Aged care failures show how little we value older people – and those who care for them

Aged Care photo

As the royal commission begins investigating the failures of the residential aged care sector, it is important such a review also considers the broader socio-political factors that have contributed to this crisis.

The commission needs to go beyond the institutional problems at individual aged care facilities, as these are a symptom of a much broader rejection of ageing in society and marginalisation of older people.

Negative stereotyping of older people is reinforced in the media, and this both informs and reflects societal attitudes. In Western society especially, we fear dependency, invisibility and dying. Aged care is a silo of these fears. And until it affects us personally, we ignore it.

How older people are marginalised in society

We have an expiry date in our society. This is not the date we die, but a time when our skills and knowledge are no longer considered to be valid or useful. Our value is largely determined by our economic contributions to society. But for many older people, this is difficult to demonstrate because they’re no longer in the workforce.

The economic impact of societal rejection of ageing is significant. Modelling by Price Waterhouse Cooper indicates that Australia’s gross domestic product would increase by almost 5% if people were supported to work longer. And data from the Australian Bureau of Statistics reveal that many Australians would like to retire later if they could.

Yet, there is evidence that older people are routinely denied work. In 2016, Age Discrimination Commissioner Susan Ryan said there was an urgent need to “tackle the discrimination that forces people out of work years before they want to leave”.

While older people should be supported to work longer if they wish, over half of Australians between the ages of 65 and 80 report a moderate or severe disability, resulting in greater dependency. A 2017 study of late-life dependency published in The Lancet found that, on average, older people will require 24-hour care for 1.3 to 1.9 years of their lives.

However, it is important that older people are not considered redundant in their societal role when dependency increases.

Aged care workers are also undervalued

Residential aged care facilities fulfil an essential role in our society. Yet, our recent ethnographic study in two residential aged care facilities in Victoria shows how this role has been compromised by an under-skilled, under-valued and overworked aged care workforce.

Older people were exposed to a revolving door of anonymous workers, significantly reducing opportunities for teamwork and fostering relationships between staff and residents. In one of the not-for-profit facilities, a single registered nurse was responsible for the care of 73 residents. This contributed to the delegation of an increasing range of tasks to unregistered personal care assistants with minimal training and delays in recognising signs of health deterioration among residents.

A reliance on general practitioners also increased the likelihood of hospital transfer. And hospital transfers can sometimes prove harmful, with previous studies showing that the noisy, fast-paced environment, bright lights and anonymous faces can have a negative impact on residents, particularly those with dementia.

Within the healthcare sector, aged care has the lowest status of all specialty areas amongst nurses and doctors. Recruiting appropriately qualified and skilled people to work in aged care is thus a constant challenge. Australia is expected to increasingly rely on imported labour to staff its aged care sector in the near future.

Ways to fix the system

Encouraging more healthcare professionals to enter the aged care sector will require a multi-pronged approach, starting with finding ways to engender more professional respect for those working in the field.

Greater emphasis also needs to be placed on improving the gerontological expertise of aged care workers. This can be strengthened by prioritising aged care in medical school education and recognising “nursing home” care as a specialist medical area. It is also imperative that personal care assistants receive greater recognition of their roles and duties.

Registration of personal care assistants as third-tier health care professionals is well overdue to ensure better oversight of their training and scope of their practice.

We also need to recognise the importance of human connection in residential aged care facilities. This requires strategies to build better relationships between residents and staff, and developing a formula for more accurate staffing allocations that reflect the real time commitments involved in aged care.

Who bears the ultimate responsibility?

It’s not enough to be shocked by the aged care scandals uncovered by the media and the decision to appoint a royal commission to investigate. We must also make older people, their contributions and end-of-life needs more visible. Increased funding and oversight will only come when we collectively say it’s important.

It is incumbent on us to ensure that residential aged care facilities do not operate as holding bays for the silenced, or wastelands for the discarded, where the occupants are expected to demand nothing and be as little cost to society as possible.

We have an opportunity to reconstruct the delivery of residential aged care. Let’s begin with the end in mind: a society that not only values older people, but values the resources required to provide the care they need and deserve.

Article from:

The Conversation

 

 

Medicinal Marijuana in Australia.

SICK Australians with some of the worst ailments will no longer wait months for relief or be forced to turn to the black market to access medicinal cannabis with the government green-lighting the legal sale of marijuana products for medical use in Australia.

Australia has finally jumped a medical hurdle that will make it easier for people with chronic illnesses to obtain legal supplies of medicinal marijuana. Well, a little bit easier, every good thing comes with a caveat in this nation where the words ‘nanny state’ is a constant.

For years now people with debilitating and wasting diseases such as cancer, epilepsy, Alzheimer’s,  M.S, arthritic discomfort and nausea from chemotherapy have had to rely upon modern drugs and methods of pain treatment with the use of chemically produced pain killers  or chemicals which by and large treat a symptom but not the associated problem and ongoing crisis.

Now the Australian government has decided that the time has come for doctors to be allowed to provide patients who meet strict criteria to have access to medicinal marijuana. But if you are thinking ‘wow what an amazing step’ think again. Like all things a government does things are not going to be that easy.

Weed Tweets ™ (@stillblazingtho) | TwitterDoctors have already been importing the drug, but they’ve been doing it on a patient-by-patient basis.

This involves a long process of approvals through the states and a government department known as the Therapeutic Goods Association, who require ‘paperwork’ (there you go, paperwork – just what an overworked doctor needs) outlining the evidence and potential benefits and it’s also reliant on the availability of the drug overseas.

Because of the need to bring the marijuana in from overseas some people have had to wait months before they actually receive their treatments, and when you are dying or suffering a debilitating disease every day in that month counts.

As of now, though, it will be easier to import medicinal marijuana from approved international suppliers, which means the product will be able to be imported in bulk and warehoused in Australia until it’s needed. And some places in Australia will be given approval (with the necessary paperwork) to grow the product under very strict conditions.

So does that mean it’ll now be easier to get?

Yes and no. A patient who already has approval to use medicinal marijuana will no longer have to wait for the product to be imported, assuming that product is one that has met all of the import regulations.

But for those who don’t already have a prescription, it won’t be any easier to get one as a result of this change.

And it will be quite hard to access the product because medicinal marijuana isn’t approved by the Therapeutic Goods Association (TGA) as a registered good. Only a government Minister could approve a product without giving the appropriate government department permission to use it.

Patients will need special approval to take it, and the TGA will provide two ways to go about getting this:

  • Firstly, doctors can apply to become “authorised prescribers” of specific non-listed drugs to patients with particular medical conditions
  • Secondly, doctors can apply for medicinal marijuana on behalf of their patients through the “Special Access Scheme”

In both cases, doctors need to be able to show that the drug would be of benefit for a particular patient with a particular disease, and the application processes are stringent.

One never ceases to be amazed at how a government bureaucrat can make a decision about a person they have never met and their health and pain whereas a doctor with years and years of firsthand experience cannot!

As well, the use of marijuana for medical purposes still needs to be legal in the state or territory in which a patient lives.

And naturally all the various states and territories have different rules and regulations, another hurdle through which a patient will have to jump.

One medico hedged her bets this way: “Doctors here don’t want pressure to provide scripts yet because we want to make sure it’s actually safe and effective first.”

And for those who may have thought that Australia was about to become the Holland of the South Seas, think again. You won’t be able to role a joint and harmonise with the world because your doctor has cracked the government code of bureaucracy. The medicinal marijuana they prescribe is most likely to be in the form of a liquid tincture, a dermal patch or synthetic spray.

At least for some there is relief on the horizon.

 

Mental health help in Australia is a joke

GPs struggle in a system ill-equipped to deal with mental health

I sat in the waiting room staring at my hands, willing them to stop shaking. Anxiety was a fighter jet, roaring through my cells, dropping grenades from head to toe.

When the doctor called my name I shuffled after her, a shrunken version of a self I no longer recognised. Fixing her eyes on a computer screen, she hammered the keys and asked me to explain why I was there.

Our complex emotional pain is being treated with six-minute medicine by time-poor GPs, says Jill Stark.
Our complex emotional pain is being treated with six-minute medicine by time-poor GPs, says Jill Stark.

Photo: Christopher Nielsen

When I told her I was experiencing what felt like an acute recurrence of the depression and anxiety I’d grappled with since I was a teenager she pushed a sheet of paper across the desk and I began to tick boxes.

During the last 30 days, how often did you feel hopeless? … During the last 30 days, how often did you feel so nervous that nothing could calm you down? … How often did you feel so sad nothing could cheer you up?

Ten questions, scored from one to five, with one being ‘none of the time’ and five ‘all of the time’. Under 20 is well. Over 30 is a severe mental-health disorder.

“You got 25, which means you’re only mild to moderately depressed, so there’s not much to worry about,” she said, reaching for the prescription pad before asking if I was suicidal.

I thought about it for a while and said no. “Good. These ones aren’t prescribed very often these days because they’re much easier to overdose on. But you’re not suicidal, so that’s fine.”

Less than fifteen minutes after I sat down I stood on the street weeping. I had no support, no plan for how I was going to make it through the day, armed only with the knowledge that should I want my kill myself the drugs I’d been prescribed were well-equipped for the job.

Journalist Jill Stark.

I wish this was an isolated experience. But since documenting my mental health battles in my recent memoir Happy Never After, I’ve been inundated with messages from people across Australia telling similar stories.

Our complex emotional pain is being treated with six-minute medicine by time-poor GPs struggling to meet demand in a system woefully ill-equipped to deal with the mental health challenges of modern life.

It was revealed in recent days that GP waiting rooms are crammed full of patients with psychological problems.

Research released by the Royal Australian College of General Practitioners found that 62 per cent of people visiting a doctor are presenting with mental health problems – significantly more than any other medical condition.

College president-elect Dr Harry Nespolon said doctors are in an impossible situation, forced to either charge patients for more time to manage these complex problems or wear the out-of-pocket costs themselves.

“As access to psychologists and psychiatrists can be restrictive, to say the least, GPs must not only work as the frontline of support – but as the entire support model, something which is currently not supported by patient Medicare rebates,” he said.

How much longer can we continue like this? When will we stop treating emotional health as the poor cousin to physical health?

We are in the grip of a mental health crisis. We have the highest Australian youth suicide rate in a decade. More people are depressed, anxious and medicated than at any other time in our history. If trends continue, clinical depression will be the second most disabling condition behind heart disease by 2020.

Raising awareness is not enough. The time for wristbands and hashtags has passed. We have learned to ask R U OK but when the answer is ‘no’, too often there is nowhere to go.

Our Medicare system needs to better reflect the times we live in and the health problems we face. Doctors need the financial support to offer longer consultations for patients with complex psychological needs.

And as a matter of urgency, we must stop rationing psychological services to ten subsidised sessions per year.

When I was at my lowest point, I saw my psychologist twice week just to keep my head above water. I raced through my Medicare sessions in five weeks.

At almost $200 per hour, I then had to raise almost $400 a week just to stay in therapy and out of hospital.

There are few other areas of healthcare where we place such arbitrary limits on a patient’s ability to recover.

Through life’s lottery I was fortunate enough to have a supportive employer, and family who could afford to fund my therapy. Without their assistance I honestly don’t think I’d be alive.

Not everyone is so lucky. Many people are no longer here because they couldn’t afford their mental illness. It’s a devastating indictment on a system that is fundamentally broken.

We must demand better. The chances of surviving our emotional pain should not be determined by the balance of our bank accounts.

Lifeline: 13 11 14

Jill Stark is a Melbourne journalist and author of Happy Never After

(c) Fairfax Media Australia.

Don’t take aspirin if you don’t need it. New medical study finds.

Millions of healthy older people with no history of heart attack or stroke take low-dose aspirin in the hope it will reduce their risk and prolong good health.

But a new Australian-led study has found that’s not the case.

The study of more than 19,000 healthy people aged over 70 found taking 100 milligrams of aspirin a day didn’t prolong their life or significantly reduce the risk of a first heart attack or stroke.

Aspirin

Handful of aspirin Lead researcher Professor John McNeil from Monash University said the results of the seven-year study should prompt people who take aspirin — when they have no medical reason for doing so — to reconsider whether it is a good idea.

And researchers found taking low doses of aspirin each day had potentially serious side effects.

The study, published in the New England Journal of Medicine, found aspirin increased the risk of serious bleeding, a well-known side effect of aspirin.

“That’s an issue in the elderly when people’s blood vessels are a bit more fragile,” Professor McNeil said.

The results of the study only relate to healthy older people aged 70 and above and not to people taking aspirin on medical advice, such as those who have had a heart attack or stroke.

Researchers also looked at whether taking aspirin affected the likelihood of developing dementia, but found little difference between those who took aspirin and those who took a placebo.

The Heart Foundation does not recommend that people who do not have coronary heart disease take daily aspirin.

“People aged over 45 with no known coronary heart disease will benefit most from a healthy lifestyle and seeing their doctor for risk assessments such as blood pressure, cholesterol and sugar levels,” a spokesperson for the Heart Foundation said.

Research ‘great benefit to older people’

Bruce Holloway is 90 but still plays tennis twice a week.

He puts his good health down to being active and in a position to make a contribution, like taking part in clinical trials.

He was keen to participate in the aspirin study when his GP asked him to take part.

“Elderly people can make a contribution to society and this is a good way of doing it,” he said.

The participants weren’t told whether they were taking aspirin or not.

“I am confident this is an important result and will have great benefit to the older people of the world,” Mr Holloway said.

“It’s important that old people in their 70s, 80s and 90s can make a contribution to society like this.”

Consult your GP first

Doctors say it’s important to seek medical advice before making any changes to your medication.

President-elect of the Royal Australian College of General Practitioners Dr Harry Nespolon, who was not involved in the study, said some older patients might be taking aspirin because they think it’s a good idea.

“They think, ‘what’s a little aspirin going to do to me?’ But there are serious consequences, as the study shows,” he said.

Dr Nespolon said while there have been mixed opinions on whether giving healthy people aspirin is a good idea, this new study “clearly shows people over 70 shouldn’t be taking aspirin as simply an aid to their health”.

ASPREE study: A snapshot

At the beginning of the study, known as the ASPREE (Aspirin in Reducing Events in the Elderly) trial, researchers in Australia and the United States recruited more than 19,000 adults aged 70 years and above who had no history of cardiovascular disease, dementia or disability.

Participants were randomly assigned to receive 100 milligrams of aspirin each day or a placebo pill, and were followed for an average of 4.7 years.

The researchers found the use of low-dose aspirin did not prolong disability-free survival (a measure used to reflect a healthy lifespan) among healthy older adults.

“We measured this by how long it took for people to remain healthy without having a permanent physical disability or developing dementia. In other words, how long people spent in a healthy state,” Professor McNeil said.

Researchers also found the use of low-dose aspirin did not substantially lower the risk of cardiovascular disease in healthy older adults, and instead significantly increased their risk of major haemorrhage (bleeding that can lead to a stroke).

(Story courtesy of ABC News Health Report Australia.)