Aged care expert blasts ‘uncaring’ lawmakers and governments that leave residents ‘waiting to die’.
Australia’s aged care system would be a “complete catastrophe” if not for the efforts of nurses, a leading geriatrician has said.
Professor Joseph Ibrahim, a consultant specialist in geriatric medicine and head of the Health Law and Ageing Research Unit at Melbourne’s Monash University, made the comments when giving evidence to the Royal Commission into Aged Care Quality and Safety.
He said aged care workers did not have enough resources to do their jobs properly.
“If it was a group of doctors, the AMA (Australian Medical Association) would be banging on about the need for resources, more pay for doctors, more resources for residents, and the situation is not good enough.
“When the ANMF (Australian Nursing and Midwifery Federation) say the same thing, they’re predominantly met with silence.
“If it wasn’t for the nurses in the aged care system … the whole thing would just be a complete catastrophe.
“If they walk away I’m not quite sure what we would be left with. But things are not good enough and it’s not acceptable the way it is now.”
Commissioner Richard Tracey assured Professor Ibrahim the Commission was “very conscious” of his concerns “and the need to have something done about them.”
Commissioner Tracey asked if current training programs were sufficient to produce “a skilled group of geriatricians who can look after the ageing generation in the decades to come”.
Professor Ibrahim said the training of specialists in geriatric medicine rarely involved any attachments or work in residential aged care.
Nurse practitioners better option than doctors
He said nurse practitioners working in collaboration with a senior medical officer were a better option for residential aged care than doctors.
“A lot of the issues that we currently face require non-pharmacological techniques, particularly for dementia, which would be better applied through nurse practitioners, rather than medical specialists.
“What we need is more cross-training in aged care for the allied health side, speech pathologists, physiotherapists, occupational therapists.
“The people that speak best with the larger part of the workforce would be nurse practitioners who understand the nature of a nurse’s work and how to fit that in. ”
Professor Ibrahim said residential aged care should be a place where older people can enjoy life.
However, residents are left “stateless” in a system that is waiting for them to die, and “no one seems to give a toss”.
He said they are stateless because federal parliament did not care about people in residential aged care and had failed to act despite 20-plus reports on the sector and now a royal commission.
“If they truly care, they would do something, or they would at least say something. They don’t say anything, they don’t act.”
He said aged care residents are citizens of the state “but the state doesn’t provide care because the federal government is supposed to.”
“The federal government doesn’t provide care because the states are supposed to.”
The aged deserve better
Referring to a typical aged care resident, Professor Ibrahim said the result of being stateless was “an 80- to 90-year-old woman who had a hard time, sacrificed her life for the betterment of everyone else and is still doing it, and no one seems to give a toss”.
“If you have to go to residential care, it usually means you’ve survived to 80. You’ve usually
got three to five diseases. You’ve lost your home, you’ve left your family behind.
“You’re coping with having dementia or severe arthritis. You’re coping with having people support you with your day-to-day living and toileting.
“I would have thought at that point in life you deserve to have something decent happen to you, and so I think that residential aged care should have the goal that it’s a place where people can at least enjoy their last few months or years before they die.
“What currently happens is most of us sit around waiting for them to die, and if they die quickly then it’s a good job done.”
He said that approach would not be acceptable in paediatric palliative care “and it’s not acceptable anywhere else”.
He said a death from an injury was a premature death, which meant someone had died before their time.
“If they’re 90 or 95, I don’t care. What I care about is they’ve died before they were supposed to.
“We accept people dying prematurely because we believe they’re old and have no benefit to society, and that’s just wrong.
“In residential care, it seems to me no one has been angry for a long time.
“The product of residential aged care is death, and deaths occur one third every year and so it seems that residential aged care is working well because every year 50,000 people die and that’s what we expect so things are happening smoothly.”
Prof Ibrahim said residential facilities provided a list of activities “from bingo to completing a jigsaw puzzle to book reading to watching the midday news”, but never asked residents, “What do you actually want?” and, “Can we help you achieve that?”
“And we get away with it because the generation that’s in residential care at the moment …. had a hard life, made do, compromised, self-sacrificed and don’t complain.”
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