Australia's tsunami of the aged

Many palliative care workers fear feeding incapacitated residents because of the risk a resident may choke, where legal consequences could make a worker responsible to some degree for negligence. Some residents as a consequence are left only to suck on a piece of ice and slowly starve to death.

There are almost 350,000 people involved in some way with aged care in Australia today. From the care worker point of view, great shortages of qualified staff exist. This is leading to high levels of stress on workers, and even bouts of depression in some. In many facilities the sheer number of residents and pressure on workers to complete their daily quota, leads to rough handling and neglect. This leads to 'burn-out' and worker turnovers as high as 90% in some facilities.

Care workers may be able to provide the physical care, but have little time or training to assist in looking after the psychological needs of residents. Personal care assistants (PCA) are not trained to detect any mental illness in residents. The certificate III in Aged Care from TAFE, the qualification PCAs are expected to have, primarily deals with bathing and handling of residents. There is only three 6 hour sessions on issues involving mental health and dementia within the course. Registered Nurses (RN) handle most of the medical issues in regards to residents, but due to much lower pay rates in aged care facilities verses hospitals, there are large shortages of these trained and experienced workers.

For the spouses and families of those requiring care in an aged facility, the process is also traumatic. The process signifies a change in relationship from being a spouse or children to becoming a guardian. This most often changes the dynamics of the relationship dramatically.

The process starts with a person undergoing an aged care assessment by the Aged Care Assessment Team (ACAT) (ACAS in Victoria) to determine what level of care the person requires.  The evaluation is based on a review of physical and mental competence, current family situation and/or ability to cope at home by themselves, needs, and medical history. A person may be then placed into a transition centre for up to 12 weeks so the resident's financial affairs can be arranged and a permanent aged care facility found by the spouse or family.

Aged care facility charged are in four basic parts. A capital component exists of a bond ranging between $300-1.5 Mil. lodged with the facility for the duration of the resident's stay, or the equivalent in interest paid. A daily charge of around $47 is levied for basic services with an additional means tested component paid, where the resident's assets are above $2 million. Finally families may also opt to pay up to $60 per day for extra services, with all charges subject to the GST. People with no assets or income will have the payments taken out of their pension. The house that the resident was living in prior to entry into the aged care facility is exempt from the means test for two years. However in many cases, families are forced to sell the house to lower the level of assets for means test purposes and use the funds for the bond.

The Department of Social Security through the VCAT recommendation basically controls the destiny of the person assessed as recommendations are binding and can only be challenged through going through an internal procedure, or if not satisfied the costly Administrative Appeals Tribunal. 

The legal situation can become very complex if the resident has made no power of attorney, doesn't have a will, or any next of kin. In such cases the resident will most probably become the ward of the state, where decisions about the future will be in the hands of a bureaucrat within the department of Social Security. Under such a scenario these people lose control over their assets and have very few rights being at almost total mercy of the state system, except for the potential intervention of an overworked and underfunded aged care advocacy service. People in this situation within an aged care facility have little recourse against any cruel and unjust practices and are generally left to suffer within the system.

This group constitute what could be called the 'forgotten Australians' languishing alone in aged care facilities, and dying by themselves. An aged care worker told the author that up to 10% of people in facilities fit this category.

The trauma in having a parent moved into an aged care facility also seems to bring out the ugly side in many families. Often family members cannot agree on what care arrangements should be made for the parent leading to bitter disagreements, and even costly court proceedings. In addition, many with the sudden authority over their parent's assets through an activated enduring power of attorney, often mismanage or inappropriately utilize the assets, leading in some cases to grave financial consequences. 

Australia's aged population is going to become an even greater burden on the economy in coming decades. This will decrease the size of the available workforce and tax base, while dramatically raising the number of people dependent on aged care. In addition, with the expected increase in the incidence of dementia within the Australian population, industry experts believe that between 500 to 1,000 new beds are required every month for the next 40 years, indicating that massive capital investment is required in this sector.

As a consequence the Australian economy will be hard pressed to grow sufficiently to compensate this large change in demographics. This is of particular importance where Australia's mineral boom is slowing down due to lower rates of Chinese economic growth. Without drastic structural changes to Australia's economy and radical policy changes, there will be chronic labor and skill shortages, and scarce public funding with many demands upon it over the next few decades.