Last night’s episode of the ABC’s Q&A, which devoted a whole hour to the aged care industry, covered topics anyone who follows the sector will already be familiar with, but it was two of the show’s older personalities – a member of the panel and a member of the audience – who stole the show.
Shirley McLaren found fame in her 80s when she appeared in the ABC’s surprise-hit TV show, ‘Old People’s Home for Four Year Olds’.
The program revealed to her the benefits of intergenerational activities. The four year olds showed “a great deal of care and compassion for the older people”, and both young and old learned from each other.
Ms McLaren, who served in the Women’s Australian Airforce for four-and-a-half years during the Korean War, asked the panel about the government’s plans to fund intergenerational programs.
Both of the panel’s politicians, the Aged Care Minister, Richard Colbeck and Labor’s Shadow Minister for Aged Care, Julie Collins, acknowledged the benefits of intergenerational activities and said there are already programs in the community.
Sean Rooney, the CEO of Leading Age Services Australia, said the program “opened the door” to new models that enable community engagement and interaction.
In the panel of politicians and lobbyists, Maggie Beer stood out for her energy and vitality. Over the last five years, Ms Beer has been trying to improve the standard of food served in nursing homes.
A member of audience described Ms Beer is an accomplished person in her senior years” who is a “recognisable role model for ageing well”, and she asked the panel if we sometimes neglect our elders.
“Do you think we as a community need to make more of an effort to celebrate ageing so that we do not forget our elders,” she asked.
Ms Beer said society should celebrate ageing. We have to have “respect for those who have lived long lives and gone through so many things that have made this country what it is today,” she said.
“There’s got to be joy in life. There’s got to be pleasure,” Ms Beer said, stressing the importance of food as we age.
Aged care advocate, Sarah Holland-Batt, whose father was abused while living in residential care, said ageism underpins many of the problems we are seeing in aged care.
“The reality is, most people in aged care spend all their days alone. They’re depressed, they’re bored,” she said.
Mr Colbeck said we need to change the way we engage with older people in society. The way Indigenous Australians respect ‘elders’ provides a good model, he said.
Joseph Ibrahaim, geriatrician, got the episode off to a grim start with his claim that “many people would rather die early than enter a nursing home.’
“Do you share their fears?” he asked the panel.
Aged care “has to change, and it can,” Ms Beer said.
Mr Rooney apologised for the shortcomings in the industry. “I’m sorry these things have happened,” he said. “We need to do better.”
A question about mandating staff ratios received applause from the audience, but there was little progress in the debate. Using a phrase that many in the audience would have heard before, the minister said mandated staff ratios were a “blunt instrument” and there was no research to show they would fix aged care’s problems.
Prof Ibrahim was also not in support of mandated staff ratios. “I think ratios is a simplistic approach to a complicated problem,” he said.
Prof Ibrahim said there was “no question” there was a need for “a minimum of staff”, but on top of more nurses, physiotherapists, occupational therapists, speech pathologists, and psychologists were also needed.
It’s how staff work together, not numbers, that will improve the aged care situation, he said.
Mr Rooney said the industry desperately needs more funding. Aged care facilities need an extra $1.3 billion before the end of the royal commission, and $500 million annually to get home care waiting lists down to a minimum of 90 days, he said.
But Mr Colbeck did not commit to any funding increases.
“I can’t make a commitment to something that hasn’t been decided by government,” he said.
Australia spends less than 1 per cent of its GDP on aged care, compared to the OECD average of 1.5 per cent.
“It’s not a sustainable viable situation as it stands,” Mr Rooney said.
Both Ms Holland-Batt and Ms Collins said greater transparency is needed in the way government funding is spent in aged care.
The panel agreed more training is needed to support people living with dementia, and not just training for care staff, but also for staff across nursing homes and in the community more broadly.
Ms Holland-Batt, whose father had dementia, said personal care staff, who deliver the majority of care, “don’t really understand” dementia.
“The fundamental ignorance of what’s required (to care for someone who is living with dementia) is really alarming,” she noted.
Professor Ibrahim said problems with the use of chemical and physical restraint have been known for more than 10 years, but a “lack of leadership” has hindered progress.
“The parliament’s generally been gutless about addressing aged care issues for the last 10 to 15 years,” he said, prompting applause from the audience.
“We lack respect for older people,” he said.
Ms Collins said there should penalties for repeat offenders in aged care, operators who fail quality assessments time and time again.
Mr Rooney said it’s “in nobody’s interest to have repeat offenders in our sector because they put at risk the people they are caring for, and they are damaging the other providers that are doing a good job.”
Mr Colbeck said the government is meeting weekly with Bupa, in an attempt to get to the bottom of their problems.
But he said, “If they’re not going to provide a service that’s adequate, we don’t want to see them in the system.”
The ABC’s reporting on aged care has been one of the key drivers of recent changes in the sector, and ultimately led to the launch of the royal commission. Last night’s Q&A enabled the national broadcaster to again put the spotlight on the troubles facing the sector. The program brought the issues out into the public arena for discussion, consideration and debate, educating viewers and hopefully bringing us one step closer to resolution of at least some of the sector’s woes. At the same time, the program forced us to reconsider how we think about aged care, ageing, and the aged.
Why on earth do we give credence to Maggie Beer and who is she to be a self elected spokesperson for the sector. I noted her public criticism of the sector not to long ago with generalisations and inaccurate information spewing forth and as far as her “involvement” in the food, I cynically wonder if its because she is commercially producing food for the Sector as her own private enterprise. Just money making while standing on a soapbox.
Its a sad indictment of the media that the only major presence at the Royal Commission was when she sat in front of the commissioners.
Absolutely right. It’s a useful diversion from the massive issue of abuse
well someone needs to fight the parasites who own the aged care homes….they feed them crap…overdose them on mind altering drugs and employ people who have no idea abd dont speak English
Maranatha house Wellington NSW has been running intergenerational programs for the past 10 years and is about to commence building an intergenerational child care centre on its grounds with the assistance of federal member Andrew Gee with a 1.5 million grant through building better regions
I agree with Mal, I don’t know why Maggie Beer was on that panel. There should have been a Nurse/Practitioner and actual staff members to give a more balanced view. The outstanding panel member was Sarah Holland-Blatt who gave an honest, truthful account of life in a RACF.
Staff ratios are important, if you haven’t worked at the coal face you just don’t understand, to get elders to their meals, first you need to attend to basic hygiene cares, showered, assist them with dressing, help them with their mobility at times,
and were still not at the dining room to enjoy that yummy meal ! How long does that take 10 min?
Its not rocket science.
Too much Grandstanding, around and around we go !
More transparency and education are also needed
Disappointed that there was no questions addressed in regards to Leisure and Lifestyle staff especially those qualified with degrees as Diversional Therapists or Cert 4 and the work they have been doing for years in regards to activities and including intergenerational programs, along with the issue with ratios and concerns the nursing industry have discussed in this Q & A session. Also, the constant stigma brought to ageing based on negative media promotion of those facilities that bring down the sector rather then celebrating the many good facilities across Australia (I have worked in 3 states in Aged Care) as many are going above and beyond with innovation, programs and residential care.
Great comment Emma. Lifestyle programs, the staff and volunteers who run them are a critical and understated part of Residential Care. The team we have with us here at Dunbar Homes work tirelessly, passionately and together with residents to provide our residents with fun and purpose. We recognise “well-being” is just as important as clinical care. It looks like you have been a part of this in your journey, and you are right, we must shine a light on the great work many providers do to balance the argument.
Very disappointing that there was not even one nurse on the panel. Why wasn’t there at least one more person who could say how vital it is that we have minimum nurse to resident ratio’s legislated.This is just a starting point. The things that Dr Ibrahim wanted very important also but they can come later. Lets get the basics right first.
I am a registered nurse and have been a Wound Care Consultant visiting residential aged care facilities (RACFs) in Sydney for over 20 years. I will start by describing a morning in a RACF that I don’t believe has ever been documented in any detail…just as an example:
i. The first thing [all] people want to do when they wake up in the morning is to go to the toilet. But there is not enough time for two carers who have arrived on duty at 0700 hours to take 20, 30, 40, residents to the toilet all at the same time.
ii. Many residents are woken at the crack of dawn (although I don’t know why they are woken at all.) I believe they should be allowed to sleep and wake up naturally. Some can walk, go to the toilet and wash their hands themselves, but there are many who wear incontinence pads and they need their pads to be changed before breakfast. Many are faecally incontinent and changing pads requires care staff to devote a lot of time to clean them up properly (or even to shower them before breakfast).
iii. Many residents will have hearing aids. Care staff has to make sure the aids are clean and batteries are working / changed / tested before they are inserted correctly into residents ears, before breakfast. This can be difficult when residents have dementia because they may become resistive and lash out at care staff (often hurting them).
iv. Dentures have to be cleaned and given to residents, or put into the mouths of residents who cannot do this for themselves. Most if not all, residents have full or partial dentures and these too have to be inserted before breakfast..
v. Then there are dependent, immobile, residents who need total assistance from at least two or three care staff using a mechanical lifter after they have had their hearing aids and dentures put in and pad changed. Lifting these residents out of bed and into a wheelchair to push them into the dining room takes time and I repeat, when residents have dementia they may become resistive and lash out at care staff (often hurting them and themselves).
vi. Breakfast may be served at 0730 hours but the kitchen closes at 0830 hours. Many residents need their food cut up for them and some need to be fed (if they have lost the use of an arm following a stroke for example). It is completely unrealistic to think that two care staff can manage all the tasks I have mentioned for 55 residents safely.
vii. This routine of toileting, pad changing and hand washing, is repeated before every meal. Then at night hearing aids and dentures have to be removed and cleaned and toileting, pad changing and hand washing, is repeated.
The comments to this article show how divisive and disparate the issue is. Each member of the panel had their own unique view, and none of them could speak for the “whole of the industry”, yet in their own ways probably everyone had some sense and truth in their arguments.
We definitely need to rid the industry of perpetually poor providers
Staff ratios will not work, but minimum staff levels and a high level of industry training can assist in this
Funding must reflect the true cost of care
Not all food served in Aged Care is “crap”
Not all providers are poor
One of the biggest risks now to us, is this: The avalanche of reporting on “problems”, and “crisis” in Aged Care could deter quality people from seeking a career, and unless some balance to the narrative (by that I mean there are plenty of good stories to be found, but it doesn’t “sell” in the mainstream media), we run the risk of failing even further. This also means people looking for care option will be frightened and may opt not to seek care if they believe they wont have a good experience.
Call out the bad, celebrate the good
I was very sad to hear of the death of Commissioner Richard Tracey AM RFD QC.
You can read the tributes on the link below. On a personal level he was so kind to me when I spoke about pressure ulcers in aged care facilities in the Darwin Supreme Court in July this year. I felt he was genuinely interested in what I was saying.
https://agedcare.royalcommission.gov.au/news/Pages/media-releases/transcript-of-tributes-to-commissioner-richard-tracey-am-rfd-qc-14-october-2019.aspx