There is no simple fix to residential aged care

Apr 11, 2024
Aged Care Worker

Aged care staff are unhappy and many older people in residential aged care are unhappy. Certainly, the NSW Health Minister and the hospitals are unhappy because there are 600 people sitting in acute hospital beds who could be in aged care facilities.

Unfortunately, there are no appropriate places for them as their problems and behaviours are too difficult.

More staff, better pay and increased training will help but not solve the problem. To solve the problem, we have to understand the nature of the problems and how the current situation came about.

When I commenced in geriatric medicine in the mid-eighties, we had nursing homes and hostels. Nursing homes were for people with dementia but no major behavioural problems and those with physical health problems requiring extensive nursing care. Hostels were for ambulant people who did not wish to live alone or had no alternative accommodation.

Older people with dementia and difficult behaviours were in long-stay government facilities while older people with mental health problems and intellectual disability were in long-stay hospitals.

Changes to aged care payments forced the closure of hostels, leaving residential aged care facilities to manage both low and high care residents. Ageing in place was the new ideology but fewer low care residents were admitted. The environment and staffing were designed for the original nursing home clients.

Neoliberal economics and NSW Government cutbacks forced the closure of the long-stay facilities. This was a saving to the State Government as the residents of these facilities were pushed into aged care at the expense of the Commonwealth.

At the same time, State governments had not built homes for younger people with traumatic brain injuries and other severe illnesses despite specific funding from the Commonwealth. So, these people were also forced into residential aged care.

Suddenly, residential aged care facilities, designed and staffed for a different client group, were now expected to care for people with dementia and an entire range of difficult behaviours, people with chronic mental health problems and older people with intellectual disability as well as younger people with traumatic brain injury.

Some of these people are among the most complex problems facing the health system. They include younger people with fronto-temporal dementia and challenging behaviours; bariatric patients with multiple physical and psychological health issues; and people with delirium requiring assessment with appropriate expertise and technology.

It is little wonder that acute care beds are occupied by older people who do not need acute care. Once admitted to the acute hospital, the aged care facilities understandably are reluctant to have them back.

Repeated entreaties to the NSW Government to build units to assess and manage people with dementia and difficult behaviours have been ignored. Even the demographic warnings of a rapidly ageing population did not concentrate the minds of planners.

If the industry is to be fixed and meet the needs of the next generation of older people, we need to go back to first principles and define the purpose of the industry. Only then can we decide what sort of facilities to build, the environmental needs and the staffing required. Until this work is done, band aid solutions will achieve little.

Aged care is a Commonwealth responsibility despite the causes of the current crisis being largely due to planning errors by States. One hopes both levels of Government can put this behind them and work together towards a solution that will meet the needs of the rapidly growing older population.

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