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Reforms to our view of ageing and aged care are promised for the future but will it be the full and necessary change in attitude and approach? I am skeptical.

The more horrors that are being revealed in the current system suggest that we are blissfully ignorant about what ageing could be like in a more intelligent and caring world.

Two memories trigger this feeling. The first was when I became aware that our hunter/ gatherer ancestors had no choice but to leave their elderly behind, with supplies of food and water, when they could no longer keep up with the travels of the group. Today we isolate our elderly, leaving them with strangers, when there is even a slight chance they will succumb to an illness which may or may not be fatal. We haven’t progressed very far when it comes to being more intelligent in the way we treat our elderly. I suspect the problem comes from the good profits that can be made today from the aged care industry.

The second contributor to my despondency is the lack of consultation with older people when the decision was taken to lock them up (referred to as ‘lock them down’ to hide the horror of the decision). I’ve already mentioned the current majority choice was for this not to happen if our older relatives had been given a choice. The horror of being isolated from family and friends, and for many also dying alone, is hard to accept as human behavior, when there are more humane choices.

It doesn’t help to remember that over 100 years ago women were fighting for equality. Conferences on the issue were held, run by men, with male speakers and a few token women in the audience. As a parallel today’s conferences on ageing are run by younger people, with young speakers and perhaps a few token older people in the audience. The sad part is that the youngsters running these functions don’t realise that what they know about ageing is largely learned from textbooks- and they haven’t actually experienced it themselves, any more than when men spoke about, but hadn’t experienced, women’s issues. So called experts on ageing don’t acknowledge that the only real experts in the field are the elderly.

If we are to avoid a repeat of the current horrific behavior towards older people, in which they are separated from those most important to them, often left to die with strangers, we need to listen to them, the real experts, about what they want for themselves, not what the self-acclaimed experts think they need.

With annual conferences on ageing currently being arranged, organisers need to be aware of what they are doing. There are currently two deterrents to conferences being really representative debates on ageing. Older people don’t attend because most have neither the physical ability to travel large distances nor necessarily the money to do so, and therefore are excluded from them. We are left with conferences on ageing without the ageing. I suspect that those who follow in our footsteps will be horrified to find that we seriously regard these conferences as truly representative of the debate on ageing. For the vast number of today’s conference attendees, the only knowledge they have of ageing is what they have read. A few may have older relatives and friends but these may not be typical of ageing in general. It is a pity it has taken a horrific pandemic to expose our lack of real knowledge of ageing and what our older people need and would like. The current dictatorship approach can be an expensive, cruel and unsatisfactory approach to the physical and mental needs of our older people.

Fortunately the truth is starting to come out.

There are already bits and pieces of research happening in different parts of the world into the effects of the current virus on the lives of older people, but to really benefit it needs to be recorded and put together to provide a worldwide picture. This would give us a platform on which to base future policies. This applies particularly to aged care.

The field is huge, dealing with the legality of locking people up in aged care, and the variety of strategies to deal with them in that situation. Contact with loved ones and the type of  that contact currently varies enormously. Some residences banned visitors completely, while others took up the idea of one man in England who attached a piece of plastic to his Hills Hoist clothesline, with holes for two pairs of plastic arm covers at different heights for him to hug his mum! This idea was taken up by at least one aged care facility which adapted both a glass door and a window to achieve the same outcome. These were providers who recognised the value of hugs to humans, particularly older ones. Other residences allowed relatives to wave to their loved ones through windows. The different outcomes in terms of residents’ health deterioration should provide instructive comparison.

Research from Israel which measured mental health in terms of depression (found to have risen during lock-down), and emotional health (lower afterwards), showing significant mental health problems, needing recognition when life for older people in care returns to normal.

Some facilities are already planning strategies for meeting these problems if a similar situation arises. If this is widespread then we should see improvements in aged care in future. It requires all these bits of research to be collected together to produce more enlightened aged care, once we are able to return to normality.

As life expectancy continues to rise the poor quality of care currently accepted in some places cannot continue. We need higher provision of care through senior staff, such as boards, with members who are qualified in aged care as well as nursing and mental wellness. Currently the qualification requirement for managers seems to be restricted to financial knowledge which is why aged care is regarded as a good investment area, and is the sole motivation for some. This seems to be the main source of inadequate care.

Meanwhile I hope that the research associated with the current knowledge expansion is centrally coordinated so that we don’t start the next pandemic with a blank knowledge slate. Older people in the 21st century have so much to offer and deserve so much better. We need to be tapping currently underutilised resources among residents, as well as insisting on fully qualified boards.

 

 

 

 

 

 

 

 

While we are at the stage of recovering from the effects of the current virus can we start identifying our dreams for the future of age care residences? More of what we had is not an option. A much more intelligent approach would be to define our goals, work out which of them are achievable for a practical future, and where to start.

Firstly, we need to identify the restrictions on our targets for change. Part of this would be to identify what we were ashamed of in the previous model, identify what we needed to do to bring the situation up to an acceptable level of care, and any inhibitors to achieving this. Financial difficulties would need to be near the head of this process. Up until fairly recently aged care was an area in which good profits could be made. As a community I don’t think we should regard aged care as appropriate for this. Feeding elderly people for 6 cents a day, as some facilities were found to be doing, casts doubt on the ethical values of the nation which allows this. Apart from anything else it reflects badly on our society that we feel this an appropriate way to treat people towards the end of their lives.

Secondly, we have and continue to have, an ever growing knowledge of ageing, what is involved and what we are likely to recognize as a necessary part of provision in future. I suspect that currently aged care is one of the few areas in which the people at the top are not required to have qualifications in their field of employment. I suspect that there is not an aged care board in the country which does not have a person on it with qualifications in management or economics, but few, if any, with qualifications in ageing or aged care.

With an increasing number of Universities offering on line courses there is no reason why anyone wanting a career in the field should not have qualifications in it. This would help to make it a more desirable and attractive area to work in, not just a job. We demand this in other areas of health and nursing, so why should we accept amateurism in aged care, at any level? It should be an area in which people are proud to work, and be proud of their achievements, not just an area of easy profits.

The recent experiences of care for aged people in which their human rights were removed because they were imprisoned through a lock up, is an indication of the disdain those working in this area have for their clients. It is interesting that in two facilities in which older people were asked if they preferred to be locked up or be exposed to greater risk, the vote was in favour of freedom and risk taking. Currently older people in care don’t live in a democracy, even though they are built in countries claiming to be such, so they can be locked up without question.

My worst fears have just been realised. I have been invited to a webinar on plans for aged care institutions once restrictions are lifted. The board consists of two economists and a manager! Not a person with qualifications in aged care in sight.

 

 

 

Each day as we learn more about ageing in aged care residential establishments I am realising that many of them are anything but homes and shouldn’t be called such until their attitudes change in the future. The latest challenge is the death of a 92 year old lady who lived through the illness caused by the virus but died afterwards from what her granddaughter described as the loneliness created by isolation regulations. It reminds me of a 92 year old who said she had lived too long- she had outlived all her friends and two of her children. I suspect that many older people can identify with these situations. They pinpoint the very different priorities many older people have from the rest of society. One elderly resident in an aged care facility said that he had come into it to die and the sooner it happened the better. Surely we can do better than this.

Management in many of the aged care facilities don’t seem to realise that death for an older person is a very different event than that for a younger person for whom it is something that will happen in the distant future and they don’t need to worry about it. Recent submissions by organisations involved in fighting for the rights of older people have now shown that banning visitors violates the human rights of residents and are not acceptable. The ban meant that for many older people the best part of their current lives had been taken away from them and what was left was hardly bearable. This is a manmade problem created by unqualified management. At one establishment with multiple deaths the board apparently didn’t instruct the staff on how to recognise the symptoms of the virus nor did they teach them how to use their protective clothing properly, thus contributing to the huge death toll. Management has now been forced to employ another person on their team who presumably has the necessary skills.

I would like to think that all aged care facilities in future will be required to employ board members and management staff with the necessary human skills required to run such a facility, not just the skills to run a successful business. A country which allows unconscionable behaviour towards its elderly residents is neither a civilised nor successful one. Older people have so much to offer to our society it doesn’t make sense to deny them the opportunity, nor facilitate them, to contribute. The current situation does not make sense particularly when some Universities are now running on line courses on ageing which are very accessible.

I hope that those older people who have died because of the virus, particularly through unintelligent and ignorant staff behaviour, particularly management staff, may not have done so in vain. If we can offer an acceptable environment then the real problem of ageing, the physical deterioration, can be catered and compensated for. Meanwhile we are spending a fortune on trying to find a cure for mental deterioration so that people can live longer in a world that doesn’t understand their capabilities or accept that they have rights. In looking at elder abuse let’s include aged care management members, their qualifications in aged care and their decisions.

One day most of us will have to move into aged care facilities. For those of us not yet at that stage we need to ensure that when we do we will move into better conditions than those that currently exist. We should be able to move into real aged care homes which help us to maintain the rights we currently have in our communities and provide an appropriate environment in which to do this.

I would like to think that one of the results of the current epidemic is that we will have a  better idea of how to cope if another one hits us. We need to know how it started, learn how to recognise it and know how to go into immediate lockdown, particularly with respect to overseas travellers who seem to be the biggest facilitators of the spread.

One area which particularly indicated lack of knowledge in the current situation was the response towards people in aged care by the people running these institutions. Some of them showed understanding of the problems but in other cases behaviour amounted to lack of understanding of ageing and in some cases actual cruelty.

The situation made me aware that we haven’t made much progress in understanding ageing even though it happens to all of us. Worse still we don’t seem to know that we don’t know! My first understanding of the situation was reading many years ago about hunter gatherer societies which had to make their older people as comfortable as possible with food and water and then leave them if they couldn’t keep up. I could see the tribe’s dilemma but was horrified by the cruelty. I’m not sure that some aged care providers behaved much better recently, without excuse, when they cut off all visits by relatives and friends, particularly when these visitors were helping with feeding etc. They were basically being asked to leave their loved ones and move on.

Two problems seem to be seen here. Firstly we live in a democracy, not a dictatorship. Shouldn’t the residents, where appropriate, and the families and friends, have been allowed to vote on it rather than enforcing these rules without consultation? Who has ownership of our lives when we are old? Secondly, what qualifications are the people making the decisions required to have in this speciality field? There is no excuse for people choosing this area of work, and in a senior position, yet not being required to be qualified, when so many University courses are offered on line and can be accessed so easily.

The behaviours referred to above suggest a lack of understanding of what it is like to age and how it changes our priorities. I believe that the average length of stay in residential aged care is just over 2 years, with people with dementia being on the lower end of stay figures. This latter group have suffered the most under these draconian rules with family members reporting that if they were able to see them through windows they could see the physical deterioration. I suspect the carers may have been suffering a similar fate through the distress of the separation. Is this very different from the distress of our hunter gatherer forefathers who had no choice?

I hope that if we ever have to go through another epidemic or similar the knowledge of ageing by those running age care facilities will be more professional. In particular, I hope that they will be aware that older people in care have a very different view of death. It is not something which will happen in the distant future which we can worry about later, but rather something on our near horizon. Every day is precious, as are our family and friends who are likely to help to fill those days with love, and all the other joys of life. It shouldn’t be taken from us by people making a profit out of our situation, who are not required to have any knowledge of what it is like to walk in our shoes, with or without a walker.

As I continue to get invitations to attend both national and international conferences on ageing I feel more and more frustrated, knowing that the true story of ageing will not be told. In particular, such conferences are not user friendly for older people, the real experts on ageing. The current situation is quite scary for an older person in Australia and I expect for other parts of the world.

Aged care is a particular problem. If we look at the provision of other types of necessary government services, such as education and health care, there are two types of provision, government and private. My understanding is that the two areas which have not followed this established pattern pattern, aged care and early childhood education, are based on profitmaking and are having difficulties with impossible user charges as there are few, if any, not-for-profit providers, particularly governments, to provide balance.

Part of the problem with aged care is that many private providers are in it because of its reputation as an area in which good profits can be made. Recent discussion on providers cutting down food expenses to $6 per person per day and cutting down on supply of incontinence items, which can cost as little as 40c, seems to validify this. Even where providers claim to be not-for-profit I am told the directors often get round this, presumably through huge director bonuses etc. One multiple, high standard provider in NSW is genuinely not for profit, and proud of it, but this information is not easy to come by.

Much of the blame for the shameful way we treat older people is the outcome of  those who run the research conferences feeling that they know all about ageing (they’ve read a lot about it and feel that they are therefore experts). If alternately they ran conferences which enabled older people to attend, including through webinars, and participate, the conferences would more clearly reflect ageing, its delights and its problems. This lack of involvement of older people means we haven’t even left first base yet in recognising, and providing for, older people’s needs. A major part of such provision would be for older people to feel that they are a valued contributor to the community. I wonder how many aged care providers, and conference organisers, have that as their goal? Ageing should be far more than a full stomach and a warm bed to sleep in.

 

Note. I noticed that there was advertising attached to some of my earlier blogs. I apologise and hope that the problem has now been rectified.

We have reached a point in the development of our fight against the current virus that we can look towards the future. Whose future? Dare I suggest that we look towards a better future for older people as well as the rest of the population?

We are slowly improving how we treat the elderly, with arrangements such as home care, for example, being an alternative for older people who have difficulty managing physically in their own homes towards the end of their lives.

Most older people say that they prefer to die in their own homes but not everyone achieves this. It makes sense that in our final days or hours we want to stay in familiar surroundings, with familiar objects which have been part of our lives, often for decades. This includes family.

At present older people in aged care facilities are often restricted in the number of visitors allowed, sometimes none, often without any consultation with residents. In some cases this means that they die alone, a situation none of us would wish for on our last, unknown final journey. Were residents asked if they were prepared to take a greater risk of catching the virus or was the decision just thrust upon them? If they had had a choice to have visitors or not, at least the outcome would have been more bearable if it had been made democratically. For many older people life without visits from family and friends, particularly grandchildren, is a life not worth living. This lifestyle is not what they chose when they moved into an aged care facility.

Of course we also have to take into account the staff who are at risk, although not as much as vulnerable residents for whom it is more likely to be a life or death situation. Were they a part of the decision making?

Being well into the older age group myself, and having two medical problems which mean that death may not be that far away, and a Ph D with thesis titled “Successful ageing” I think I have a greater knowledge of old age than the ‘youngsters’ who make decisions about us! It horrifies me that our knowledge and decision making skills are regarded as non-existent as far as being old is concerned. Once our bodies start to be limited it seems to be assumed that our brains have gone the same way and we can no longer make decisions or be involved in life,  How rude, and how restricting.

Part of my anger is that I have been contacted by yet another organisation claiming to speak out for all age groups- but without an older person in sight! In another area, if restrictions on socialising are lifted, many conferences are planned for later in the year on ageing issues, again without the involvement of older people. Younger people can’t understand what ageing is like until they have walked a mile in our shoes.

My dream for the future is to have all aged care facilities a modest hive of demographic activity and involvement, both within and outside the facility, except for those residents who have lost the necessary mental capacity. There is no reason why all elderly people should be cast aside under the assumption that once the body deteriorate so does the mind. The assumption should be made that all older people still have a lot to offer, just as they did in their younger days. Let’s really value them. It would also make workplaces involving older people a proud environment in which to be involved and make employment there a privilege.

 

Once again older people are presented with the challenge of a new enemy in the form of a virus against which we have little defense. Many of us are likely to leave this earth earlier than anticipated. Worse still, for those who have already transitioned to aged care facilities and other types of care, contacts with friends and relatives are being rationed. The restrictions being put in place are sensible and inevitable given our vulnerable situation but difficult to bear for those on the receiving end. Older people are being cut off from their families at a time when they need them most.

The situation is inevitable if we are to save as many as possible but can we give hope that those who survive will do so in better circumstances than we had before? I hope that when we are able to look back on pre-virus  days we will have vowed never to let it happen again.

The major problem seems to be that aged care is notorious as being a sector in which it is easy to make a fast buck, rather than an area in which better conditions can be provided for those either entering the last phase of their lives or even in the very last stage. In the financial world salaries and bonuses paid to directors and other senior positions are made public. This should also apply in the aged care sector so that those in it to make a quick fortune are exposed.

Other situations arise because of the bias against older people I have mentioned previously- senior staff tend not to consult the older people in their care or researchers consult older people in their society. For example how many aged care facilities provide breakfast at a specific time? Have the staff forgotten the luxury of a lie in at weekends? Older people who have toiled all their lives should have this luxury everyday. I heard of one retirement home where the residents asked the staff if they could have a buffet breakfast in which residents could eat when it suited them. The staff reluctantly agreed to give it a try. It was a huge success. Residents could eat when it suited them and the staff liked it because they didn’t have to have everyone showered and dressed by a specific time. An added bonus was that only one member of staff needed to be on duty in the dining room and all the rest could help the residents get showered. The only downside was a gentleman with Alzheimer’s who kept forgetting he had already had breakfast!

Let’s look forward to a better future for our older people once we come through this challenge.

Over 100 years ago women were fighting for equality. Conferences were held on the role of women and the opportunities available to us. These events were organised by men, the speakers were men and most of the audience were males, with a few token women. Such events were of course ridiculed by women. From that low base is it any wonder that today equality is still a long way off, with the number of women in parliament and on boards well below half, women’s pay less than men’s and Me Too campaigns receiving a huge amount of support and sympathy.

History is repeating itself. We older people would like our current talents and contributions to society recognised and more opportunities available to use them. Currently conferences around the world, both international conferences and those within countries, are being organised for 2020. They are supposed to be about ageing but for most older people they are physically and financially out of reach, yet this is the group containing the experts in the field. These conferences are being organised by younger people, the speakers are younger people and most of the audience will be younger people. Sound like a familiar pattern? The sad part is that when these organisers themselves are classed as ageing they will still be unable to attend,  perhaps for the same reason as men who have resisted sharing money, power and influence for all these years. Just as our world misses out on so many skills women have to offer, so also are they missing out on the skills and  knowledge of older people, the real experts on ageing.

How should we solve this problem? The major problems I suspect are money and mobility although we would have to check with older people themselves to make sure this is the complete list. It doesn’t seem to occur to conference organisers that enabling older people to attend would make these events more interesting , more relevant and would mean that they achieved more. It seems ridiculous that young people, students, are subsidised heavily both through the conferences and their places of study to enable them to attend, but older people usually have to fund themselves. Travel is less easy to address but webinars, if properly organised, can be an acceptable substitute. These enable all participants to contribute from their different perspectives.

About 20 years ago I came across some research done into one aspect of ageing in the UK. The charity which funded it said it was on condition that the researchers involved older people in the research group. The researchers said afterwards that by doing so their research had been much more accurate and useful. Do all research projects today include older people in their research teams? I don’t think so. Why not? Is it because researchers want to maintain absolute power, just as men did all those years ago? If not, why aren’t older people included more in this area in which they are the real experts?

 

The re-opening of my blog is more difficult because of advertisements I have not authorised. I have been using computers for over 50 years and am not impressed with some of the changes which occur! It will take time but I hope to sort the problem out.

 

We are so used to this statement that it no longer creates a positive reaction, but to me this puts us in a dangerous situation which is why I have decided to resurrect my blog. Not surprisingly as each year passes I get a different view of ageing!

I was familiar with the comparison between women fighting for equality and older people fighting to be heard, but it took the ‘Me too’ movement, and the continuing pay gap between men and women, to make me realise that women have really made little progress in what is now well over 100 years. Will older people still be fighting to be heard in well over 100 years time? Can we afford either situation?

A few weeks ago I got an invitation to an international conference on ageing being held in a few weeks time. The two ladies advertising it seemed to have plenty of qualifications but obviously lacked any experience of ageing themselves. 100 years ago we had conferences on women’s issues organised by men, the speakers were men and most of the audience were men with a few token women invited. The parallel today is with conferences on ageing run by younger people, with young speakers and young audiences and a few younger older people who are still physically able to attend.

The inefficiency of both systems is obvious but it is largely the women who are capable of being heard and who can therefore change their situation, even if slowly. As things stand at present we oldies don’t stand a chance of being heard.

I have to compensate for my comparative immobility by relying on webinars which I can watch from home but these have limited value, again because they are organised by younger people who have to base their knowledge on what they read, and who have limited contact with older people. About 20 to 30 years ago a couple of researchers into ageing in the UK applied for a grant from a charity, but were told they could only have it if they included some older people in the research team. They said afterwards it made a huge difference to the quality of the research, yet few other researchers seem to have realised how important this is. It’s the equivalent of men doing research into women’s issues, without involving women, which I assume would be laughed at today.

So where do we start? To me the obvious place is to raise the profile of older people and show that we still have a value in the community. When I started looking I found that there is plenty of material, and that I am not the only person aware of this need and willing to do something about it. One on-line magazine is already on board. In their latest edition they give the example of an elderly lady with dementia and a beautiful voice, and her carer, equally talented, who recorded a famous song from the past. It got to number 7 on the English charts. What a huge amount of pleasure that gave so many people across the world. Even with dementia we have a value.