As a surgeon, I have cared for many elderly patients  but I have no direct experience of aged care outside hospitals.  So I need to explain why I have the temerity to criticise what those with vast amounts of experience are doing and tell them what I think they should be doing.  

My experience over a long life is that those looking in from outside can often see what is happening much more clearly than those directly involved.  But they can also get the wrong impression when there is insufficient information available.

It is very important that outsiders who see problems speak up but this must be followed by a dialogue between those inside the system and those outside it.   Those inside must carefully consider what their critics are saying and if they don’t accept that view they must be able to explain and justify their reasons for this.   If the issues raised are serious and remain unresolved then accurate data must be collected by a third party to resolve the matter.

My experience is that too often those inside the system are dedicated and believe implicitly in what they are doing.  They reject the criticisms, get angry and then demonise their critics. The more likely that they are wrong, the more likely that they will do this. What Aged Care Crisis is trying to do is to create a forum within which these issues can be debated and in which policy, practices and failures can be debated without anger and acrimony.

My other reason for writing at this time is that I am getting old myself and am looking critically at what the future might hold for me.  I don’t like what I see.  I have the experience and feel that I have a social responsibility to speak out and explain why.

In summary

I have worked in three different countries with different health systems.  I have worked in private hospitals, university hospitals and in private practice.  I have known about dysfunction in health care in the USA since the 1960s and watched similar problems developing elsewhere.  I have a wide and direct experience of dysfunctional social systems and the people who believe in them.

I have experienced the pluses and minuses of different political and medical systems and seen how communities and the professions respond to these.  I have studied social sciences with an interest in understanding what was happening in these situations.  I have studied and written about and been an activist in both health and aged care.  I feel I am well qualified to criticise and raise issues that are relevant and need careful consideration.

There is an urgent need for the community to debate issues and to be involved in what is happening.  They need independently collected and accurate information if they are to participate effectively.  ACC is trying to initiate this process and this is my contribution.

My background

I grew up in a minority English community in a country town in South Africa in the 1930s where my father was a doctor.  Our view of the world was a paternalistic colonialist one.  During this period, the much larger non-English white community became increasingly fascist adopting a pro-Nazi, anti-Semitic and anti-British position.  The country was soon at war with Nazi Germany and we were confronted by the horrors of the holocaust.  After the war my family moved to a city.  The country entered the apartheid era.

I trained in medicine in South Africa and then specialised in surgery in England working in the NHS.  I returned to South Africa.  There I became interested in what was happening around me as well as in the outside world.  It puzzled me that vast numbers of obviously good, decent and intelligent people could adopt a belief system that quite obviously harmed others --- sometimes, as in Germany, Russia and China, resulting in millions of deaths.  Yet these people seemed blind to the consequences for others. 

I was also puzzled at the way some doctors in these systems abandoned their ethical responsibility to their patients in order to serve these ideologies.  Under apartheid, many of these things were happening around me on a daily basis and I knew many obviously decent people who were supporting this.

This led me to study social sciences.  I became interested in frames of analysis that had developed in socialogy during the previous few years.  They offered ways of understanding how these harmful belief systems became so important for believers that they simply could not see the consequences for others.  They had no doubts and would get angry, reject criticisms and demonise their critics labelling them as communist.  Since that time, those general frames of analysis have become a sub-discipline called the Sociology of Knowledge.  It has influenced communication theory, which I studied, and also education.  

Although I have not followed the further development of these ideas in depth, they have influenced the way I have addressed social issues.  I do not see the people themselves as primarily responsible but the patterns of thinking that are a critical component of failed systems are revealed in what they say and do.  To study them, we need to look at what is said by and about individuals, and study the things they do.

I emigrated to Australia with my family in 1997 and because of my interest in teaching (and the use of technology) I joined the University of Queensland where I worked until my retirement in 1997.

Dissenting views

Health Care: An unhappy encounter with a large corporate run international US hospital at the end of the 1980s turned me into a whistleblower.  When I found that the problems were industry wide and country wide in the USA I studied the sector then became a dissenting voice opposing the corporatisation of medicine in Australia.   

I like to flatter myself that my efforts and the Corporate Medicine Information web site I started in 1996 contributed to four of the largest US multinationals, who either entered Australia or planned to do so, leaving the country or abandoning their plans.   

The medical profession, whom I supplied with information, were also active.  In the 1990s they successfully scuttled many government plans.  They put one big Australian company out of the hospital business.  This clearly establishing the sort of conduct that would be acceptable in Australian hospitals.  As a consequence, we have so far escaped the full consequences of corporatisation and not followed the US path.  The battle in health care is ongoing.

Aged Care: There have been major problems in the corporatisation of aged care in both the USA and the UK.  I have written about those in the USA on my Corporate Medicine web site.  Over the years I have made submissions to inquiries in Australia and challenged government policy.   More recently I have worked more closely with Aged Care Crisis.

Australia has been slower in corporatising aged care than these countries but that is now changing rapidly. The Abbott/Turnbull government is driving that process.

Aged Care Crisis (ACC)

Those of us who support and work with ACC come from different disciplines and different perspectives.  We have different understandings of what is happening in aged care and see different solutions.  The views I am expressing are my own and not necessarily shared by everyone else.

We all share the view that there is a crisis in aged care, that the system is not working, that Australia is not collecting the information we need to evaluate what is happening in aged care, and that as a community we need to debate these problems urgently and develop strategies to address them.

The Solving Aged Care section of this web site aims to open up a discussion in the community where issues can be analysed and debated and where the community’s understanding and analysis of aged care can be nourished and grow. 

We do not want to exclude the industry, but we want them to confront our views and debate them with us within the context of our concerns and not theirs - a context where our voice dominates, is credible and cannot be ignored or discounted.  We also want our voices to be heard nationally and eventually have community representatives appointed to aged care bodies.

My contribution: I am contributing to this debate by writing two sets of complementary web pages.  

I am opening the debate by writing these pages for Aged Care Crisis and their website. The analysis of the problems in aged care in Part 5 is brief and the focus in Parts 2 to 4 is on what we can do to solve aged care.  It also looks at what is happening in other countries, what others are saying about aged care and about the weaknesses in our political system.  The focus is on solutions.   This site is directed to a general audience.

I am extending and deepening that debate by writing a second set of web pages on another website of my own (Inside Aged Care).  Here I examine what is happening in aged care in much greater depth using several different perspectives.  I illustrate what is happening by using many examples and with quotes from publicly available material.  I indicate how the proposals I am making  would work to counter the problems.  It is an in-depth analysis underpinning the proposals. 

The pages on Inside Aged Care are intended for those with a deeper academic interest wanting to look more deeply at the social processes or whose interest has been aroused by the ACC pages.  Those wanting to criticise my analysis and comments in Part 5 may need to explore my website and the examples given there before doing so.

Both web sites seek criticism and comment.  Both will put up proposals, arguments and criticisms from others that further the debate.  The intent is to engage and to get people talking about aged care.  Life expectancy is increasing rapidly and almost all of us will be old one day.  What happens in aged care will affect every one of us.


#4 Michael 2017-07-29 10:34
Andrea. My apologies for delay in responding to your post. We know that these things are happening and far too often. Politicians as you say are not doing anything and it is going to be up to us as a caring community to band together and do something about it. That is what this web site is suggesting.
The Australian Law Reform Commission recently completed their review into elder abuse and specifically into issues like this. They would have liked to hear your story. But don't hold your breath that government will act.
#3 Andrea 2017-06-09 15:13
I would just like to highlight that my Mother was placed in an aged care facility by her estranged daughter who did not have any Power or Enduring Power of Attorney. In fact my Sister did not have any legal authority at the time. As a result of this debacle, my Sister offered to pay an amount of money for the bond that was never freely available which only resulted in complete hardship for me.

Until the bond was paid, Mum's savings were being eroded away by almost $60.00 per day in interest as well as paying a means tested fee of over $11.00 per day.

After Mum was placed into the facility, a Guardianship Hearing took place and the NSW Trustees did not take any action in view of the fact that matters were not done legally. If the NSW Trustees cannot uphold the law, then what hope is there for a War Widow with dementia?

We need laws to protect our most vulnerable members of the community and until all levels of Government step up and take responsibility, these problems will never be resolved.

Very angry and disappointed.
#2 Michael Wynne 2015-11-21 17:41
Thank you for insightful comment Tania. I think aged care is another example of a service where it is difficult for motivated doctors to provide the sort of good care they are comfortable with and they go elsewhere. The vacuum is filled by those prepared to cut corners and make money by taking on more work than they can do.

Most older Australians would probably like to continue with their own trusted doctor provided they had the interest, skills and the time, were close enough and had geriatric support. My impression is that it seldom works out that way so that a more dedicated and better trained staffing system for aged care facilities would be preferable.

The differing views of gerontologists and GPs on the issues you raise are addressed in Part 4, on the page "Different Viewpoints" - in the slider "Australian Medical Opinion" Both issues would be a prime concern for the proposed hub. It would be well placed to address it.

I favour your view but, as an outsider I do not have the experience to contribute strongly to the debate myself. If you would Like to make a comment in Part 4 or if you prefer contribute a page setting out the issues from your perspective and suggesting changes I will invite those involved to contribute and develop a discussion on this important issue.
#1 Tania 2015-11-16 13:47
Michael, you have some great ideas. What I found with my mother is that the medical care available was one of the main problems. The fact is that most people who enter aged care have to change their doctors. I hate to say it but the two visiting GPs my mother saw seemed more interested in seeing as many people in as short amount of time to maximise their income from nursing home visits. Medicare rebates roughly amount to $200 an hour if they see four patients assuming 15 minutes per patient for a Level B, which is not a bad income, but I suspect the ones who treated my mother try to fit this in a much shorter time. Do you think that advanced training in geriatric medicine should be mandatory for GPs treating over the over 75s and should there be some appropriate increase in remuneration. The problem becomes however that the current medicare rebates is not sufficient to attract high quality GPs, and what happens is that there is cost shifting to the states when these elderly people end up in hospital due to poor medical treatment. Not sure how to solve that one.