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Greg

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 #16 
Picking up on Margaret's comment, do we need to have a framework for friends and relatives to support and advocate for aged residents? Do we need to see that the profit motive, if present, is dependent on very good quality care? How can we all contribute. In politics and banking we have found that "If you don't care they wont care.". Would there be merit in estabishing a "Friends of the elderly" groups that informed family, nursing home staff and the general community of what would work best for aged patients?
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Margaret

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 #17 
I have had some access to Nursing Homes and have seen so much good.

I believe that night-time is when observers can see what happens at night when Staff seem to be more prone to stress and violence. And the Full Moon does make a difference. Managers of Homes should be aware of this and counter it with better training and selection of staff. I suppose this means more funding which means higher fees for residents. Those supported by the Public trustee seem to come at the bottom of the heap with those not visited by caring friend and relatives.

I visit someone who has no family but a group of vigilant friends.
We have been able to get her services such as physio by pressuring the Public Guardian to release funds from her house rental.

This week was extraordinary. It must have been Inspection time. So many staff. So many activities. Bus trips suddenly materialized.Such happy residents. The whole place was smiling and alive. All Staff on their best behaviour. Amazing to see. Now we've seen what they can do, we will be trying to keep them up to the mark.
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Greg

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 #18 
So many helpful suggestions. I am going to take a bit of time digesting then get back to you. Margaret made a good point. Government is makiing millions out of fining bank for things its MPs and regulators did nothing to stop. Let's remove the incentive for government to foster bad behaviour in order to earn fines money.
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Fenella1

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 #19 
The majority of aged care homes are large facilities which are challenging to manage and where residents can end up feeling institutionalised. I think one solution is the small group home, housing no more than about six residents, cared for by a small team of well-trained staff. There are a few of these around, but we need many more spread out through our communities. This would give our elderly more choice and would make the transition from home to residential care much easier.
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Barbara1

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 #20 
My mother was an advocate for residents of nursing homes - A volunteer job she undertook for about a decade from her early 70s. So she is very aware of the limited rights they seem to have and of those who did not have family to advocate for them (hence this service is no doubt much more widely needed!). (Mum is now 93 and has just entered the stage of needing some basic home help herself).

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Margaret3

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 #21 
The real problem is the understaffing of nursing homes. If there was more staff this sort of behavior would not be happening. The staff client ratios are no way manageable and this causes stress and frustration of the staff, in those that should not be in the care industry it will manifest itself in this undesirable behavior.

The bureaucracy involved is increasingly detracting from the amount of meaningful one on one time with the clients. This is in every industry education, nursing and aged care.  When this sort of thing is detected instead of any fines etc going into government coffers it should be put into sorting out the problem. A help team should be sent to review the organisation and implement "best practice", to ensure the incident is not repeated.
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Bruce

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 #22 
i feel so helpless with this issue as i don't know what is best to do.  certainly if we took on Barbara's suggestion and got the various media involved we might get some suggestions come in from the caring healthcare workers who are on the front line.  it makes me so sad to see people treated this way after what i see is largely due to families just letting go their elderly parents.  i dread to think of how those with no children finish up as there is generally no one around to care any more.
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Barbara1

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 #23 
Tania has articulated all the needs Extremely well!! send it to all politicians, media etc asap I suggest.
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Tania2

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 #24 
I have interest in this as I dealt with my mother's problems while still looking after a primary school child. The problems are huge.  There needs to be more home care places available. These remain severely underfunded, especially for moderate to higher care needs. (2) the ACAT teams need to involve significant family members when determining need for care (3) THere needs to be communication between the providers of home care packages, significant family members and GPs. Home care workers observe lots of problems and tell nobody. (4) Aged care workers in the community need to be properly remunerated and have excellent English skills. I am all for multiculturalism, but my mother had to deal with a succession of recent immigrants, often with poor English skills, one of whom used her credit card illegally. (5) Emergency departments need a dedicated section for the elderly where experienced geriatricians can provide on call advice to overworked and inexperienced resident doctors (6) Hospital teams should not be able to collude and force people into nursing homes. Yes happened to us. A social worker actually threatened that my mother would be sent to a home sight unseen, which is of course completely illegal (7) Hospitals should involve families in treatment decisions at the start, not when they just want to turf the elderly person (8) Employee responsibility for making sure the patients can access their food. I confirmed with the CEO of a major hospital that there is no one employee who has the responsibility of ensuring patients can eat, in other words, can they reach the tray, hold the cutlery, see the food and so on.  So if your relative is in hospital, make sure you are there at meal times!!!

Now I will get to the aged care facilities. They need (1) dedicated managers with advanced nursing training at the very least who have proven interpersonal skills (2) A registered nurse with geriatric trainng on duty at all times (3) higher staff to patient ratios (4) aged care workers in facilities must have legislated training standards of at least one year duration and better remuneration otherwise nothing will change  (5) Dementia care needs to be improved. There are many new innovations, few of which are implemented in Australian facilities I suspect.  (6) geriatric specialists should be more accessible to nursing homes to provide high level medical treatment for complex patients and advice to GPs. (7) Accreditation visits should be occur requently without warning  otherwise accreditation is useless and the facilities just game the system. (8) Consideration should be given to having the option of surveillance cameras in rooms with the permission of residents and families. The only way that some elder abuse has been uncovered is when families have been able to secretly video it. Unfortunately all of this requires a paradigm shift, better systems and more funding but it can be argued that better care at an earlier stage and making it possible for people to stay in their homes for longer will save money in the long run.
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Barbara1

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 #25 
Statistically, most elderly people are living in their own HOMES (over 85% of those aged over 70), so nursing homes are not for the majority.
The Fed Govt has finally realised that it is CHEAPER overall to keep people in their own homes by supporting aged-care packages, hence the recently introduced MyAgedCare policy (but as usual it is extremely bureaucratic and hard to navigate) as a starting point.....my own mother is now just starting on it (at a low level),aged 93, after being totally self-supporting till now - and I am convinced that her long period of independence and very active retirement has been enhanced by keeping busy with the tasks of keeping her own home and garden, doing decades of 'hiking and walking', as well as very active involvement in many volunteer organisations.
THESE are the KEY ways to stave off deterioration of the body and mind so there needs to be MUCH more emphasis on exercise, activities and a good diet for the elderly both at home and especially in nursing homes too! 
Society has to introduce a NEW mindset as to the definition of old, elderly, frail etc as this is changing with improved medical advances, the transition of baby boomers into an 'active retirement phase' (70 is the new 60 etc). For starters, journalists and editors need to refrain from categorising anyone over 60 as 'elderly' when reporting in the media !! That term should be reserved for the over 80s (at the very least!).
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Advait1

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 #26 
My first job at 19y was as a kitchen hand in a retirement home. Before I present the more nuanced details - 4 Corners is and isn't correct - it needs to be pointed out: no one will care for your family the way you do. You cannot buy the care and affection you would like the elderly to have. When I buy groceries I know there isn't a lovely old couple picking eggs out of a coop and milking cows. People are indulging in wilful blindness if they take a company at their word and don't take responsibility for outcomes. Some people only had visitors during Christmas - when the kitchen put out the best spread of the year to delude the kids. Families are not exempt from blame!

The Bad
I've heard good things about the high-end offerings, but mid-low tier retirement homes are like schools, prisons and factories. Highly structured in their routines, trying to maximise real estate plus other resources and have a kind of temporary monopoly on the humans involved - the worst kind of lock-in that limits accountability. Given this was the lay of the land I almost understand why the primary corporate impulse was towards optimisation and cost-cutting. It is too easy to look at a well-oiled machine and think "hmm we could save another 2% here..."

The ratio was 1 nurse to 5-10 residents. The morning routine was the hardest since they bathed, dressed and helped in other ways.

The home had in a brilliant move of corporate strategy outsourced the catering to another company. Food is a critical part of life and needs to be done well. But should you be dissatisfied with the quality of service you don't talk to the home, you complain to the other company that has a manager that is incentivised to cut costs and stretch every dollar. 4 Corner meals looked too familiar. The smart families bought their parent a small fridge and filled it up.

An important lesson was that the more cantankerous and demanding people got better service - not necessarily what they deserved or paid for. The kinder souls and more accomodating people got taken advantage of - if you have a parent that is 'too nice' you need to rethink the retirement home. Those least capable of speaking out, like people with severe dementia, Parkinson's and senility got shafted on a regular basis. We served virtually identical meals, at times in pitiful portions, the grotesque purees you saw, day in day out to those people. I just became so numb to this daily reality. I was fortunate to get out because I couldn't hack it anymore if I had to.

The Good/Neutral(?) Perspective
I saw a broad variety of people placed in the same environment and some of them made the most of it, whilst others withered away. I saw great friendships and cliques between veterans and other residents. A lot can be said for self-determination.

Other people really knew what they were getting into and therefore tolerated things better. I don't have sympathy for some of the scenes in 4 Corners because some people refused to work within the structure of the retirement home - it doesn't take long to get the nature of the programme. I understand their desire for attention and the toll isolation can take on them, but at the same time we teach children to eat in a reasonable amount of time, not throw tantrums and live within the limitations of school, naptime, homework and household chores.

Once again where are the families?! Not all indignation is well placed. So much of this is an inability to deal with the loss of agency as one gets old.

The nurses seemed well-trained and caring enough. I genuinely think most of them did their best. I don't think they were underpaid. One can always say they're underpaid, but if year after year you continue in the same profession you are making a choice. I never thought I was underpaid as a kitchen hand working for minimum wage because the work was simple and I was utterly replaceable. The ambitious nurses got specialisations, bargained and worked weekends/public holidays - it depended on how badly they wanted it.

It's not as though the residents were blameless, on occasion there were lewd remarks and sexual advances made on the nurses. Some people were god-awful to deal with - I don't think anyone went the extra mile for them.

A sad fact of life was that people died all the time and this made you somewhat detached. The ambulance came around every fortnight. Newer nursing/retirement homes are strategically built near hospitals. You become numb once this is just part of your career - and I was just a kitchen hand. I don't know what it was like for the nurses.
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Greg

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 #27 
Thank you for these comments. They are invaluable. There is no reason in the world why this situation should continue. We all need to think the issues thrugh carefully. I hope many more people will come forward with their views. We have achieved many reforms that wre said to be impossible. First we have to get as much information out on the table as posible so that we can identify practical, affordable and effective solutions. Government puts a lot of money into aged care and voters can control government without to much effort. Please encourage anyone you know to have their say on this. I woujld like to finaish it in a couple of weeks then move in the direction of some action. Thanks again for the comments.
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Clive1

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 #28 
The 4 Corners expose program on aged care shows capitalism at it's common worst. Huge sums of money put up by these aged folk or their relatives with lots of additional charges and only a pittance returned to family on their death only to be treated in this inhumane manner by grossly underpaid and under trained unsupervised under manned staff and eating like kings on the $6.50 daily food allowance.
I would not want to go on if I was ever in this position, wearing a seldom changed nappy and having no or few visitors except for getting slapped around by staff, knowing I had no prospects of my situation ever improving with some poor souls not being able to even get out of bed and looking at the ceiling all day it would be euthanasia for me.
Meanwhile these "first class, inspected with notice, 100% fully accredited homes" advertise like first class hotels with few knowing the illusion stops at the front door.
This all goes to support, one would hope, a blissfully unaware army of happy share holders fed by a very lavishly paid no expense spared senior staff to bolster up the illusion and recruit more victims.
As we see from similar programs and the royal commissions this behavior is the norm and to be expected, be it these homes, banks, insurance companies ad infinitum. Screw as much money as possible out of the punters and staff, trim your expenditure to the bone, deny on a stack of bibles any wrong doing (my staff never informed me this was happening) and smile impishly at the wonderful future prospects at the next shareholders meeting. You have only to follow the share price which invariably rises if a company lays off staff.
At a time of bribery and cover ups, little regularly monitored regulation, or govt. interest in compliance and a profit is king corporate mentality I see no prospects for any improvement in the future, this will soon blow over and return to business as usual just as it has with the banks and dodgy house lending after the subprime fiasco.
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Fenella1

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 #29 
The 4 Corners report was horrifying in the extreme. The quality of care our elderly receive can vary greatly. As Jay1 posted, so much depends on the attitude of individual care workers - and it shouldn't be this way.  In my experience of aged care, staff burnout and stress is another serious issue and needs to be addressed by management. Staff are only human (and often quite young and not well trained), and in this line of work can easily become frustrated and overloaded. Their poor wages means they are tempted to take on as many shifts as possible just to make ends meet. Lack of oversight is another issue, particularly after hours. It is usually down to a handful of staff to manage large numbers of residents and nobody has the time to supervise staff or regularly look in on residents, let alone provide reassurance or emotional support.
Given these and many other factors too numerous to go into here, it is the case that our elderly residents, particularly those in high care, simply become 'wallpapered'. After a while nobody notices their presence. Let's hope that as a community and with our lobbying of politicians, our elderly residents can once again be given back their humanity and achieve the respect and care they deserve
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Jay1

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 #30 
I have had my parents in both situations. Cared for by my sibling who mismedicated them, put pressure on them to loan her money, that she never intended repaying and actually took money from their accounts with out their knowledge. It was a nightmare for my parents. Elder abuse by their own children is a very common occurrence. Long story but got my dad, after mum passing, into an aged care facility. While he was very mobile and lucid things were great but as he detoriated more and needed a higher level of care, things weren’t 100% right. It’s hard, you have to trust that people are caring for them but understaffing and cost cutting means the elderly don’t get the level of care they should be entitled to. One thing I found with the staff at dads facility was some staff were absolutely committed to caring for the elderly but to some staff it was just a job. And you could pick it, it was very obvious. I think that’s the biggest issue. When the staff are not fully committed then many things slip, when some staff don’t have the ability to deal with the demands that come about with the elderly, then we will keep hearing about more physical abuse.
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