Rock the Boat in Age Care

National Elder Abuse Conference 22-23 July 2019

What did I learn at the Rock the Boat Conference?

As we now start to embrace the Aged Care Quality Standards  striving  to engage, empower and safeguard our consumers of aged care services. It's timely to reflect on the concept of Ageism and how it influences policy development, service delivery and supported decision making.

Bethany Brown posed the question "When will you be old? "The answer was rock bottom for me, as an advocate I've always believed in human rights and that you are able to choose your own identity, level of interaction, and delivery of health care and social respect. The reality of today’s society was punched into me by Bethany’s answer to this question. You do not get to decide when you will be old, this is decided for you by society!

In an era where the number of people over 65 will outnumber the number of children under five it's astounding that ageism continues to be a silent force undermining policy development, service provision, and early institutionalisation. In short,  ‘we value abled persons more the disabled people and with age comes disability’ (Professor Joseph Ibrahim) 

As I reflected on this I realised just how true that really is. Too many times in my role as a chronic care nurse specialist and Aged care nurse I've been questioned by medical services as to why I'm advocating for transfer to acute services, increase allied health care or support services to stay at home. The answer has been limitations to funding, availability of service providers or simple that the consumer simple does not fit into any funding streams.

The senior people in our community are the pillar of our community. Everything we are is a direct reflection of their contribution to our society. I'm sure we would like to think that the work they do is also appreciated as a contribution to society that the next generation can build and improve on.  So why do we have Ageism in the year 2019?  Isn't it time to make sure that as people become older in years that they continue to have a voice, truth and transparency regardless of their limitations, health condition or where you live.

All consumers of Aged Care Services have a right to full participation in health care and the environment they live in. Consumers do not park their rights at the front door when they enter accommodation services. Professor Joseph Ibrahim acknowledges the idea of ageing, requiring assistance for another service or person is frightening.  As I reflected on this my first thought was how I always hear the argument from service providers of the struggle that aged care services have to meet safety standards, compliance, the concept of duty of care and risk mitigation. I reflected on how these same concepts are inversely removing the consumers rights, self-esteem and identity. As I unpacked this I realised that to truly meet Aged Care Quality Standards  standard one privacy and dignity the processes  Dignity of Risk, Advanced care planning and supported decision making are paramount as a first step towards underpinning consumer care and  supporting consumers rights.

The key is for Aged care service providers to move away from the medical model of health care and embrace a person centred model of supported decision making in care delivery.  Whether it's through natural ageing, chronic disease, disability or injury we all deserve the best support, choice of medical care and social wellbeing to ensure quality of life.  

What is the key then for service providers to ensure that their service is providing care that ensures quality of life?  Kate Swaffer states it is just good business sense. If you are providing a service then your staff need to be able to execute that service. Kate goes on to say "...it is just dumb business if you don’t give your employees the right skills...” It's essential for Aged Care service providers and policy makers to move away from the medical model paradigm and revisit Aged care through another lens, the lens of the consumer.

Supported decision making as opposed to decision support is an approach that would project Aged care services providers in the right direction. Everybody regardless of their chronic condition has the right to participate in the decision-making process about their care. Too often do we rush to the Medical Power of Attorney, next of Kin to assist with decisions about a loved one’s care and exclude the consumer form the process based on a perceived level of capacity for that person to participate in the decision-making process. Don’t get me wrong the Medical Power of Attorney, or next of Kin is essential to provide support decision making I am just pointing out that this title should not mean we exclude the consumer from the dialogue and not hear their choice.  Many people who experience delirium or dementia are excluded from key discussion such as discharge planning, leading to premature and unwanted admission to aged care services.

I have had the pleasure with working with people using a self-management approach to their health care for the past 10 years. I would like to share a story with you from one of my dearest friends Peter Rose, and his experiences as a consumer in the medical model compared to the person centred model.

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