The Australian population is ageing. Approximately a quarter of a million people live in residential aged care facilities (AIHW, 2015). By 2050, approximately 25% of Australia’s population will be over 65 (ABS, 2016).
Understandably, people have been outraged and distressed by the recent Four Corners focus on neglect and abuse of our vulnerable elderly in Australian Nursing Homes.
The human stories and images are deeply troubling, and raise significant concerns for our loved ones and for our own old age. The implicit message from the programme is that the neglect and abuse they captured in the program could be just the tip of the iceberg. The iceberg metaphor is a helpful way of understanding that what we observe as the problem, is really only the ‘small piece’ we see (the tip of the iceberg) because there are many other factors involved that are not apparent at first glance.
Residents in nursing homes are often left alone for long periods of time. In Part 1 of the ABC programme we see Neda who is left in the dark after breakfast. She starts calling out “help, help”, and “I don’t appreciate being here”. When the care staff eventually arrive to get her up out of bed, she says “hello, hello”, followed by “don’t go away, don’t go away”. Neda reminds me of a gentleman, Bill (not his real name), whom I saw when I was working in a Behaviour Assessment and Intervention Service. Bill was referred for calling out “help, help”, just like Neda. When I first visited Bill in the nursing home he was lying in bed in his dark single room with both the door and the curtains closed. He was calling out “help, help”. Bill’s daughter said she frequently found Bill locked away in the dark. Staff expressed concern that Bill was frightening the other residents and disturbing the neighbours. Shutting the door and closing the curtains was their way of dealing with the problem. This was their management strategy prior to referral. You can read more about this case in Turner and Snowdon (2009).
What the Four Corners program (Parts 1 & 2) alluded to, was that this abuse and neglect occurs within a broader context, as does all human behaviour. It is this context that needs closer examination to fully understand how behaviours such as these can happen, and how they might be addressed.
Having worked closely with the Aged Care sector for the past 24 years, including having been involved in clinical practice and research in the field, in this and coming blogs, I want to explore three main contextual factors that bear on the conduct we have observed:
- Clinical – related to the prevalence of dementia, behaviour disturbance, and mental illness in aged care residents;
- Workforce – related to lack of appropriate training and/or reliable training standards for nursing home staff; and
- Systemic – related to lack of regulation and acceptable service delivery standards in the industry.
My view is that a thorough consideration of these elements will provide a framework and tools to formulate a practical response to the issues raised in the 4 Corners program; and an agenda to advocate for change.
On the 9th October Prime Minister Scott Morrison announced the Terms of Reference for the Royal Commission into Aged Care Quality and Safety. I propose to make a number of submissions to the Royal Commission to advocate for that change, based on my years of research and experience in providing clinical psychology services in aged care facilities.
I hope you get some practical benefit from my observations. Stay tuned for Part 2, coming soon.
18th November 2018
References and Links
ABC 4 Corners Programme Who Cares (2018).
Australian Institute of Health and Welfare (2015). https://www.aihw.gov.au/getmedia/088848dc-906d-4a8b-aa09-79df0f943984/aihw-aus-214-aw17.pdf.aspx?inline=true
Australian Bureau of Statistics (2016). http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/3222.0Media%20Release12012%20(base)%20to%202101
Terms of Reference for the Royal Commission into Aged Care Quality and Safety (2018).
Turner, J., & Snowdon. J. (2009). An innovative approach to behavioural assessment and intervention in residential care: A service evaluation. Clinical Gerontologist, 32:260-275. Turner & Snowdon 2009
©JANE TURNER 2018