Transforming the aged care crisis

If ever there was a time for change in aged care, it is now.

The COVID-19 outbreak in Victoria has highlighted the vulnerability of older people in our community. Strategies introduced to protect older people from COVID-19 have reinforced their ‘otherness’ – increasing their isolation and loneliness.

Taken with the findings of the Royal Commission into Aged Care Quality and Safety, the pandemic has provided a prime opportunity to develop processes to strengthen older people’s social networks, community connections, health and to help people to grow old at home.

The timing for such a shift also aligns with the emergence of the well-educated, activist baby boomers who will soon come to represent the largest ever augmentation to Australia’s population of over 70 year-olds.

This change, however, must not simply be more money or new systems; we have had several such changes since the 1980s.

It requires a cultural shift to respecting and valuing older people in our community.

The strategies employed in the recent pandemic outbreaks resulted in critical failures of care. As of 3 November, 75 per centof the Australians who died of COVID-19 were in residential aged care facilities (685 of 907).

Hospital admission records of people admitted from aged care facilities document dehydration and malnutrition, reinforcing issues of neglect that were identified in the Royal Commission into Aged Care Quality and Safety.

In some cases, these diagnoses were present in people who were COVID-19 negative on admission, but later developed and succumbed to COVID-19 – a contributory factor being their suboptimal admission state.

There appears to be a disconnect between the autonomy and independence that people strive for and a system which delivers the opposite; this has been acknowledged as financially unsustainable anyway.

The importance of families in caring for its older members has strong historical support, yet the system and certainly the recent crisis, excludes this support network.

Australian policies and programs need to support older people’s desire to live and thrive in their community by providing suitable housing, accessible footpaths, accessible shopping strips, health services and transportation.

Australia was an early adopter of the World Health Organization (WHO) framework to develop age-friendly communities with signed agreements in municipal councils and the various states having ‘age friendly’ initiatives, but only modest improvements have been seen.

Key to appreciating the unique aspirations and needs of older Australians is to understand and respect individual values and preferences.

Individual values, that is what people hold as most important, as well as the preferences and priorities people set for the way they hope to live their lives and the care they receive may vary between cultures, age groups and cognition.

Australia’s ageing population is culturally, linguistically, geographically, sexually and spiritually heterogenous.

Person-centred care of older people demands an understanding of these nuances.

We could consider this approach as “humanising” an older person living with an illness, not “pathologising” them.

In the latest Australian Census, over one third of Australians over 65 years were born overseas (37 per cent), with a majority born in Europe (67 per cent) followed by Asia (16 per cent).

Aboriginal and Torres Strait Islander people over 65 years comprise around five per cent of all First Nations people in Australia.

Research by Aboriginal and Torres Strait Islander academics highlights the importance of health service providers “getting to know a person, so the person can have the best opportunity for being in control and possessing self-determination”.

We should learn from First Nations peoples’ strength-based approach, which offers solutions to overcoming challenges, not focussing on the challenges themselves.

Connection and integration of health care provision with family, country and community have been identified as integral.

Ageing has traditionally been viewed as a decline in health with accrual of disease. This has led to a pervasive culture that views ageing negatively.

As it is only in the last century that the human lifespan has gained a remarkable extra 30 years of life, it is only recently that have we had a large enough population of older people to understand the true nature of ageing.

Two important things have come from this phenomenon; firstly, that healthy ageing is possible and secondly that we need leadership and services that serve individual needs – one size does not fit all.

Many older people want to remain living independently.

In fact, half to two thirds of people in nursing homes are there because they have dementia, yet the recent Lancet Commission confirmed 40 per cent of dementia is preventable.

Recent centenarian studies show that, while disease rises exponentially with age, once you live to over 90, it’s likely you have led a healthier life than others.

Today, greater longevity is possible but only by remaining active and engaged with ageing can we increase quality of life in our last decades of life.

Many older people continue in full or part-time employment well into their later years of life which reflects improvements in health coupled with better job opportunities for older Australians and increased female engagement in the workforce.

Older Australians contribute significantly to the economy through continued participation in the labour force, their income and assets as well as family and civic engagement.

More than 13 per cent of people over aged 65 continue to engage regularly in the workforce, 14 per cent regularly provide paid or unpaid childcare and more than 20 per cent participate in community volunteering.

Australian economic projections show continued increases in productivity, with an average annual GDP growth of 2.8 per cent forecast to 2054-55.

However, with the declining number of younger people entering the workforce, this growth is unlikely to be realised without harnessing the older workforce whether in paid or unpaid roles.

A focus on health and quality of life in older Australians is not just socially, but also fiscally responsible.

The authors acknowledge the contributions to this project from the family members who provided evidence at enquires and colleagues Dr Chontel Gibson, Dr Troy Walker and Dr Stephen Campbell for review of final manuscript

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