Pearls and Irritations

There is an obvious conflict of interests in any care industry where profits have to be made and returned to shareholders, rather than ploughed back into better care. Profit is never a good incentive for the common good. It’s easier to cut back on staff, food quality, proper supervision and social activity for those in care, while ramping up schemes that confuse people about entry and exit costs in aged care homes and deny families peace of mind and financial justice. Lack of enforcement of proper standards means the providers too often get away with it. 

The recently revealed scandalous treatment of older people in both retirement living and aged care calls for a serious rethinking of the aged care system as a whole.

Although many people believe that all “old” people live in nursing homes, in Australia only 7.8% (270,559) people over 65 are actually in residential aged care. Another 7% (184,000) are living in retirement villages. Because we are living longer and have a healthier lifestyle, the years of disability-free living have increased by 5 years and most people are not in need of institutional care until the last few years of their life.  But if they need care and support as they get older, a rich country like Australia should be able to provide the highest quality end of life experience. There should be no opportunity for rip off schemes in retirement villages or neglect and cruelty such as that reported by Michael Blanchard in The Age.

The 7.1 million Australians already in the age group 50-75 (middle age, rising to 9 million by 2031) will demand a better deal as they get older and governments at every level will have to respond more carefully. So too will the 2.7 million (rising to 3.9 million) people aged 65-79. They’ll want something very different. Moreover, this middle-ageing group is used to getting what they want, not just what others decide for them. They are well educated, healthy and productive. So in planning for old age they won’t want a paternalistic system of aged care. They’ll demand a system of flexible, adaptable support as they shift from fully independent living to wanting help tailored to their particular needs.

Aged care in Australia is heavily subsidised by government and recent reforms actively encourage a free market model   This free market model has the advantage of empowering consumers as (at least in theory) it gives them a choice about care providers. The new consumer-driven aged care packages (Commonwealth Home Support) mean that an older person can pay for precisely what they want, not what someone else thinks they need. If you want to be driven to the shopping centre you can be, you don’t have to accept having your kitchen cleaned up, even if it needs to be. Loneliness is the biggest killer and companionship, having someone to listen to you (not necessarily even to have an equal conversation with) may be more important than being helped in the shower. People can now tailor their own package and dismiss carers with whom they have no rapport. The problem is where there is no choice, as in rural areas, or where the older person and their family is not able to make an informed choice due to cognitive decline, lack of literacy or exposure to rip off schemes. After all, you are not likely to look for aged care until you need it due to significant physical or mental decline.

There is also an obvious conflict of interests in any care industry where profits have to be made and returned to shareholders, rather than ploughed back into better care. Profit is never a good incentive for the common good. It’s easier to cut back on staff, food quality, proper supervision and social activity for those in care, while ramping up schemes that confuse people about entry and exit costs in aged care homes and deny families peace of mind and financial justice. Lack of enforcement of proper standards means the providers too often get away with it.

But the free market model also encourages competition and the clever disrupters are already showing the big players that outdated assumptions and shoddy practices will not be profitable in the future.  There are some inspiring international examples. The Intergenerational learning centre in Seattle (built 1991) combines pre-school care with aged care, with 125 children (ages 0 – 5) and 400+ aged residents. Numerous studies have linked social interaction with decreased loneliness, delayed mental decline, lower blood pressure and reduced risk of disease and death in elders. Socializing across generations has also been shown to increase the amount of smiling and conversation among older adults. As well as reductions in ageism with younger generations.

Dutch nursing homes are offering free accommodation to university students in return for acting as a neighbour for aged care residents in their 80s and 90s. Students teach skills in technology, and have social time with residents. The program reaches over 500 aged care residents and helps reduce the effects of loneliness, improves social skills, technological skills, improved levels of happiness through familiarity, increased recollection of past memories through such things as poetry.

Ageing in place is the current name of the game, but we could go further. There is room for new forms of inter-generational aged care homes, where young and old share accommodation, either in a purpose-built complex such as those above or as with the HomeShare program which carefully matches up older people living alone with young students in need of cheap housing in return for help around the house and garden, or with other chores. The results are positive for both the older person and their younger companions.

The essential quality of a good carer is an ability to communicate and empathise with the person in their care. So, poor English language skills or a purely instrumental attitude will not suffice. Nor will an English-speaking carer do for an Italian or Chinese older person. It will have to be horses for courses, and all care training courses must emphasise the personal relationship side of caring. Middle-aged people in search of a meaningful but not full-time job may well have more appropriate life experience and emotional intelligence than young trainees.

Given that most aged care is already carried out by family members, media stirring about intergenerational conflict doesn’t help. The aged have contributed to society, helped their offspring and grandchildren through a lifetime. The middle-aged are supporting their millennial adult children as well as their ageing parents. That intergenerational exchange is a guide to better policies in all aspects of aged care, even once the few who may need it move out of the family home into institutional care.

Dr Patricia Edgar and Dr Don Edgar are sociologists and Ambassadors for the National Ageing Research Institute.

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