Is the "crisis" in aged care actually a crisis of identity?

With the enormous changes occurring in residential aged care services in Australia, I am starting to wonder if the crisis that the media constantly talks about is not a crisis of care but a crisis of identity.

Gone are the days where a nursing home was a place you were old and sick and you went there to die. Depending on who you talk to, it’s no wonder that the residential aged care system doesn’t know if its Arthur or Martha.

To any government, residential aged care is constant headache caused by relentless media attention and a conundrum that successive leaders have failed to solve. I remember a former Minister for Ageing saying once that the most important role of an Aged Care Minister was to keep aged care out of the news. This in many ways is a resigned acceptance that aged care only makes the news when things are bad, so it’s best to just keep it hidden. No news day is a good day.

Everything in aged care is split, for profit homes, not for profit homes, state government homes, local government homes, different competing unions (in NSW the HSU and the NSWNMA but you can also throw in the QNU, ANF and several others around the country), three disconnected peak bodies, federal & state complaints bodies, commonwealth legislation, state legislation .... we are the worst version of multiple personality disorder known to man.

I don’t think the Department of Health actually knows what we are. I get the impression they are the ball inside the pinball machine that bangs against all the obstacles (consumer directed care, person centred care, homelike environment, rehabilitation unit, subacute hospital, over regulated, under regulated, deregulated, give out money, claw back money) until it falls into the gutter and the game is over. It is now impossible to get a straight answer to any question because nobody knows anything and when you do get a response, it often comes from an anonymous email address and makes no sense at all. As an illustration of this, I have recently been attempting to find out about Day Therapy Centres, Transitional Care and Short Term Restorative Care. I have a community desperate for services that are delivered with respect for their cultural and religious beliefs. I have the resources (including a fully equipped gym and a community centre) to provide these services. I get directed to the grants section by one anonymous section team, who tell me there are no grants, they don't know when a grant applications will become possible and grants are only given out during a grants round (despite the last two grants on their website saying they were ad hoc grants awarded outside of a round). I'm told to "monitor the website" because I have nothing else to do with my day. Then I get told by an another anonymous team to go to the ACAR people, who similarly tell me they cannot confirm or deny whether ACAR will occur, and if it does occur, they cannot say when it may occur. I get a phone call from the Ministers office telling me they can answer my question about ACAR but they may not be able to "give me the details I am after". Brilliant.

The Aged Care Complaints Commissioner and to a lesser extent, the Aged Care Quality Agency see us as mini hospitals that are supposed to miraculously provide any level of clinical care required by a ‘care recipient’, with little regard for the quantity, quality or availability of clinical nursing and allied health specialists in the sector or the overwhelming absence of qualified medical staff who more often than not, fly in and fly out like an offshore oil rig worker (only for 15 minutes not 15 days). Even the Queensland government doesn’t understand the distinction between an aged care facility and a hospital and thinks we dump people there because we want to save money.

The hospitals think we are a joke without reflecting on how well they would perform if they received funding that allowed Registered Nurses to look after 30, 40, 50, 75, 90, 100 people at a time being assisted by a largely poorly trained workforce. My recent experience showed that they complained when they had to look after 7 in a private hospital because “I would be looking after 4 if I was across the road in the public hospital”.

Many aged care providers now see themselves as some kind of hybrid hotel / resort / retirement village which seems in conflict with the very people who are seeking care. Some of my not too distant past new admissions were aged well over 90, with the eldest being 102. While it is clear that this overzealous marketing is aimed at the baby boomer children and beyond, it is debatable whether many aged care residents, who typically now enter at an advanced age with multiple acute and chronic co-morbidities, will or could actually avail themselves of such luxuries. In the past four years I have not met one resident capable of affording the $950,000+ minimum RAD let alone the near $2 million RADs now being demanded by some of these 'high end' services.

My thirteen year old son (who has grown up in aged care homes since he was a baby) recently visited the open day of a new facility with me. He got to the end and I asked, what did you think? His response was simple “the people living here won’t use most it, it looks like an art gallery, everything was white (yes white handrails against a white wall) and in two weeks it will smell like urine because they don’t have enough staff” (after the tour guide refused to answer a lady’s question about staffing levels). I couldn't have said it better myself. I know of one such home that has been open more than two years and is still only 1/3 full.

Others now see themselves as the Intercontinental Hotel with amazingly talented chefs who produce food out of this world. So, now we have some residents eating almost Michelin starred cuisine while others are fed reheated slop and party pies. I don’t think I would like to eat either on a regular basis. The feedback that I regularly receive is that residents want fresh, nutritious, varied meals that meet their nutritional and cultural needs.

With all the media attention, it is easy to forget that it is a very small minority of older Australians who enter residential aged care. The majority have and hopefully always will be cared for at home in the community where they belong. Residential aged care needs reform, it needs to improve, it needs to meet the needs of the communities that it serves. Quality care, sustainable skilled workforce, respect ... these are the important things - not flashy chandeliers, tiny meals on giant plates and art gallery interiors.

I am not quite sure whether many of the changes now evident in residential aged care serve the communities we care for and I think that maybe we have lost our way, straying from the mission of caring for the aged, sick and vulnerable of society and becoming caught up in some kind of corporatised war that has pitted us against each other … all competing to build the latest and greatest Taj Mahal to meet the needs of a generation who are not in aged care, don’t want to enter aged care and will do anything possible never to go there.