Let us put ourselves in the position of an 'average' nursing home resident. You are largely confined to a chair and/or a bed. The only way you can voice your needs is to press your buzzer (if you can reach it and it works) or to tell (if you can speak) those who come to your room to assist in toileting, bathing or dressing.
In some cases, these mostly well-meaning staff members have limited ability to understand or converse with you because English is not their, or perhaps your, first language.
In almost all cases they are under enormous pressure to finish with you as quickly as possible and move on to the next resident.
Who then can speak on your behalf with any authenticity? Very few people really. Being old and frail is a place where most of us have never been and many of us prefer not to think about.
Yet there are many who think that they can. But how well they do is another matter. Just look at the comment from Richard Gray, of Catholic Health Australia, and author of the following email about kerosene baths:
... I ask that you all raise a glass and toast the person who inspired us to form NACA, Bronwyn Bishop. Make sure there is no kerosene in the glass, that’s for the bath! ...
Source: 23 Feb 2012: "Let's raise a toast!" Aged Care leaders joke about kerosene baths
(By Sharona Coutts, Joel Tozer, The Global Mail)
In the same exchange, he then went on to claim:
"... The view I've always taken is that what's in the best interests of the consumers is in the best interests of the providers, ..." he says.
Really? The interests of providers and residents coincide? That would have to be a huge surprise for those families who question the dangerously low staff/resident ratios which occur in many homes. But such views do perhaps explain why providers are a formidable presence in most of the government-funded aged-care advocacy groups and the various government advisory groups? (There are nine representatives of providers on the current Ageing Consultative Committee.)
What about the well-known, government-funded advocacy groups for older people? Four of those are on the Ageing Consultative Committee. How well do they advocate for the aged and infirm? Let us take the 'Council of the Ageing' (COTA) for example. It does much good work promoting healthy living issues. But can we really expect an organisation that receives most of its funding from government to speak out fearlessly on the parlous state of aged care in this country?
When have we ever heard representatives of COTA calling for mandated minimum staff/resident ratios in nursing homes or speak out fulsomely about the often heartbreaking issues so commonly experienced by frail older people moving into residential care?
Can we then depend on the professionals who work in aged care to voice the feelings, needs and concerns of vulnerable older people? Not as much as we should! Too often problems and solutions are framed in ways consistent with their own careers. For example, bureaucrats working in aged care often have their own, and the government's, agenda as a priority.
Registered nurses in aged care are becoming fewer. They no longer have to be on site – only on call. It is hard for them to call for change when their jobs are on the line. Clinicians are finding it increasingly difficult to visit aged-care homes although some do speak out when they find that they cannot get the treatment they prescribe implemented. Other health professionals such as physiotherapists, occupational therapists and music therapists are few on the ground. Oral health is problematic.
That is not to say that there are not times where professionals and their peak bodies call for change on behalf of the very old.
We do know, for example, that Dr Clive Rogers and Dr Peter Foltyn, both consulting dentists, have told us of the terrible state of the teeth of many nursing home residents and the almost complete lack of dental care. Various submissions to the recent Productivity Commission Inquiry (Caring for Older Australians) came from general practitioners demanding better staff/resident ratios.
So who are authentic spokespersons for frail aged people? Perhaps more notice should be taken of residents and their families when they do speak out. The various reincarnations of the Aged Care Complaints Schemes have all failed in this. Time after time, we hear of families who believe that their complaints, along with evidence of neglect or abuse, have been disregarded. Sometimes investigators have not even spoken to them.
Then we could remove the fear of retribution which prevents people from speaking freely about their concerns. This is always a grave concern. Families fear for their relatives in care and staff fear dismissal. There is a great need for well-trained managers of homes who listen to families and encourage a working culture where speaking freely is acceptable.
Then we should all remember that, unless we drop dead early, we too might be one of those old men or women in a nursing home bed calling out for someone to help us.