The care economy: Ageing is not a disease – who knew?Nov 13, 2023
Becoming an Elder in many societies is a process of active shared engagement across the generations, and holding a meaningful and honoured place in one’s community. Sadly, that time-honoured community cultural process has been pretty much eradicated in modern westernised, market-driven systems of ‘Aged Care,’ such as dominate the Australian ‘market.’
No wonder so many people love watching the reality TV series “Old people’s home for four year olds, and for teenagers.” It looks such fun, and so loving in the cross-generational interactions.
But that is not the reality in far too many of our aged care facilities and home care services. The multiple Royal Commissions into Aged Care have uncovered horror stories of neglect, cost-cutting, profiteering and outright abuse. Welcome to the sharp end of the Care Economy.
While we can hope that genuine reform will be implemented across ‘the aged care sector’ as a result of the recommendations of the last Royal Commission, it’s the very fact that we’re all used to identifying it as ‘a sector’ that is at the heart of the problem.
‘The Sector’ has been detached from the rest of society, and its ‘Consumers and Carers’ are left there in an isolated battle with ‘the System,’ that has so many rules, checks and balances it becomes overwhelming.
That’s after these poor people have had to enter the massive challenge of finding their way through ‘the My Aged Care’ website. An IQ Test even for IT-savvy young people, let alone ‘old codgers’ used to pen and paper.
All of this can be traced back to two causes – the Medicalisation of ageing, and the Market Economy framing of how Elders are ‘cared for.’
The Clinical Medical Model dominates all Health and Human Services in Australia. It is an expert-driven one-size-fits-all way to atomise, cost, package, monitor and measure the delivery of units of care. It has nothing to do with honouring people, their relationships with each other and their communities, or their sense of Identity and Purpose in the world.
Elders become recipients of units of care, which get ticked off a list, and the machine moves on to its next function. Meanwhile the elders are left feeling useless, a burden, and increasingly detached from any reason ‘to be’ in our world. And their carers feel guilty that they can’t create a more meaningful and satisfying way for their loved ones to enjoy life.
On top of all of that stress-creating market machinery comes the modern nightmare of Compliance and Accreditation, which is meant to justify the free market approach by ensuring it is ‘Quality Controlled.’ But in reality it actually magnifies all the problems inherent in this dehumanised process, while satisfying the bean counters. Echoes of the BBC’s famous TV series ‘Yes Minister’ episode, where the perfect hospital was found to be running without a hitch – but that was because it had no patients.
Neoliberal, economic rationalist logic says these mechanisms ensure ‘Efficiency and Effectiveness.’ They do not. They create heavy burdens on staff, managers and the clients to serve the interests of the ‘Reporting Upwards System,’ to keep getting approved for funding. It’s ‘busy work’ that replaces real human interactions and the sort of care that shows up in ways not connected with keeping people fed, bathed, medicated and toileted, and marking that all off on an iPad checklist.
This treadmill looks like it’s only going to get worse in the combined response to the horrors exposed by the Royal Commission, and the market-serving values woven throughout the Government’s Care Economy design framework.
What needs to happen to prevent such a nightmare outcome is for communities to engage with their elders and design processes that reclaim their role as contributors to the Common Good.
Having an Identity and Purpose is what those of us who are ageing want. Not being processed like chickens in a poultry factory.
And to be able to achieve that sort of cultural change, there has to be a Lived Experience re-balancing of the scales in management of ‘the sector.’ So that Communities, Consumers and Carers are key decision makers in the Planning, Design, Delivery and Ongoing Assessment of the next era in Aged Care.
The current focus on Disinformation, that has been highlighted by the media’s lack of truthful and critical reporting of the Voice Referendum, is very pertinent to what is needed in reform of Aged Care.
Whatever ends up being proposed as ‘Solutions’ need to be tested against the combined ‘pub test’ and Community Common Sense informed by the Common Good.
Otherwise we will end up back in the same place. Having been diddled by another ‘Impression Management’ exercise, such as Groucho Marx famously described:
“Honesty and Fair Dealing! That’s what people want!… If we can fake that we can make a million!”