With an aging population, and new retirement homes popping up everywhere it seems, caring for the elderly with dignity will continue to be a big issue. A recent report in the Lancet notes :
"In 2016, there were 366,000 people working to support 1.2 million older Australians. By 2050, we will need 980,000 workers to care for 7.5 million."
Tracey Burton, the chief executive of one of Australia's largest aged-care providers, warns that the sector needs to urgently attract more workers, especially now that skilled migration has "ground to a halt". As unemployment grows, Burton thinks it offers deeply meaningful work.
The counsel assisting the Australian Aged Care Royal Commission writes :
"…looking after older people should be a part of who we are. We should have an innate respect for them and elevate their place in our community: All of Australia should value and develop our connection with them."
Whilst paying exuberant lip service to "kindness", in practice Western culture values independence and productivity over caring jobs, whether that care be motherhood, the home or for aging parents. Such tasks can be viewed as "thankless" or simply impossible alongside full-time work and other worries.
The result seems to have been that we no longer look up to the elderly in our communities with as much respect and as a key source of wisdom. In cultures in which the elderly are interwoven into the fabric of society and what that society views as a "productive" life, such as how the elderly are traditionally viewed within the Maori indigenous culture in New Zealand, elders within the community appear to play a greater role and caring for them comes as a natural part of life.
Covid-19 has exposed many of the cracks beneath the surface of Western culture and aged care. The Lancet reports :
"Of the 904 deaths from COVID-19 in the country at the time of writing, 682 have been in aged care homes, mostly in the state of Victoria. That 75% of the country's deaths have occurred in such facilities gives Australia one of the highest rates worldwide of deaths in residential aged care as a percentage of total deaths."
I personally know an elderly woman who died during the lock-down in Auckland because her daughter was not allowed in and staff failed to detect an infection. Her daughter had already come to the realisation that she couldn't rely on staff to adequately care for her mother and normally would come in daily for a couple of hours. Her doubts were realised in a tragic way.
However, can we ever really expect that "staff" can love and care for a person in the same way as family can? It seems unlikely that institutional care on its own could ever be truly high-quality to me, apart from in the odd lucky situation. We are lucky to have the help of staff and the option of such institutions, but surely it must always come down to people who actually love that person to oversee their care on a day-to-day basis. In well-functioning families this reciprocal care is shown throughout life as children grow up, are assisted when having their own children, and in turn assist their parents in their old age.
Sarah Russell, public health researcher and aged care advocate, writes :
"Private providers don't necessarily care about aged care - they care about making a profit… What is aged care for? Is it because older people are a great cohort to make money off? Why are we locking people down and locking relatives out? What type of life is that for them?"
Royal Commission research indicates that quality and safety in homes is driven by four factors: total staff numbers, staff skill mix, staff continuity, and clinical governance. So perhaps these are the factors that families need to consider when choosing between institutional care providers.
The Australian Aged Care Royal Commission is scheduled to release its final report in February next year.