining is not working. . We are looking for a consensus on something that will work - something specific that we can press for.
#1 Tuly Rosenfeld 2015-11-28 14:39
It seems so clear what is happening and continues to do so. Most people I speak to have one or more "horror strorise" or personal experiences that show how difficult it is to navigate the health care system if you are frail or old or a carer or all of the above. So if it is so well known and most people agree it's happening why are the solutions so elusive.