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Introduction
This is a wide ranging 252 page report based on 192 submissions as well as multiple exhibits, site inspections and community forums. A vast amount of effort. It was commissioned in June 2002, prepared by the 40th Parliament and published by the 41st after the election in 2004.
The Liberal/National coalition was in power during both periods and as a consequence, the report is largely affirmatory and positive about the current system. The recommendations are bland suggesting satisfaction with the system and more of the same. It is not clear whether the report deliberately downplays the problems in nursing homes, or whether complainants realised that this would happen and so did not supply information. In contrast the report commissioned by the labour dominated senate in 2004 gives a rather different picture.
The terms of reference for this report were brief but comprehensive.
On 26 June 2002, the Minister for Ageing, the Hon Kevin Andrews MP, asked the Committee to inquire into the long-term strategies to address the ageing of the Australian population over the next 40 years.
The report started off by commenting and drawing on multiple previous reviews and reports, only some of which are on my list.
This was a very different review to the Hogan report. Perhaps it was a political response to criticisms of the impersonal market focused Hogan report. If so then it was a monumental effort. While it did not ignore financial considerations it concentrated very much on the needs of the ageing and of the role of the community in this. It made what I have called the nurturing of the aged a core community concern. The focus was in improving the quality of life for the aged and in caring for them while they remained in the community. The changes and involvement proposed would bring the aged into regular communication with other generations and provide them with opportunities to define their lives.
A focus on Community Care
The report explored ways of making the community more aged friendly and of dispelling stereotypical thinking. It had a wide focus addressing urban planning, housing, transport, healthy ageing (eg. smoking and obesity), elder abuse, the capacity of the community to save, superannuation, continued employment, lifelong learning (University of the Third Age), problems for the aged in hospitals, integration and team work, research into ageing as well as the roll of and support for carers in the community. It was critical of the knowledge and role currently played by doctors in aged health and in nursing homes. It urged better undergraduate training in caring for the aged.
The report was generally positive about a number of community initiatives and it used these as examples. At the same time it is clear from the report that there are many areas which they saw as problem areas where things were not as they should be.
Nursing Homes
The report did not ignore nursing homes entirely but this section was shorter. It saw the other activities in the community as making the elderly less at risk of needing nursing home care. The most disappointing aspect of this report was its failure to apply these same insights to residents within nursing homes. It consequently failed to address the quality of life of residents and the critical role that staff play in this.
The shortage of nursing staff and the problems with agency staff received attention. The difficulty in getting doctors to care for residents was addressed. Attention was given to the need for more ancillary services, dementia care and for respite care.
Concerns about staff competence and shortages, the risks posed by agency staff, the quality of management and other matters show that the committee was aware of the serious concerns developing in the community about the way care was being provided in nursing homes, and the reasons why it was suboptimal.
Particularly revealing was the statement on page 151 that "a shared understanding of what constitutes quality and how best in may be assessed and rewarded is an ongoing challenge". This seems to be a tacit admission that many of those who made submissions saw the term quality in ways which differed markedly from that adopted by the nursing home accreditation agency. There was also concern that the focus on documentation took staff away from care and placed the focus on "documentation and the right choice of words" rather than the care given.
Concluding
The recommendations are generally feel good and do good ones focused primarily
on care in the community. The report does not examine fundamental conflicts
and issues within the system. It glosses over the accreditation system and
hardly mentions the complaints system.
That all is not well in aged care, and nursing homes in particular, is revealed by the large amount of attention given to elder abuse in its various forms - nursing homes are mentioned here.
A few extracts will give the flavour of this report.
The Committee concludes that the Community Services Ministers' Advisory Council should direct the Positive Ageing Taskforce to broaden the scope of their work on elder abuse to identify and develop guidance on ways in which older people can be assisted to maintain control over their lives and affairs. (Page xxv)
The Committee further concludes that guidance be implemented by all State and Territory Governments to provide a consistent approach across Australia to protecting the dignity of all older Australians. (para 3.79) (Page xxv)
Governments and communities have responsibilities to remove barriers to maximising the benefits of an ageing population, and to foster positive environments in which individuals and their families can continue to make a positive contribution. Each individual, too, must plan for their future as part of Australia's ageing population - planning that encompasses healthy ageing, continuing engagement in work and the community, and financial security in later life. (Page 11)
The Committee heard evidence stressing the importance of the social networks that foster age friendly communities, kinship and family networks, neighbours and friendship groups, and formal and informal community groups more broadly (Page 13)
Older people themselves play a critical role in fostering social networks and connectedness. The Committee heard many stories of the two-way benefits flowing from older people's engagement in mentoring, 'grandparenting', volunteering (discussed in chapter 6), and active involvement in University of the Third Age (U3A) (Page 17)
Community interaction assists older people to maintain social links, stay physically active and stay mentally, emotionally and physically healthy. Older Australians who are actively engaged in their community and have purpose and meaning in their life are healthier on average and, according to the Dubbo study, may be less at risk of entering residential aged care. (Page 17)
The Council on the Ageing (COTA) suggested to the Committee that the Australian Government should place much stronger and explicit policy emphasis on lifelong learning and education for older people (Page 19)
The full report can be found at
http://www.aph.gov.au/house/committee/haa/strategies/report.htm#fullreport/
Click Here to go back to the main report page
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