Lack of Funds amounts to Elder Abuse: But neither Party is Talking about it

Dr Tristan Ewins

In a reflection in Saturday’s Age (11/5) Merle Mitchell explained that institutionalization in aged care left her without a home.  Institutionalized care can mean loss of social networks and community.  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 counselor 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 the lack of ratios, and 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 – whether through discussion of politics, philosophy, religion ; or if you prefer - discussion of the football ; and remembrances of years past.  Just sitting people in common rooms to stare at televisions is not the answer!


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.  And morphine must be made available to the dying.  (I have been told it’s only available in hospitals)  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 (and some lack family as well) , and 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’.

A lot has been made of elder abuse recently.  And there are some shocking stories.  But Conservatives prefer to focus on individual instances and deflect attention away from SYSTEMIC ELDER ABUSE in the form of insufficient regulation and funding.  So far in the current election campaign neither side has had anything much to say about Age Care reform, and provision of extra funding.  The initiatives suggested here are crucial to the well-being of our loved ones ; but they come at a cost: probably billions a year.  Meanwhile Conservative PM Scott Morrison focuses on tax cuts for the already well-off and thinks he can hoodwink us with mantras on ‘economic management’.  Those tax cuts will also mean austerity ; some of which will hurt the poor and vulnerable.

Sometimes  Aged Care workers (mainly women) need better training ; and to retain the best workers a Labor government should subsidise Aged Care worker salaries – as it is doing with child care workers. It can be a grueling job ; but it is one of the most important jobs of all to care for the most vulnerable of all. Loved ones we would not forsake for all the world.  Those workers need respect ; and they need support.

Labor is bringing in money from tax reform ; closing loopholes and so on ; but is not yet committed to significant aged care reform.  Beyond already-mooted reforms it is emphasizing its attempt to outbid the Coalition on a Surplus.  But when the Aged Care Royal Commission hands down its findings it must urge Labor to somehow dedicate comparable funds to those made available for the National Disability Insurance Scheme. (NDIS)  (assuming Labor wins the election)  Even if it means imposing a dedicated-purpose, progressively structured levy.  The political parties have treated this issue like a political football for over a decade.   That has to stop ; and we need real action on Aged Care NOW. 

Shorten is beginning – tentatively – to ‘break the mold’ – on small government.  The sufferings of the aged ; and their need for love and dignity is too important to again “leave it until next time”. Morrison is a hypocrite ; parading his ’Christian credentials’  while preferring tax cuts to caring for the vulnerable.   But Bill Shorten needs clarity and resolve.  It is an argument he can win.  We’re talking about our loved ones here ; and possibly of our own futures.  Bill Shorten must foreshadow the necessary commitment of resources now ; or he must support an immediate shift of policy on funding, ratios and standards following the Aged Care Royal Commission.   Lack of funds amounts to systemic abuse of our elderly.  Elder abuse cannot be ‘fixed’ without the provision of extra billions every year. 

Aged Care Reform NOW.

Letters on the US Presidential Election and 'Small Government' in Australia

above: Left-wing US Presidential Candidate Bernie Sanders

 

The following are another series of letters to The Age and to the Herald Sun ; addressing topics as diverse as the US Presidential election; to Richard Denniss on economic reform;  a response to Peter Costello on ‘small government’;  on the threat of ‘elder abuse’ by government;  and the case against austerity!  Unfortunately the clear majority were not published.

Dr Tristan Ewins

Richard Denniss on Economic Reform

Richard Denniss (‘The Age’, 15/2) makes a compelling argument regarding the real nature of the social choices we need to make, and the social priorities we need to set.  Are lower corporate and personal income tax rates, as well as other concessions and subsidies for the well-off really a greater priority than quality, accessible state education ; a fair welfare system which is sustainable for those depending on it; social insurance for the disabled and the aged ; and comprehensive public health which is truly responsive to human need?  Peter Martin (15/2) makes the point that the top 10% consider themselves ‘battlers’, whereas in fact they are amidst the truly wealthy and the upper middle class. We cannot afford social services, welfare, social insurance and public infrastructure without a genuinely progressive tax mix.  And we must not be scared to put the arguments for redistribution and higher social spending – without which the minimum human and social needs of a great many Australians would not be met.  This election the progressive parties should be aiming to increase social expenditure by at least 2.5% of GDP (or $40 billion in a $1.6 Trillion economy) rather than parrot conservative mantras on ‘cutting expenditure’.

Responding to Peter Costello on 'Small Government'

Peter Costello (Herald-Sun 16/2) argues  “spending, not tax, is our biggest problem”.   Yet Australia’s public spending is low by OECD comparisons. The problem is that ‘small government’ imposes a ‘false economy’.  Some social needs are non-negotiable.  Health, Education, Aged Care, pensions for the vulnerable and for those who have earned it through a lifetime of work.  Crucially: In these fields ‘collective consumption’ via tax actually gives us a better deal as taxpayers than we would receive as private consumers.  To illustrate – in their book “Governomics  - Can We Afford Small Government?’ Miriam Lyons and Ian McAuley argue that whereas ‘high taxing’ and ‘high spending’ Nordic countries “contain health costs to 9 per cent of GDP”, in the US the figure is 18% despite only 40% coverage.   Australia’s Medicare is somewhere in the middle: It is an effective universal coverage scheme – but neglect and under-funding leave us ahead of the US but behind the Nordics.  So even with progressive tax and higher social expenditure these policies can actually get costs down as a proportion of GDP, and in the process free up a greater portion of the economy for ‘negotiable’ needs (eg: entertainment, holidays) which improve our quality of life. 

Continuing the Argument against 'small government'

Conservatives are arguing Turnbull must “slash government spending”.  But where would that come from?  The unemployed live in such poverty it interferes with their ability to seek work. The Disabled already experience poverty through no fault of their own.  Student poverty forces mainly young people to seek out work that actually prevents them from getting the most out of their study.   The Aged are forced to sell their houses to access sub-standard Aged Care even when they are from a working-class background.  Waiting lists are spiralling out of control in public health ; and we have the threat of a permanently two-tiered Education system which disadvantages those unable to afford private schooling.  Mental health is neglected and many mentally-ill can expect to die 25 years younger on average.   There is insufficient public money for infrastructure and privatisation passes on added costs that hurt the broader economy.  Public housing could increase demand and make housing affordable for more families.  So in fact more public money is needed – not less.  AND the deficit must be brought under control as well.  Only PROGRESSIVE tax reform (not the GST) can tackle all these crises fairly.  Cutting savagely is not the answer.

Meanwhile on Elder Abuse by the Federal Government!:

Christine Long (‘the Age’ 24/2/16) provides an exposition on elder abuse, usually at the hands of relatives.  Yet the worst elder abuse and negligence comes as a consequence of the actions (and otherwise negligence) of the Federal Government.   Nursing homes lack staff to resident ratios, and what is more there is no provision for a registered nurse on the premises 24/7.  Indeed nursing homes are often akin to ‘warehouses for old people’. There is little or no mental stimulation or diversity in environment.  Lack of staff means residents do not always eat, and some are left in their own excrement for protracted periods for the same reason.  What is more, onerous user-pays mechanisms are forced upon working class families who may have struggled their entire lives to afford a home.  User pays aged care is akin to regressive tax – but much worse even than the GST.  For quality of life in old age other reforms are also necessary.  A significant increase in the Aged Pension.  Free public transport.  Taxi vouchers, and social gatherings to cater for all interests.  Programs to combat loneliness and the likelihood of suicide.  A National Aged Care Insurance Scheme would be a great place to start.

Responding on the US Presidential Campaign: Bernie Sanders' Prospects

 

Rita Panahi  (Herald-Sun, 15/2) decries US Presidential Candidate Bernie Sanders as “An ageing socialist who wants to raise existing taxes and introduce a bunch of new ones.”   The unspoken assumptions, here, are that small government is un-contestable, and redistribution unthinkable.  The Herald-Sun (15/2) was also concerned that what are probably the top 10 per cent of families live ‘pay-check to pay-check’ on $200,000 a year and more to maintain their lifestyles.  But according to the ABS  the average pre-tax individual wage in November 2013 was $57,980. And many truly battled on close-to-minimum wage: cleaners, skilled child-care workers, aged care workers, retail, hospitality and tourism workers.  In 2015 the minimum full-time wage was barely $650/week.  So redistribution is fair for many reasons.   Arguably everyone should have minimum rights to social inclusion, shelter, nutrition, education, and health care.  Best provided through the social wage, social insurance and various social services which demand progressive tax as ‘the price we pay for civilization’.  But pay is also based on ‘demand and supply’ in the labour market, and some workers’ industrial strength. Those mechanisms do not guarantee fairness.  You don’t get fairness and human decency without redistribution including services, welfare, public infrastructure and progressive tax.

Meanwhile:

Julie Szego (‘The Age’ 25/2) infers that women supporting Bernie Sanders in the US Presidential Election is not the ‘feminist choice’.  Underlying this is the assumption that identity is privileged over broader outcomes and over ideology . But if Sanders succeeded in winning free universal health care women would stand to gain as women – exactly because women are otherwise disadvantaged financially due to the exploitation of feminised professions, and due to women’s interrupted working lives.  Secondly, if Sanders raised the minimum wage this also would help the most exploited women in those same feminised professions.  Whereas Hilary Clinton can be seen as supporting a ‘liberal feminist agenda’ Sanders agenda ought appeal to ‘socialist feminists’  concerned also with class, and with the inequalities even between women themselves.   In this context it would not be ‘a betrayal of feminism’ to support Sanders.  Modern progressive politics needs to be based on reciprocal solidarity between human beings against oppression, exploitation, subordination and domination.  Here gender does not ‘trump’ other issues any more than those issues (eg: class) ‘trump’ gender. The agenda is for us all ‘to see the struggle through to the end’ with nothing less than ‘full human liberation’ as the aim.

 

Aged Care Crisis - Australia’s Greatest Shame

And What are Rudd, Milne and Abbott going to do about it?

 

above: The needs of Australia's Aged citizens are just as urgent as the needs of the Disabled - sometimes more.  There is no excuse for not implementing National Aged Care Insurance along similar lines to the NDIS - or 'Disability Care Australia'.

In this article Socialist Left activist, Tristan Ewins takes a look at the recent report on Aged Care at ABC's "Lateline" program - and puts the argument for comprehensive Aged Care Insurance - how it should be funded - and the services it should provide...

 

Last night ABC’s ‘Lateline’ lifted the lid on an Aged Care Crisis which we have been trying to draw attention to for years at ‘Left Focus’ and “ALP Socialist Left Forum’.     (for example, there was the following article in 2009 – the first of many at ‘Left Focus’ – see: http://leftfocus.blogspot.com.au/2009/02/another-look-at-aged-care-crisis-call.html  )

We will begin by recalling the basic substance of that recent (July 15^th ) story.

Following the observations from the ‘Lateline’ Program, Margot O’Neil reported for the ABC after conducting a year-long investigation that common complaints about the quality of aged care in Australia included residents:

“being left in faeces and urine, rough treatment, poor nutrition, inadequate pain relief, verbal abuse, and untreated broken bones and infections.

And  further:

“one woman has told the ABC that her grandmother, who survived Nazi concentration camps, believes her experiences in aged care are worse than her wartime ordeal.”

Jane Green – daughter of former high intensity aged care resident Margaret McEvoy – recalled her own specific story to the ABC how, explaining how:

“For five days, staff tried to make Ms McEvoy walk. In fact, she had an undiagnosed broken thigh bone, a raging infection, and severe dehydration.”

The ABC further observed that:  “Ms Green, who is also a nurse, had to fight to get her mother taken to hospital, where she was immediately put into palliative care. She died six weeks later.”

In a similar story nurse and health care lecturer Mardi Walker:

“was horrified when she found her [91 year old] grandmother with exposed raw ear cartilage due to lack of turning, and one of her arms immobilised after staff botched injections.”

She recalls that: "They would just keep injecting into the same spot and she would scream. My mother said it was horrific, because she would scream.”

The ABC also made the accusation:  “Repeated surveys find that 20 to 50 per cent of nursing home residents are malnourished, and the Australian Medical Association says there are not enough doctors to visit residents.” 

And meanwhile: “The Nursing Federation says there are not enough properly trained carers, while Palliative Care Australia says only one in five residents receive proper palliative care.”

New Aged Care and Mental Health Minister Jacinta Collins responded by reaffirming that the Government had  a “10 year plan.”

When asked by ‘Lateline’ the Minister had no credible answer to why the government has failed to act decisively in response to Aged Care abuses and systemic failures when compared with its response to abuse of cattle in Indonesia. 

Lateline journalist Emma Aberici further pressed Minister, Jacinta Collins on why Aged Care accreditation processes do not include assessments of the mental and physical well-being of aged care residents, including dehydration, malnutrition, depression, bedsores, falls, chronic pain, pain-management, over-use or inappropriate use of anti-psychotic medication, forced restraint and so on.

Collins was uncertain what research was being conducted in these fields.  She asserted that families can discern between different providers in the best interests of their loved ones.

But if there is a SYSTEMIC failure due to chronic LACK OF FUNDS and failure to enforce sufficient standards, then it stands to reason that families often have little choice.   And that is especially so when they are looking for a residence relatively close-by to enable regular visits.

Collins observed that over 200,000 Australians are currently in residential care – and that is going to expand dramatically with the ageing population. She also suggested that staff to resident ratios might be considered ‘in the future’. 

Finally, the Minister proclaimed she would visit Aged Care facilities ‘on the ground’ to see for herself the quality of care.   

But time is of the essence and action needs to be ‘locked in’ now  to be implemented in the near future – as a matter of urgency.   Collins also needs to visit a very wide range of facilities without notice in order to get a better idea of what conditions are really like ‘on the ground’ , while consulting closely with families who have reported neglect and abuse.

While Collins deserves to be given a degree of slack on account of only recently taking the Ministry, the Lateline Report shows that the time for procrastination and empty rhetoric is over. 

Rudd, Milne and Abbott need to immediately form a response to this story, and to the many stories provided by some residents and many families who have been trying – often without success – to bring this issue to the forefront of public discourse for years.  They need to devote new funds – many billions of new funds for every year. 

Alberici observed that most high intensity care resident spend less than 2 years in care.  And yet those can be two years of Hell. Whereas improvements in the standard of care could provide much greater comfort, better health, and perhaps extended (quality) life-spans.

For a long time we have championed this cause at ‘Left Focus’ and ‘ALP Socialist Left Forum’.   We will now re-iterate what needs to be done; and what we demand be done:

Firstly a National Aged Care Insurance Scheme needs to be established along similar lines to the National Disability Insurance Scheme – which in 2010 was estimated to cost $15 billion a year.  ($22 billion by 2020)   

A National Aged Care Insurance Scheme demands a similar commitment of resources; implemented as quickly as possible given the urgency of the suffering of our families and loved ones.  Immediate funding options include further increases to the Medicare Levy, cutbacks in superannuation concessions for the wealthy and the upper middle class, and reductions in the rate of Dividend Imputation. (reverting to 75% would save about $6 billion)

Such funding needs to secure the following outcomes:

·        Official quality control that includes comprehensive ongoing assessments of the mental and physical well-being of aged care residents, including dehydration, malnutrition, depression, bedsores, falls, chronic pain, pain-management, over-use or inappropriate use of anti-psychotic medication, forced restraint and so on .

 

·        Generous nurse/staff to patient ratios – improving the quality of care by freeing nurses and staff to turn residents to avoid bedsores;  wash residents whenever necessary; provide comfort and social interaction; ensure food is of decent quality and is actually eaten;  constantly monitor residents and ensure that health needs are always addressed as a matter of urgency.

 

·        Weekly visits by doctors and immediate provision of dental care for any who have the need .

 

·        Better training, pay scales and career paths for Aged Care professionals including nurses and other qualified staff.

 

·        Privacy for aged care residents including private rooms and other personal space.

 

·        Daily facilitated Social interaction; outings to shops, gardens and churches; access to information and communications technology and services; libraries; facilitated reading; discussions and games – A better life than being sat down to stare at a television, or perhaps just at walls all day!

 

·        Better programs encouraging volunteers to visit residents and provide conversation and comfort.

 

·        Provision of gardens and similar space to provide greater tranquillity and a change-of-scenery; as well as time in the sunlight during the warmer months

 

·        The best quality palliative care for all who have the need

 

Meanwhile for low-intensity care residents, and those being cared for by loved ones, greater financial support is necessary for Carers, as well as regular respite, and institutionalised support when it comes to health, outings, diverse social interaction, and construction of extensions or ‘granny flats’.

Stop Regressive User-Pays!

For all levels of care, meanwhile, User-Pays mechanisms need to be immediately wound back.  This in itself will cost billions – on top of the cost of actually improving the quality and legislated standards of care.   

Again – we need to see this as a comprehensive National Aged Care Insurance Scheme along similar lines to the National Disability Insurance Scheme. (NDIS)  Those needing care should not be driven to take out tens or even hundreds of thousands of equity against their houses. This operates as a grossly regressive ‘flat tax’.  Residents from relatively poor and working class families especially don’t deserve this ‘final cruel blow’.

Residents who need only low-intensity care, meanwhile, need to enjoy the appropriate level of care, enabling greater flexibility and freedom as long as possible.

Finally Funding for Advocacy groups is necessary in order to empower families; and for purposes of supporting advocates for those not in a position to stand up for themselves against abuses.  (Eg: those without family, and those with dementia)

This issue will resonate powerfully with families: families who love their elders dearly, and those who (legitimately) fear for their own futures.   The mainstream parties – Greens, Labor, Liberals – all need a comprehensive response to the issues raised by Lateline – culminating in a consensus on a National Aged Care Insurance Scheme along similar lines to what occurred with the NDIS.  Procrastination, opportunism or mean-spiritedness on this issue need to be condemned in the strongest possible terms.

For those of us who care about this issue we need to maintain the pressure – and the profile of this issue.  We need to ensure the fullest possible reform over the shortest possible passage of time – as the needs of our most vulnerable are urgent – their sufferings neglected until now - demanding immediate action.

This issue is out in the open now for everyone to see.  There are no more excuses.

References:

http://www.abc.net.au/news/2013-07-16/shocking-claims-elderly-being-mistreated-in-nursing-homes/4821492

http://en.wikipedia.org/wiki/DisabilityCare_Australia