Ageism at the heart of our failure

How we talk about older people primes us to care less and spend less, says Susan Banks

SO, the interim report of the Royal Commission into Aged Care Quality and Safety is out. It’s impressive work. The commissioners have been listening to the experiences of people who live or work in the system intended to support the wellbeing of older Australians.

This first report starts to spell out what is happening. As many of us suspected — especially those who have been touched by this system — the possibility of growing older safely and with a sense of our own worth in society appears slim.

The opening statements are important — that the “language of public discourse is not respectful towards older people”, and that this way of thinking shapes how aged care is delivered. Indeed, the commissioners say ageism is at the heart of the problem, driving discrimination. This underpins a system that is “woefully inadequate”, and fails to deliver safety, care or quality. Aged care in Australia lacks innovation, flexibility, transparency and accountability. It allows human rights to be ignored.

The report sets out how we got here, then turns to the experiences of Australians

(un) lucky enough to live into old age, or to need support to lead an ordinary life. This includes younger people with disability. Few stories are positive. The report’s title, “Neglect”, is fleshed out with stories of loss — loss of connection, of a sense of home, of power to make choices, be heard and live one’s preferred life, of safety and of liberty. Very few older people will tell you they are looking forward to moving into an aged care facility. The common attitude in my study of aged care and disability support was “I’ll die first”.

Being carried out of their familiar home in “a wooden box” was the preferred exit. Younger people living with disabilities were equally adamant that the prospect of being placed in a nursing home was “disgusting”.

What do the commissioners conclude? For now, they note the system is based on transactions not relationships. That voices of older people and families are muted, and finding your way into and through the system is hard. That regulation is neither clear nor aspirational. And the “workforce is under pressure, under-appreciated and lacks key skills”.

Can we find the source of these problems? And therefore work out how to fix them? I think the absence of respect identified in the opening pages has a great deal to do with it.

Respect starts at the top. When politicians and economists talk about ageing and disability as a burden, they are telling us people experiencing those things are taking more than their fair share of the pie. We are being encouraged to resent them.

When the wonderful fact of increased life expectancy is described in terms of “tsunami”, we know that having a growing older population must be a bad thing. When the only good citizen is one who is working, paying taxes and therefore part of the market, then those unable to work — because of impairments, rules or just a lack of jobs — have little value (of course this plays out in other parts of Australian life, not just for older people).

These ways of describing people promote disrespect. They may prime us as a nation to spend far less than needed on care. High quality care and disability support are human rights, something we must find fair ways to pay for (as we find fair ways to pay for defence, for example).

Speaking of pay, staff wages and conditions demonstrate how little our politicians and policymakers respect older people. Aged care nurses are paid less than their peers outside the sector, and aged care and disability support workers are among the poorest paid employees in Australia. These are the people who can create good — even wonderful — experiences and maintain a person’s sense of worth. But they have insecure and sometimes dangerous work, unreliable career paths and inhumane time pressures.

A system based on respect would support these staff. It would give them more money and more time. Time is produced by having more staff (mandated ratios, for instance). More time would mean staff not being required to race people through 6–10 minute waking-up-to-readyfor-breakfast schedules. More time would mean staff being

able to find the clothes you want to wear, clean your teeth gently, spend as long as it takes to help you with your meal. And more time would mean staff could spend some of it building relationships and caring about (not just for) the people. While skills are important, even the best trained cannot do a good job under the time pressures created by a poorly funded and disrespectful system.

Love, high quality care and respect can be given by all staff, highly trained or not; the same is true of abuse and neglect. And there are many stories of nursing home or home care managers and boards who turn away, or keep problems in-house, or treat staff and those they support with contempt or benign neglect. Trying to make do with too little can make even the most conscientious of us guilty.

The interim report shows our beliefs about ageing (and disability at any age) have to change. The next task is to explore the systemic problems and form recommendations. In the meantime, change can begin. It will show up first in how our leaders respond to the challenge of respecting older people and supporting the human rights of Australians in the aged care system.

You can read the report at agedcare.royalcommission.gov .au/publications/Pages/ interim-report.aspx

Dr Susan Banks is a researcher in health, ageing and disability. She is a Senior Research Fellow on the Anticipatory Care Action Learning Project at the University of Tasmania’s Institute for the Study of Social Change, and a member of the Preventing Elder Abuse in Tasmania research team.