Many older people in Australia dread the idea of moving – let alone needing to move into a residential aged care facility. And now many people are also hearing alarming reports from the Royal Commission into Aged Care Quality and Safety, which began in 2018 and is due to end in late 2020.
Does residential aged care have to be a frightening prospect? And at a wider society level, what can be done to improve Australia’s aged care system?
Being able to acknowledge the feelings associated with the stage that you’re at – whether you’re the person moving into care or arranging care on a relative’s behalf – is a very important starting point.
I think it’s reasonable to expect that moving into a care facility will be frightening. It’s a time in life where most people do feel very vulnerable. They might be physically frail and they may live with a real sense of loss as they watch friends and relatives, even their partner, pass away. Moving into a new stage of life brings with it a lot of uncertainty. It’s normal to feel vulnerable and afraid.
There are ways to make the process a little clearer and less scary. Start with trying to differentiate between feelings and facts. In the tumult, ask yourself: are you dealing with emotional distress or are you dealing with the facts?
For example, is it clear what sort of care the person who needs to move would like? What are their preferences? What really matters to them? If you have facts like these, this knowledge can help to guide what you’re looking for – and this can make the process less frightening and uncertain.
What is a realistic expectation about the sort of care that a residential aged care facility can provide? I think families need to have a broad conversation about this and think through some of their hopes and expectations about a care facility.
Residential aged care is not home. The truth is that an external provider is being paid to be able to do as good a job as they can, but it’s not going to be the same as living in the home environment surrounded by family. There is obviously a huge amount of grief that comes with that.
There are so many things we can be doing to improve the aged care system in Australia – and that is exactly what the Royal Commission into Aged Care Quality and Safety is all about. It’s about making aged care better for our ageing population in the long term. I do think the majority of aged care providers are out there trying to make a difference and I know there’s a lot of good work going on.
There are some critical areas that need improvement in Australia’s residential aged care:
Direct care staff need to be supported with specialist, ongoing dementia care training, mentored by experienced staff. They need to be given a sense of a career pathway in aged care.
Day-to-day delivery of dementia care should be led by those offering the direct care – the multi-skilled care staff (we call them ‘homemakers’), rather than registered nurses. They should be given the freedom to offer individually-tailored care rather than delivering task-based care that conforms to institutional routines.
Developing positive, transparent relationships with families is important. Regular communication leads to dynamic, trustworthy relationships with families and can make all the difference.
People thrive best in a small home environment, so it’s important to make sure that the homes are as warm and welcoming as possible. Kitchens that look like real kitchens, not industrial kitchens, living rooms adorned with family photos and smaller sitting areas can all make it seem more like home.
Ultimately, people with dementia all over Australia should be supported to stay connected to their local communities, keeping up with networks, interests and connections. They need to be treated like every one of us wants to be treated and involved in things that they find meaningful and purposeful. Because that really isn’t a scary prospect.
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