We should no longer accept substandard aged care. Soon enough, we’ll need it, too.
No one I know has said that they are looking forward to living in an aged care institution.
The home we selected for our mother – who's in her nineties – seemed a good choice.
It had an imaginative layout. Instead of long empty corridors, the circular design encouraged mobility. We hung my mother’s favourite pictures, photos and tapestries on the walls of her room. The staff were attentive and visible.
An infection-induced delirium was lifted with antibiotics, which allowed my mother to participate in activities.
In four years, however, there have been major staff cuts. Now they are down to the bone. The regulations say staff ratios should be "adequate".
This is regulatory talk for "whatever".
Recently, staff have been bustling around, rearranging the furniture as they expect an "unannounced" accreditation visit. Students on placement bulk up the appearance of staff presence, as do carers from temping agencies.
The deregulation of the sector has boosted provider profits and reduced staff care.
This is "luxury aged care" done cheaply.
According to my personal inquiries, from 10pm until 7am, there's only one care staff member on each floor in a six floor facility. There is one nurse for the entire building for the night shift. And there are around 20 to 30 residents on each floor.
It is painful watching my mother decline. Though the garden lifts her mood. She loves the sun and feeding the birds. On too many bad days, she told me that no-one is there for her. They tried to medicate away her awareness of this, but my siblings and I intervened.
On antidepressant medication, she had become disengaged and, in her own words, "like a zombie". The ABC Four Corners episodes regarding physical abuse and substandard care in residential aged care were alarming. Similarly, institutionalised emotional neglect of the elderly in these homes is rife.
The words and music of dementia advocate, singer-songwriter Mark Seymour, stay with me. He spoke of the time with his mother sitting beside her in the common lounge room of the aged care home she lived in. He came to see it as a time of refuge and remembering. He could just be with his mother. He composed a song for her — 'Classrooms and Kitchens'. Mark reportedly said that even when communication seemed impossible, music remained.
The fruits of many simple insights and research are absent in my mother’s aged care home. There is constant intrusive noise. Unanswered bells scream for attention, punctuated by the cries of the bed-bound.
There's also the confused wandering of an ambulant:
'I want to go home. Why am I here?'
"We are short staffed" is a common refrain, as staff rush by wheeling trolleys and collecting laundry.
The rooms are clean and well-furnished. Yet emptiness consumes.
Most residents cannot make sense of the flickering giant plasma screen used to "occupy" residents in the communal rooms. The commercial entreaties to buy new things are meaningless to this captive audience.
One resident announces:
"This a prison. You are all in prison."
My mother notes the ads for funeral insurance that target afternoon viewers.
She is one of the more, let's say, fortunate residents. My siblings and I ensure that she is visited each day.
Activities are offered, but many residents are not able to comprehend the films or the whiteboard-based games. Many of them are unsuitable to the visually and hearing impaired. I have found my mother seated at the back, asking what is going on.
She is pleading to be rescued.
Most residents respond best to personalised attention in small groups from staff who know them.
And yes, the aged and cognitively impaired are still human beings with personalities preferences and needs. They are not just bodies to be managed.
Profits are pleasing the shareholders as staff cuts continue. There appears little commitment to consistent staffing.
Most residents are unable to navigate the multi-story building, with its seemingly identical routes and passages to the courtyard garden. Staff seldom have time to take the residents outside, just to sit or walk the pathways. Being outside calms people with cognitive impairment. It lifts their mood far more effectively than medication. Equally effective is touch and the willingness to sit and be with a person.
Even as residents wander haphazardly into past memories, conversation is possible and very helpful. Some imagine that their middle-aged children are small and need their care. Reassurance and support are more helpful than contradiction.
The dining rooms are laid out restaurant like, but harried staff don't have time sit with residents encouraging them to eat. The hastily-served food is often unappealing and sent back uneaten on the plastic trays. Staff rush between floors to make up staff numbers.
Management listens with tutored clinical empathy but maintains that things are just in flux temporarily.
"Staff ratios are not an issue," they say.
The ever-changing management reassure. "We are seeking more permanent staff and getting the shifts right."
The patients are still waiting.
Moving my mother might be more trauma for little or no gain. In over four years, I have observed staff who are genuinely dedicated and skilled. Others are insensitive or incompetent.
How is this monitored when temporary staff come and go and are overstressed, low-paid and provided with minimal training?
Weekends are the loneliest. I have gone in search of staff, unable to find anyone. How can the frail and immobile access help?
I find my mother sitting alone, saying:
"They just left me here."
Confusion. Frustration. Forgetfulness. Anger. Paranoia. Abandonment. This is the stuff of dementia. Who would believe residents if they complained of neglect?
Confined in a weird alternate dimension, devoid of familiar signposts, they are lost. Dementia means wandering in-and-out of time and space. The institution mirrors this parallel universe.
It’s a numbers game. Bodies in beds, reduction of costs, minimal staff, maximum profit. Residents and their families are the product, not the raison d’etre.
Welcome to your neo-liberalised future, where the word "care" carries no import.
Things weren’t better in the bad old days. Now they're just shinier on the outside.
Lyn Bender is a professional psychologist. You can follow Lyn on Twitter @Lynestel.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Australia License
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