Aged care: We can’t pretend to be surprised

As a society, we have been disgracefully slow to act appropriately and ensure that those we love were being truly cared for. But now the royal commission is set to blow everything open, writes Terry Sweetman.

This week I feel like I’ve walked out of an orphanage and wandered into an old folks’ home.

Such are some of the ominous similarities between the Royal Commission into Institutional Responses to Child Sexual Abuse and the comparatively infant inquiry into the aged care sector. Most startling is the realisation that each commission was tasked with inquiring into things about which most of us already held suspicions or even had first-hand experience.

The first commission forced us to accept hard evidence that gags about priests and altar boys were anything but bad jokes. It gave the victims of child abuse a voice, an opportunity to look their abusers in the face and, for some but not all, a degree of closure and possible financial compensation.

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It gave the rest of us a sickening insight into the extent of abuse, how and why so many institutions became hunting grounds for paedophiles, and how the established machinery of regulation failed.

The commission into aged care also delves into issues of which many of us have been well aware through personal experience or media exposure.

Royal Commissioner Richard Tracey has heard some shocking evidence. Picture: AAP/Kelly Barnes

Ageing is one of life’s processes that nobody can avoid, and most of us have had family members placed in care and treated with greater or lesser kindness and expertise. Those fortunate enough to have been sheltered from first-hand experience must be well aware from a relentless drip-feed of sometimes terrible stories over the decades that aged care is a sector that is desperately inadequate and sometimes shamefully unregulated. The fact that reports and revelations of abuse and neglect led to the establishment of this commission speaks for itself. I suspect we’ll hear more — and possibly worse — as the inquiry continues and deliberate cruelty and criminality might well be revealed.

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And if we were shocked by 76,000 or so calls, letters and private hearings held by the child abuse inquiry and the 2575 referrals made to authorities (including the police), consider the potential in an aged care sector accessed by more than 1.2 million people a year, about 270,000 of them in residential care. A hint: Residential aged care providers have reported to the commission more than 112,000 incidents of substandard clinical care, nearly 68,000 incidents where medication management was inadequate, over 35,000 occasions of personal care being deficient, and more than 12,000 cases of inadequate nutrition over a five-year period.

Stories of deliberate cruelty and criminality might well be revealed during the aged care inquiry. Picture: Supplied

Poignant evidence has been given by (and on behalf) of articulate seniors of attainment, education and experience and revealed instances of casual indignities inflicted on the aged, often the result of inadequate staff or inadequately trained staff. Thousands of others cannot speak for themselves and rely on the good offices of others.

And there was a focus on the element of dementia in the aged care sector, including the possibilities of wrong diagnoses because of cultural differences, the care of those experiencing it, the overuse of drugs and the anguish of their families.

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Elderly witnesses told of the difficulties of frail but mentally capable residents living cheek by jowl with dementia with sometimes debilitating results, including violent confrontations and social isolation.

Nursing homes have long been the refuge of last resort for comparatively young people with other disabilities (sometimes multiple sclerosis, for example) but the epidemic of various forms of dementia may require whole new definitions of the purpose of the aged care sector.

The commission heard testimony from aged care workers, including Kathryn Nobes, and the struggles they face. Picture: AAP/Royal Commission into Aged Care Quality and Safety

The odd thing is that just as we had known from innumerous inquiries that child sexual abuse was a rife, we had no idea just how bad it was and did precious little to curb it, prevent it or respond to it. Similarly, we have all been aware of the changing patterns of ageing and family life, but have been disgracefully slow to act appropriately. After all, it’s been a long time since granny was able to see out her days and die in her family home.

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As far back as 2011 the Productivity Commission sounded the alarm about an ageing population in which those aged over 85 (the major users of aged care services) would rise to 1.8 million by 2050. It warned of a significant growth in both demand for and spending on aged care services and a “significant expansion” in the aged care workforce.

And, pertinent in light of the burgeoning numbers of people with dementia, it warned demand for care services would become more diverse.

Underlying this was an “expected relative decline in family support and informal carers”. That’s us.

As the royal commission proceeds, we can expect to be shocked, sickened and angered but I’m not sure we can pretend to be entirely surprised.

@Terrytoo69