tag:theconversation.com,2011:/ca/topics/nursing-home-7064/articlesNursing home – The Conversation2024-03-21T19:08:08Ztag:theconversation.com,2011:article/2262362024-03-21T19:08:08Z2024-03-21T19:08:08ZAged care workers have won a huge pay rise. What about the cleaners, cooks and admin staff who support them?<p>This month, the Fair Work Commission handed Australia’s aged care workforce an <a href="https://www.abc.net.au/news/2024-03-15/aged-care-workers-pay-rise-case-ends/103591208">historic pay rise</a>, with some groups’ wages set to increase by more than 28%. </p>
<p>The news was a welcome relief for much of the female-dominated workforce, who have faced <a href="https://theconversation.com/todays-aged-care-falls-well-short-of-how-wed-like-to-be-treated-but-there-is-another-way-177067">chronic staffing shortages and poor rates of pay</a> in recent years. </p>
<p>But not everyone working in the aged care industry was counted equally. </p>
<p>A whole host of workers essential to running aged-care facilities – such as cooks, cleaning staff and administrative assistants – are included in what’s called the <a href="https://www.agedcareguide.com.au/talking-aged-care/providers-indirect-and-direct-care-workers-how-stage-three-will-impact-you">indirect care workforce</a>. Many of them will get a raise of just 3%. </p>
<p>Australia now risks continuing to leave behind this hardworking and often overlooked group. </p>
<h2>Who gets more</h2>
<p>Most direct care workers on the Aged Care Award – such as nurses and care staff – will see a big pay increase from July this year, inclusive of <a href="https://www.fwc.gov.au/documents/decision-summaries/2024fwcfb150-summary.pdf">an interim 15% raise </a> awarded in 2023. </p>
<p>For example, workers on Level 3 of the award will see an overall wage increase of approximately 23% year over year, while workers on Level 5 (holding Certificate 4 in Aged Care and Disability) will see their pay go up by 28.5%.</p>
<p>Experienced nursing assistants on the new Aged Care Award will also receive a pay increase of 23%.</p>
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<h2>Who gets left behind</h2>
<p>Running an aged care facility is a multifaceted operation. Approximately <a href="https://helloleaders.com.au/article/aged-care-workers-could-see-28-pay-boost-indirect-care-workers-left-behind">100,000 residential aged care workers</a> are in “indirect care” roles, working across administrative and clerical services, food services, and laundry.</p>
<p>In its <a href="https://www.fwc.gov.au/documents/decision-summaries/2024fwcfb150-summary.pdf">decision</a>, the commission ruled that a “fundamental difference” between the work of direct and indirect care workers meant they did not deserve an equal pay increase.</p>
<p>The expert panel <a href="https://www.fwc.gov.au/documents/decision-summaries/2024fwcfb150-summary.pdf">said</a>: </p>
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<p>Without diminishing the importance of the work of indirect care for the proper functioning of residential aged care facilities, the above workers do not perform work equivalent in value to the direct care workers. </p>
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<p>For many workers in the areas of infection prevention and control, as well as some indirect workers in dementia wards, it awarded a pay increase of just 3%. </p>
<p>Other segments of the indirect care workforce received greater recognition. Laundry hands, cleaners and food service assistants who interact directly with residents saw this extra contact acknowledged, and won a raise of about 7%. </p>
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<img alt="A list of the aged care workforce, showing the direct care workforce is about 320,000 people and the indirect care workforce is about 100,000 people" src="https://images.theconversation.com/files/583350/original/file-20240321-16-1dhogn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583350/original/file-20240321-16-1dhogn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583350/original/file-20240321-16-1dhogn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583350/original/file-20240321-16-1dhogn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583350/original/file-20240321-16-1dhogn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583350/original/file-20240321-16-1dhogn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583350/original/file-20240321-16-1dhogn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<h2>A widening pay divide impacts quality of care</h2>
<p>At 3%, the lowest pay increase for this group is below the <a href="https://www.rba.gov.au/inflation-overview.html">current Australian inflation rate</a> of 4.1%. For them, increases in take-home pay will fail to meet the rising cost of living. 7% is only slightly higher, and just a fraction of the raises awarded in direct care. </p>
<p>Pay disparity in the treatment of indirect care workers could further entrench a serious equity divide, the impacts of which we may already be seeing. </p>
<p>At large provider BaptistCare NSW and ACT, employee turnover among direct care workers <a href="https://www.theweeklysource.com.au/sector-moves-people/direct-care-worker-turnover-drops-after-pay-rise-but-indirect-worker-turnover-remains-stubbornly-at-38">fell by about 6%</a> after last year’s interim pay rise, to 29.3%. But among their indirect care colleagues who did not receive the raise, turnover remained stubbornly high, above 38%.</p>
<p>High staff turnover poses a serious challenge to delivering quality aged care. </p>
<p>By influencing attitudes at work, the pay divide could also be exerting a profound influence on the quality of care delivered. </p>
<p>BaptistCare NSW & ACT has shared <a href="https://www.theweeklysource.com.au/sector-moves-people/direct-care-worker-turnover-drops-after-pay-rise-but-indirect-worker-turnover-remains-stubbornly-at-38">anecdotal reports</a> that indirect care staff have become less willing to assist their higher paid colleagues.</p>
<p>Australia cannot afford further negative influences on its aged care sector. </p>
<p>It hasn’t been long since the <a href="https://www.abc.net.au/news/2019-10-31/aged-care-royal-commission-report-finds-unsafe-industry/11658328">Royal Commission into Aged Care found</a> the “unkind and uncaring” system had failed to meet the needs of elderly people, and could even be neglecting them. </p>
<p>Pay rises for direct care workers are an important step in improving the quality of our aged care offering. But we could risk it all if we continue to leave part of its workforce behind.</p>
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Read more:
<a href="https://theconversation.com/who-will-look-after-us-in-our-final-years-a-pay-rise-alone-wont-solve-aged-care-workforce-shortages-225898">Who will look after us in our final years? A pay rise alone won't solve aged-care workforce shortages</a>
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<img src="https://counter.theconversation.com/content/226236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Xerri is affiliated with the Centre for Work, Organisation, and Wellbeing at the Griffith Business School, Griffith University. </span></em></p>Most of the indirect care workforce will only see a pay rise between 3% and 7%.Matthew Xerri, Senior Lecturer in Human Resources, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2212102024-01-30T19:08:35Z2024-01-30T19:08:35ZHow do I handle it if my parent is refusing aged care? 4 things to consider<figure><img src="https://images.theconversation.com/files/571318/original/file-20240124-17-qpq0ml.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C3000%2C1980&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-woman-hugging-her-old-mother-440621344">De Visu/Shutterstock</a></span></figcaption></figure><p>It’s a shock when we realise our parents aren’t managing well at home.</p>
<p>Perhaps the house and garden are looking more chaotic, and Mum or Dad are relying more on snacks than nutritious meals. Maybe their grooming or hygiene has declined markedly, they are socially isolated or not doing the things they used to enjoy. They may be losing weight, have had a fall, aren’t managing their medications correctly, and are at risk of getting scammed.</p>
<p>You’re worried and you want them to be safe and healthy. You’ve tried to talk to them about aged care but been met with swift refusal and an indignant declaration “I don’t need help – everything is fine!” Now what?</p>
<p>Here are four things to consider.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-a-home-care-package-and-who-is-eligible-112405">Explainer: what is a home care package and who is eligible?</a>
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<h2>1. Start with more help at home</h2>
<p>Getting help and support at home can help keep Mum or Dad well and comfortable without them needing to move.</p>
<p>Consider drawing up a roster of family and friends visiting to help with shopping, cleaning and outings. You can also use home aged care services – or a combination of both.</p>
<p>Government subsidised home care services provide from one to 13 hours of care a week. You can get more help if you are a veteran or are able to pay privately. You can take advantage of things like rehabilitation, fall risk-reduction programs, personal alarms, stove automatic switch-offs and other technology aimed at increasing safety.</p>
<p>Call <a href="https://www.myagedcare.gov.au/">My Aged Care</a> to discuss your options.</p>
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<a href="https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older man with a serious expression on his face looks out a window." src="https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Is Mum or Dad OK at home?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-elderly-man-lost-thought-164848472">Nadino/Shutterstock</a></span>
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<h2>2. Be prepared for multiple conversations</h2>
<p>Getting Mum or Dad to accept paid help can be tricky. Many families often have multiple conversations around aged care before a decision is made.</p>
<p>Ideally, the older person feels supported rather than attacked during these conversations. </p>
<p>Some families have a meeting, so everyone is coming together to help. In other families, certain family members or friends might be better placed to have these conversations – perhaps the daughter with the health background, or the auntie or GP who Mum trusts more to provide good advice.</p>
<p>Mum or Dad’s main emotional support person should try to maintain their relationship. It’s OK to get someone else (like the GP, the hospital or an adult child) to play “bad cop”, while a different person (such as the older person’s spouse, or a different adult child) plays “good cop”.</p>
<h2>3. Understand the options when help at home isn’t enough</h2>
<p>If you have maximised home support and it’s not enough, or if the hospital won’t discharge Mum or Dad without extensive supports, then you may be <a href="https://academic.oup.com/gerontologist/article/60/8/1504/5863160">considering a nursing home</a> (also known as residential aged care in Australia). </p>
<p>Every person has a legal right to <a href="https://humanrights.gov.au/our-work/9-your-right-choose-where-you-live">choose where we live</a> (unless they have lost capacity to make that decision).</p>
<p>This means families can’t put Mum or Dad into residential aged care against their will. Every person also has the right to choose to take risks. People can choose to continue to live at home, even if it means they might not get help immediately if they fall, or eat poorly. We should respect Mum or Dad’s decisions, even if we disagree with them. Researchers call this “dignity of risk”.</p>
<p>It’s important to understand Mum or Dad’s point of view. Listen to them. Try to figure out what they are feeling, and what they are worried might happen (which might not be rational). </p>
<p>Try to understand what’s really important to their quality of life. Is it the dog, having privacy in their safe space, seeing grandchildren and friends, or something else? </p>
<p>Older people are often understandably concerned about losing independence, losing control, and having strangers in their personal space. </p>
<p>Sometimes families prioritise physical health over psychological wellbeing. But we need to consider both when considering nursing home admission. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826495/">Research</a> suggests going into a nursing home temporarily increases loneliness, risk of depression and anxiety, and sense of losing control.</p>
<p>Mum and Dad should be involved in the decision-making process about where they live, and when they might move.</p>
<p>Some families start looking “just in case” as it often takes some time to <a href="https://www.abc.net.au/everyday/questions-to-ask-when-choosing-an-aged-care-home-for-a-loved-one/10302590">find the right nursing home</a> and there can be a wait. </p>
<p>After you have your top two or three choices, take Mum or Dad to visit them. If this is not possible, take pictures of the rooms, the public areas in the nursing home, the menu and the activities schedule.</p>
<p>We should give Mum or Dad information about their options and risks so they can make informed (and hopefully better) decisions.</p>
<p>For instance, if they visit a nursing home and the manager says they can go on outings whenever they want, this might dispel a belief they are “locked up”.</p>
<p>Having one or two weeks “respite” in a home may let them try it out before making the big decision about staying permanently. And if they find the place unacceptable, they can try another nursing home instead.</p>
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<a href="https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older Asian woman sits with her daughter." src="https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">You might need to have multiple conversations about aged care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/exhausted-tired-asian-senior-woman-touching-1685125546">CGN089/Shutterstock</a></span>
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<h2>4. Understand the options if a parent has lost capacity to make decisions</h2>
<p>If Mum or Dad have lost capacity to choose where they live, family may be able to make that decision in their best interests.</p>
<p>If it’s not clear whether a person has capacity to make a particular decision, a medical practitioner can assess for that capacity. </p>
<p>Mum or Dad may have appointed an <a href="https://www.tag.nsw.gov.au/wills/appoint-enduring-guardian/what-enduring-guardian">enduring guardian</a> to make decisions about their health and lifestyle decisions when they are not able to.</p>
<p>An enduring guardian can make the decision that the person should live in residential aged care, if the person no longer has the capacity to make that decision themselves. </p>
<p>If Mum or Dad didn’t appoint an enduring guardian, and have lost capacity, then a court or tribunal can <a href="https://www.tag.nsw.gov.au/guardianship/information-about-guardianship">appoint</a> that person a private guardian (usually a family member, close friend or unpaid carer). </p>
<p>If no such person is available to act as private guardian, a public official may be appointed as public guardian. </p>
<h2>Deal with your own feelings</h2>
<p>Families often feel <a href="https://link.springer.com/article/10.1007/s12144-023-04538-9">guilt and grief</a> during the decision-making and transition process.</p>
<p>Families need to act in the best interest of Mum or Dad, but also balance other caring responsibilities, financial priorities and their own wellbeing.</p><img src="https://counter.theconversation.com/content/221210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lee-Fay Low has received funding from aged care providers HammondCare, and The Whiddon Group, and collaborated with HammondCare, The Whiddon Group, BaptistCare, Catholic Heatlhcare, Scalabrini Aged Care, Montefiore Aged Care, Chinese Association of Social Services, Multicultural Care, Australian Nursing Home Foundation, Summitcare and Silverchain.
She has also received funding from the NHMRC, MRFF, Dementia Australia, NSW and federal governments.</span></em></p>You’re worried and you want to see them well cared for. You’ve tried to talk to them about aged care but been met with swift refusal. Now what?Lee-Fay Low, Professor in Ageing and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1800362022-06-03T01:28:00Z2022-06-03T01:28:00ZHow to complain about aged care and get the result you want<figure><img src="https://images.theconversation.com/files/459997/original/file-20220427-16-7tss4w.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-senior-citizens-talking-nurse-hospital-128291111">Shutterstock</a></span></figcaption></figure><p>It can be hard to know what to say, or who to talk to, if you notice something isn’t right for you or a loved one in residential aged care.</p>
<p>You might have concerns about personal or medical care, being adequately consulted about changes to care, or be concerned about charges on the latest bill. You could also be concerned about theft, neglect or abuse.</p>
<p>Here’s how you can raise issues with the relevant person or authority to improve care and support for you or your loved one.</p>
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Read more:
<a href="https://theconversation.com/what-is-quality-in-aged-care-heres-what-studies-and-our-readers-say-104852">What is 'quality' in aged care? Here's what studies (and our readers) say</a>
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<h2>Keep records</h2>
<p>You can complain about any aspect of care or service. For instance, if medical care, day-to-day support or financial matters do not meet your needs or expectations, you can complain. </p>
<p>It is best to act as soon as you notice something isn’t right. This may prevent things from escalating. Good communication helps get better results.</p>
<p>Make written notes about what happened, including times and dates, and take photos. Try to focus on facts and events. You can also keep a record of who was involved and their role. </p>
<p>Keep track of how the provider responded or steps taken to resolve the issue. Write notes of conversations and keep copies of emails. </p>
<h2>Who do I complain to?</h2>
<p><strong>Potential criminal matters</strong></p>
<p>If you have concerns about immediate, serious harm of a criminal nature then you should contact the police, and your provider immediately. These types of serious incidents include unreasonable use of force or other serious abuse or neglect, unlawful sexual contact, stealing or unexpected death. </p>
<p>The provider may have already contacted you about this. They are required to report such <a href="https://www.agedcarequality.gov.au/consumers/serious-incident-response-scheme">serious incidents</a> to both the Aged Care Quality and Safety Commission within 24 hours, and to the police.</p>
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<p><strong>Other matters</strong></p>
<p>For other matters, talk to the care staff involved. Try to find out more detail about what happened and why things went wrong. Think about what you expect in the situation.</p>
<p>Then talk to the most senior person in charge, to see if they can make changes so things don’t go wrong in the future. This person may be called the nursing unit manager, care manager or care director.</p>
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Read more:
<a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">How to check if your mum or dad's nursing home is up to scratch</a>
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<p>Providers must acknowledge and investigate your complaint, tell you their findings and actions taken, and follow up to see if you are satisfied.</p>
<p>If you would like support to talk to the provider, the <a href="https://opan.org.au">Older Persons Advocacy Network</a> can help. This free service provides independent and confidential support to help find solutions with the aged-care provider. The network can also help you lodge a formal complaint. </p>
<h2>How to I lodge a formal complaint?</h2>
<p>If you are not satisfied with the way your provider responded, you can lodge a complaint with the <a href="https://www.agedcarequality.gov.au">Aged Care Quality and Safety Commission</a>. </p>
<p>Be prepared to submit the facts and events, plus emails and correspondence, you have already collected. Think about what you want to happen to resolve the complaint.</p>
<p>Each complaint is handled individually and prioritised depending on the risks to you or your loved one. The commission will start its processes within one business day when complaints are urgent. The resolution process took <a href="https://www.agedcarequality.gov.au/sites/default/files/media/acqsc-annual-report-2020-21.pdf">an average 40 days</a> in 2020-21.</p>
<p>You can complain confidentially, or anonymously if you feel safer. But the commission may not be able to investigate fully if it’s anonymous. Also, there are limits to what the commission can do. It cannot ask providers to terminate someone’s employment, or provide direct clinical advice about treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elderly woman looking worried on phone" src="https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460233/original/file-20220428-22-p1digh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can complain confidentially or anonymously if you feel safer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-portrait-upset-senior-woman-1390185308">Shutterstock</a></span>
</figcaption>
</figure>
<p>Sometimes the commission has issued a “non-compliance” notice to the provider (for a failure to meet quality standards), and action may again <a href="https://www.abc.net.au/news/2022-05-02/aged-care-complaint-about-southern-cross-care-young/101009716">be limited</a>. So it is a good idea to check the <a href="https://www.myagedcare.gov.au/non-compliance-checker">non-compliance register</a> beforehand to see if your provider is listed.</p>
<h2>What do others complain about?</h2>
<p>From October to December 2021, <a href="https://www.agedcarequality.gov.au/sites/default/files/media/acqs-sector-performance-data-oct-dec-2021.pdf">about a third</a> of Australian nursing homes had a complaint made to the commission against them. Some had more than one complaint. More than half of these complaints were lodged by family, friends or other consumers.</p>
<p>The top reasons for complaints were about:</p>
<ul>
<li><p>adequacy of staffing</p></li>
<li><p>medication administration or management</p></li>
<li><p>infectious diseases or infection control</p></li>
<li><p>personal and oral hygiene</p></li>
<li><p>how falls are prevented and managed </p></li>
<li><p>consultation or communication with representatives and/or family members.</p></li>
</ul>
<h2>What if I’m still not happy?</h2>
<p>If you’re not happy when you receive the commission’s outcome, you can request a review with 42 days.</p>
<p>You can also request the <a href="https://www.ombudsman.gov.au">Commonwealth Ombudsman</a> to review the complaint if you’re not satisfied with the commission’s decision or the way the commission handled your complaint.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elderly man leaning on fist, looking worried" src="https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460240/original/file-20220428-15-dkgitd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You or your loved one can ask for a review if you’re still not happy with the outcome.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-old-male-put-head-on-1529466320">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Remember, you have a right to complain</h2>
<p>The <a href="https://agedcare.royalcommission.gov.au">Aged Care Royal Commission</a> spotlighted the neglect and substandard care that can occur in nursing homes. Despite attempts to <a href="https://www.health.gov.au/resources/publications/concepts-for-a-new-framework-for-regulating-aged-care">lift the standard of aged care</a>, we know residents and carers still have concerns.</p>
<p>Residents, and their representatives or families, have a legal <a href="https://www.agedcarequality.gov.au/consumers/standards/resources">right to speak up and complain</a>, free from reprisal or negative consequences. This right is also reflected in the <a href="https://www.agedcarequality.gov.au/consumers/consumer-rights">Charter of Aged Care Rights</a>, which providers are legally required to discuss with you and help you understand.</p>
<h2>Moving to another facility</h2>
<p>If you have exhausted all avenues of complaint or feel conditions have not improved, you may decide to move to another provider or facility, if available. This option may not be possible in rural areas.</p>
<p>This is a difficult decision. It takes time, as well as financial and emotional resources. Starting again with a new provider can also be disruptive for everyone, but sometimes it may be the right choice.</p>
<hr>
<p><em>Contact the <a href="https://opan.org.au">Older Persons Advocacy Network</a> on 1800 700 600, the <a href="https://www.agedcarequality.gov.au">Aged Care Quality and Safety Commission</a> on 1800 951 822 or the <a href="https://www.ombudsman.gov.au">Commonwealth Ombudsman</a> on 1300 362 072.</em></p><img src="https://counter.theconversation.com/content/180036/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Wesson has previously worked at Montefiore Residential Care and continues to have a professional link with them. She has previously received funding from Dementia Australia, and has provided advice about restrictive practice legislation via a local PHN.</span></em></p><p class="fine-print"><em><span>Lee-Fay Low receives funding from the NHMRC and Dementia Australia. She has previously received research funding from aged care providers including HammondCare and The Whiddon Group, as well as state and federal governments. She has also received honorarium from Roche. She has provided input and advice to multiple aged care providers and government bodies including to the Royal Commission into Quality and Safety in Aged Care, and the Aged Care Quality and Safety Commission.</span></em></p>Here’s how to go about raising issues with the relevant person or authority to improve aged-care standards for you or your loved one.Jacqueline Wesson, Senior Lecturer (Teaching and Research), Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of SydneyLee-Fay Low, Professor in Ageing and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1833642022-05-30T20:32:34Z2022-05-30T20:32:34ZWhat happens if you want access to voluntary assisted dying but your nursing home won’t let you?<figure><img src="https://images.theconversation.com/files/465198/original/file-20220525-24-g1ekn6.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/birthroom-hospital-equipment-85290190">Shutterstock</a></span></figcaption></figure><p>Voluntary assisted dying is now lawful in <a href="https://theconversation.com/voluntary-assisted-dying-will-soon-be-legal-in-all-states-heres-whats-just-happened-in-nsw-and-what-it-means-for-you-183355">all Australian states</a>. There is also <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">widespread community support</a> for it.</p>
<p>Yet some residential institutions, such as hospices and aged-care facilities, are obstructing access despite the law not specifying whether they have the legal right to do so. </p>
<p>As voluntary assisted dying is implemented across the country, institutions blocking access to it will likely become more of an issue. </p>
<p>So addressing this will help everyone – institutions, staff, families and, most importantly, people dying in institutions who wish to have control of their end.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/voluntary-assisted-dying-will-soon-be-legal-in-all-states-heres-whats-just-happened-in-nsw-and-what-it-means-for-you-183355">Voluntary assisted dying will soon be legal in all states. Here's what's just happened in NSW and what it means for you</a>
</strong>
</em>
</p>
<hr>
<h2>The many ways to block access</h2>
<p>While voluntary assisted dying legislation recognises the right of doctors to <a href="https://theconversation.com/was-take-on-assisted-dying-has-many-similarities-with-the-victorian-law-and-some-important-differences-121554">conscientiously object</a> to it, the law is generally silent on the rights of institutions to do so.</p>
<p>While the institution where someone lives has no legislated role in voluntary assisted dying, it can refuse access in various ways, including:</p>
<ul>
<li><p>restricting staff responding to a discussion a resident initiates about voluntary assisted dying</p></li>
<li><p>refusing access to health professionals to facilitate it, and</p></li>
<li><p>requiring people who wish to pursue the option to leave the facility.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/planning-for-death-must-happen-long-before-the-last-few-days-of-life-104860">Planning for death must happen long before the last few days of life</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what happened to ‘Mary’</h2>
<p>Here is a hypothetical example based on cases one of us (Charles Corke) has learned of via his role at Victoria’s <a href="https://www.safercare.vic.gov.au/about/vadrb">Voluntary Assisted Dying Review Board</a>. </p>
<p>We have chosen to combine several different cases into one, to respect the confidentiality of the individuals and organisations involved.</p>
<p>“Mary” was a 72-year-old widow who moved into a private aged-care facility when she could no longer manage independently in her own home due to advanced lung disease.</p>
<p>While her intellect remained intact, she accepted she had reached a stage at which she needed significant assistance. She appreciated the help she received. She liked the staff and they liked her.</p>
<p>After a year in the facility, during which time her lung disease got much worse, Mary decided she wanted access to voluntary assisted dying. Her children were supportive, particularly as this desire was consistent with Mary’s longstanding views. </p>
<p>Mary was open about her wish with the nursing home staff she felt were her friends. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sick elderly patient in hospital bed, nurse wearing gloves holding fingertips" src="https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465200/original/file-20220525-22-3r79vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mary’s condition worsened so she requested voluntary assisted dying.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-ward-senior-female-resting-bed-1985507447">Shutterstock</a></span>
</figcaption>
</figure>
<p>The executive management of the nursing home heard of her intentions. This resulted in a visit at which Mary was told, in no uncertain terms, her wish to access voluntary assisted dying would not be allowed. She would be required to move out, unless she agreed to change her mind. </p>
<p>Mary was upset. Her family was furious. She really didn’t want to move, but really wanted to continue with voluntary assisted dying “in her current home” (as she saw it).</p>
<p>Mary decided to continue with her wish. Her family took her to see two doctors registered to provide assessments for voluntary assisted dying, who didn’t work at the facility. Mary was deemed eligible and the permit was granted. Two pharmacists visited Mary at the nursing home, gave her the medication and instructed her how to mix it and take it. </p>
<p>These actions required no active participation from the nursing home or its staff.</p>
<p>Family and friends arranged to visit at the time Mary indicated she planned to take the medication. She died peacefully, on her own terms, as she wished. The family informed the nursing home staff their mother had died. Neither family nor staff mentioned voluntary assisted dying.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-all-hope-for-a-good-death-but-many-aged-care-residents-are-denied-proper-end-of-life-care-156105">We all hope for a 'good death'. But many aged-care residents are denied proper end-of-life care</a>
</strong>
</em>
</p>
<hr>
<h2>Staff are in a difficult position too</h2>
<p>There is widespread community support for voluntary assisted dying. In a 2021 survey by National Seniors Australia, <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">more than 85%</a> of seniors agreed it should be available.</p>
<p>So it’s likely there will be staff who are supportive in most institutions. For instance, in a survey of attitudes to voluntary assisted dying in a large public tertiary hospital, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15285">88% of staff</a> supported it becoming lawful.</p>
<p>So a blanket policy to refuse dying patients access to voluntary assisted dying is likely to place staff in a difficult position. An institution risks creating a toxic workplace culture, in which clandestine communication and fear become entrenched.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/where-can-you-choose-to-end-your-life-56246">Where can you choose to end your life?</a>
</strong>
</em>
</p>
<hr>
<h2>What could we do better?</h2>
<p><strong>1. Institutions need to be up-front about their policies</strong></p>
<p>Institutions need to be completely open about their policies on voluntary assisted dying and whether they would obstruct any such request in the future. This is so patients and families can factor this into deciding on an institution in the first place.</p>
<p><strong>2. Institutions need to consult their stakeholders</strong></p>
<p>Institutions should consult their stakeholders about their policy with a view to creating a “<a href="https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00891-3">safe</a>” environment for residents and staff – for those who want access to voluntary assisted dying or who wish to support it, and for those who don’t want it and find it confronting.</p>
<p><strong>3. Laws need to change</strong></p>
<p>Future legislation should define the extent of an institution’s right to obstruct a resident’s right to access voluntary assisted dying. </p>
<p>There should be safeguards in all states (as is already legislated <a href="https://documents.parliament.qld.gov.au/tp/2021/5721T707.pdf">in Queensland</a>), including the ability for individuals to be referred in sufficient time to another institution, should they wish to access voluntary assisted dying. </p>
<p>Other states should consider whether it is reasonable to permit a resident, who does not wish to move, to be able to stay and proceed with their wish, without direct involvement of the institution. </p>
<hr>
<p><em>The opinions expressed in this article are those of the authors and do not necessarily reflect the views of Victoria’s Voluntary Assisted Dying Review Board.</em></p><img src="https://counter.theconversation.com/content/183364/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>A/Prof Charlie Corke is Deputy Chair of the Victorian Voluntary Assisted Dying Review Board</span></em></p><p class="fine-print"><em><span>Neera Bhatia does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Aged care facilities and hospices can block access to voluntary assisted dying, despite it being legal in your state.Neera Bhatia, Associate Professor in Law, Deakin UniversityCharles Corke, Associate Professor of Medicine, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1616742021-06-13T20:06:43Z2021-06-13T20:06:43ZIs it worth selling my house if I’m going into aged care?<figure><img src="https://images.theconversation.com/files/405528/original/file-20210610-39379-d3pfs8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-real-estate-sign-board-text-1779607850">Shutterstock</a></span></figcaption></figure><p>For senior Australians who cannot live independently at home, residential aged care can provide accommodation, personal care and general health care.</p>
<p>People usually think this is expensive. And many assume they need to sell their home to pay for a lump-sum deposit.</p>
<p>But that’s not necessarily the case. Here’s what you need to consider.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">So you're thinking of going into a nursing home? Here's what you'll have to pay for</a>
</strong>
</em>
</p>
<hr>
<h2>You may get some financial support</h2>
<p>Fees for residential aged care are complex and can be confusing. Some are for your daily care, some are means-tested, some are for your accommodation and some pay for extras, such as cable TV.</p>
<p>But it’s easier to think of these fees as falling into two categories:</p>
<ul>
<li><p>an “entry deposit”, which is usually more than <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/eighth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2020-eighth-report-on-the-funding-and-financing-of-the-aged-care-industry-may-2020.pdf">$A300,000</a>, and is refunded when you leave aged care </p></li>
<li><p>daily “<a href="https://www.myagedcare.gov.au/aged-care-home-costs-and-fees">ongoing fees</a>”, which are $52.71-$300 a day, or more. These cover the basic daily fee, which everyone pays, and the means-tested care fee.</p></li>
</ul>
<p>To find out how much government support you’ll receive for both these categories, you will have a “<a href="https://www.myagedcare.gov.au/income-and-means-assessments/#aged-care-home">means test</a>” to assess your income and assets. This means test is similar (but different) to the means test for the aged pension.</p>
<p>Generally speaking, the lower your aged-care means test amount, the more government support you’ll receive for aged care.</p>
<p>With full support, you don’t need to pay an “entry deposit”. But you still need to pay the basic daily fee (currently, <a href="https://www.myagedcare.gov.au/aged-care-home-costs-and-fees">$52.71</a> a day), equivalent to 85% of your aged pension. If you get partial support, you pay less for your “entry deposit” and ongoing fees.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">How to check if your mum or dad's nursing home is up to scratch</a>
</strong>
</em>
</p>
<hr>
<h2>You don’t need a lump sum</h2>
<p>You don’t have to pay for your “entry deposit” as a lump sum. You can choose to pay a rental-style daily cost instead.</p>
<p>This is calculated as follows: you multiply the amount of the required “entry deposit” by the maximum permissible interest rate. This rate is set by government and is currently at <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/schedule-of-fees-and-charges-for-residential-and-home-care-schedule-from-20-march-2021_0.pdf">4.01%</a> per year for new residents. Then you divide that sum by 365 to give a daily rate. This option is like borrowing money to pay for your “entry deposit” via an interest-only loan.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"626991737660010501"}"></div></p>
<p>You can also pay for your “entry deposit” with a combination of a lump sum and a daily rental cost.</p>
<p>As it’s not compulsory to pay a lump sum for your “entry deposit”, you have different options for dealing with your family home.</p>
<h2>Option 1: keep your house and rent it out</h2>
<p>This allows you to use the rental-style daily cost to finance your “entry deposit”. </p>
<p><strong>Pros</strong></p>
<ul>
<li><p>you could have more income from rent. This can help pay for the rental-style daily cost and “ongoing fees” of aged care</p></li>
<li><p>you might have a special sentimental attachment to your family house. So keeping it might be a less confronting option</p></li>
<li><p>keeping an expensive family house will not heavily impact your residential aged care cost. That’s because any value of your family house above <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/schedule-of-fees-and-charges-for-residential-and-home-care-schedule-from-20-march-2021_0.pdf">$173,075.20</a> will be excluded from your <a href="https://www.servicesaustralia.gov.au/organisations/health-professionals/services/aged-care-entry-requirements-providers/residential-care/residential-aged-care-means-assessment">means test</a></p></li>
<li><p>you can still access the capital gains of your house, as house prices rise.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Lease sign on front fence of house" src="https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405552/original/file-20210610-15-3u26en.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Renting out your house can be an option.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sign-lease-front-old-residential-house-1492504154">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p><strong>Cons</strong></p>
<ul>
<li><p>your rental income needs to be included in the means test for your aged pension. So you might get less aged pension</p></li>
<li><p>you might need to pay income tax on the rental income</p></li>
<li><p>compared to the lump sum payment, choosing the rental-style daily cost means you will end up <a href="https://www.smh.com.au/money/super-and-retirement/seek-help-when-weighing-up-how-to-pay-for-your-aged-care-20191202-p53g16.html">paying more</a> </p></li>
<li><p>you are subject to a changing rental market.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/home-owning-older-australians-should-pay-more-for-residential-aged-care-131565">Home-owning older Australians should pay more for residential aged care</a>
</strong>
</em>
</p>
<hr>
<h2>Option 2: keep your house and rent it out, with a twist</h2>
<p>If you have some savings, you can use a combination of a lump sum and daily rental cost to pay for your “entry deposit”. </p>
<p><strong>Pros</strong></p>
<ul>
<li><p>like option 1, you can keep your house and have a steady income</p></li>
<li><p>the amount of lump sum deposit will not be counted as an asset in the pension means test.</p></li>
</ul>
<p><strong>Cons</strong></p>
<ul>
<li><p>like option 1, you could have less pension income, higher age-care costs and need to pay more income tax</p></li>
<li><p>you have less liquid assets (assets you could quickly sell or access), which could be handy in an emergency.</p></li>
</ul>
<h2>Option 3: sell your house</h2>
<p>If you sell your house, you can use all or part of the proceeds to pay for your “entry deposit”.</p>
<p><strong>Pros</strong></p>
<ul>
<li><p>if you have any money left over after selling your house and paying for your “entry deposit”, you can invest the rest</p></li>
<li><p>as your “entry deposit” is exempt from your aged pension means test, it means more pension income.</p></li>
</ul>
<p><strong>Cons</strong></p>
<ul>
<li>if you have money left over after selling your house, this will be included in the aged-care means test. So you can end up with less financial support for aged care.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-adds-value-to-your-house-how-to-decide-between-renovating-and-selling-140627">What adds value to your house? How to decide between renovating and selling</a>
</strong>
</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>Keeping your house and renting it out (option 1 or 2) can give you a better income stream, which you can use to cover other living costs. And if you’re not concerned about having access to liquid assets in an emergency, option 2 can be better for you than option 1.</p>
<p>But selling your house (option 3) avoids you being exposed to a changing rental market, particularly if the economy is going into recession. It also gives you more capital, and you don’t need to pay a rental-style daily cost.</p>
<hr>
<p><em>This article is general in nature, and should not be considered financial advice. For advice tailored to your individual situation and your personal finances, please see a qualified financial planner.</em></p>
<p><em>Correction: this article previously stated the amount of lump sum deposit will not be counted as an asset in the aged-care means test, as a pro of option 2. In fact, the amount of lump sum deposit will not be counted as an asset in the pension means test.</em></p><img src="https://counter.theconversation.com/content/161674/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Zhang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You may not need to sell the family home before entering aged care. There are other options.Colin Zhang, Lecturer, Department of Actuarial Studies and Business Analytics, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1345212020-03-25T12:29:00Z2020-03-25T12:29:00ZWho cares for those most vulnerable to COVID-19? 4 questions about home care aides answered<figure><img src="https://images.theconversation.com/files/322739/original/file-20200324-155702-1vnmfgy.jpg?ixlib=rb-1.1.0&rect=0%2C213%2C5092%2C3145&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most home care aides are single women.</span> <span class="attribution"><span class="source">Terry Vine/Shutterstock.com</span></span></figcaption></figure><p><em>Editor’s note: The elderly and those recovering from surgeries are among the most vulnerable to becoming seriously ill as a result of COVID-19. An army of <a href="https://www.bls.gov/data/#unemployment">3.5 million home care aides</a> are responsible for taking care of them and others who need help, whether in homes or assisted care facilities. <a href="https://www.umb.edu/faculty_staff/bio/marc_cohen">Marc Cohen</a>, <a href="https://www.ltsscenter.org/team/robyn-stone/">Robyn Stone</a> and <a href="https://scholar.google.com/citations?user=xhht0KcAAAAJ&hl=en&oi=ao">Christian Weller</a>, gerontology and public policy researchers at the University of Massachusetts Boston, have been studying this group and explain who they are – as well as their vulnerabilities.</em></p>
<h2>1. What do home care aides do?</h2>
<p>Home care aides are a crucial part of our health care system for people who need extra help. They play a critical role in helping address and manage the potentially <a href="https://www.vox.com/2020/3/23/21190033/coronavirus-covid-19-deaths-by-age">catastrophic impacts</a> of the current pandemic on seniors and those living with disabilities. </p>
<p><a href="https://www.doi.org/10.1377/hlthaff.2019.00021">Most aides help people in their homes</a>. But many – called certified nursing assistants – also work in assisted living facilities and nursing homes. </p>
<p>Next to family members and other unpaid caregivers, they provide the vast majority of hands-on assistance to these vulnerable populations. Their work includes help with personal tasks such as cooking, eating, bathing and toileting. It also includes assistance with running errands, such as going shopping and taking people to the doctor. </p>
<p>In addition, such aides are the “eyes and the ears” of the health care system, often observing subtle changes in condition that assist other health care professionals in the management of chronic illnesses and functional decline. They are also an important source of emotional support for care recipients and their families.</p>
<p>For those receiving care at home, the presence of a consistent visit from a home health aide can mean the difference between aging in place and having to move to an institutional setting. The support provided by aides in both home and institutional settings may also help keep people from having to make unnecessary trips to the emergency department or be admitted to a hospital unnecessarily – something particularly important at this time of crisis.</p>
<h2>2. Who are the people providing this care?</h2>
<p><a href="https://www.linkedin.com/in/beth-almeida-7aa05323/">Our current research project</a> – in collaboration with economic research consultant <a href="https://www.cove-research.com/about">Beth Almeida</a> – involves trying to understand the link between the economic status of home care aides and labor force shortages in this sector. </p>
<p><a href="https://cps.ipums.org/cps/">Analyzing data from the Bureau of Labor Statistics</a>, we found that aides are on average 43 years old and have more than two decades of work experience. Almost half have at least some college education and 34.6% have some professional license or certification. </p>
<p>They also tend to be members of economically disadvantaged groups. More than a third of all aides are African American, and more than a quarter are foreign-born. The majority are also single women, and almost half of all aides have children.</p>
<p><a href="https://www.russellsage.org/publications/who-will-care-us-0">Turnover among home care aides</a> also tends to be lower than similar professions, which suggests to us that they are especially committed to their jobs. </p>
<p><iframe id="7hldM" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/7hldM/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>3. What does their economic situation look like?</h2>
<p>Home health aides are generally low-wage, mostly hourly workers. </p>
<p>Our calculations found that almost half of all aides don’t earn enough to afford the <a href="https://livingwage.mit.edu/pages/about">basics of living</a>. On average, aides earned US$13.40 per hour in 2019.</p>
<p>And while workers with more education are usually rewarded for it, home care aides are not. One additional year of education beyond high school <a href="https://www.russellsage.org/publications/who-will-care-us-0">raises earnings for aides by just 9%</a>, compared with 45% for the average U.S. worker. </p>
<p>Their financial insecurity extends beyond low pay. Many are uninsured or underinsured for the very risks that they often face, especially in the current situation. In 2018, 14% of aides <a href="https://cps.ipums.org/cps/">lacked any health insurance</a> – compared with <a href="https://www.census.gov/library/publications/2019/demo/p60-267.html">8.5% for the general population</a>. </p>
<p>And many other aides have massive holes in their coverage, according to our own calculations based on the Fed’s <a href="https://www.federalreserve.gov/consumerscommunities/shed.htm">2018 Survey of Household Economics and Decision-making</a>. We found that a whopping 71% of health care support staff, mainly aides, had a health care emergency that was not fully covered by their insurance and left them with a debt they still owed at the time of the survey. That compared with 38% of the general population. </p>
<p>Finally, almost two-thirds of these workers said they couldn’t come up with $400 if a future emergency arose, while almost a third indicated they already couldn’t pay all of their bills. </p>
<p><iframe id="paE3M" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/paE3M/6/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>4. How are they affected by the current pandemic?</h2>
<p>The current crisis creates substantial health risks for aides. </p>
<p>Most aides work in people’s homes. And, while we don’t know for sure how many aides are still working in people’s homes, we think most will likely continue doing their jobs – whether either because people depend on their help or simply because they have few other sources of income and little savings and <a href="https://www.washingtonpost.com/dc-md-va/2020/03/23/home-health-care-aides-coronavirus-elderly">have to keep working</a>.</p>
<p>But that also means that <a href="https://www.nytimes.com/2020/03/22/nyregion/coronavirus-caregivers-nyc.html">they will be going to work</a> not knowing whether the older adult or family member living there has the virus. In many cases, they will also end up caring for many people released home or into rehabilitation from hospitals after treatment, smoothing the transition from hospital to home for people who have survived the devastating virus.</p>
<p>Yet, they <a href="https://www.news5cleveland.com/news/local-news/investigations/ohio-governor-asked-to-help-home-health-aides-amidst-coronavirus-pandemic">lack essential protective equipment</a>, even <a href="https://www.nytimes.com/2020/03/22/nyregion/coronavirus-caregivers-nyc.html">basics such as hand sanitizers and gloves</a> amid national shortages. These materials would allow aides to more safely do their jobs. </p>
<p>Home care workers are essential to helping society’s most vulnerable get through the crisis and eventually to flattening the curve of coronavirus infections. Without them, we could see a surge in demand for hospital beds and respirators – <a href="https://www.usatoday.com/story/money/cars/2020/03/22/coronavirus-ventilator-shortage-gm-tesla-covid-19/2895190001/">already in short supply</a> – and more people could die as a result. </p>
<p>[<em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-daily">Our newsletter explains what’s going on with the coronavirus pandemic. Subscribe now</a>.</em>]</p><img src="https://counter.theconversation.com/content/134521/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Weller is a senior fellow at the Center for American Progress, Washington, DC</span></em></p><p class="fine-print"><em><span>Marc Cohen is Research Director at the Center for Consumer Engagement in Health Innovation at Community Catalyst.</span></em></p><p class="fine-print"><em><span>Robyn Stone receives funding from the Gordon and Betty Moore Foundation and the Colorado Department of Health Policy and Financing. She is affiliated with LeadingAge. </span></em></p>Home care aides play a critical role in providing health care to the elderly and other groups at the greatest risk of infection. Yet these workers are vulnerable too.Christian Weller, Professor of Public Policy and Public Affairs, UMass BostonMarc Cohen, Clinical Professor of Gerontology and Co-Director of the LeadingAge LTSS Center @UMass Boston, UMass BostonRobyn Stone, Co-director of the LTSS Center, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1233732019-10-07T03:17:54Z2019-10-07T03:17:54ZNursing homes for all: why aged care needs to reflect multicultural Australia<figure><img src="https://images.theconversation.com/files/295525/original/file-20191004-52857-1mqbk5.jpg?ixlib=rb-1.1.0&rect=7%2C4%2C991%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Do nursing home staff know and respect your cultural background or language? Here's why that's important.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/front-view-asian-female-doctor-senior-1358292224?src=F_OfsvTypGbKDD8sMKllrw-1-10">from www.shutterstock.com</a></span></figcaption></figure><p>This week, the <a href="https://agedcare.royalcommission.gov.au/Pages/default.aspx">aged care royal commission</a> looks at <a href="https://agedcare.royalcommission.gov.au/hearings/Pages/default.aspx">diversity in aged care</a>, an issue becoming increasingly relevant to both residents and the staff who care for them. </p>
<p>Diversity includes gender, sexual orientation, religion and social background. The issue is important because if we aim to offer older people and families choice and control in aged care, we must meet the diverse needs of <em>all</em> older people.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-culture-affects-the-way-we-look-after-ourselves-it-should-shape-the-health-care-we-receive-too-114917">Our culture affects the way we look after ourselves. It should shape the health care we receive, too</a>
</strong>
</em>
</p>
<hr>
<p>Australia’s rich diversity is reflected in its older population. In 2016, more than one-third (37%) of Australians aged <a href="https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/demographics-of-older-australians/culturally-linguistically-diverse-people">65 and over</a> were born overseas and one-fifth (20%) were born in a non-English speaking country. </p>
<p>These figures have increased continually since 1981, when <a href="https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/demographics-of-older-australians/culturally-linguistically-diverse-people">one-quarter</a> (25%) of older people were born overseas.</p>
<h2>Diversity within diversity: culture and language</h2>
<p>Culture is important for every person. It indicates a way of life based on customs, beliefs, language and experiences shared with family and a wider community or group. </p>
<p>According to the <a href="http://fecca.org.au/wp-content/uploads/2018/03/FECCA-Submission-Aged-Care-Workforce-Strategy.pdf">Federation of Ethnic Communities’ Councils of Australia</a>, many people from culturally and linguistically diverse backgrounds don’t want to move to a nursing home. This is for a number of reasons. </p>
<p>They may not want to be away from family and community, they might speak a different language to staff and other residents, and homes may not understand or meet their individual cultural needs.</p>
<p>Our <a href="https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/jnu.12269">previous research showed</a> living in an aged care facility could make some older people feel disempowered. Language and cultural diversity can further add to that disempowerment. For the older people we studied, communication, companionship, and staff knowing them as individuals was very important.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/between-health-and-faith-managing-type-2-diabetes-during-ramadan-115469">Between health and faith: managing type 2 diabetes during Ramadan</a>
</strong>
</em>
</p>
<hr>
<p>Language is particularly important for older people’s physical health and well-being. Many culturally and linguistically diverse older people say they <a href="https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/diverse-groups-of-older-australians/culturally-linguistically-diverse-people">speak English well</a>. However, with age and cognitive decline, they may lose the ability to communicate in English and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1741-6612.2006.00181.x">revert to their first language</a>. </p>
<p>And as <a href="https://www.aihw.gov.au/reports/aged-care/dementia-among-aged-care-residents-first-informat/contents/table-of-contents">more than half of nursing home residents</a> have dementia, with the associated deterioration in language and cognition, communication can be more difficult still.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295526/original/file-20191004-52791-i0mnwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295526/original/file-20191004-52791-i0mnwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295526/original/file-20191004-52791-i0mnwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295526/original/file-20191004-52791-i0mnwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295526/original/file-20191004-52791-i0mnwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295526/original/file-20191004-52791-i0mnwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295526/original/file-20191004-52791-i0mnwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Appreciating someone’s cultural background can help residents make friends.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-senior-woman-showing-cards-friends-692477059?src=zKJaDlH7hKfDtd-KOFKV_g-1-3">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Being aware of their peer’s culture and language can help residents build relationships with each other, family and staff.</p>
<p>Different cultural expectations and language barriers can create misunderstanding and resident and family dissatisfaction. This can affect residents’ care and quality of life.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">How to check if your mum or dad's nursing home is up to scratch</a>
</strong>
</em>
</p>
<hr>
<h2>How can we support appropriate care?</h2>
<p>Aged care needs to be <a href="https://agedcare.health.gov.au/sites/default/files/documents/07_2015/dss1582_aged_care_strategy_cald_a4_vaccessible.pdf">responsive, inclusive and sensitive</a> to a person’s culture, language and spiritual needs. So it is important for nursing homes to understand those needs.</p>
<p>For those who are culturally diverse, <a href="https://agedcare.health.gov.au/support-services/people-from-diverse-backgrounds/partners-in-culturally-appropriate-care-picac-organisations">government-funded support</a> and culturally specific nursing homes can help. These include services for <a href="https://frondithacare.org.au/">Greek</a>, <a href="http://www.villadelsole.com.au/">Italian</a>, <a href="https://www.agedcareguide.com.au/margriet-manor">Dutch</a>, <a href="https://www.jewishcare.org.au/page/services/residential-aged-care">Jewish</a> and <a href="http://ccssci.org.au/services/residential-aged-care/on-luck-chinese-nursing-home">Chinese</a> older people, reflecting post-war migration. </p>
<p>However, organisations like these cannot meet everyone’s needs. So all residents need care that <a href="http://www.culturaldiversity.com.au/service-providers/inclusive-services-standard">respects</a> cultural and social differences, <a href="https://www.futurelearn.com/courses/older-people/0/steps/25437">works with</a> older people and family, and supports choice. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-do-aboriginal-australians-want-from-their-aged-care-system-community-connection-is-number-one-118913">What do Aboriginal Australians want from their aged care system? Community connection is number one</a>
</strong>
</em>
</p>
<hr>
<h2>What might appropriate care look like?</h2>
<p>Staff need ongoing cultural competence training to deliver <a href="https://agedcare.health.gov.au/sites/default/files/documents/02_2019/actions-to-support-older-cald-people-a-guide-for-aged-care-providers.pdf">appropriate and supportive</a> care. </p>
<p>Staff cannot know everything about the many cultural and language groups in Australia. They can, however, practise in way that is culturally appropriate, by:</p>
<ul>
<li><p>never making assumptions about someone’s culture, heritage, language or individual needs. No two people are the same, even if they are from the same culture and language background</p></li>
<li><p>talking to the resident with an interpreter, if needed </p></li>
<li><p>learning what is important to the resident. For example, staff could ask family members or close friends to bring in photos or mementos important to the older person</p></li>
<li><p>talking with family of residents who are unable to communicate in English to make a list of key words or phrases for staff. This could include how to say “hello”, or how to ask “are you comfortable?”, or “are you in pain?”</p></li>
<li><p>making sure the older person isn’t isolated in the nursing home. This could involve working with the local community of the person’s culture, and asking for volunteers who could come and visit the older person.</p></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295720/original/file-20191007-121088-1o6oa7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295720/original/file-20191007-121088-1o6oa7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295720/original/file-20191007-121088-1o6oa7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295720/original/file-20191007-121088-1o6oa7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295720/original/file-20191007-121088-1o6oa7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295720/original/file-20191007-121088-1o6oa7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295720/original/file-20191007-121088-1o6oa7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Family members can be a huge help to staff in understanding the resident’s language, culture and preferences.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1009369066?src=zUqmxT_Vc1PAP3mSVzVDrQ-1-20&size=huge_jpg">Nadya Chetah/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Appropriate and respectful aged care is a human right</h2>
<p>Culture and language diversity in aged care is a <a href="https://www.ohchr.org/EN/ProfessionalInterest/Pages/OlderPersons.aspx">fundamental human right</a>. Embedding diversity in all aspects of aged care is also recognised by <a href="https://agedcare.health.gov.au/support-services/people-from-diverse-backgrounds/aged-care-diversity-framework">government</a>, and in how the quality of aged care is assessed. </p>
<p>New <a href="https://agedcare.health.gov.au/quality/aged-care-quality-standards">aged care quality standards</a>, which came into effect this July, include being treated with dignity and respect, with identity, culture and diversity valued, and all residents able to make informed choices about the care and services they receive.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
</strong>
</em>
</p>
<hr>
<p>If the outcomes of this royal commission are to benefit Australians now and especially in the future, older people from culturally and linguistically diverse backgrounds must not be an afterthought in the aged care discussion. They must be part of the planning.</p><img src="https://counter.theconversation.com/content/123373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Rawson is on the Executive Committee, Australian Association of Gerontology Victoria Division and is a
member of the Policy Development Committee, Council on the Ageing (COTA) Victoria.
</span></em></p>Australia’s rich diversity is reflected in its older population. It’s time our nursing homes do the same.Helen Rawson, Senior Research Fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1234492019-09-29T19:55:47Z2019-09-29T19:55:47ZHow to check if your mum or dad’s nursing home is up to scratch<figure><img src="https://images.theconversation.com/files/294244/original/file-20190925-51414-1f0h4w1.jpg?ixlib=rb-1.1.0&rect=5%2C7%2C992%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If family members are in a nursing home, it's difficult to know if they're getting the care they need. Here are some ways to find out.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1022450005?size=medium_jpg">Nancy Beijersbergen/from www.shutterstock.com</a></span></figcaption></figure><p>If you’ve read the headlines about poor standards in Australia’s nursing homes, it’s only natural to be concerned about your own family or friends in residential aged care.</p>
<p>For instance, there was <a href="https://www.abc.net.au/news/2019-09-12/bupas-aged-care-homes-failing-standards-across-australia/11501050">news in recent weeks</a> that 45 of 72 Bupa nursing homes in Australia had failed to meet all health and safety standards, with 22 putting residents at “serious risk”.</p>
<p>Then there are the <a href="https://www.abc.net.au/news/2019-02-22/first-fortnight-of-hearings-for-royal-commission-wrap-up/10837116">harrowing stories of neglect and abuse</a> coming from the <a href="https://agedcare.royalcommission.gov.au/">Royal Commission into Aged Care Quality and Safety</a>, which is due to release an interim report by the end of October.</p>
<p>So, how do you check if your loved one’s nursing home is really up to scratch? How do you interpret audit reports about residents’ health and safety? And how else could you find out if your mum or dad’s nursing home lives up to the promise of its marketing brochures?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bupas-nursing-home-scandal-is-more-evidence-of-a-deep-crisis-in-regulation-123442">Bupa's nursing home scandal is more evidence of a deep crisis in regulation</a>
</strong>
</em>
</p>
<hr>
<h2>Who keeps an eye on nursing home standards?</h2>
<p>Every nursing home in Australia receiving government funding is assessed and accredited by the <a href="https://www.agedcarequality.gov.au">Australian Aged Care Quality and Safety Commission</a>. Assessments are conducted every three years or more often if there are concerns. </p>
<p>Commission staff check if each nursing home meets eight <a href="https://www.agedcarequality.gov.au/sites/default/files/media/Aged%20Care%20Quality%20Standards.pdf">minimum standards</a>. These include whether residents are treated with respect, the nursing home is providing safe and effective clinical care, and staff have adequate qualifications and training to do their jobs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-quality-in-aged-care-heres-what-studies-and-our-readers-say-104852">What is 'quality' in aged care? Here's what studies (and our readers) say</a>
</strong>
</em>
</p>
<hr>
<p>Commission auditors interview residents, families and staff; observe care; and review the facility’s documentation. Visits can be unannounced to get a better picture of what regular care is like. Auditors then use that information to write a site audit.</p>
<p>It takes about a month after a site audit for the commission to decide on the quality of care. Then there’s up to another month for the audit report to be posted online.</p>
<p>Posting the decision publicly can be delayed further if a nursing home asks for the decision to be reconsidered. We understand this often happens if a home receives a poor report.</p>
<h2>What is a bad report?</h2>
<p>When a home is judged as not meeting standards, the commission will decide how serious it believes these deficiencies are. In increasing order of seriousness, the report says if a home is:</p>
<p><strong>1. Not meeting standards</strong>. Nursing homes can be judged as not meeting one or more of the eight minimum aged care standards. Each standard has three to seven individual requirements. Nursing homes don’t have to meet all the individual requirements to meet the overall standard. The more standards or requirements a nursing home fails to meet, the poorer the care.</p>
<p><strong>2. Serious risk</strong>. If a nursing home is given a “serious risk” judgement, the quality of care has placed or may place the safety, health or well-being of a resident at serious risk. An example might be a home not having enough skilled staff, leading to clinical mistakes, such as the wrong medication administered often.</p>
<p><strong>3. Sanctions</strong>. Sanctions are imposed on homes when care places an immediate and severe risk to residents’ health, safety or well-being. This might be for multiple organisational problems (such as with clinical care, staffing, wounds not being cared for), leading to multiple poor outcomes (such as assault, avoidable illness, and the dangerous administration of medication). Homes can also be sanctioned if they do not fix continued non-compliance. </p>
<p>Families are notified in writing, and facilities must hold a meeting for residents and families to tell everyone what the problems are and how they will fix them by a certain date.</p>
<p>When a nursing home is sanctioned, it is penalised in several ways, depending on what was poor about the care:</p>
<ul>
<li>the home is not allowed to receive Commonwealth subsidies for any new resident for a set time (usually six months)</li>
</ul>
<p>and</p>
<ul>
<li>an adviser and/or administrator is appointed to the home to help it comply with its responsibilities</li>
</ul>
<p>and/or</p>
<ul>
<li>the home provides specified training to staff within a set time.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis</a>
</strong>
</em>
</p>
<hr>
<p>A home’s history of non-compliance, serious risk decisions and sanctions are archived online (see below for details). So it might be worth taking a look when choosing a nursing home, as well as checking on an existing one. </p>
<p><strong>4. Revoking accreditation status</strong>. If sanctions are imposed and there is no improvement, the commission can revoke a home’s accreditation status. This means a home cannot take new residents or receive government subsidies. Some of these homes reapply for accreditation, others <a href="https://www.abc.net.au/news/2019-07-11/gold-coast-earle-haven-retirement-village-shuts-homeless/11301050">shut down</a>.</p>
<h2>How do I find out? Looking online</h2>
<p>The most up-to-date information on nursing homes not meeting standards (non-compliance) and sanctions is through <a href="https://www.myagedcare.gov.au/non-compliance-checker">myagedcare’s non-compliance checker</a>. This allows you to see if an individual home has not met standards, is sanctioned currently or has been in the past. Some archived sanctions on the website go back to 2002.</p>
<p>However, the myagedcare website doesn’t list “serious risk” reports. For those, you have to go to the Aged Care Quality and Safety Commission’s <a href="https://agedcarequality.govcms.gov.au/monthly-register-serious-risk-decisions-residential-services">website</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There’s lots of information online about nursing home standards and care, not all of it easy to understand.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mid-age-couple-working-home-on-200730065?src=m2fXbslTrNQEIMtQQD8SKA-1-25">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>You can also search the commission’s <a href="https://www.agedcarequality.gov.au/reports">website</a> for audit and consumer experience reports, which provide more detail on the quality of care.</p>
<p>Audit reports can be difficult to understand because their intended audience is aged care professionals, not the general public. Reports before July 2019 are on the 44 old aged care standards. Reports from July 2019 are on the new eight standards.</p>
<p><a href="https://www.agedcarequality.gov.au/consumers/consumer-experience-reports-residential-aged-care-services">Consumer experience reports</a> show what residents said about their care. That’s from whether staff followed-up when they raised an issue, to what they thought about the food. These reports are easier to follow.</p>
<h2>How do I find out? Other ways</h2>
<p>It can be hard for family to know if their expectations for care are reasonable, particularly when feelings of sadness and guilt colour those expectations. </p>
<p>So, it can help to consider the aged care standards when making your own decisions about whether the quality of care is good enough. </p>
<p>You can do this by observing what happens day to day. Do residents wait too long for attention, for instance, to be taken to the toilet? Do staff speak respectfully and kindly to residents? Are meals appetising and healthy? What happens when residents are distressed? Is there high staff turnover? </p>
<p>Does the nurse on duty know the detail of your loved one’s clinical needs, for instance, diet, illnesses or medications? Is the manager responsive when you raise issues? </p>
<p>You can also talk to other families about their experiences of care.</p>
<h2>What should I do next?</h2>
<p>If you find that your loved one’s home doesn’t meet standards or is sanctioned, here’s what to expect. </p>
<p>The commission gives the home a set period of time (usually three or six months) to improve care. Commission staff keep visiting the home until they are confident the home is meeting standards.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Commission staff come back to the nursing home until they are confident standards are being met.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-nurse-working-rest-home-horizontal-334234871">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>You will probably want to visit regularly and keep an even more careful eye on your mum or dad’s care. Speak to the home or commission about any concerns.</p>
<p>You can ask your home’s management: </p>
<ul>
<li><p>about its plan to improve care</p></li>
<li><p>about staff changes and staff ratios — staff often leave or are asked to leave when there are sanctions and lots of new and agency staff are a challenge to providing quality care</p></li>
<li><p>for regular written updates and meetings including actions taken and the outcomes. This could be data on the home’s use of antipsychotic medications, and how often residents have falls, critical incidents or pressure ulcers.</p></li>
</ul>
<p>As a resident or nominated family member, you have <a href="https://www.agedcarequality.gov.au/consumers/consumer-rights#single%20charter%20of%20aged%20care%20rights">a right to information and to complain</a> about your loved one’s aged care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">So you're thinking of going into a nursing home? Here's what you'll have to pay for</a>
</strong>
</em>
</p>
<hr>
<h2>When should I consider switching to another home?</h2>
<p>The issue of whether to move a loved one to a new nursing home is a difficult one. It’s a personal decision involving weighing up the negative impacts you think the care is having with your own energy levels, <a href="https://www.myagedcare.gov.au/aged-care-home-accommodation-refunds">funds</a> and whether <a href="https://www.abc.net.au/life/questions-to-ask-when-choosing-an-aged-care-home-for-a-loved-one/10302590">you can find</a> a suitable new home.</p>
<p>Government reforms presume market forces <a href="https://www.smh.com.au/business/the-economy/how-market-forces-have-failed-the-nation-20180918-p504f1.html">will drive up the quality</a> of aged care. In the meantime, we hope the resources in this article will help you make a more informed decision about your loved one’s care.</p><img src="https://counter.theconversation.com/content/123449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lee-Fay Low collaborates with and has received funding from multiple aged care organisations and sat on committees for the Australian Aged Care Quality Agency, the predecessor to the Aged Care Quality and Safety Commission. She is funded by an NHMRC Boosting Dementia Leadership Development Fellowship and has received funding from the NHMRC, Department of Health, NSW Health, Dementia Australia and other research funding organisations. </span></em></p>If you’ve read the headlines about poor standards in Australia’s nursing homes, it’s only natural to be concerned about your own family or friends in residential aged care.Lee-Fay Low, Associate Professor in Ageing and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1220002019-09-26T21:27:59Z2019-09-26T21:27:59ZWhy people choose medically assisted death revealed through conversations with nurses<figure><img src="https://images.theconversation.com/files/293967/original/file-20190925-51421-1h9vzhm.jpg?ixlib=rb-1.1.0&rect=31%2C18%2C3013%2C1903&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Without an understanding of the complexities of medically assisted dying, it's difficult for patients and families to make good decisions.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Since Canada <a href="https://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent">legalized Medical Assistance in Dying (MAiD)</a> in 2016, as of Oct. 31, 2018, more than <a href="https://www.canada.ca/en/health-canada/services/publications/health-system-services/medical-assistance-dying-interim-report-april-2019.html">6,700 Canadians have chosen</a> medications to end their life. </p>
<p>Canadians who meet eligibility requirements can opt to self-administer or have a clinician administer these medications; the vast majority of people choosing MAiD have had their medications delivered by physicians or nurse practitioners. Canada is the first country to permit nurse practitioners to assess for medically assisted dying eligibility and to provide it.</p>
<p>The precise meaning and implications of MAiD — in particular, who can request medical assistance in dying in Canada — is still evolving through court rulings. Québec’s Supreme Court recently struck down the <a href="https://globalnews.ca/news/5888949/quebec-court-medically-assisted-dying-law/">reasonably foreseeable death requirement under the Criminal Code</a> and the end-of-life requirement under Québec’s <a href="http://legisquebec.gouv.qc.ca/en/ShowDoc/cs/S-32.0001">Act Respecting End-of-Life Care</a>. </p>
<p>Without the requirement of a reasonably foreseeable death, it is likely that other <a href="https://www.thelawyersdaily.ca/business/articles/15413/landmark-ruling-on-medically-assisted-death-may-set-stage-for-more-challenges">legal challenges will occur to extend assisted dying to other groups such as those whose sole underlying condition is severe mental illness</a>.</p>
<h2>Involvement of nurses</h2>
<p>Our research has explored how the <a href="https://doi.org/10.1177/1527154419845407">nursing profession is regulating the new area of responsibility</a> towards medically assisted dying and how <a href="https://doi.org/10.1177/0969733019845127">nursing ethics</a> might guide <a href="https://journals.lww.com/advancesinnursingscience/Fulltext/2019/07000/Ethical,_Policy,_and_Practice_Implications_of.7.aspx">policy and practical implications of nurses’ experiences</a>. </p>
<p>Current legislation guards the right of health-care providers to conscientiously object to participation in MAiD. Nurses who do <a href="https://doi.org/10.1111/nin.12308">conscientiously object</a> have a professional obligation to inform their employers of that objection, to report requests for MAiD, and to not abandon their clients. They also must ensure that their choices are based on “<a href="https://www.cna-aiic.ca/%7E/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive">informed, reflective choice and are not based on prejudice, fear or convenience</a>.” </p>
<p>The nurses who surround the process of medically assisted dying are an important source of insight into the complex and nuanced <a href="http://pesut-lab.sites.olt.ubc.ca/projects-2/maid/">conversations our society needs to have about what it is like to choose, or be involved with, this new option at the end of life,</a> and to be involved in supporting patients and their families toward death with compassion.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293901/original/file-20190924-51457-1ffq5oo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293901/original/file-20190924-51457-1ffq5oo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293901/original/file-20190924-51457-1ffq5oo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293901/original/file-20190924-51457-1ffq5oo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293901/original/file-20190924-51457-1ffq5oo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293901/original/file-20190924-51457-1ffq5oo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293901/original/file-20190924-51457-1ffq5oo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Researchers are following how the nursing profession is regulating nurses’ involvement in medically assisted dying.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Impoverished stereotypes</h2>
<p>Our most recent research involved interviews with 59 nurse practitioners or registered nurses across Canada who accompanied patients and families along the journey of medically assisted dying or who had chosen to conscientiously object. Nurses worked across the spectrum of care in acute, residential and home-care settings. </p>
<p>During our research, and as we followed media stories, we became aware that as with other morally contentious issues, involvement in MAiD has often been discussed in one-dimensional ways: We noted stereotypes of health-care providers and patients who <a href="https://www.calgaryjournal.ca/more/living/4716-i-ll-see-myself-out-medical-assisted-dying.html">heroically conquer suffering, death and the system by taking control</a> of what might otherwise have been a difficult and prolonged dying. We also observed caricatures of <a href="https://www.timescolonist.com/opinion/op-ed/lawrie-mcfarlane-do-religious-principles-outweigh-a-peaceful-death-1.23919174">oppositional or religious right-wing persons and institutions</a> who stand in the way of compassion and dignity. </p>
<p>Neither of these perspectives do justice to the complexities of MAiD as it is enacted. Without an understanding of those complexities, it is difficult for patients and families to make good decisions. </p>
<h2>Nurses accounts of MAiD</h2>
<p>Nurses told us that medically assisted dying is about so much more than the act itself. Medically assisted dying is a conversational journey with patients that lasts weeks or even months. </p>
<p>These discussions patients have over time with skilled and compassionate health-care professionals help to determine whether this is what they really want, or whether there are other options that might relieve their suffering. </p>
<p>Conversations between patients and their families are essential to negotiating a common understanding and moving forward together. </p>
<p>Indeed, evidence has suggested that these conversations, when experienced as meaningful by patients, may help to alleviate the suffering that leads to the request for a medically assisted death. This is particularly true if the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553124/">suffering has arisen from the sense of isolation</a>. </p>
<p>If and when patients decide to proceed with MAiD, then conversations are required to ensure that all of the organizational details (what, where, when, how) are patient-centred choices and that those who are involved know the part they are to play. After the act of medically assisted dying, it is compassionate conversations that support families in navigating an uncharted bereavement process. </p>
<p>So yes, medically assisted dying is about supporting autonomy, but it is also about understanding that autonomy exists within, and is shaped by, our constellation of relationships. We need to be talking more about the essential nature of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828197/">what it means to have a good death</a>.</p>
<h2>Complex reasons to choose death</h2>
<p>MAiD is often spoken of as the definitive intervention that ensures control over the alleviation of suffering. But, we have learned that MAiD can also be chosen as the antidote to a system that fails in compassion or equitable palliative care access. </p>
<p>It may seem the perfect solution for rural and remote patients who <a href="https://www.cihi.ca/sites/default/files/document/access-palliative-care-2018-en-web.pdf">want a home death but are unable to find sufficient palliative care in their context</a>. </p>
<p>It may seem the best option for patients who do not want to enter what they perceive to be the <a href="https://pjb.mycpanel2.princeton.edu/wp/index.php/2016/08/15/elderhood-a-case-for-abolishing-nursing-homes-in-the-united-states/">dehumanizing environments of</a> <a href="https://www.cbc.ca/news/canada/british-columbia/als-bc-man-medically-assisted-death-1.5244731">residential care</a>. </p>
<p>We heard a story of one man who had overstayed the time allowed on a palliative care unit. His doctor was a conscientious objector to medically assisted dying so each time health professionals planned to transfer him to residential care, the man asked for a medically assisted death. In doing so his stay in palliative care was assured. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293963/original/file-20190925-51410-1sfcwoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293963/original/file-20190925-51410-1sfcwoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293963/original/file-20190925-51410-1sfcwoo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293963/original/file-20190925-51410-1sfcwoo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293963/original/file-20190925-51410-1sfcwoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293963/original/file-20190925-51410-1sfcwoo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293963/original/file-20190925-51410-1sfcwoo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">We need to ensure that inequitable access or lack of caregiving networks do not become the default reasons for requesting a medically assisted death.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>We heard other stories of patients who were <a href="https://spcare.bmj.com/content/8/2/184">not willing to tax their caregivers any longer</a>, particularly if those caregivers sent cues that they were exhausted. </p>
<p>So, while medically assisted dying does promise control over people’s suffering, it can also be used as a form of resistance to a challenging system or depleted support. </p>
<p>We need to plan ways to ensure that inequitable access or <a href="https://www.theglobeandmail.com/canada/article-with-a-looming-aging-crisis-who-is-helping-the-caregivers/">lack of caregiving networks</a> do not become the default reasons for requesting a medically assisted death. </p>
<h2>Deeply impactful</h2>
<p>Nurses emphasized how important it is to have preparatory conversations repeatedly. Organizing an assisted death is labour-intensive for all involved; it requires thoughtful and detailed planning within the care system and among families and support networks.</p>
<p>Often the first time that patients and families hear a detailed explanation of the process is when the nurse or the physician first assesses eligibility.
Nurses said it is not uncommon for patients to experience uncertainty, to vacillate in their decision around an assisted death, or to experience fear at the moment of death. </p>
<p>It is tough to talk about your uncertainty when so many have invested time and energy into planning your death. At the time of assisted death, nurses and physicians go to extraordinary lengths to ensure a “good death” by normalizing the process, fulfilling patient wishes and providing exemplary clinical care. </p>
<p>Despite all of this, the death is often deeply impactful because it is so different than the death we have known where people gradually fade away.
Persons receiving medically assisted death are fully there one minute, and gone the next. </p>
<p>Within minutes they go from talking, to unconscious, to a grey pallour that signifies death, and this “greying” affects even seasoned health-care providers. The death can provoke an array of overwhelming emotions in health-care providers and families alike, both positive and negative.</p>
<p>With the changing landscape of medically assisted dying in Canada, the need for reflective conversations becomes ever more urgent. We need to better understand how medically assisted dying changes the nature of death to which we have become accustomed and how those changes impact all those involved.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/122000/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Barbara Pesut receives funding from Canadian Institutes of Health Research. She is affiliated with NNPBC.
</span></em></p><p class="fine-print"><em><span>Sally Thorne participates on research teams funded by Canadian Institutes of Health Research and is a member of the Board of Directors for both the Michael Smith Foundation for Health Research and the Association of Nurses and Nurse Practitioners of British Columbia.
</span></em></p>Nurses who surround the process of medically assisted dying are an important source of insight into the real conversations our society needs to have about what it’s really like.Barbara Pesut, Professor, School of Nursing, University of British ColumbiaSally Thorne, Professor, School of Nursing, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1216372019-08-14T05:07:59Z2019-08-14T05:07:59ZPatients have rights. Here’s how to use yours<figure><img src="https://images.theconversation.com/files/287949/original/file-20190814-136203-jkg1tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What rights do you have when discussing medical treatments or test results with your doctor?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/professional-treatment-nice-smart-pleasant-man-750044245?src=7aaC6FBe4ldDNXdnqzhvig-1-24">from www.shutterstock.com</a></span></figcaption></figure><p>Working your way around the health-care system can be overwhelming. This is especially hard when care takes place in health systems <a href="https://theconversation.com/waiting-for-better-care-why-australias-hospitals-and-health-care-are-failing-104862">under stress</a>.</p>
<p>However as a patient, you have rights about how you’re treated. This includes not just your actual therapy, but how you’re spoken to, how your records are handled and even whether you wish to be treated at all.</p>
<p>Now, the Australian Commission on Safety and Quality in Health Care <a href="https://www.safetyandquality.gov.au/national-priorities/charter-of-healthcare-rights/review-of-the-charter-of-healthcare-rights-second-edition">has updated</a> its <a href="https://www.safetyandquality.gov.au/sites/default/files/2019-06/Charter%20of%20Healthcare%20Rights%20A4%20poster%20ACCESSIBLE%20pdf.pdf">charter of patient rights</a>.</p>
<p>The idea is to promote a more active role in health care for patients (and their carers) by reminding them of their seven rights: access to health care, safety, respect, partnership, information, privacy and giving feedback. </p>
<p>But what do these rights really mean when it comes to day-to-day issues you or your family might face with your GP, in hospital or in a nursing home?</p>
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Read more:
<a href="https://theconversation.com/why-an-australian-charter-of-rights-is-a-matter-of-national-urgency-121411">Why an Australian charter of rights is a matter of national urgency</a>
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<h2>Example 1: leaving hospital early</h2>
<p>Imagine an elderly patient who has been hospitalised with an infection. After a couple of days of treatment, she <a href="https://jamanetwork.com/journals/jama/article-abstract/203118">wants to go home</a> to live alone. The patient’s doctors are worried she won’t be able to take care of herself and try to convince her to move into a rehabilitation facility. She refuses.</p>
<p><em>Respect</em> means the patient has the right to make her own choices, even if they could result in harm. But this doesn’t mean just abandoning the patient to her rights. A first step is the right to <em>information</em>, to ensure she understands the risks of going home. <em>Partnership</em> requires communication with the patient herself as well as other people she chooses, like family members and friends. This helps <a href="https://www.sciencedirect.com/science/article/pii/S0738399113004722">support the patient</a>.</p>
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Read more:
<a href="https://theconversation.com/hospital-discharges-to-no-fixed-address-heres-a-much-better-way-106602">Hospital discharges to ‘no fixed address’ – here's a much better way</a>
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<h2>Example 2: dementia restraints</h2>
<p><a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/dementia/overview">More than half</a> of all people in permanent residential aged care have dementia. </p>
<p>Sometimes patients become physically aggressive, becoming a danger to themselves and others. Physical and chemical restraints for these people has been widespread, and is being considered by the <a href="https://agedcare.royalcommission.gov.au/Pages/Terms-of-reference.aspx">Royal Commission into Aged Care Quality and Safety</a>.</p>
<p>Restraints won’t be the right thing <a href="https://ama.com.au/position-statement/restraint-care-people-residential-aged-care-facilities-2015">in all cases</a>. Whether it’s right for a particular person requires balancing <em>respect</em> for the patient’s own views and dignity, with other people’s rights to <em>safety</em>. <em>Respect</em> can be facilitated by working in <em>partnership</em> with the patient and their family to identify safe options other than restraint.</p>
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Read more:
<a href="https://theconversation.com/physical-restraint-doesnt-protect-patients-there-are-better-alternatives-111060">Physical restraint doesn't protect patients – there are better alternatives</a>
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<h2>Example 3: health information disclosure</h2>
<p>Trips to the emergency department are often scary and sensitive. The visit can be even worse if you feel others can overhear your conversations with doctors or nurses.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-6723.2005.00702.x">More than one in ten</a> people who went to the emergency department of a major Melbourne hospital reported this experience. These people felt the loss of their <em>privacy</em>. It also might fail to show respect, dignity and consideration, as required in the right to <em>respect</em>.</p>
<p>But not every unwanted disclosure of health information will be wrong. Some might even be necessary to meet other health-care rights. </p>
<p>For instance, an emergency department with curtains instead of walled rooms to help people or equipment move more freely might meet the <em>safety</em> right even though it risks a patient’s right to <em>privacy</em>. But the charter at least means hospitals and treating teams have to justify any unwanted disclosure of health information. It also means patients who feel uncomfortable can <em>give feedback</em>, another of their rights.</p>
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Read more:
<a href="https://theconversation.com/paper-tsunami-how-the-move-to-digital-medical-records-is-leaving-us-drowning-in-old-paper-files-119534">Paper tsunami: how the move to digital medical records is leaving us drowning in old paper files</a>
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<h2>How does Australia stack up?</h2>
<p>Other countries have created similar lists of patients’ rights, including <a href="https://www.hdc.org.nz/your-rights/the-code-and-your-rights/">New Zealand</a> and <a href="https://www2.gov.scot/Resource/0039/00390989.pdf">Scotland</a>.</p>
<p>The most valuable part of the Australian charter is improving patient and carer understanding of existing health-care rights. This makes it easier to know when to complain to a state or territory <a href="https://www.ahpra.gov.au/Notifications/Further-information/Health-complaints-organisations.aspx">complaints commission</a>, or the <a href="https://www.ahpra.gov.au/Notifications/Raise-a-concern.aspx">Australian Health Practitioner Regulation Agency</a>.</p>
<p>Although the Australian Commission on Safety and Quality in Health Care is releasing <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/australian-charter-healthcare-rights/supportive-resources-second-edition-charter">more resources</a> for patients, its charter may not go far enough in protecting groups who <a href="https://www.abc.net.au/news/2019-07-29/naomi-williams-tumut-sepsis-death-inquest-findings/11355244">experience systemic bias</a> in their health-care interactions. This includes many Aboriginal and Torres Strait Islander people.</p>
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Read more:
<a href="https://theconversation.com/ms-dhu-coronial-findings-show-importance-of-teaching-doctors-and-nurses-about-unconscious-bias-60319">Ms Dhu coronial findings show importance of teaching doctors and nurses about unconscious bias</a>
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<p>Another pitfall of the charter is its non-binding nature. It describes the rights patients should expect but it does little to enforce them. This can leave the charter as something of a toothless tiger, an issue also discussed <a href="http://www.cmaj.ca/content/182/13/E641.short">internationally</a>. </p>
<p>The charter also doesn’t deal with potential <a href="https://www.bmj.com/content/bmj/335/7631/1187.full.pdf">patient responsibilities</a>. These are the obligations consumers have for their own health, like treating staff considerately and keeping medical appointments. </p>
<p>It’s hard to see how one can exist without the other.</p><img src="https://counter.theconversation.com/content/121637/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Eckstein is an investigator on two current Australian Research Council Discovery Program Grants - Genomic Data Sharing: Shaping an Optimal Regulatory Framework and Reforming the Regulatory Environment for Innovative Health Technologies: Identifying Congestion and Filling Gaps.</span></em></p><p class="fine-print"><em><span>Rebekah McWhirter is on the board of Women’s Health Tasmania and has been supported by NHMRC and ARC grants.</span></em></p>It’s all very well having rights. But what do these rights really mean when you’re with your GP, in hospital or in a nursing home?Lisa Eckstein, Senior Lecturer in Law and Medicine, University of TasmaniaRebekah McWhirter, Research Fellow, Centre for Law and Genetics, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1215612019-08-12T19:59:38Z2019-08-12T19:59:38ZRed tape in aged care shouldn’t force staff to prioritise ticking boxes over residents’ outcomes<figure><img src="https://images.theconversation.com/files/287634/original/file-20190812-71913-1gmysg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The aged care royal commission has looked at regulation in aged care.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Last week’s hearings at the <a href="https://agedcare.royalcommission.gov.au/hearings/Pages/post-hearing-submissions.aspx">aged care royal commission</a> in Brisbane looked at regulation in aged care. While rules and regulations are designed to safeguard residents, bureaucratic “red tape” also contributes to the failings in aged care. </p>
<p>The fear among nursing home staff of failing a review visit by an Aged Care Quality and Safety Commission surveyor has been known to shift the focus from care for residents to meeting paper trail requirements.</p>
<p>The best outcome for aged care residents and their families would be new reporting requirements <a href="https://www.researchgate.net/publication/335110268_The_Distinction_between_Process_and_Outcomes_Focused_Governance_and_Accountability_Frameworks">centred on outcomes rather than processes</a>. Their primary focus should be on the mediation of critical incidents – that is, looking at what caused them and how they could be prevented in future – and the maintenance of health.</p>
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Read more:
<a href="https://theconversation.com/our-ailing-aged-care-system-shows-you-cant-skimp-on-nursing-care-115565">Our ailing aged care system shows you can't skimp on nursing care</a>
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<h2>How did we get here?</h2>
<p>The crisis in the aged care sector has emerged over time. At least in part, systemic problems in organisations <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/%28SICI%291099-1735%28199603%2913%3A1%3C13%3A%3AAID-SRES66%3E3.0.CO%3B2-O">arise from interactions</a> among its key players. These interactions must be aligned to achieve its <a href="https://pdfs.semanticscholar.org/e33a/5f696b7af6c2eaa3fdbefe94dbf42234bebe.pdf">common goals</a>. </p>
<p>But the key players in the aged care system pursue divergent agendas. Regulators focus on process adherence, while staff struggle with their limited capacity to manage the complex needs of residents. Meanwhile, proprietors focus on economic viability.</p>
<p>The prevailing approach of dealing with the problem of a particular key player in isolation will not solve the problems of aged care as a whole. </p>
<h2>Governance and accountability</h2>
<p>Our research suggests the need for a major culture shift in the aged care system.</p>
<p>Around the world, governments are being urged to put less emphasis on <a href="http://johnbraithwaite.com/wp-content/uploads/2016/06/Regulating-Aged-Care-Ritualis.pdf">process measurement</a> and more on <a href="http://www.iqg.com.br/uploads/biblioteca/the_strategy.pdf">outcome transparency</a>. </p>
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Read more:
<a href="https://theconversation.com/weve-had-20-aged-care-reviews-in-20-years-will-the-royal-commission-be-any-different-103347">We've had 20 aged care reviews in 20 years – will the royal commission be any different?</a>
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<p>Peter Drucker, a well-known management consultant, educator and author, once said “management is doing things right; leadership is doing the right things”. </p>
<p>Ticking the boxes of a protocol to demonstrate “regulatory compliance” – that is, doing things right – is no longer an option on its own. Residents and their families expect staff to be attentive to residents’ changing <a href="https://www.ncbi.nlm.nih.gov/pubmed/19674233">physical, emotional, social and cognitive needs</a>; that is, doing the right things.</p>
<p>These insights tell us the aged care system needs to be <a href="https://www.springer.com/gp/book/9783319646046">redesigned</a>.</p>
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Read more:
<a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis</a>
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<h2>What would this look like in practice?</h2>
<p>Let’s consider two common aged care problems – falls and diabetes – whose management is significantly influenced by the chosen accountability framework. The differences between an outcomes-based approach (that is, adapting care to problems in their context) and a process-based approach (adhering to a protocol) are stark.</p>
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<img alt="" src="https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287636/original/file-20190812-71921-u53rxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The extent to which staff in aged care are required to focus on documentation may detract from their capacity to care for residents.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>The first example: a resident has a fall. Rather than only assessing her for injuries and vital signs (as per protocol), staff would also assess potential reasons for the fall – for example, lack of mobility, pain, low blood pressure, or polypharmacy (taking multiple prescription medications at once) – and involve allied health professionals in preventive and rehabilitative care. This could include muscle strengthening exercises, gait and balance retraining, pain management and medication review. These are measures that could reduce the likelihood of the patient falling again, thereby improving her outcomes.</p>
<p>And let’s take a resident with normally stable diabetes, who one day records an elevated blood sugar reading. Rather than just giving him more insulin, staff would also assess potential underlying reasons for the elevated reading. These could include loss of appetite, an infection, or an episode of <a href="https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386">delirium</a>.</p>
<h2>The royal commission should do many things, but adding red tape isn’t one of them</h2>
<p>Increasing frailty and/or significant memory decline are the main reasons for admission to an aged care facility. These people are particularly vulnerable as their health changes frequently and rapidly. </p>
<p>Being bogged down by <a href="http://johnbraithwaite.com/wp-content/uploads/2016/06/Regulating-Aged-Care-Ritualis.pdf">regulatory ritualism</a> reduces the time staff have available to spend on residents’ physical, social, emotional and cognitive needs. </p>
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Read more:
<a href="https://theconversation.com/dont-wait-for-a-crisis-start-planning-your-aged-care-now-113572">Don't wait for a crisis – start planning your aged care now</a>
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<p>True accountability in aged care is achieved by demonstrating how the provided care has impacted a resident’s well-being. In that regard, the Aged Care Quality and Safety Commission should provide leadership and primarily act as an educator, helping facilities to become <a href="https://www.penguinrandomhouse.com/books/163984/the-fifth-discipline-by-peter-m-senge/9780385517256/">learning organisations</a>. If an aged care facility fails to “learn and improve”, then sanctions and penalties become necessary.</p>
<p>More bureaucracy would only serve to perpetuate the current crisis, and would fail those residents and families who have suffered from <a href="https://agedcare.royalcommission.gov.au">the current failings in the sector</a>.</p>
<p><em>Len Gainsford, a former adjunct research fellow in accounting & governance at Swinburne University of Technology, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/121561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joachim Sturmberg is Foundation President of the International Society for Systems and Complexity Sciences for Health (ISSCSH). </span></em></p>Bureaucratic ‘red tape’ has contributed to the current crisis in our aged care system. We need a system of accountability that focuses more on residents’ outcomes, and less on processes.Joachim Sturmberg, Conjoint Associate Professor of General Practice, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1142952019-05-15T20:20:50Z2019-05-15T20:20:50ZSo you’re thinking of going into a nursing home? Here’s what you’ll have to pay for<figure><img src="https://images.theconversation.com/files/274306/original/file-20190514-60541-17030gr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The system is a complex mix of daily and refundable fees, base payments and means tested contributions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1010198827?src=qwsbOY_NttuNXNSAqEXynA-3-22&size=huge_jpg">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>This week at the <a href="https://agedcare.royalcommission.gov.au/hearings/Pages/default.aspx">aged care royal commission</a> hearings, the <a href="https://www.sbs.com.au/news/call-to-change-way-aged-care-is-funded">CEOs of three aged care providers</a> called for a change in the way residential aged care is funded to improve the quality of care. </p>
<p>This followed a <a href="https://www.smh.com.au/federal-election-2019/labor-s-promise-to-fix-aged-care-would-cost-billions-peak-body-20190513-p51mt4.html">plea from Aged Care Services Australia</a> for the government and opposition to address what it called a “crisis in residential aged care funding”. </p>
<p>But while <a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">most</a> residential aged care funding comes from government, residents also have to contribute. So how does this complicated payment system work? </p>
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Read more:
<a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis</a>
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<h2>Who is eligible for subsidised care?</h2>
<p>In July 2014, the government introduced several changes to the residential aged care accommodation and care fees rules. These were part of <a href="https://agedcare.health.gov.au/aged-care-reform">wider reforms</a> to the aged care system initiated under the <a href="https://www.legislation.gov.au/Details/C2013B00043">Aged Care (Living Longer Living Better) Act 2013</a>. </p>
<p>One of the biggest changes was the introduction of <a href="https://www.myagedcare.gov.au/costs/aged-care-homes-costs-explained/income-and-assets-assessment-aged-care-home-costs">means testing</a>. Many residents of aged care facilities are now expected to pay a portion of their care and accommodation costs themselves, but whether and how much they contribute is determined by an assessment of their personal financial circumstances. </p>
<p>A person who receives a full age pension and has just a small amount saved in a bank account, for example, <a href="https://www.myagedcare.gov.au/fee-estimator/residential-care/form">will likely have</a> their accommodation and care costs fully subsidised by the government – aside from a daily care fee, which is a proportion of the pension. </p>
<p>Someone who receives a higher income and owns significant shares and investments may need to pay some or all of their accommodation and care costs.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-wait-for-a-crisis-start-planning-your-aged-care-now-113572">Don't wait for a crisis – start planning your aged care now</a>
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<h2>Costs of aged care</h2>
<p>There are four main costs associated with residential aged care:</p>
<p><strong>1) Daily care fee</strong></p>
<p>This fee covers living costs such as meals, cleaning, heating and power. All residents of an aged care facility pay this fee, which is fixed at 85% of the age pension.</p>
<p><strong>2) Daily means tested care fee</strong></p>
<p>Some residents also need to pay an additional contribution towards the cost of their care. The Department of Human Services conducts an income and assets assessment to work out whether people need to pay this fee, and if so, how much it is.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/274307/original/file-20190514-60529-18l2oba.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/274307/original/file-20190514-60529-18l2oba.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274307/original/file-20190514-60529-18l2oba.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274307/original/file-20190514-60529-18l2oba.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274307/original/file-20190514-60529-18l2oba.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274307/original/file-20190514-60529-18l2oba.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274307/original/file-20190514-60529-18l2oba.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">All residents pay a base fee for care, but depending on your ability to pay, you may have to contribute more.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-nurse-care-support-senior-elderly-1214528551?src=qwsbOY_NttuNXNSAqEXynA-3-12">Sasirin Pamai/Shutterstock</a></span>
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<p><strong>3) Accommodation costs</strong></p>
<p>This includes the cost of the room and other physical amenities provided by the aged care facility. Some residents have their accommodation paid for fully or partly by the government, while others need to pay accommodation costs privately.</p>
<p><strong>4) Additional services fees</strong></p>
<p>Some facilities offer extra services such as newspaper delivery, hairdressing and cable TV. Fees for these additional services only apply if the resident agrees to pay them.</p>
<h2>Accommodation costs get really complicated</h2>
<p>Out of these costs, accommodation costs are often the highest as well as the most confusing. </p>
<p>Those who need to pay all or some of their accommodation costs have a couple of different <a href="https://www.myagedcare.gov.au/costs/aged-care-homes-costs-explained/paying-accommodation-aged-care-home">payment methods</a> to choose from:</p>
<p><strong>Refundable accommodation deposit (RAD) or refundable accommodation contribution (RAC)</strong></p>
<p>RADs and RACs are lump sum payments for a resident’s accommodation. They work like an interest free loan paid to the aged care provider, who is then able to invest this amount, for example in improvements to the facility and services, and earn interest on it. </p>
<p>The lump sum amount is refunded to the resident or their estate if they move or pass away, and is <a href="https://www.myagedcare.gov.au/costs/aged-care-homes-costs-explained/accommodation-refunds">guaranteed</a> by the government even if the provider goes bankrupt.</p>
<p><strong>Daily accommodation payment (DAP) or daily accommodation contribution (DAC)</strong></p>
<p>DAPs and DACs work like a rental payment. Residents pay the aged care provider the daily rate of lost interest on what the lump sum amount would be for their room. The interest rate is <a href="https://agedcare.health.gov.au/sites/default/files/documents/12_2018/schedule_of_fees_and_charges_for_residential_and_home_care.pdf">set by the government</a> and is currently 5.96%.</p>
<p>You can also pay through any combination of these methods, such as 60% RAD and 40% DAP. For example:</p>
<blockquote>
<p>Linda agrees on a RAD price of A$320,000 for her room, and wants to pay this amount in a lump sum. When she leaves the facility, the RAD amount will be refunded to her or her estate.</p>
<p>Gary also chooses aged care accommodation with a RAD price of A$320,000, but he wants to pay the daily amount rather than make the full payment upfront. Gary’s DAP is calculated from the RAD amount for his accommodation, and comes to about A$52 per day.</p>
<p>Maria wants to pay some of her accommodation costs as a lump sum RAD and the rest via a DAP. If her accommodation is also priced at A$320,000 and she pays A$192,000 as a part RAD, her DAP for the remaining amount is about A$21 per day. </p>
</blockquote>
<h2>Is the accommodation payment system fair?</h2>
<p>The answer depends on where you stand on broader issues around fiscal responsibility and intergenerational equity.</p>
<p>Governments have argued the reforms implemented since 2013 are necessary to sustain the aged care system into the future, particularly given a rapidly ageing population and growing budget deficit. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/would-you-like-to-grow-old-at-home-why-were-struggling-to-meet-demand-for-subsidised-home-care-112963">Would you like to grow old at home? Why we’re struggling to meet demand for subsidised home care</a>
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<p>In terms of the payment options themselves, there are some significant advantages to paying an accommodation lump sum if you are in a financial position to do so. It can help preserve your estate and age pension eligibility, as the RAD or RAC amount is refunded and is exempt from the pension income and asset tests.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/274308/original/file-20190514-60554-10uiwd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/274308/original/file-20190514-60554-10uiwd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274308/original/file-20190514-60554-10uiwd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274308/original/file-20190514-60554-10uiwd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274308/original/file-20190514-60554-10uiwd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274308/original/file-20190514-60554-10uiwd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274308/original/file-20190514-60554-10uiwd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Daily payments aren’t refundable and add up over time.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/3109802?src=qwsbOY_NttuNXNSAqEXynA-1-31&size=huge_jpg">iofoto/Shutterstock</a></span>
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<p>The DAP and DAC payments are not refundable. </p>
<p>But given that the <a href="https://agedcare.health.gov.au/sites/default/files/documents/08_2018/acfa_sixth_report_2018_text_fa3.pdf">average value</a> of RADs and RACs held by providers in 2017 was A$283,499, a rental-style payment may be the only option for many people. </p>
<p>There are <a href="https://www.myagedcare.gov.au/costs/fees-annual-lifetime-caps">annual and lifetime caps</a> to the means-tested care fee, but not for accommodation payments, so this daily cost will stack up over time. </p>
<p>Keep in mind, however, that the <a href="https://agedcare.health.gov.au/sites/default/files/documents/08_2018/acfa_sixth_report_2018_text_fa3.pdf">average length of stay</a> in permanent residential aged care was just under three years in 2017, and many people pass away or leave the facility after a stay of just three, six or 12 months.</p>
<p>Some recent reforms aim to make the system easier to navigate and more transparent, such as the introduction of the <a href="https://www.myagedcare.gov.au">My Aged Care</a> gateway and the requirement for aged care providers to make their accommodation pricing public.</p>
<p>But the system is still highly complex, and the onus is on government and care providers to provide accessible information. </p>
<p>A consumer-led system will only work if consumers are informed. This requires investment in education and awareness campaigns to promote greater knowledge of aged care policy, fee structures and options, as well as affordable sources of financial and legal advice.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-residential-aged-care-facilities-are-getting-bigger-and-less-home-like-103521">Australia's residential aged care facilities are getting bigger and less home-like</a>
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<img src="https://counter.theconversation.com/content/114295/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Davy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While the majority of aged care funding comes from government, residents also have to contribute. Here’s how the payment system works.Laura Davy, Research Fellow, Public Service Research Group, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1066072019-01-17T19:14:11Z2019-01-17T19:14:11ZAged care royal commission benefits Generation X: it’s too late for the silent generation<figure><img src="https://images.theconversation.com/files/254039/original/file-20190116-152983-r3k00j.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C994%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Healthy people now in their 50s and 60s will be the first generations to benefit from reform. For people already in care, changes will come too late.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-happy-blond-haired-mature-woman-1105621715?src=hzVE5gB5cx4Z3cX2MB5OmQ-2-48 ">from www.shutterstock.com</a></span></figcaption></figure><p>A surprising group of people stand to benefit from the <a href="https://agedcare.royalcommission.gov.au/Pages/default.aspx">aged care royal commission</a>, whose <a href="https://agedcare.royalcommission.gov.au/hearings/Pages/default.aspx">hearings</a> start today. These are residents of nursing homes in the far future — people in their 50s and 60s, and their children. How is that possible?</p>
<p>All current nursing home residents the royal commission was established to help will have died before there is any substantive change. </p>
<p>The latest <a href="https://www.gen-agedcaredata.gov.au/Resources/Access-data/2018/September/Aged-care-data-snapshot%E2%80%942018">statistics show</a> there are 207,142 older people living in 2,695 facilities owned by 902 different providers. These providers receive more than A$11.2 billion a year from the commonwealth government. A total of 57,769 residents, or more than 27%, <a href="https://www.gen-agedcaredata.gov.au/Topics/People-leaving-aged-care">die every year</a>.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/many-older-people-in-care-die-prematurely-and-not-from-natural-causes-77942">Many older people in care die prematurely, and not from natural causes</a>
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<p>Residents on average live in nursing homes for <a href="https://gen-agedcaredata.gov.au/Topics/People-leaving-aged-care">two years and six months</a>. This is shorter than the average of <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Browse_by_Topic/law/royalcommissions#1977">three to five years</a> it takes for most royal commissions to form, investigate, conclude and deliver their recommendations. </p>
<h2>How did we get here?</h2>
<p>It’s been a long road to this royal commission, paved with repeated shocking and disturbing episodes of neglect, abuse and poor care for our vulnerable elderly parents, grandparents and neighbours in residential care.</p>
<p>However, <a href="https://service.sa.gov.au/cdn/icac/ICAC_Report_Oakden.pdf?platform=hootsuite">Oakden</a> was the final straw. The South Australian aged care mental health facility <a href="https://www.abc.net.au/news/2017-09-22/oakden-closed-as-last-two-residents-moved-out/8974156">closed</a> in 2017 <a href="http://www.courts.sa.gov.au/CoronersFindings/Lists/Coroners%20Findings/Attachments/774/ROLLBUSCH%20Graham.pdf">following revelations</a> of abuse and neglect <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/4ae57e8040d7d0d58d52af3ee9bece4b/Oakden+Report+Final+Email+Version.pdf?MOD=AJPERES&CACHEID=4ae57e8040d7d0d58d52af3ee9bece4b">dating back a decade</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/too-many-australians-living-in-nursing-homes-take-their-own-lives-92112">Too many Australians living in nursing homes take their own lives</a>
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<p>This royal commission has its genesis in the 1997 <a href="https://www.legislation.gov.au/Details/C2017C00241">Aged Care Act</a>. Perhaps its greatest failing was a lack of an explicit single national common standard and understanding of the purpose of residential aged care facilities. That is what should be achieved for the person who becomes a resident.</p>
<p>We all understand the purpose of child care, schools, hospitals and prisons. We judge these by how they improve the lives and well-being of people they serve. However, the absence of a common positive social understanding of the purpose of nursing homes contributes to the community’s inability to judge how well they perform. The Act describes nursing homes’ tasks, activities and services but this is not enough.</p>
<h2>Evidence was there, but not acted on</h2>
<p>Another important and under-recognised factor is that the decade the Aged Care Act was written coincided with new thinking around <a href="https://www.ncbi.nlm.nih.gov/books/NBK225182">patient safety</a>, <a href="https://community.cochrane.org/handbook-sri/chapter-1-introduction/11-cochrane/112-brief-history-cochrane">evidence-based practice</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113460/">clinical governance</a>.</p>
<p>However, over the next two decades, successive governments, regulators and providers did not manage to actively or sufficiently apply this new knowledge to practice. That includes evidence from premature deaths <a href="http://vifmcommuniques.org/residential-aged-care-communique/">investigated by coroners</a> across Australia.</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/what-is-quality-in-aged-care-heres-what-studies-and-our-readers-say-104852">What is 'quality' in aged care? Here's what studies (and our readers) say</a>
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<p>For instance, <a href="http://webarchive.nla.gov.au/gov/20040604221357/http://judgments.fedcourt.gov.au:80/2000/J000434.yes.htm">Riverside</a> nursing home’s licence was revoked after 57 residents had kerosene added to baths <a href="https://www.theage.com.au/national/kerosene-bath-nurses-banned-20020329-gdu35d.html">in January 2000</a> to control an outbreak of scabies. A fundamental contributing factor was the failure to apply up-to-date evidence. We’d known about a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000320.pub2/full">better treatment for scabies</a> since 1931.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/theres-no-need-to-lock-older-people-into-nursing-homes-for-their-own-safety-73954">There's no need to lock older people into nursing homes 'for their own safety'</a>
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<p>In <a href="http://www.coroners.justice.nsw.gov.au/Documents/finding,%20recommendation%20and%20reasons%20-%20quakers%20hill%20fire.pdf">Quakers Hill</a>, a recently employed registered nurse admitted to deliberately lighting a fire that killed 14 people. Contributing factors included the failure of clinical governance systems to recognise and assist impaired health professionals; and a lack of scrutiny of the employee’s qualifications and credentials.</p>
<p>And in Victoria, staff <a href="https://www.coronerscourt.vic.gov.au/sites/default/files/2018-12/caterinamontalto_201711.pdf">failed to disclose</a> to the family, GP and coroner the true circumstances of a resident who was found dead, lying head-first in an outdoor water feature. A contributing factor was not promoting <a href="https://safetyhub.co.nz/wp-content/uploads/2013/09/Safety-Paradoxes.pdf">the right culture</a> for <a href="https://www.safetyandquality.gov.au/wp-content/uploads/2013/03/Australian-Open-Disclosure-Framework-Feb-2014.pdf">incidents to be reported and disclosed openly</a>.</p>
<h2>What will the royal commission uncover?</h2>
<p>The royal commission will revisit the known. It will also uncover more criminal acts and other deliberate acts of <a href="https://www.alrc.gov.au/publications/elder-abuse-report">elder abuse</a>. It will examine <a href="https://www.monash.edu/__data/assets/pdf_file/0009/1507914/Hazard-Edition-84.pdf">care that causes unintended harm</a> and <a href="https://www.mja.com.au/journal/2017/206/10/premature-deaths-nursing-home-residents-epidemiological-analysis">premature death from injury</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/elder-abuse-report-ignores-impact-on-peoples-health-75926">Elder abuse report ignores impact on people's health</a>
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<p>The scale of the investigation is enormous and far greater than most people realise. We don’t know the breadth and depth of harm across the nation as this has not previously been examined in a rigorous, systematic way that we do with health care. </p>
<p>The royal commission appears to have limited its investigation to the nature of care over the past five years, which covers the current 207,142 living residents and the those who died in the past five years (around 290,000 residents).</p>
<p>The health department’s submission to the <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportrep/024167/toc_pdf/ReportontheInquiryintotheQualityofCareinResidentialAgedCareFacilitiesinAustralia.pdf;fileType=application/pdf">House of Representatives inquiry into residential aged care</a> (<a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/AgedCareFacilities/Submissions">submission 72, p8</a>), advised receiving reports of assault or alleged assault of 1.2% of residents a year. Over five years, the total number of residents affected would be more than 12,400 incidents (1.2% of 207,000 residents each year for five years). </p>
<p>Along with these serious incidents of potential abuse remains the question of substandard clinical care. A conservative estimate would be based on the premise that aged care performs as well as health care, which <a href="https://www.gmc-uk.org/-/media/documents/preventable-patient-harm-across-health-care-services_pdf-73538295.pdf">harms a minimum of 6% of patients</a> from each interaction. This equates to more than 62,100 incidents of harm (6% of 207,000 residents each year for five years).</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/violence-between-residents-in-nursing-homes-can-lead-to-death-and-demands-our-attention-87087">Violence between residents in nursing homes can lead to death and demands our attention</a>
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<p>The scale of neglect and abuse is potentially so large the royal commission will be consumed with addressing the potential criminal and human rights abuses. This is also consistent with why royal commissions are usually called — to investigate corruption, impropriety, illegal activity or gross administrative incompetence.</p>
<p>The challenge facing the royal commission is to better understand and rectify substandard clinical care by identifying how the aged care sector, government, regulators and health professionals failed to recognise, report and address this harm. By comparison, we’ve know how to do this in the health care sector since 2000.</p>
<p>We also need the royal commission to lead to reforms that shift the sector from being ranked <a href="http://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=Australia">17th of 96 countries internationally</a> to one that is exceptional, on par with the <a href="https://interactives.commonwealthfund.org/2017/july/mirror-mirror/#chapter5">performance of our health care system</a>.</p>
<h2>Who is this royal commission for?</h2>
<p>This royal commission matters most to those who are still young, healthy and living at home. It is this group who will receive the benefits of any positive reforms or suffer the consequences of any shortcomings. </p>
<p>Given the broad terms of reference for the royal commission, it is difficult to imagine how it will deliver its findings in 12 months. A more realistic estimate is the inquiry will take up to three years followed by a fourth year for the incumbent government to consider the recommendations, a fifth year for reform to be debated in parliament and legislated, then five years for any substantive policy and practice reforms to be put in place. </p>
<p>This takes us to 2030, by which time at least four cohorts of residents will have entered a nursing home and died.</p><img src="https://counter.theconversation.com/content/106607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim has received funding from Commonwealth and State Health Departments for research, education and consultancies. He was an expert witness for the Coroner's Court in South Australia for the Inquest into a resident's death at Oakden and provided evidence to the multiple inquiries into aged care including but not limited to those lead by Carnell-Paterson, Senate and, House of Representatives. </span></em></p>By the time the aged care royal commission’s recommendations lead to improvements in our nursing homes, four cohorts of residents will have died. Here’s why.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/973742018-08-01T02:20:34Z2018-08-01T02:20:34ZGetting the temperature just right helps people with dementia stay cool<figure><img src="https://images.theconversation.com/files/229913/original/file-20180731-102498-1bk3bqz.JPG?ixlib=rb-1.1.0&rect=0%2C52%2C3479%2C1415&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are currently no rules to ensure that aged-care facilities provide a comfortable indoor environment.</span> <span class="attribution"><span class="source">University of Wollongong</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Everyone knows how bad it feels when the temperature is uncomfortably hot or cold. For most of us it doesn’t last long as we can take simple steps to get comfortable, such as putting on clothes, opening a window, or switching on a heater. </p>
<p>But what happens when you can’t control the temperature where you live? This problem is faced by many residents of aged care facilities, and can be particularly difficult for those living with dementia. To find out how these residents cope we recently carried out a <a href="http://journals.sagepub.com/doi/full/10.1177/1533317517704898">three-year research project</a> on the effects of indoor environment in aged care facilities in south-eastern NSW. This was part of a broader program of University of Wollongong research on the <a href="https://stand.uow.edu.au/a-house-for-all/">impact of indoor environment on elderly people</a>. </p>
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Read more:
<a href="https://theconversation.com/australias-aged-care-residents-are-very-sick-yet-the-government-doesnt-prioritise-medical-care-88690">Australia's aged care residents are very sick, yet the government doesn't prioritise medical care</a>
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<h2>Dementia and agitation</h2>
<p>Dementia is a collection of symptoms that affect people’s behaviour, thinking, and their ability to communicate and perform everyday tasks. Sometimes people with dementia can become agitated or distressed, which can be disturbing for other people around them. This often happens for no clear reason. </p>
<p>This is a big issue for the aged care sector since approximately half of all residents in aged care facilities have dementia.</p>
<p>While current <a href="https://www.aacqa.gov.au/providers/accreditation-standards">rules governing the accreditation</a> of aged care facilities in Australia do make reference to the <a href="https://www.aacqa.gov.au/providers/residential-aged-care/resources/pocket-guide-accessible-verison">need to provide ‘comfortable internal temperatures and ventilation’</a> there is no specific reference to what temperature ranges are considered comfortable. We set out to find whether this should be remedied and whether there is a relationship between agitation among residents living with dementia and the indoor temperatures to which they are exposed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/228540/original/file-20180720-142432-1syb9ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/228540/original/file-20180720-142432-1syb9ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/228540/original/file-20180720-142432-1syb9ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/228540/original/file-20180720-142432-1syb9ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/228540/original/file-20180720-142432-1syb9ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/228540/original/file-20180720-142432-1syb9ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/228540/original/file-20180720-142432-1syb9ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dr Federico Tartarini (right) led the study that found that indoor temperatures in aged care centres have a dramatic impact on the wellbeing of residents, particularly those living with dementia. Photo: University of Wollongong.</span>
<span class="attribution"><span class="source">Author supplied</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Tracking the temperature</h2>
<p>Firstly we set up a network of sensors in six aged care facilities to monitor indoor environmental conditions, such as air temperature, humidity, air velocity and noise.</p>
<p>In collaboration with the care staff of one particular facility we then assessed the frequency and intensity of a range of agitated behaviours exhibited by residents living with dementia over the course of a year.</p>
<p>The most important <a href="http://journals.sagepub.com/doi/full/10.1177/1533317517704898">finding of this study</a> was that the frequency and intensity of agitated behaviours of residents with dementia significantly increased when they were exposed to uncomfortable air temperatures. </p>
<p>A statistically significant correlation was found between rates of agitation of residents and their cumulative exposure to temperatures outside their comfort zone of between 20°C and 26°C.</p>
<p>More generally, the data collected from the hundreds of temperature sensors across all our case study facilities over a one-year period showed that some facilities were often uncomfortably hot or cold (below 19°C in winter and over 30°C in summer) for significant periods. </p>
<h2>Poorly designed buildings</h2>
<p>This was attributable to many different factors including poor thermal design of the buildings and poor control of the heating and cooling systems. Interestingly, our analysis showed <a href="https://www.sciencedirect.com/science/article/pii/S0360132318300246?via%3Dihub">staff were significantly less tolerant of variations in indoor temperature than residents</a>, probably because they were generally more active than the residents (i.e. moving around and working), and therefore had higher metabolic rates. They may have also had higher thermal comfort expectations than the residents.</p>
<h2>Regulations can help</h2>
<p>The evidence appears to suggest that maintaining a comfortable temperature
will reduce the behavioural and psychological symptoms of dementia.</p>
<p>There is a clear need for new regulations that ensure aged care facilities provide comfortable indoor environmental conditions, particularly for elderly residents, but also for the staff working in these facilities. </p>
<p>The aged care sector needs good indoor environmental rating tools, built on recent research evidence, to guide the design of their facilities and to audit their operations. </p>
<p>This type of approach has already been successfully applied in the commercial building sector, where <a href="https://theconversation.com/green-building-scheme-review-adds-yet-more-policy-uncertainty-32748">mandatory disclosure</a> of the real energy consumption of larger offices, for example, is required of owners wishing to sell or lease their property.</p>
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Read more:
<a href="https://theconversation.com/why-is-it-so-cold-in-here-setting-the-office-thermostat-right-for-both-sexes-45585">Why is it so cold in here? Setting the office thermostat right – for both sexes</a>
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<p>Publicly available ratings of the actual indoor environment provided to aged care residents and staff would alert architects, managers and staff to the importance of thermal comfort and help elderly people, and their families, make a more informed choice as to the best facility in which to live.</p><img src="https://counter.theconversation.com/content/97374/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Federico Tartarini does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article. He has previously received funding for research on the impact of indoor environmental conditions in aged care facilities from an Australian aged care provider.</span></em></p><p class="fine-print"><em><span>Paul Cooper does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article. He has previously received funding for research on the impact of indoor environmental conditions in aged care facilities from an Australian aged care provider.</span></em></p><p class="fine-print"><em><span>Richard Fleming does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People with dementia can become agitated or distressed when the temperature isn’t right, but some aged-care facilities aren’t designed or operated to keep them comfortable.Federico Tartarini, Associate research fellow, University of WollongongPaul Cooper, Senior Professor and Director of the Sustainable Buildings Research Centre (SBRC), University of WollongongRichard Fleming, Professorial Fellow and Executive Director, Dementia Training Australia, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/842042017-09-19T19:40:20Z2017-09-19T19:40:20ZHurricane Irma nursing home deaths shows stark dilemma of whether to stay put or evacuate<p>The <a href="http://edition.cnn.com/2017/09/13/health/florida-nursing-home-deaths/index.html">death of Florida nursing home residents</a> whose air-conditioning failed last week during Hurricane Irma highlights the tragic consequences of some of our most vulnerable citizens during a natural disaster.</p>
<p>So, it’s easy to assume evacuating nursing home residents in such situations is the safest option.</p>
<p>But <a href="http://www.sciencedirect.com/science/article/pii/S1525861017301007">our review shows</a> evacuation can cause more harm than staying put. So we need to take that into account when planning for the next natural or man-made disaster.</p>
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Read more:
<a href="https://theconversation.com/irma-and-harvey-very-different-storms-but-both-affected-by-climate-change-83800">Irma and Harvey: very different storms, but both affected by climate change</a>
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<p>Disasters can be caused by natural hazards (an environmental process or phenomenon, like a cyclone) or man-made ones (technological or industrial conditions, like a nuclear accident).</p>
<p>And disasters are more likely to affect older people because they are <a href="http://www.ingentaconnect.com/content/asag/gen/2007/00000031/00000004/art00005">physically frailer and often require supportive care</a>. For instance, when Hurricane Katrina battered the US Gulf Coast in 2005, <a href="https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/hurricane-katrina-deaths-louisiana-2005/8A4BA6D478C4EB4C3308D7DD48DEB9AB">almost half</a> <a href="http://content.healthaffairs.org/content/25/5/w407.short">of the people</a> who died were <a href="http://www.sciencedirect.com/science/article/pii/S1525861008002132">over 75</a>.</p>
<p>Disasters from natural hazards, like Australia’s recent <a href="http://www.bom.gov.au/announcements/sevwx/qld/qldtc20170325.shtml">Tropical Cyclone Debbie</a> in Queensland, are expected to <a href="http://www.bom.gov.au/climate/current/annual/aus/2015/">increase in frequency and intensity</a> <a href="https://www.ncdc.noaa.gov/sotc/global/201607">due to climate change</a>.</p>
<h2>What we did and what we found</h2>
<p>We <a href="http://www.sciencedirect.com/science/article/pii/S1525861017301007">analysed the results</a> of ten studies involving nursing home residents who had been evacuated during natural or man-made disasters.</p>
<p><a href="http://europepmc.org/abstract/med/23250017">Residents who evacuated</a> were more likely to die in the first month than those who remained. Those who evacuated were also more likely to die sooner than expected up to four months after the disaster. </p>
<p>The most common cause of death was pneumonia, which was attributed to <a href="http://www.publichealthjrnl.com/article/S0033-3506(12)00380-0/abstract">poor living conditions</a> once evacuated.</p>
<p>Residents most likely to die after an evacuation were over 80, frail, dependent on others for their care, men, and those with multiple illnesses.</p>
<h2>Why can evacuations kill?</h2>
<p>Standard evacuation procedures might not work so well for nursing home residents for a number of reasons. Residents’ cognitive impairment and lack of mobility could compound the physiological stress of evacuation. This stress, coupled with unintentional changes and errors in how residents are cared for during a disaster, may increase their risk of dying prematurely.</p>
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<a href="https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186337/original/file-20170918-26983-16eim2a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Mobility problems can mean standard evacuations don’t work so well for some nursing home residents.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/673535773?src=cTOfjGmM_Tcta15D4DXIOw-1-0&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Evacuations can lead to direct injuries, like falling over, or indirect problems, like existing heart disease worsening because of the increased mental and physical demands in relocating. </p>
<p>Similarly, the disaster can cause direct injuries, like drowning in a flood, or indirect ones, like a flood preventing essential resources (like food and medications) from reaching residents.</p>
<h2>So, what can we do?</h2>
<p>People with a family member in a nursing home should be made aware of the home’s disaster response plan. This includes plans to respond to likely scenarios specific to its local area, and where residents could be evacuated.</p>
<p>It might be better to evacuate in some disasters (for example, nuclear disasters). But for others, it is better to seek other alternatives, like sheltering in place (for example, cyclones). In reality, the preferred response may not always be available or practicable.</p>
<p>The unpredictability of disasters, lack of appropriate transport, immobility of residents or the availability of a safe place to go poses challenges. Similarly, sheltering in place may not be practical due to a lack of staff, supplies and power generators. </p>
<h2>How do we plan for future disasters?</h2>
<p>This heightens the need to have a well-prepared evacuation plan that includes the preferred response and contingency plans.</p>
<p>When <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2006.107532">planning for future disasters</a> we need to identify residents who are more likely to benefit from being evacuated and those who need to shelter in the nursing home. </p>
<p>We also need to plan for managing a nursing home after an evacuation. While it’s easy to focus on the needs of residents, this is also a time of <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2006.107748">mental and emotional stress for carers</a>, who may be short-staffed due to death, injury or exhaustion, <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.8.1436">dealing with their own grief, and caring for residents</a>.</p>
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<a href="https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186334/original/file-20170918-1353-utctq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">We also need to plan for what happens in nursing homes after some residents have been evacuated, and staff are under pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/507437176?src=gn8fqXjZcM9W1QX3VO5yJA-1-5&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Including nursing homes in state or national disaster plans could improve outcomes for residents in disasters. During <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2006.107748">Hurricane Katrina</a> and <a href="http://www.sciencedirect.com/science/article/pii/S1525861006005846">Rita</a> in the USA, <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.8.1436">nursing homes received little support</a> from federal, state and local response agencies during or after the disasters. </p>
<p>We also need to coordinate disaster plans with <a href="http://www.tandfonline.com/doi/abs/10.3109/10903127.2011.561401">multiple agencies</a>. This includes nursing homes, which may both evacuate and shelter residents and emergency services, which may help to <a href="http://www.tandfonline.com/doi/abs/10.3109/10903127.2011.561401">develop and prepare</a> people to implement those plans. Governments, hospitals, search and rescue agencies and those who provide the necessary supplies and equipment should also be part of a coordinated approach disaster planning.</p>
<p>Plans might include giving priority to vehicles carrying nursing home residents where there’s lots of slow-moving traffic. This would shorten travel times and reduce residents’ stress.</p>
<p>Communicating with <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2006.107748">residents’ carers</a> should be a high priority during evacuations. Specific protocols should also be in place to ensure residents receiving the right type of ongoing care both during and after evacuation. This must include carers being able to access residents’ medical records. </p>
<p>Without proper disaster plans tailored for nursing home residents, older people will continue to die needlessly in disasters.</p><img src="https://counter.theconversation.com/content/84204/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim receives funding from the Federal Department of Social Services, the Victorian Department of Health and Human Services, Victorian Managed Insurance Authority and the Department of Forensic Medicine, Monash University.</span></em></p><p class="fine-print"><em><span>Melissa Willoughby does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Evacuating nursing home residents during a disaster can be even more dangerous than staying put.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityMelissa Willoughby, Research Assistant, Department of Forensic Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/793262017-07-10T23:18:47Z2017-07-10T23:18:47ZStressed? Running on empty? It’s not compassion fatigue<figure><img src="https://images.theconversation.com/files/175059/original/file-20170621-30190-94an1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Growing patient demands, paperwork and workplace stress take their toll on health-care providers.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>A 71-year-old man with advanced dementia is being wheeled into his residential care home by two paramedics after a scheduled MRI. They notice him smile as he feels the warmth of the morning sun on his usually forlorn face. They decide to stop and let him soak up the rays for a few more minutes, knowing this may be one of his last opportunities to do so.</p>
<p>What is the impact of this compassionate act on this patient? What is the cost for the health-care providers?</p>
<p>The story we are told is that compassion, which is <a href="http://www.dx.doi.org/10.1186/s12904-016-0080-0">increasingly demanded within health care</a>, is finite. Health-care providers are finding it increasingly difficult to provide it — in the midst of growing patient workloads, paperwork, institutional demands and workplace stress. Like cars, when health-care providers use this fuel in their work, they run the risk of <a href="http://www.compassionfatigue.org/pages/RunningOnEmpty.pdf">depleting their compassion “gas tanks”</a> in the process.</p>
<p>The result: compassion fatigue. </p>
<p>But what if compassion fatigue is a myth? As an associate professor in the Faculty of Nursing at the University of Calgary, my research has focused on <a href="http://www.dx.doi.org/10.1016/j.jpainsymman.2015.10.009">finding ways to improve compassionate care</a> within health care. Members of <a href="http://www.dx.doi.org/10.1177/0269216316663499">my compassion research lab and colleagues</a> across Canada have <a href="http://www.dx.doi.org/10.1016/j.ijnurstu.2017.01.003">examined the concept of compassion fatigue</a> within health-care research. </p>
<p>We found no evidence that there is anything especially tiring about compassion. We discovered that the very idea of compassion fatigue causes health-care providers to mistakenly guard this precious commodity. It also distracts from the very real challenges of occupational stress. </p>
<h2>Cost of caring?</h2>
<p>Our research revealed that compassion fatigue was originally conceptualized as the “cost of caring.” The argument is this: the more that health-care providers are exposed to traumatic patient situations, the more their compassion is eroded. In other words, loss of compassion is an inevitable outcome of caring. </p>
<p>Over time, a second, more pervasive, understanding emerged. This views compassion itself as the cause of fatigue, rather than a symptom of occupational stress. Seen this way, expressions of compassion, in and of themselves, cause compassion fatigue. </p>
<p>As a result, health-care providers become susceptible to suffering from the very thing that their patients need. Ironically, this leaves us in a quandary, a vicious cycle, a supply-demand glut that itself perpetuates the problem — namely, as the demand for compassion by patients increases, health-care providers are required to expend this apparent finite resource.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/175068/original/file-20170621-9586-z7hwqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175068/original/file-20170621-9586-z7hwqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175068/original/file-20170621-9586-z7hwqb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175068/original/file-20170621-9586-z7hwqb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175068/original/file-20170621-9586-z7hwqb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175068/original/file-20170621-9586-z7hwqb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175068/original/file-20170621-9586-z7hwqb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many health-care providers wish for the institutional support to offer more compassion in their work.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>This also implies that there is something unique about compassion that makes it much less “fuel efficient” and potentially more harmful to health-care providers than standard forms of care or even expressions of apathy. </p>
<p>This has consequences for health-care delivery. It encourages an approach in which health-care providers mistakenly guard this precious commodity. They face a dilemma— to provide patients with the compassion they want (and jeopardize themselves in the process) or leave patients’ needs unmet.</p>
<p>Much like protectionist governments who try to protect their internal resources and economies out of fear that they will be disadvantaged if they extend them beyond their borders, compassion fatigue implies that expending too much compassion to others will be detrimental to health-care providers’ own wellbeing.</p>
<h2>Traumatizing care-giving?</h2>
<p>In our review of the literature, we also discovered the term “compassion fatigue” originated in the field of crisis counselling. It was first used to describe secondary traumatic stress experienced by counsellors working with trauma victims. It was adopted into mainstream health care to provide a more sympathetic, less stigmatizing, term for burnout and secondary traumatic stress.</p>
<p>The result is that all care-giving is potentially traumatic. And health care is given a special status in comparison to other occupations, where stress and burnout are attributed to factors such as poor work-life balance, increased workload and lack of support. </p>
<p>Transplanting compassion fatigue from the field of secondary traumatic stress and applying it broadly to health care not only equates all care-giving as potentially traumatic, but gives occupational stress among health-care providers special status in comparison to other occupations.</p>
<p>How exactly this occurs is not clear either. Patients have <a href="http://www.dx.doi.org/10.1016/j.jpainsymman.2015.10.009">defined compassion</a> as “a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.” But it is not clear which of these key ingredients of compassion cause compassion fatigue or are more vulnerable to compassion fatigue. As a result, <a href="http://www.dx.doi.org/10.1111/jan.12686">research measures, indicators and interventions</a> for compassion fatigue rest on a somewhat fragile foundation.</p>
<h2>A stimulus for health-care renewal?</h2>
<p>The idea of compassion fatigue has negative consequences. For health-care providers, it distracts from the very serious, multifaceted issues of occupational stress that they face on a daily basis. It also implicates them unfairly as the problem in the process. And it suggests that there is something inherently lacking within health-care providers themselves.</p>
<p>What’s more, if there was a link between compassion fatigue and provision of compassion, then health-care providers should be some of the least compassionate individuals in society. This conclusion is not supported by research or by patients. In over 13 years of clinical experience the vast majority of health-care providers I have had the privilege of working with would warmly welcome greater opportunities to provide compassionate care. </p>
<p>Instead, the focus should be on developing compassionate health-care systems to support these individual health-care providers. </p>
<p>Compassion should be re-conceptualized as a health-care stimulus — renewing our health-care systems from the inside-out, sustaining health-care providers and meeting an important patient need in the process.</p><img src="https://counter.theconversation.com/content/79326/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shane Sinclair receives funding from the Canadian Institutes of Health Research</span></em></p>The myth of compassion fatigue suggests that compassion is a finite resource. The reality is that health-care providers are over-worked and need better institutional support.Shane Sinclair, Associate Professor and Cancer Care Research Professor, Faculty of Nursing, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/759262017-06-15T00:59:10Z2017-06-15T00:59:10ZElder abuse report ignores impact on people’s health<figure><img src="https://images.theconversation.com/files/172656/original/file-20170607-5695-1x30mfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Elder abuse covers physical, sexual, psychological, emotional and financial abuse.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=qLGUben2CIC-F6xAluzo_g-1-2">from www.shutterstock.com</a></span></figcaption></figure><p>The good news is that Australia is doing something positive to improve the lives of our parents and grandparents. The bad news is we can no longer pretend there are golden years awaiting us all in old age.</p>
<p>The release today of the long awaited Australian Law Reform Commission (ALRC) report into <a href="https://www.alrc.gov.au/inquiries/elder-abuse">elder abuse</a> is a substantial step forward in addressing physical, sexual, psychological, emotional and financial abuse of the elderly.</p>
<p>As expected, the report only addresses the legal aspects of elder abuse. What is missing is the impacts of elder abuse on health and well-being, particularly as older people who are victims of abuse and neglect are <a href="http://www.tandfonline.com/doi/abs/10.1080/08946566.2016.1142920">more likely to die earlier</a>.</p>
<p>Despite this gap, we need to be brave enough to read the 428 page report, and act on the 43 recommendations.</p>
<p>Australia’s recent examples of confronting other sources of abuse and neglect – including the harm to the <a href="https://www.humanrights.gov.au/publications/bringing-them-home-report-1997">Stolen Generation</a>, <a href="http://www.childabuseroyalcommission.gov.au/about-us">child sexual abuse</a>, <a href="http://www.rcfv.com.au/Report-Recommendations">family violence</a> and abuse of people with a <a href="https://www.humanrights.gov.au/report-national-inquiry-human-rights-people-mental-illness">mental illness</a> – should prepare us to take this next step.</p>
<h2>Aged care a major target</h2>
<p>A total of 14 out of the ALRC’s 43 recommendations are about improving aged care, in both residential settings and the home.</p>
<p>Recommendations include improving the reporting and monitoring of serious incidents, such as sexual or physical abuse, with the process to be overseen by an independent body. While a reporting system will not prevent abuse, it is an essential and welcome first step.</p>
<p>Another recommendation addresses the perennial matter about quality of care and staffing in residential aged care services, including looking at optimal staffing models and levels.</p>
<h2>How little we know</h2>
<p>We know older people are at greater risk of abuse and neglect than the general population because of their physical frailty, cognitive impairment, multiple illnesses, social isolation, and need for assistance with personal or domestic tasks.</p>
<p>Yet, there is currently little information about the overall number and severity of incidents of elder abuse and neglect in Australia. Our recent <a href="https://www.mja.com.au/system/files/issues/206_10/10.5694mja16.00873.pdf">analysis</a> of coroners’ investigations into extreme incidents leading to death goes part way to addressing that issue.</p>
<p>So we welcome the report’s recommendation of a national study to tell us how common elder abuse in Australia is. Perhaps what is most confronting is that we do not already collect this information, even though we know it is occurring.</p>
<p>For instance, there’s evidence of nursing home residents who <a href="https://www.ncbi.nlm.nih.gov/pubmed/25630802">assault other residents</a>, <a href="https://academic.oup.com/gerontologist/article-abstract/doi/10.1093/geront/gnx022/3572447/A-Systematic-Review-of-Sexual-Assaults-in-Nursing?redirectedFrom=fulltext">sexual assault</a> and the use of <a href="https://academic.oup.com/ageing/article-abstract/doi/10.1093/ageing/afw246/2801280/Physical-restraint-deaths-in-a-13-year-national?redirectedFrom=fulltext">physical restraint</a> in aged care. But we have no overall picture of what’s happening.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Inappropriate care, including unnecessarily restricting where and when older people walk, also needs to be addressed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/628433834?src=42ps9k91dsoIOz-e10wIUw-1-0&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Also not included in the report is whether providing inappropriate health care is a form of abuse. Examples include using resuscitation <a href="http://www.resuscitationjournal.com/article/S0300-9572(15)00129-X/pdf">against someone’s wishes</a>, or in residential aged care where a frail older person is <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajag.12014/abstract">restricted from walking alone</a> even though they want independence and accept an increased risk of falling.</p>
<h2>Sexual assault remains hidden</h2>
<p>Of all the hidden aspects of abuse and neglect, sexual assault is the least acknowledged, detected, and reported type, especially in people living in residential aged care. While this is mentioned in the report, it deserves far more attention. This is especially important considering the role of health sector and health professionals who should be working to improve identifying, reporting, managing and responding to sexual assaults.</p>
<p>Our recent <a href="https://academic.oup.com/gerontologist/article-abstract/doi/10.1093/geront/gnx022/3572447/A-Systematic-Review-of-Sexual-Assaults-in-Nursing?redirectedFrom=fulltext">review</a> identified care staff and health professionals are poorly equipped to appropriately identify and respond to sexual assault. This situation was not helped by the lack of supporting policies in aged care facilities to investigate and support victims.</p>
<p>These situations persist because of community inaction. We are reluctant to accept the possibility of these incidents because they are too horrific to contemplate. We reassure and rationalise our inaction by saying the perpetrators are a very small minority of criminally minded individuals, which is not the reality. In fact the perpetrators are more often a person who is in a <a href="https://www.ncjrs.gov/pdffiles1/nij/grants/226456.pdf">position of trust</a> such as a family member or carer.</p>
<h2>Screen, identify and intervene</h2>
<p>The ALRC report comes 15 years after the World Health Organisation made its <a href="http://www.who.int/ageing/projects/elder_abuse/alc_toronto_declaration_en.pdf">declaration</a> for the global prevention of elder abuse.</p>
<p>The fact that such a report is needed is, in part, a reflection of Australia’s complex, fragmented arrangement of health, aged care and legal systems. This leads to a divergent, discordant or contradictory approach towards older people that unnecessarily impinges on their rights, choices and freedoms.</p>
<p>So, the greatest challenge in preventing elder abuse is equipping the law, health and aged care sectors to be better at screening, identifying and intervening to protect their rights. Incredible sensitivity is also required as the vast majority of children, partners and care staff are fabulous advocates and supporters of older people.</p>
<p>More research is also needed to inform decisions about social policy, aged care practice and resource allocation. This requires a dedicated, co-ordinated, multidisciplinary approach and the necessary technical expertise in aged care, law, health care, public health, injury prevention and public policy.</p><img src="https://counter.theconversation.com/content/75926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim receives funding from the Federal Department of Social Services, the Victorian Department of Health and Human Services (Ageing and Aged Care Branch), and the Department of Forensic Medicine, Monash University.</span></em></p><p class="fine-print"><em><span>Lyndal Bugeja receives funding from the federal Department of Social Services, the Department of Forensic Medicine, Monash University and Monash Nursing and Midwifery. </span></em></p>A report that recommends 43 ways to prevent elder abuse acknowledges we don’t even know how often it occurs in Australia.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLyndal Bugeja, Associate Professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/774732017-05-21T20:10:31Z2017-05-21T20:10:31ZThe shocking state of oral health in our nursing homes, and how family members can help<figure><img src="https://images.theconversation.com/files/170064/original/file-20170519-12263-3x7xay.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Families who are around at mealtimes can check their relatives are swallowing food properly and alert nursing home staff if there's a problem.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/245858767?src=XqE-p4XS2Egd6bE9b4TKng-1-9&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>The recent <a href="http://www.smh.com.au/nsw/push-for-inquiry-after-woman-found-with-maggots-in-her-mouth-at-nsw-nursing-home-20170509-gw0p1j.html">report</a> of a nursing home resident found with maggots in her mouth brings home how devastating neglected <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/report_nacdh%7Ereport_nacdh_ch1%7Ereport_nacdh_what">oral health</a> can be.</p>
<p>While shocking, this story is far from surprising. Researchers have long highlighted that people living in aged care have substantially <a href="http://aphcri.anu.edu.au/aphcri-network/research-completed/successful-ageing-and-oral-health-incorporating-dental">poorer oral health</a> and <a href="http://www.adelaide.edu.au/arcpoh/downloads/publications/reports/national-oral-health-plan/oral-health-australians-cover.pdf">three times</a> the risk of untreated tooth decay than people living in the community.</p>
<p>The aged-care sector should also be well aware of the issue. In 2014, complaints to the government’s <a href="https://www.agedcarecomplaints.gov.au/">aged-care complaints scheme</a> led to an <a href="https://www.agedcarecomplaints.gov.au/wp-content/uploads/2015/12/Industry-Feedback-Alert-Oral-Health-and-Dental-Hygiene.pdf">industry-wide alert</a> and training on <a href="https://agedcare.health.gov.au/publications-articles/resources-learning-training/better-oral-health-in-residential-care-training">what to do to improve standards</a>.</p>
<h2>What do we mean by oral health and why is it an issue?</h2>
<p>Oral health is not just about the health of teeth and gums. It also covers looking after areas including the lips, tongue and inside the cheeks.</p>
<p><a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422896">Most aged-care residents</a> are aged over 85, frail, have complex health conditions, are on multiple medications, and rely on staff to meet all their care needs. These and other factors, such as lack of access to oral health services, greatly <a href="http://aphcri.anu.edu.au/aphcri-network/research-completed/successful-ageing-and-oral-health-incorporating-dental">increases their risk</a> of having poor oral health. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169731/original/file-20170517-24350-1hms8mc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Poorly fitted dentures make eating and speaking more difficult, and can cause people to die from choking.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/581290165?src=U8pr1j-MFa0FLIjhgwRYlA-1-21&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Many medications <a href="https://link.springer.com/article/10.1007/s40268-016-0153-9">can cause a dry mouth</a>, resulting in painful cracks in the lips or tongue, and an increased risk of infection. A dry mouth can also make chewing and swallowing food more difficult.</p>
<p>Other problems include tooth decay and gum disease, and a significantly <a href="https://www.ncbi.nlm.nih.gov/pubmed/15614684">increased risk</a> of developing <a href="http://emedicine.medscape.com/article/296198-overview">aspiration pneumonia</a>, where inhaled saliva or food moves bacteria into the lungs.</p>
<p>Dentures that no longer fit can not only make eating and speaking more difficult, but can also cause residents to die from <a href="http://www.sciencedirect.com/science/article/pii/S0001457512002199">choking</a>.</p>
<p>These problems affect people’s health, well-being and quality of life; as well as their dignity and social inclusion, due to an unsightly mouth or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/halitosis-or-bad-breath">bad breath</a>.</p>
<h2>What happens in practice?</h2>
<p>To learn more about what happens in practice, we asked aged-care <a href="https://www.ncbi.nlm.nih.gov/pubmed/27091278">nurses and nursing assistants</a> about their experiences of providing oral care. </p>
<p>They agreed with guidance for best practice, for instance brushing people’s teeth twice a day and cleaning their dentures. But they said they could not always perform these tasks. Some blamed lack of time and not enough staff. Others felt staff had enough time but negative attitudes, not seeing oral care as a priority over other daily care tasks. </p>
<p>Staff described not having the appropriate equipment, products, or access to dental-health services like <a href="http://onlinelibrary.wiley.com/doi/10.1111/idh.12187/abstract">dental hygienists</a> and dentists. They also said family members were sometimes reluctant to pay for things like toothbrushes and toothpaste, or visits to the dentist. </p>
<p>The residents who need the most help with oral care often missed out entirely. Staff avoided tooth brushing if residents had swallowing disorders. They also stopped providing oral care if residents were resistant or aggressive, including people with dementia. Some residents went without oral care “<a href="http://ogma.newcastle.edu.au:8080/vital/access/services/Download/uon:24046/Attachment02?view=true">for weeks</a>”.</p>
<h2>How to fix the problem</h2>
<p>The problem of poor oral health in aged care is not just about some staff being reluctant to provide good routine care. It is not necessarily about a lack of evidence-based <a href="https://www.fightdementia.org.au/sites/default/files/20070200_Nat_QDC_QDC2QualDemCareStandards.pdf">standards, care guidelines</a> or <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455398">education resources</a>.</p>
<p>This complex problem has arisen due to many broader issues in the aged-care system. Some of these are highlighted in a <a href="http://aphcri.anu.edu.au/files/Aged%20care%20Full%20report%20FINAL.pdf">recent report</a>, including insufficient funds and lack of access to dental services.</p>
<p>So we need a <a href="http://aphcri.anu.edu.au/aphcri-network/research-completed/successful-ageing-and-oral-health-incorporating-dental">collaborative</a> approach to improving oral health in aged care, that involves funders, policymakers, aged-care residents, family members, staff and health professionals working together.</p>
<p>Family members and aged-care staff might feel helpless in the face of such barriers to good oral health. So here are five actions they can take.</p>
<h2>1. Advocate for the resident</h2>
<p>Aged care residents have the <a href="https://agedcare.health.gov.au/publications-and-articles/guides-advice-and-policies/charter-of-care-recipients-rights-and-responsibilities-residential-care">right</a> to the <a href="https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-25-health.html">same access to health care</a> as their peers living in the community. This includes having their teeth brushed and dentures cleaned properly, along with regular access to oral health services.</p>
<p>Many people living in aged care cannot communicate their needs and rely on others to speak on their behalf. Raising concerns with the manager or making a <a href="http://www.abc.net.au/health/consumerguides/stories/2003/02/20/1837237.htm">complaint</a> can be daunting. So keeping a written record can help family members and staff communicate their concerns clearly when raising complaints with the manager or the <a href="https://www.agedcarecomplaints.gov.au/">Aged Care Complaints Commissioner</a>.</p>
<h2>2. Be vigilant at mealtimes</h2>
<p>Visiting around mealtimes, or helping the person to eat, can be a chance to pick up problems. Ask the resident permission to look into her mouth to check if she is swallowing or removing leftover food promptly. </p>
<p>Look in particular around the teeth and gums, between the teeth and the cheeks, and on the roof of the mouth. Ask for a referral to a speech pathologist if you think the person has trouble swallowing, as swallowing can get more difficult with age. </p>
<p>Smelly saliva and bad breath are also linked to poor oral health. So, routinely checking if the person has a “clean mouth” could help identify problems. If you see or smell something, say something. </p>
<h2>3. Ask for more information</h2>
<p>Ask the care staff about your family member’s oral-care routines. How well do these align with the nursing home’s policies and guidance provided to families? Before more problems arise, seek the services of dental health professionals.</p>
<h2>4. Discuss costs</h2>
<p>Relying on family members being willing or able to fund oral care products leaves residents more vulnerable to poor oral health, particularly if they have no family involvement. Prioritising oral care and discussing any costs involved is important. </p>
<h2>5. Help residents participate and take more control</h2>
<p>Oral care is considered “personal care”. Knowing how much support to provide during this intimate task can be tricky, particularly if the person doesn’t like others touching their face or brushing their teeth. An occupational therapist can help increase the person’s participation in both mealtime and oral care activities.</p>
<p>Residential care staff may also need information on <a href="http://synapse.org.au/information-services.aspx?category=Behaviour">ways to help</a> residents accept oral care. Consider what a person’s behaviour in response to attempts at oral care, like resisting tooth brushing, might be communicating.</p><img src="https://counter.theconversation.com/content/77473/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bronwyn Hemsley receives funding from the National Health and Medical Research Council of Australia</span></em></p><p class="fine-print"><em><span>Andrew Georgiou receives funding from National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Joanne Steel and Susan Balandin do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Poor oral health in our nursing homes can lead to many complications, including choking to death. Here’s how family and staff can help advocate for better care.Bronwyn Hemsley, Associate Professor in Speech Pathology, University of NewcastleAndrew Georgiou, Professor, Centre for Health Systems and Safety Research, Macquarie UniversityJoanne Steel, Lecturer, University of NewcastleSusan Balandin, Chair in Disability and Inclusion, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/682532016-11-29T09:58:32Z2016-11-29T09:58:32ZHere’s why some Dutch university students are living in nursing homes<figure><img src="https://images.theconversation.com/files/145575/original/image-20161111-9048-12wzua0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>In today’s society both young and old increasingly find themselves living in a bubble of like-minded and similar-aged peers. This is especially true of university students who leave home at 18 to live with people of the same age – who have quite often had similar life experiences. </p>
<p>Given this, the report that a <a href="http://www.citylab.com/housing/2015/10/the-nursing-home-thats-also-a-dorm/408424/">Dutch nursing home</a> has established a programme providing free rent to university students in exchange for 30 hours a month of their time “acting as neighbours” with their aged residents is unusual.</p>
<p>The programme has seen students in their early twenties sharing lives with residents in their eighties and nineties. As part of their volunteer agreement, the students also spend time teaching residents new skills – like how to email, use social media, Skype, and even graffiti art.</p>
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<h2>Reducing loneliness</h2>
<p>The incentive behind Humanitas Deventer’s “exchange” programme is the <a href="http://www.telegraph.co.uk/news/health/elder/9953019/Toll-of-loneliness-isolation-increases-risk-of-death-study-finds.html">research base</a> that shows that reducing loneliness and social isolation improves well-being and extends life expectancy in the elderly.</p>
<p>And though research on the impact on students seems yet to be explored, from my own experience of running a <a href="http://readingproject.exeter.ac.uk/">similar project at the University of Exeter</a>, I know that it is overwhelmingly positive – giving young people a sense of connection with older generations, and significantly increasing the likelihood that they will continue to volunteer after university. </p>
<p>Since 2011 student volunteers from the university’s Department of English and Film donate their time to bring conversation, literature, and friendship to the residents of over ten residential care homes across the city. And since the project’s inception it is estimated that around 250 active volunteers have reached over 500 elderly residents – at least half of whom have dementia. </p>
<h2>Reading between the lines</h2>
<p><a href="http://readingproject.exeter.ac.uk/">The Care Homes Reading Project</a> draws upon the natural skill set of its target volunteer community – which includes a love of reading and an understanding of the power of literature to impact lives positively. </p>
<p><a href="http://www.bbc.co.uk/news/health-22775438">Research</a> shows reading poetry with dementia sufferers – many who learned poetry by heart when they were younger – brings comfort and reassurance through hearing and reciting familiar verses. </p>
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<img alt="" src="https://images.theconversation.com/files/145580/original/image-20161111-9077-4f5yo9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145580/original/image-20161111-9077-4f5yo9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145580/original/image-20161111-9077-4f5yo9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145580/original/image-20161111-9077-4f5yo9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145580/original/image-20161111-9077-4f5yo9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145580/original/image-20161111-9077-4f5yo9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145580/original/image-20161111-9077-4f5yo9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Young at heart.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>Rhythm and rhyme bring a sense of order and predictability and, as this project has seen first hand, poetry can spark memories previously unknown to carers and even to family members. </p>
<p>Residents regain a sense of themselves as “a whole person, past and present”, as one care home manager put it. And in one brilliant example, a 100-year-old resident found a shared play-reading session with one student volunteer revived long-buried leading-lady speeches once delivered when she was an actress.</p>
<h2>Shared passions</h2>
<p>Our experience in Exeter has shown that students can help to supplement the quality of care in homes by providing relief for overstretched staff. And residents typically respond with enthusiasm to the novelty of younger visitors and to the creativity students bring to their sessions. </p>
<p>Residents are also encouraged to be creative by writing their own poetry. And English students offer expertise in selecting and discussing appropriate literature, and show sensitivity to the emotional response that language can have.</p>
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<img alt="" src="https://images.theconversation.com/files/145578/original/image-20161111-9065-7bbgto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145578/original/image-20161111-9065-7bbgto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145578/original/image-20161111-9065-7bbgto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145578/original/image-20161111-9065-7bbgto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145578/original/image-20161111-9065-7bbgto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145578/original/image-20161111-9065-7bbgto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145578/original/image-20161111-9065-7bbgto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Reading with dementia sufferers brings comfort and reassurance.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Many students find the visits often evolve into wider-ranging conversations and discoveries of other activities that bring happiness and interest to the residents. One student now not only visits a care home to read but also to hold ballet classes. And in the same home other residents have made use of students’ language skills, holding French and German conversation sessions. </p>
<p>Volunteer students look forward to their weekly visits. They find it is a space they can share poetry and stories – away from the demands of assessments. And many have said that it reminds them why they chose to study English literature in the first place. </p>
<p>Students also learn how past generations read the very same poems in surprisingly different ways. They see first hand how literature stays with us throughout life. And how the experience of shared reading helps to overcome the social and ideological disconnect between generations that plagues contemporary society.</p>
<h2>Breaking boundaries</h2>
<p>The moral health of a society is plainly visible in the way it treats its most vulnerable members, especially the aged. The government <a href="https://consult.education.gov.uk/school-frameworks/schools-that-work-for-everyone/supporting_documents/SCHOOLS%20THAT%20WORK%20FOR%20EVERYONE%20%20FINAL.pdf">recently announced</a> that universities will be required to demonstrate their commitment to enhancing social mobility by establishing or supporting schools, so why not also mobilise the resources universities offer to enhance opportunity and well-being at the other end of life’s spectrum? </p>
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<img alt="" src="https://images.theconversation.com/files/145581/original/image-20161111-9093-ktvw6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/145581/original/image-20161111-9093-ktvw6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145581/original/image-20161111-9093-ktvw6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145581/original/image-20161111-9093-ktvw6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145581/original/image-20161111-9093-ktvw6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145581/original/image-20161111-9093-ktvw6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145581/original/image-20161111-9093-ktvw6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Students could use spare time to help the elderly.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>The largest resource universities possess is the student body – a force with time, energy, few domestic responsibilities, and a desire to use their developing skills to make a positive difference in the local community. </p>
<p>Our reading project in care homes shows how both young and old can benefit from this type of arrangement. So just like the Dutch, it would be great if Universities in the UK could also look to reduce the cost of tuition fees or accommodation in exchange for meaningful social investment to get more people young and old spending time together.</p><img src="https://counter.theconversation.com/content/68253/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Johanna Harris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What students can learn from time spent in care homes.Johanna Harris, Senior Lecturer in English, University of ExeterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/389702015-07-27T20:06:47Z2015-07-27T20:06:47ZReducing depression in nursing homes requires more than just antidepressants<figure><img src="https://images.theconversation.com/files/88961/original/image-20150720-12576-1s8lvze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Aged care residents are three times more likely to have suicidal thoughts than their house-bound peers.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-262066235/stock-photo-disabled-man-suffering-from-loneliness-in-old-age.html?src=3PLkYTVpWZyiNb0kyUYiNg-1-145">www.shutterstock.com</a></span></figcaption></figure><p>More than half (52%) of aged care residents have <a href="http://www.aihw.gov.au/publication-detail/?id=60129544869">symptoms of depression</a>, compared with 10-15% of older people living in the community. As well as feelings of sadness and low mood, aged care residents with depression feel uninterested in activities, hopeless about the future, guilty about the past and may desire death. </p>
<p>Some actively contemplate taking their own lives. The prevalence rate of suicidal thoughts in residential aged care settings can be <a href="http://www.annalsoflongtermcare.com/article/challenges-associated-managing-suicide-risk-long-term-care-facilities">as high as 46%</a>. This is more than <a href="http://onlinelibrary.wiley.com/doi/10.1002/gps.2070/abstract">three times the rate</a> found in older adults who are housebound but in the community.</p>
<p>People entering residential aged care facilities are, on average, older than those living in the community. They have more complex care needs due to physical and cognitive difficulties. They may also have difficulties adjusting to their loss of independence and routine. These factors all increase their <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129544771">risk of depression</a> and suicidal ideation. </p>
<p>However, mental illness <a href="http://www.ncbi.nlm.nih.gov/pubmed/17164162">often remains undetected</a> among aged care residents.</p>
<p>There are several reasons for this. People living in residential aged care usually have complex care needs, making the identification of depression difficult, as the emotional symptoms become confused with those of other conditions. Older people are also less likely than younger people to recognise their own symptoms, often attributing them to normal ageing. </p>
<p>Further, although facility-based carers are in a position to act as informants, they often <a href="http://www.ncbi.nlm.nih.gov/pubmed/17164162">lack the training</a> to detect symptoms of depression and do not routinely screen for suicide ideation. </p>
<p>Depression is a manageable condition and the symptoms can be improved or managed through therapy and medication. Medications are effective but are often <a href="http://www.bmj.com/content/343/bmj.d4551">associated</a> with <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012103/">side effects</a>, and for older adults <a href="https://www.gmjournal.co.uk/uploadedfiles/redbox/pavilion_content/our_content/social_care_and_health/gm_archive/2006/february/feb06p61.pdf">may not be recommended</a> alongside some other medications and conditions. </p>
<p>Yet, when residents are recognised to have symptoms of depression, they are often only prescribed medications (particularly antidepressants) despite the effectiveness of non-medication approaches. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18311844">Research shows</a> interventions such as cognitive behavioural therapy (a talk therapy that addresses how you think and act) are at least equally effective as anti-depressants for improving late-life depression. </p>
<p>Other interventions such as exercise, music and singing, animals and pet therapy, reminiscence-based activities (such as reviewing one’s life, talking with others about the past), behavioural activation (such as doing pleasant activities) can <a href="https://www.bspg.com.au/dam/bsg/product?client=BEYONDBLUE&prodid=BL/1263A&type=file">also be effective</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/88963/original/image-20150720-12546-1jvhkk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/88963/original/image-20150720-12546-1jvhkk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/88963/original/image-20150720-12546-1jvhkk1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/88963/original/image-20150720-12546-1jvhkk1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/88963/original/image-20150720-12546-1jvhkk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/88963/original/image-20150720-12546-1jvhkk1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/88963/original/image-20150720-12546-1jvhkk1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Interventions such as pet therapy can help treat depression.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-64625506/stock-photo-pet-therapy-series-beautiful-silver-tabby-and-white-kitten-being-kissed-by-an-elderly-rest-home.html?src=FGYSt5rn5GN_7WI3-c2tkQ-1-0">Sue McDonald/Shutterstock</a></span>
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<p>The poor use of therapy and non-drug interventions is the result of a number of factors. </p>
<p>First, funding for such activities in residential aged care is limited. Residents in government-subsidised places are not eligible for Medicare rebates, under programs such as <a href="http://www.health.gov.au/mentalhealth-betteraccess">Better Access</a>, to see a psychologist. In contrast, those living in the community have access to such rebates. Psychologists and other mental health care professionals are rarely employed within such residential settings. </p>
<p>Second, psychologists and other mental health care professionals are rarely trained to work with older adults, much less with those with cognitive impairments or who are living in residential settings. We need more training in the field of clinical geropsychology. </p>
<p>Third, residents and professional care staff may regard psychological care as stigmatising and impractical, given the presence of physical and cognitive co-morbidities. Such perceptions are inconsistent with research evidence on the benefits and adaptability of a range of non-medication interventions for older adults living in residential care. </p>
<p>Outreach programs may address gaps in service delivery and education. Swinburne University, for example, <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajag.12114/abstract">has operated a well-being clinic</a> for older adults, a specialised service to provide counselling to older people in residential care. Postgraduate students travel to the facilities to offer these services. </p>
<p>We have learnt from this experience that counselling and other psychological and social activities can be extremely effective approaches to helping our elders feel less alone, less depressed and less hopeless. Rather than simply medicating the growing proportion of Australians who are admitted to aged care, we need to treat the whole person and the underlying causes of their depression.</p>
<p><em>For support in a crisis, please call Lifeline Australia on 13 11 14 – a 24-hour, confidential service available from landlines, payphones or mobiles. If your life or anyone else’s is in immediate danger, call 000.</em></p><img src="https://counter.theconversation.com/content/38970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sunil Bhar is the co-founder of The Wellbeing Clinic for Older Adults.</span></em></p>More than half (52%) of aged care residents have symptoms of depression, compared with 10-15% of older people living in the community.Sunil Bhar, Deputy Chair, Psychological Sciences; Convenor, Clinical Psychology Programs, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/438472015-06-25T08:05:36Z2015-06-25T08:05:36ZNursing homes are no place for young people with disabilities<figure><img src="https://images.theconversation.com/files/86358/original/image-20150625-13008-y0rpoy.jpg?ixlib=rb-1.1.0&rect=0%2C307%2C1772%2C1103&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nursing homes are not set up or resourced to facilitate the independence of younger residents.</span> <span class="attribution"><span class="source">The Summer Foundation</span></span></figcaption></figure><p>More than 7,000 young Australians with disabilities are forced to live in nursing homes because they’re unable to find suitable accommodation that meets their needs. But this may be about to change. A <a href="http://www.aph.gov.au/%7E/media/Committees/clac_ctte/young_agedcare/report.pdf?la=en">Senate Inquiry</a> report, tabled yesterday in federal parliament, has set a 2018 deadline to ensure these residents can move into appropriate housing.</p>
<p>The report identifies 12 key recommendations, one of which is the urgent need to prevent new admissions of young people into nursing homes. Once young people move into nursing homes it’s hard to get them out. They lose skills and their social connections. </p>
<p>Take 44-year-old Gordon Irvine, for instance. Gordon made significant progress during four weeks of rehabilitation after his brain injury and was able to walk with a frame when he was first admitted to a nursing home. After living in a nursing home, however, he was unable to stand unassisted. </p>
<p>Nursing homes are not set up or resourced to facilitate the independence of younger residents. As Gordon said:</p>
<blockquote>
<p>I feel like less of a human being, as I can no longer do the things I used to be able to do. </p>
</blockquote>
<p>Many young people (59%) are admitted to an acute or rehabilitation hospital before their first admission to a nursing home. So it’s critical that state disability services and the National Disability Insurance Scheme (NDIS) collaborate with the health system to prevent young people moving from hospitals to nursing homes.</p>
<p>Many people at risk of admission to residential aged care facilities are not eligible or suited to existing rehabilitation services in Australia. They need slow stream rehabilitation which allows a more extended time frame to achieve small but functionally significant gains. </p>
<p>While there are pockets of excellent transitional and slow stream rehabilitation services throughout Australia, the Senate report recommends the development and implementation of a national rehabilitation strategy.</p>
<p>The Senate Inquiry report outlines a range of practical recommendations related to assessment, information, advocacy and a national rehabilitation strategy that together will go a long way to prevent new admissions of young people to nursing homes. The report also recommends the establishment of a joint taskforce to ensure these recommendations are coordinated across all levels of government. </p>
<p>The report recognises that the NDIS alone cannot solve the issue of young people in nursing homes in Australia. The NDIS is an ambitious reform, and is poised to transform the lives of hundreds of thousands of people with disability to support them to work. However, most young people will not move out of nursing homes as a result of the NDIS because there are not enough places to move to. </p>
<p>Australia desperately needs more housing that is both accessible and affordable. Many young people in nursing homes (46%) are in partner relationships and 27% are parents of school age children, so a range of housing options including options for people to live with their partner and/or children is needed.</p>
<p>We don’t need any more group homes in Australia. Given the choice, many people with disability would move to more individualised housing and support options. This would create vacancies in group homes for people who either choose to live in a group setting or require an intensive level of support.</p>
<p>The Summer Foundation, the organisation I lead that is dedicated to getting young people out of nursing homes, has developed a <a href="https://www.youtube.com/watch?v=5DvjpQpBIpc">housing demonstration project</a> to show how this can work. </p>
<p>The project consists of six apartments for people with high support needs peppered throughout a larger mixed private and social housing development. The housing is centrally located and within 500 metres of a train station and shops, to maximise independence and inclusion and minimise transport costs and reliance on paid supports. </p>
<p>Residents can use an iPad or smart phone to control lighting, heating, cooling, blinds, door bells and doors, as well as to contact support staff. This technology means they have greater independence and privacy, while still having access to 24-hour on-call support if they have an urgent need for unplanned support or an emergency. </p>
<p>We’re also developing a second housing demonstration project in the Hunter NSW NDIS trial site. </p>
<p>Housing for people with disability must be incorporated into mainstream housing strategy instead of continuing to build segregated and specialist housing – this will create the scale and range of housing options we need.</p>
<p>I hope the Senate Inquiry report will herald the renewal of strong government policy leadership, and ensure effective collaboration across the health, housing, disability and aged care sectors. No one sector has the expertise or resources to resolve the issue of young people in nursing homes in Australia on its own.</p><img src="https://counter.theconversation.com/content/43847/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Di Winkler is the CEO and Founder of the Summer Foundation</span></em></p>More than 7,000 young Australians with disabilities are forced to live in nursing homes because they’re unable to find suitable accommodation that meets their needs. But this may be about to change.Di Winkler, Occupational Therapy Department, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/331632014-11-24T09:56:39Z2014-11-24T09:56:39ZMore aging boomers, but fewer doctors to care for them<figure><img src="https://images.theconversation.com/files/65220/original/image-20141121-1043-7fk2n6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We need to rethink care for the elderly. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=qUDM-5_-F4BxTDcWUdl13Q&searchterm=nursing%20home&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=150773027">Image of hands via Lighthunter/Shutterstock</a></span></figcaption></figure><p>By 2030, the last of the Baby Boomer generation will have turned 65 years old, putting the population of “senior boomers” in the United States at approximately <a href="https://www.aamc.org/download/82874/data/helpwanted.pdf">71 million</a>. Currently, only about <a href="http://online.wsj.com/articles/a-remedy-for-the-looming-geriatrician-shortage-1402001802">7,000 certified geriatricians</a> – physicians specializing in the care of older adults – are practicing in the US. That’s about one geriatrician for every 10,000 of these expected seniors, assuming that the number of geriatricians remains stable. However, the number of new trainees in the field of geriatrics is going down.</p>
<p>In 2010 there were 1,000 fewer geriatricians in practice than a <a href="http://www.eldercareworkforce.org/newsroom/news-from-members/article:03-08-2011-geriatric-medicine-in-the-united-states-2010-update/">decade earlier</a>. To compound this problem, only about <a href="http://www.americangeriatrics.org/files/documents/Adv_Resources/SS_IOM%20presentation12_19_12.pdf">220 physicians</a> complete geriatrics fellowship training programs. </p>
<p>Geriatricians often act as primary care doctors, and at times as specialist consultants, for patients who are advancing in age and may require targeted, specialized care to maintain function and quality of life. Geriatricians are attuned to the specific needs of the patient at all stages of aging, regardless of what or how many chronic conditions that patient may have. As America’s population ages, these doctors will play a critical role in caring for senior citizens.</p>
<p>Many factors contribute to the declining number of geriatric specialists. Geriatrics fellowships require extra years of training. Despite their additional training, geriatricians are among the lowest paid physicians across all medical specialties. This is largely due to the fact that reimbursements for geriatrics services are lower, which translates to lower pay for the geriatrician. Further, the specialty also suffers from a general lack of prestige. These are all reasons why medical students aren’t as interested in pursuing geriatrics as a specialty. </p>
<p>Without a fundamental change in public policy, financial reimbursement, and training this is unlikely to change anytime soon. So, how can we care for an aging population while our pool of geriatricians is shrinking?</p>
<h2>New models of care</h2>
<p>The shortage of geriatricians does not necessarily condemn the elderly to poor medical care. New models of care are emerging that focus on better coordination of care for older adults that will help improve their likelihood of remaining healthy.</p>
<p>If we want care for older adults that is more than just “good enough,” we need more boots on the ground to provide that care. We don’t just need more geriatricians. We need more pharmacists, nurses, nurse practitioners and physician assistants trained in the special needs of the older patient. There are many examples of new care models that demonstrate the effectiveness of comprehensive, coordinated care for older adults. </p>
<p>In hospital settings for example, Acute Care for the Elderly (ACE) units use teams made up of nurses and nurse practitioners, physicians, social workers and other health-care professionals. These interdisciplinary teams use coordinated care principles to ensure better patient outcomes at a lower cost than traditional care, with a relatively small investment of geriatrician time. </p>
<p>Another program, Nurses Improving Care for Healthsystem Elders (NICHE) empowers nursing leaders to help health-care organizations improve the care of older adults by implementing principles designed to stimulate culture change within health-care systems that help make hospitals more senior-friendly. At present, over 575 hospitals have NICHE designation. </p>
<p>In outpatient settings, Program of All Inclusive Care for the Elderly (PACE) improves patient satisfaction while reducing use of institutional care and overall costs for poor, functionally impaired older adults by improving coordination between community and clinical services. </p>
<p>In each case, the geriatrician’s expertise is amplified throughout health-care organizations through care systems, better use of resources, technology, financial incentives and teamwork. </p>
<h2>Responding to reality</h2>
<p>The recruitment and training of geriatricians is an important part of the vision for excellent health care for elderly adults in the future. However, that is only part of the issue. Our health-care system needs to respond the realities of caring for older patients. </p>
<p>It takes more time to care for medically complex, often functionally or cognitively impaired older patients. This is an under-appreciated fact about geriatric care. Clinicians must be able to operate in a system that is conducive to coordinated, patient centered care. Ideal systems allow practitioners to take the additional time needed to provide the best possible care. </p>
<p>The extra time it takes to provide proper care for seniors also has to be accounted for in reimbursement mechanisms. If not, there is a risk that the services older patients need will only be available to those who can afford to pay extra for them.</p>
<p>What older adults need in order to optimize function and quality of life transcends simply the medical issues and extends to policies and infrastructure of our health-care systems and communities. Whether our society prioritizes these needs sufficiently to meet them remains an open question.</p><img src="https://counter.theconversation.com/content/33163/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>By 2030, the last of the Baby Boomer generation will have turned 65 years old, putting the population of “senior boomers” in the United States at approximately 71 million. Currently, only about 7,000 certified…Jonathan Flacker, Chief, Section of Geriatrics and Gerontology Professor, Emory UniversityRebecca L Dillard, Assistant Program Director at Emory Center for Health in Aging, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/162992013-10-01T04:52:43Z2013-10-01T04:52:43ZAn age-old problem: society fails to truly embrace its seniors<figure><img src="https://images.theconversation.com/files/30753/original/bhd32wct-1378355558.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1024%2C682&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We need to see old age as success and value older people as expressions of this accomplishment.</span> <span class="attribution"><span class="source">Vinoth Chandar</span></span></figcaption></figure><p><a href="http://www.abc.net.au/news/stories/2010/10/07/3031615.htm?site=farnorth">Cockroaches</a> in the kitchen, <a href="http://www.wsws.org/en/articles/2000/03/aged-m10.html">kerosene in the bath</a>, <a href="http://www.abc.net.au/news/2013-08-13/aged-care-understaffed-as-nursing-home-patient-numbers-rise/4884056">abuse</a> and <a href="http://www.canberratimes.com.au/act-news/one-in-five-nursing-home-residents-malnourished-study-finds-20130522-2k1oe.html">malnutrition</a> - these are the aged-care stories that often make headlines. </p>
<p>We, the public, respond with outrage and calls for more staff and more money. But there is something really wrong here - and it is not about more staff and more money. Such actions are ultimately bandaids. </p>
<p>What we have is a societal problem. </p>
<p>Sure, there will be some facility boards, managers, staff and families doing the wrong thing, but if we are to genuinely address the issues in older people care, we need to move beyond blame and shame of individuals and facilities. </p>
<p>We have to care as much about older people as we do about younger people if we are to witness real and sustained improvement. </p>
<p>I have never heard children called bed blockers; I have never seen tin rattlers at the lights collecting for older people. I know of no product that purports to help us look older. </p>
<p>The vested interests in Western society make a fortune from their success in teaching us to worship youth: anti-ageing creams, hair dyes and surgery are just some examples.</p>
<h2>Social responsibility</h2>
<p>It is way past time that we took social responsibility for recognising that people of any age are people. They may have pimples, wrinkles, smelly nappies, HIV AIDS, dementia, no legs or be Siamese twins.</p>
<p>The bottom line is that very few people meet the poster-person image of “normal” and then only for a very short time. </p>
<p>Unless we die, we will all be old and as a society that is a success: life expectancy was 47 years old not so long ago. Now, thousands reach 100. Of those who reach 85, many will live with dementia. </p>
<p>None of this has to be “ugly” if, as a society, we value people and their diversity.</p>
<p>Currently, we are conflicted: we use every modern technological wizardry, regardless of cost, to show how clever we are at saving lives; then, we complain that our successes are a burden on society. </p>
<p>We complain about the people who try to care with insufficient education and leadership. We blame everyone but ourselves. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/31285/original/9qvq4fbn-1379045413.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31285/original/9qvq4fbn-1379045413.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31285/original/9qvq4fbn-1379045413.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31285/original/9qvq4fbn-1379045413.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31285/original/9qvq4fbn-1379045413.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31285/original/9qvq4fbn-1379045413.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31285/original/9qvq4fbn-1379045413.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aged care is not just about staffing and wages. It’s a societal problem.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<p>Well, guess what? Until you and I recognise the value of older people, and make care of older people and people with dementia an issue of high importance beyond elections, then we are hypocrites to be horrified by what happens in nursing homes. </p>
<p>If old age is so awful, then let us pick an age after which it is okay to die and stop all the medical interventions. In this case, we would need a major campaign to educate people that dying is all right. </p>
<p>Depending on your beliefs, you would learn that you simply become ashes or that you pass through the pearly gates and, after a suitable period of grieving, everyone will get on with their lives. </p>
<p>On the other hand, if we choose to throw resources at cure/survival, and if we really care about how people are treated in aged care, then we must re-evaluate our view of old age.</p>
<p>We need to see it as a success of monumental proportions and value older people as expressions of this accomplishment.</p>
<p>This change in attitude also requires the courage to face our own ageing and a commitment to removing the taboo, as a society, about death, dying and the real meaning of life. </p>
<h2>Ageing campaigns</h2>
<p>What we need is a major public awareness campaign about valuing older people and ageing. </p>
<p>We invest far more in multicultural awareness, indigenous welfare and gay, lesbian, bisexual, transsexual and intersex (GLBTI), than we do in overcoming the stigma associated with old age and especially dementia. </p>
<p>Certainly, the recent election campaign failed to address the growing needs and impact of our “<a href="http://www.theaustralian.com.au/national-affairs/election-2013/ageing-tsunami-ignored-in-campaign/story-fn9qr68y-1226710090284">ageing tsunami</a>”. Tony Abbott’s suggestion that he will unlink funding from the <a href="http://www.smh.com.au/federal-politics/federal-election-2013/coalition-to-abolish-pay-rise-for-aged-care-workers-20130829-2srqz.html">workforce compact</a> is even more worrying.</p>
<p>Increased wages for aged care workers do have a role to play in valuing older people. And there needs to be a carrot/stick approach to ensure there is quality staff of all levels, including GPs, providing such care. </p>
<p>Accreditation has improved aged care, with a lot of “shonky” providers leaving the industry. We do not want them back. But the financial reward is only one factor in staff recruitment and retention. And aged care ratios do not solve any problems.</p>
<p>What aged care needs is vision, leadership, staff development and decisions driven by the goals and needs of older people and their carers. And ultimately, it needs a social system that cares more about older people than shifting blame and pointing at the proverbial other.</p><img src="https://counter.theconversation.com/content/16299/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rhonda Nay does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cockroaches in the kitchen, kerosene in the bath, abuse and malnutrition - these are the aged-care stories that often make headlines. We, the public, respond with outrage and calls for more staff and more…Rhonda Nay, Emeritus Professor La Trobe University, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.