A glass of wine or quality of care

Listening to Australia Talks on Radio National this week I was disappointed but not surprised by the paucity of the conversation about our aged care crisis. On the 21st January, the Productivity Commission’s Caring for Older Australians draft report was released recommending an extensive overhaul of the aged care sector. In just under 40 years, there will be almost four times as many Australians, or 3.6 million people, in need of aged care. The Productivity Commission has the job of finding ways to fund such a large increase in older people who will need aged care. The Productivity Commission’s deputy chairman Mike Woods is in favor of shifting the cost burden to wealthy older Australians through a new co-contribution scheme. This would appear to be acceptable but on other points the draft has drawn criticism especially by those who do the caring.

According to the Australian Nursing Foundation the draft report ignored the important issues of quality of care and workplace conditions. With more older people requiring care, there will be a substantial need for more staff and a better skill mix. Patients in nursing homes today are sicker; they often have feeding tubes, urinary catheters, and complex wounds that require specialised nursing care.

How then  have we arrived at this state of affairs where the number of nursing home residents will shortly quadruple? Why are these residents sicker and older than previously? On  Radio National’s Australia Talks there was no attention paid to this issue. There was no discussion about the fact that you can be old and crumbly and possibly in nappies  but have a high-tech pacemaker implanted in your chest? Why do we not want to discuss the fact that we are living past our use-by date?

Our lifetimes have seen great advances in medical technology;  vast industries have been built around our dependence as health consumers who swallow pills and line up for treatments until we die. For example,  the lucrative pacemaker industry is part of the huge US Medical Supplies and Devices industry that includes 12,000 companies with a combined annual revenue of about $50 billion. Modern medicine is increasingly obsessed with technology, intended to extend a person’s quantity and quality of life. More than 1 million persons in the United States have implantable pacemakers, and the majority of this population, is older than 65 years. In 2005, a survey revealed that the total new pacemakers implanted in Australia was 11,850, up from 9,498 in 2001.

Another feature of the Productivity Commission’s draft report was the reference to choice.   Mark Butler, the Minister for Mental Health and Ageing suggests that ‘a lot of older Australians want to be able to consider choices about having a glass of wine at night, or a different range of bed arrangements, ensuites.’ One wonders if the minister has stepped inside a nursing home. Does choice in the form of wine at night and a private toilet and shower really matter when you are in the last days of your life and possibly demented and incontinent? Aged care is about quality and caring, not about lifestyle choices. Few people choose to go in to a nursing home – choice doesn’t really come into it.

But these vital issues around quality of life and our inevitable end were not discussed on Australia talks.

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