Institutionalized aged care can mean a loss of social networks and community. As Merle Mitchell reflected in 'The Saturday Age' on May 11th this year, in her opinion, there was the feeling that "death would be a better resolution for everyone". Fortunately, though, she did not lose contact with all her friends, and that helped preserve her "cognitive capacity". She presses the case for a counsellor for all residents and for staff and suggests that if the effort was made to keep residents engaged that may enable stimulating discussions on all manner of issues.
Merle also enjoys extra exercise half an hour a day, but that is an 'extra' that has to be paid for ($50 a day). Many cannot afford it. In the end, some of the biggest problems are low staff/resident ratios, and lack of personal control over everyday life. With 'institutionalization' you get up when you're told to; you eat when you're told to; you go to bed when you're told to.
Merle's story is one of an extraordinary number being considered by the Aged Care Royal Commission. Unless the process is somehow corrupted the Commission will almost certainly advocate for better ratios for nurses and staff. It will consider the quality of food; the provision of privacy; the provision of mental stimulation.
This mental stimulation could be through discussion of politics, philosophy, religion, football, or remembrances of years past. Just sitting people in common rooms to stare at televisions is not the answer!
More specifically, the Commission has already explored residential care and the problem of dementia well as Aged Care in the Home, and issues of Access and Inclusion. Through the remainder of June and July the Commission will consider person-centred care, aspects of care, access and quality of life. An interim report will be provided by 31 October 2019, and a final report will be handed down by 30 April 2020.
While the final findings are a while off, the Aged Care Royal Commission has made it clear there is the need for a minimum $2 billion extra a year for home care alone, and possibly $2.5 billion.
This would involve a "tripling the number of level 3 and 4 Home Care Packages" with "all aged care providers [required]to publish staff-to-resident ratios."
National Seniors Australia observes how:
Chief Advocate Ian Henschke believes the parties don't believe there are sufficient votes in aged care, and as a society we have little respect for the frail elderly.
Henschke also comments that:
It is very disappointing that people will protest on the streets when animals are being mistreated, but when our older Australians are suffering we tend to be silent.
Better ratios would mean more time to dress and wash in the morning. It could help ensure residents stay healthy and actually eat their food. Gentle exercise should be provided for everyone capable – regardless of cost. There must be a wide range of books, and increasingly internet access as well.
A nurse on site 24/7 is crucial in the case of emergencies. Further, morphine must be made available as necessary to the dying, something which I have been told is not necessarily available in nursing homes.
There must be outings for those capable. And preferably facilities must include gardens where residents can relax and be at peace. Personal choice must be extended as far as possible.
At home care must also be a viable option and there has been progress. But some are still left waiting too long for packages. Staying at home in familiar surrounds full of memories is very important. But again maintaining social engagement is crucial. Including several outings a week; taxi vouchers; gatherings with like-minded individuals; in short – general quality of life. The support of family is crucial in all this, but some families neglect their elders while some lack family as well. In such instances, communities must step in to provide support and affection. Obviously, not everyone can do that work; only people whose hearts are 'in the right place'.
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