Aged care model of care

Last Friday I wrote a story titled ‘some kind of wonderful’ that took away from the true message of my article. Today I want to remedy this with a stronger emphasis.

The current service delivery model, delivered through residential aged care homes, is institutionalised care. The needs of older people are not adequately meet by this archaic model of care.

On 31 October 2019 the Royal Commission into Aged Care Quality and Safety Interim Report was released. The following is taken directly from the Commission’s website.

‘The Royal Commission into Aged Care Quality and Safety’s Interim Report has found the aged care system fails to meet the needs of its older, vulnerable, citizens. It does not deliver uniformly safe and quality care, is unkind and uncaring towards older people and, in too many instances, it neglects them.

Commissioners Richard Tracey AM, RFD, QC and Lynelle Briggs’s AO investigation into Australia’s aged care system led them to describe the aged care system as “a shocking tale of neglect”.

“The neglect that we have found in this Royal Commission, to date, is far from the best that can be done. Rather, it is a sad and shocking system that diminishes Australia as a nation”.’

Two weeks ago Mrs Merle Mitchell gave evidence to the Commission. Mrs Mitchell is a former president of the Australian Council of Social Services. She knows what she is talking about. In 2019 Mrs Mitchell told the commission the biggest problem in aged care was the staff to residents ratio. Her message was clear. Without enough staff residents will have an inferior level of care.

Mrs Mitchell told the commission about her current situation. Due to the COVID-19 community lockdown she can only leave her room four times a week. That is, for one hour at a time, for physiotherapy. She said that every morning when she wakes up she thinks ‘damn I’ve woken up!’ She would rather be dead. Every older person needs a dignity of care. That means choice and control over their lives and how they live.

Further, the Interim Report states the following.

‘The aged care system needs fundamental reform and redesign. It identifies systemic problems in aged care with a system that:

  • is designed around transactions, not relationships or care
  • minimises the voices of people receiving care and their loved ones
  • is hard to navigate and does not provide information people need to make informed choices about their care
  • relies on a regulatory model that does not provide transparency or an incentive to improve, and
  • has a workforce that is under pressure and under-appreciated and that lacks key skills.’

The final report is due on 26 February 2021.

We all like to have choice and control about where and how we live. It is the same for those in aged care. The elderly should have a say in selecting the staff who care for them. Similarly for their recreational activities. They must participate in all areas of decision-making, if they are able.

Older people deserve a warm and friendly place to call home. A place where they share their lives with others. Family and friends can visit and take them on outings. But not all people have visitors. Without family and friends to visit, life in the current model of residential aged care is a very lonely place.

Again, we all like to have choice when it comes to food. It is the same for the elderly. To assist providers of aged care to serve nutritional meals the Federal Government partnered with Maggie Beer. But how many are taking up the Master Classes offered for aged care chefs and cooks? A few? One place I know of is Southern Cross Care, East Fremantle.

Mrs Mitchell said living in residential aged care is not a home, but an institution. She is correct. The model of support in aged care is like the now defunct segregated and institutionalised disability care model. It is outdated and ill-equipped. A person-centred care model treats the consumer and significant others in their life as active participants. They have a voice and are listened to.

The reason that the disability support model shifted to community-based care in the 1970s is that it gave residents a better quality of life. In the 1980s Australia saw the closure of large institutionalised buildings.

How then did the institutionalised disability model of care creep back into aged care? Was it due to the ageing population in Australia? Therefore, a new business opportunity and a way to make money.

joyful adult daughter greeting happy surprised senior mother in garden
It is time to partner care with compassion.
Photo by Andrea Piacquadio on

The model of care has to change from institutionalised care to community-based care. A small group of people 4-6 living in a house, their home.

The small household model of care is very successful in the Netherlands and other European countries. People live in a household of no more than eight people. One service provider in Western Australia, Mercy Health, introduced the small house model in their not-for-profit homes in 2017. They found it enriches peoples lives, even those living with dementia.

It is time for change. I hope it comes quickly after the Royal Commission finalise their report in February 2021. It is time to partner care with compassion. Older people must experience the same universal human rights like everyone else.

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