This time I am pissed about aged care. Again. I’m not even sure
where to start on how pissed the general discussion about aged care makes me. Actually,
it’s not just about aged care. Let me take the opportunity to be grumpy about a
lot of things. A few needles in strawberries and increasing food saboteur jail
terms is on table. Some white kid gets punched in Kings Cross and voila, king
hit legislation with, let’s guess, longer jail terms. A few black kids die
being chased by police … nothing. A black woman dies in custody … nothing. A
woman dies every week at the hand of an intimate partner, well, we’ll throw a
few words at it, but basically, … nothing. Horror stories about some aged care
facilities have been surfacing for years, and after many years of …. nothing ….
for some reason, the government throws
some money, not at actual services, but at investigation. It shits me that
things are ignored until they become politically expedient. And all those
longer jail terms as a solution? I’ll come back to that one.
I could save our government a few billion in running a royal
commission if they’d like. It’s pretty easy to sum up. Stop privatising
essential services!!!!! What do they expect to happen when they hand over the care
of our elderly for people to make money off? Victorian public aged care facilities
have legislated nurse ratios. They are the only ones that do and they not the source of
these horror stories. They still aren’t perfect. I would love to see more staff
in dementia facilities, where one on one interaction is one of the best ways of
managing agitated, distressed and wandering behaviours. The movement towards supporting people to stay
at home and aging in place is leading to an aged care population with
increasingly high needs, whilst the staff ratios don’t change. But even public
facilities are at the mercy of the complicated bloody funding system that doesn’t
even see managing dementia as a complicated medical condition. All aged care is
complicated. You’d be hard pressed to find a resident with less than four of
the following: multiple comorbidities, polypharmacy, chronic pain, cognitive
impairment, communication difficulties, nearing end of life or mental health
issues. Not to mention normal grieving for moving out of home, loss of
independence, loss of peers and family, approaching death. Or supporting families. Does that look like
a simple care to you?
But despite the limitations of the system, most nursing homes
provide good care. I’ve worked in 5 of them. I’ve had grandparents in them. The
staff are dedicated and doing the best they can in a flawed system. Let’s not
start a demonization of the predominantly female, underprivileged, overworked
and underpaid workforce in aged care. Perhaps the billions of dollars on a
royal commission could just be spent on improving services and providing
regulation and monitoring in line with the recommendations of experts that already
exist? As an aside, what are we going to call these incredibly expensive
investigative whims of government when we eventually become a republic?
Articles and news programs “revealing the truth” about aged
care are all the rage this week. They are full of the emotional language of
shock journalism. Who cares if someone was a WW2 veteran? That does not make them more worthy of care than another person. And can we at least get our
bloody information straight? One of the
kafuddles is about the food. And, yes, the food is not perfect. But minced
moist is not a meal. It is a texture. It is a texture recommended by a speech
pathologist based on a person’s capacity to chew and swallow. They are a high
risk for choking and aspiration without it. Many, many foods can be made minced
moist. It just so happens that most of what is made in nursing homes is some
variation on meat and three veg. As many Australians are not as vehemently
opposed to meat and three veg as I am, they probably won’t have a problem with
that. They all look kinda similar when they’ve gone through a blender, but they
are actually real meat and real vegetables. Residents who are able can choose
from a menu (sandwiches and salad are always available as well as a hot meal),
others are chosen by staff based on what they know about the resident’s tastes.
Yes, sometimes there are party pies. Most people have junk meals occasionally,
and let’s be honest, we quite like it.
I’d love to see a more culturally diverse diet, and more vegetarian
and vegan foods. This will come, as the next generations who have had a
lifetime of greater food diversity and have a bunch of food fetishes age. But
some of them will still need their curry served minced moist. Kale smoothies
will be suitable for all textures, although we may need to add thickener. Green
gloop. I can’t wait.
Shock journalism loves dramatic statements. Like that 75% of
residents are on psychiatric meds, then talking about antipsychotics as if that
is what the 75% are on. Antipsychotics and sedatives are a last resort, and
strangely enough, higher staff ratios provide for more nonpharmacological
interventions further reducing their use. But antidepressants are also a
psychiatric drug. We all know people who take them. Older people also take
them. Others have sedatives for sleep or anxiety or epilepsy. Some even have antipsychotics
for, well, psychosis. Schizophrenia. Borderline personality disorder. Mood
stabilisation in bipolar disorder. I don’t know if the 75% figure has any
basis, but I’m very happy saying that they are not all on psychiatric drugs for
behaviour management. And personal carers cannot give drugs “at their
discretion”. Only a registered nurse can, and only in line with the conditions
set out in the doctor’s order. So let’s not all panic about staff with 12 weeks
training handing out drugs willy nilly.
Then there is the 50% suffer from malnutrition. It’s probably
true. The simple fact is that it is really hard to maintain a healthy weight in
old age. As bodily systems slow down, food is not well digested. Chewing and swallowing
becomes increasingly difficult. Tissue repair is not as good. Muscle mass is
lost, and lost quicker with loss of mobility. Any illness will knock you
around. Cachexia. The recommendation of going into old age with a BMI of 22-25
is in consideration of the fact that you will need a buffer to help maintain weight.
The food provided in nursing homes is not the major issue. In fact, we feed,
feed, feed residents. Breakfast, morning tea, lunch, afternoon tea, dinner,
supper. 3 courses are offered for lunch and dinner. Residents are put on high
energy high protein diets at the first sign of weight loss. Supplement drinks
on top of the normal meal regime. And still they lose weight.
A few years ago, there was a meme going around about how we
treat our prisoners better than our elderly. How typical as we continue to grow
our prison population that we make these comparisons. I don’t think we should
treat our prison population poorly. Being locked up is their punishment, not
being made to suffer any more whilst in there. In fact, I think most of our
prison population shouldn’t even be there. The government will probably call a
presidential commission into the prison overpopulation crisis at some point in
the future, at which time I could also save them a few billion by pointing out
the many recommendations by experts that already exist, saying that
rehabilitation, reparation and reconciliation is the most effective way to deal
with offenders. And maybe address the socioeconomic issues feeding crime whilst
we are at it. Locking people up for longer is about as evidenced a deterrent
for crime as is “just say no” to drug use. Oh fuck, they’re on that bandwagon
again this week as well, aren’t they? But anyway, without further digression
into those rants, the meme was in fact, incredibly wrong about the care
provided in most nursing facilities.
Neoliberalism is the source of our current problems in aged
care. You know, those myths that the private sector will provide the best
services for the best cost, and we as consumers exercise choice that keeps it
that way? Yeah, right. When you need a bed for your grandmother in a crisis,
you end up taking the bed available. Choice is a luxury when the demand for
services outweighs their provision and takes away any dubious advantage that
competition provides in the provision of essential services. After the government
has wasted some more time and money investigating things that professionals,
academics and people on the ground in the field already know, maybe they will
eventually heed that public provision and regulation of essential services
leads to much better outcomes than the free market. But I won’t hold my breath.
