“This is not a life.”
“This is not my home.”
“Don’t let this happen to anyone else.”
“Left in her own feces, and still no one came.”
“Mum doesn’t feel safe.”
That’s a small sampling of the testimony that the Royal Commission Into Aged Care Quality and Safety heard from residents of long-term care and their family members during its public hearings.
The Australian commission’s interim report, titled simply, “Neglect," was equally blunt and chilling.
“We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them.”
Commissioners Richard Tracey and Lynelle Briggs may be writing about the dismal state of long-term care in Australia, but their pull-no-punches observations apply well to Canada too.
In our two countries, a world apart, eldercare is fragmented, unsupported and underfunded.
The new report notes that in Australia, there is a wait list of about 120,000 people for a spot in “aged care,” which includes residential and home-based long-term care.
There is no directly comparable number for Canada but there are more than 34,000 people waiting for a long-term-care bed in Ontario alone, and demand is rising rapidly across the country. Canadian provinces don’t even track the wait list for home care and long-term support at home is hard to come by.
The Australian inquiry was ordered after numerous media reports of abuse and neglect in long-term care facilities. The issues included poor wound management, inadequate continence management, dreadful food, a high incidence of assault, the overuse of chemical restraints and inadequate access to palliative care.
“It is shameful that such a list could be produced in 21st century Australia,” the commissioners wrote.
The report says there are systemic reasons for dreadful care and they need to be addressed.
Staffing problems in residential care and home care are severe, owing to lack of workforce planning and difficult work conditions, including poor pay and heavy workload.
“Aged care is not a valued occupation,” the inquiry report states, adding that often “exemplary care is happening despite the aged care system in which they operate, rather than because of it”.
Like Canada, Australia has a mix of private and public delivery of home care and residential care services. The system is framed as a market where seniors can shop around for services but the reality is that most people who need advanced care are in no position to negotiate prices, services or care standards, so they are at the mercy of providers.
These failings, and more, are all-too-familiar in Canada.
Earlier this year, the final report of the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System - which examined how rogue nurse Elizabeth Wettlaufer was able to kill eight seniors under her care - was released.
The 1,491-page Canadian report was a long-winded and mealy-mouthed, blaming “the system,” making a bunch of vague recommendations and failing to capture patients’ desperate need for better access and care.
The 272-page Australian report, in striking contrast, uses blunt language to reflect the frustrations and fears of patients and family members. It also demands immediate action, including an injection of funding for long-term home care services as a way to keep people out of institutional care.
The Australian Prime Minister has promised that there will be additional funding for “home care packages” before Christmas.
Furthermore, the inquiry promises that in volume two of the inquiry, due in November, 2020, it will propose a detailed revamping of the entire aged-care system.
In Canada, we seem to order inquiries in lieu of action; in Australia, there appears to be a genuine desire to learn from failings and correct them.
Sometimes the best way to see our flaws is through someone else’s eyes.
Australia’s Royal Commission Into Aged Care offers much on which to reflect and act upon, a stark reminder that we urgently need to offer better and more dignified elder care. The opening words of the inquiry’s report should serve as a call to action:
“This cruel and harmful system must be changed. We owe it to our parents, our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more.”