Although the focus on aging across Asia is on countries like Japan, Singapore and China, Australia, regarded as a land of the young, is aging as fast as any, and its care for its elderly approaches a national disgrace.
Today, many elderly people are being moved out of their homes into aged care facilities. With 14.7 percent of Australia’s population over the age of 65 and expected to rise to 24 percent by 2050, a crisis is occurring as life expectancies reach an all-time high. Australia has one of the highest elderly dependency ratios in the world at 21.5 percent, which brings up a multitude of issues relating to palliative care, patient rights and the right to be released from pain and suffering.
With a wide spectrum of needs, ranging from people who are aging naturally, to those in need of high levels of palliative care due to physical and/or mental disabilities, the situation is extremely complex. The issue of aged care also has mammoth economic and fiscal consequences.
Aged care was largely ignored as an issue in the recent federal election. Without being somehow exposed to the aged care system, it is very easy to dismiss the issue of little direct concern. However nothing could be further from the truth from both human and socio-economic perspectives.
An ABC Lateline report by Margot O'Neil after a year-long investigation, aired last year, found that many residents are left for long periods of time in their own feces and urine, are dehydrated, subjected to arbitrary and oppressive practices like restrictive diets, verbal abuse and rough treatment, have inadequate pain relief and even suffer from undiagnosed bone fractures and infections from falls. Many suffer bedsores from not being properly dried, which causes great pain.
In addition, 20-50 percent of residents in aged care facilities were undernourished. There are also not enough doctors around Australia to call on all residents and doctors are reluctant to take on new residents as patients.
According to O'Neil, Palliative Care Australia claims that only one in five residents receive adequate care, and that powerful anti-psychotic medicines are used to both sedate and restrain residents. Up to 60 percent of those in aged care facilities are on some type of anti-psychotic medicine.
Interviews with residents, family and workers confirm this bleak picture. Antibiotics are so frequently used in some aged care facilities that there is a great risk that bacteria will become resistant to antibiotics.
Boredom is the greatest problem for many. Some cannot accept they are in an aged care facility, and still believe their life should be as before. This often prompts family members to treat parents like children and stop listening to them, especially when talking becomes like talking to a stranger. Many residents have no visitors.
Many with dementia develop anger and continually try to escape, while others mentally return to happier times in their lives, some even forgetting how to speak English, returning to their native tongues.
More than 2,250 residents in aged care facilities were allegedly assaulted during 2011-12. Many of these assaults against women were of a sexual nature. According to a Federal Government report these assaults are on the increase. Issues of sexuality for the elderly are almost completely ignored, leading to emotional problems.
Even more astounding was the regularity of cover-ups in aged care facilities over assaults, neglect, and even deaths.
According to one palliative care worker, depression and fear can almost be "felt" within some aged care facilities where she has worked. She went on to say that "although there are some humorous aspects to the job, some residents would say each day, 'I hope I die today'." Many are embarrassed at their helpless predicaments, where they must rely on others to do simple things like go to the toilet. This leads to great depression, loss of self esteem, dignity, and will to live on.
According to the accounts of those who spoke to the author, some residents are just left to die by various means, particularly if there are no next of kin. One worker told the story of a woman who was in deep fear of dying, pleading to get out of the facility, when later on that night she passed away.
Many palliative care workers fear feeding incapacitated residents because of the risk a resident may choke, where legal consequences could make a worker responsible to some degree for negligence. Some residents as a consequence are left only to suck on a piece of ice and slowly starve to death.
There are almost 350,000 people involved in some way with aged care in Australia today. There are great shortages of qualified, leading to high levels of stress and even bouts of depression. In many facilities the sheer number of residents leads to rough handling and neglect. This leads to worker turnover as high as 90 percent in some facilities.
Care workers may be able to provide the physical care, but have little time or training to assist in looking after the psychological needs of residents. Personal care assistants (PCA) are not trained to detect any mental illness in residents. The certificate III in Aged Care from TAFE, the qualification PCAs are expected to have, primarily deals with bathing and handling of residents. There are only three 6-hour sessions on issues involving mental health and dementia within the course.
Registered Nurses handle most medical issues, but due to much lower pay rates in aged care facilities than hospitals, there are large shortages of these trained and experienced workers.
For families, the process is also traumatic and signifies a change in relationship from being a spouse or child to becoming a guardian. This most often changes the dynamics of the relationship dramatically.
The process starts with an aged care assessment by the Aged Care Assessment Team (ACAT) (ACAS in Victoria) to determine what level of care the person requires. The evaluation is based on a review of physical and mental competence, current family situation and/or ability to cope at home by themselves, needs and medical history. The patient may then be placed into a transition center for up to 12 weeks so that his or her financial affairs can be arranged and a permanent aged care facility found by the spouse or family.
People with no assets or income may have required payments taken out of their pensions. The home that the resident was living is exempt from the means test for two years. However in many cases, families are forced to sell houses to lower the level of assets for means test purposes.
The Department of Social Security basically controls the destiny of the person assessed as recommendations are binding and can only be challenged through going through an internal procedure, or if not satisfied the costly Administrative Appeals Tribunal.
The legal situation can become very complex if the resident has made no power of attorney, doesn't have a will or any next of kin. In such cases the resident will most probably become the ward of the state, where decisions will be in the hands of bureaucrats within the department of Social Security. Under such a scenario these people lose control over their assets and have very few rights, being at the almost total mercy of the state system, except for the potential intervention of an overworked and underfunded aged care advocacy service.
People in this situation within an aged care facility have little recourse against any cruel and unjust practices and are generally left to suffer within the system.
This group constitutes what could be called the “forgotten Australians,” languishing alone. An aged care worker told the author that up to 10 percent of people in facilities fit this category.
The trauma in having a parent moved into an aged care facility also seems to bring out the ugly side in many families. Often family members cannot agree on what care arrangements should be made for the parent, leading to bitter disagreements, and even court proceedings. In addition, many with the sudden authority over their parent's assets through an enduring power of attorney often mismanage or inappropriately utilize the assets, leading in some cases to grave financial consequences.
Australia's aged population is going to become an even greater burden on the economy in coming decades. This will decrease the size of the available workforce and tax base, while dramatically raising the number of people dependent on aged care. Industry experts believe that between 500 to 1,000 new beds are required every month for the next 40 years, indicating that massive capital investment is required in this sector.
As a consequence, the Australian economy will be hard pressed to grow sufficiently to compensate this large change in demographics. This is of particular importance as Australia's mineral boom is slowing due to lower rates of Chinese economic growth. Without drastic structural changes to Australia's economy and radical policy changes, there will be chronic labor and skill shortages, and scarce public funding over the next few decades.
This requires urgent public discussion and debate about social values and how aged care should be approached in the future.
The Australian government has responded by commissioning a host of inquiries over the last decade and a half, of which only snippets of recommendations have been implemented.
The above requires attitudinal changes. However any debate on such issues is likely to lead to massive polarization in community views, and consequent lack of decision and action by government.
Funding will have to be orientated towards user-pays with some form of national aged care insurance, although it will be very expensive due to the large proportion of people over 65. Family values will have to accommodate parents living at home and being cared for, following some successful European examples. Massive skilled migration will be needed to have sufficient workers in the aged care sector. More aged care facilities need to be built, especially in rural Australia, which is lagging behind urban centers.
We know the problems, but are there any better solutions?
Governments of both persuasions have failed, now it's up to the community to start the debate. Successive Governments have listened too much to vested interests within the aged care industry, which has been plagued with scandals over the years.
If there are to be reforms, legislators must know the community is demanding them.
One must make a stand to prevent the system becoming a brave new world where people are helplessly locked up with no rights and no dignity.