COVER STORY: by Max TeichmannNews Weekly
Aged Care: where to from here?
, March 25, 2000
Max Teichmann believes that the media frenzy around the Riverside Nursing Home has somehow failed to identify the key issues in the aged care debate.
The Riverside Nursing Home drama, quickly converted into melodrama by the media and the Labor Parties, Federal and State, seems to be slowly limping to an undignified close.
Yet again, a rare opportunity for our society to examine major social problems - in this case the problems of ageing per se, the aged, the duties and present attitudes of their families; the record of the present Government and its predecessors, and that of the states; future directions for aged care; internal and external social and economic changes, occurring almost regardless of the political process - this opportunity has been squandered. Sacrificed to party political point scoring, media barons' pay back politics, and the hidden agenda of the nurses' union.
But then, foreign and defence policy, universities and all the dedicated work put in by David Kemp's department; taxation; constitutional reform; sub-tertiary education; employment .... have all been trashed, so to speak - as matters of common concern, surviving only as political footballs, in the apparently eternal game of resentment, complaint, and bump us back into government.
In a paper read to the Aged Care Conference in Hobart in 1997, the Manager of the Old Colonists Association of Victoria, Rob Slater AM, reminded his listeners of the dramatic changes in the status and situation of our aged, from before WWII until now: changes in the attitudes of the children and other relatives, rather than any originating from the aged parents themselves.
Up until the forties the elderly usually remained within the family unit, sharing the living standards, much of the social life, and suffering minimal loss of self-esteem, with no marked sense of isolation. Elderly spinsters and bachelors often lived with married siblings or nieces.
Post WWII ushered in smaller houses, or else those with fewer bedrooms. Rising demands for privacy meant no room for widowed parents. Sometimes a bungalow in the back helped to maintain the territorial distance between the generations, while still including the aged in the life of the family.
But the widespread relegation of the older generation produced that period of ad hoc private nursing homes, often started up by doctors and nurses, where people were packed into crowded converted houses, usually engendering great losses of privacy; and some self-esteem. Little stimulation, and a great dependence upon visits from relatives. Visits which became fewer and fewer. And old people staying on in their own homes frequently lapsed into isolation and benign neglect. Including self-neglect.
A revolt against these somewhat Dickensian situations ran right through the seventies and eighties, with government and the municipalities expected to play a much larger role; and doing so. Retirement villages, hostels and nursing homes arose, promising face-to-face contact with doctors, trained nursing, and caring and support staff.
Simultaneously older people were encouraged to stay on in their homes, being promised new support from governments and councils, of a quality not inferior to that being supplied to those in institutions. It is only now being realised how much this would all cost and how many institutions need to drastically raise their standards.
The behaviour and the attitudes of the non-aged, particularly the children, and that of State bodies, have evolved thus.
Firstly, the children denied or withdrew most feelings of obligation towards their parents, leaving them to sink or swim, emotionally, financially or health-wise. When confronted with the needless distress or decay of their old, they called in the State - and said it was its responsibility. (We have seen similar attitudes, similar rejections, similar denial of responsibility by these people towards their own children).
So the State, municipalities, and charities, religious or otherwise, have been charged with the full responsibility for caring for people's parents; at least those who can't afford to make it themselves.
On average, only around ten per cent of institutionalised parents are receiving regular visits from their families; those still self-supporting probably faring better, though not much better.
Whitlam's virtual abolition of Probate Duties made the remaining property of parents a matter of great interest for their children. It always was, of course. The wholly reasonable demand by our Federal Government that people with possessions, with a house or apartment, should at least partly utilise them to pay an entry fee - a bond - to help the institution, public or private, with its capital funding, from which all maintenance, expansion of needed facilities, etc, was to come - this projected entry requirement was turned into a cause celebre by the media, Labor and their Senate allies; so had to be dropped. It was an exercise in political point-scoring, of trying to turn the votes of older citizens, and their loving families against the conservatives. There was little or no thought or concern as to how aged care was to be funded, in the future; how standards were to be raised as everyone demanded.
The campaign against nursing homes being allowed to charge an up-front fee - as hostels had since Whitlam's time, thereby enabling them to provide facilities far superior to the run-down, undercapitalised nursing homes sector - is a classic case of successful disinformation.
There was no proposal for people to sell up their homes or farms, rather to provide payments over a number of years, up to $13,000 where such monies were known to be available, in one form or another. Where not available, the fee would be waived; a similar procedure long established for hostels.
The Liberals - by simply not properly briefing the public, nor their own back benchers, before a sudden policy announcement - (they had learnt nothing from Hewson's idiotic GST tactics) - rendered themselves vulnerable to an orchestrated disinformation campaign. So both they and Labor are responsible for the present situation.
So, the increasingly complex and bureacratised Aged Care operation is supposed to be run on the cheap; for families don't want to put in for their parents either emotionally or financially - irrespective of their own financial situation - anymore than they do for their own children. And no one seems to want to pay increased taxes, either direct or indirect. Result: stalemate, and periodic scapegoating of someone like Bronwyn Bishop.
Bishop has quite inadequate resources made available for her work - thanks possibly to Treasury. And she has a smallish department, who are so busy putting out brush fires that they have little time for forward planning or analysis. Nevertheless, they started two years ago on a process of bringing existing aged care facilities up to standards higher than many had hitherto attained; and setting a time limit for compliance, as was necessary if the rogues and slackers in the industry were ever going to come to the party. The press, and Opposition said they should've done it after Day One. (No mention of what had not been done before Day One).
Bishop and the Government are on a licking to nothing. If they didn't modernise, force a rise in standards, and employ necessary sanctions to do so, they would be hammered.
If they do their job, many sub-standard homes will have to shape up or close up. At this point, the nurses union started crying that 2500 jobs would be lost. In the short run some might - but in an industry crying out for staff, this should not be a long term problem: on the contrary. But this is a problem for people who like to stay exactly where they are - immobilism - and I don't mean only patients or their families.
One reason, apart from a scarcity of administrative resources, that Bishop's people wouldn't be into spot checks, is the fear of finding so many defective operations and the mini crises this would cause. So they have been treading quietly. And every attempt to deal with a sub-standard facility seems fated to receive the sensationalist, mendacious and opportunistic buck-passing treatment from the media, the opposition and their friends, that the Riverside affair has engendered. As Howard said, "We're damned if we do, and damned if we don't."
In passing, the total symmetry between the words and actions of the media, one powerful segment transparently engaged in pay back politics, and little else ... and those of the opposition and Democrat politicians, in Canberra and in the States, suggests that one should consider the latter as a rent-a-crowd of certain powerful interests and lobbies, rather than political parties per se.
This, if true, is extremely depressing, for the Liberals are making mistakes, and doubtless will make more. The whole area is complex, with undertones of the human tragedy, and deserves fairness and good will on all sides.
But present indications are that government funding is not going to be sufficient to meet all needs, any more than in the past, and that councils, supposed to care for those still in their homes, are not going to be sufficiently forthcoming either. Taxpayers and ratepayers alike won't bite the bullet; too many families have opted out, and cover their motives by attacking governments when things go wrong, as they must. And the rise of regulations and bureaucratic interventions has spawned a rapidly growing industry of managerial carers who really care for no one, but who are exponentially inflating the costs of aged care. As they have in education, health, migration, universities, Aborigines and Aid - just the latest additions to the New Class.
In the end the welfare problem is not simply, or even mainly, an economic or political or industrial question - it is at least as much a product of the decline, or as David Cooper triumphantly announced in 1971, the "Death of the Family". This also signalled the Death of the Heart, which Elizabeth Bowen had earlier described; (notice the rising interest in euthanasia by ... whom?); and the possibly terminal decline of the Responsibility Ethic. An adult position, that one! Responsibility for one's self and for others. And this brings in the aged themselves, who also have responsibilities and duties; age not being a cop out.
But as with youth, while not idealising either, after long observation I feel the sins of both groups are venial, not mortal. Whereas the intermediate group, the baby boomers, might, upon introspection, find themselves in a situation of some moral danger, if they continue living as is.