Thursday 20 September 2018

A nursing home experience

After mum went into a nursing home (I should say more precisely, "After I put mum into a nursing home") there was never any time over the next two-and-a-half years that she lived there that she was being treated with anything other than careful solicitude. The stories that are coming out, that are linked to the prime minister's decision to set up a royal commission into the aged care industry, are alien to my experience. In the place mum lived in the staff were kind and considerate and always made sure to check on mum so that she wouldn't be unnecessarily inconvenienced.

There was one problem with another resident, who lived in a room near mum's, and who used to call out to mum to ask her to help her. This resident was very old and frail and bossy and would try to get mum to come to her room and help her to get to the toilet. I mentioned this circumstance to the staff in the nursing home and they eventually moved that resident to a different part of the building so that she could be better looked after and so that she wouldn't bother mum anymore.

The only thing that I consider a problem in nursing homes is their sanitariness. Mum had cellulitis on her legs because of her poor circulation. This is a condition that makes it easy to get infections. She was also taking a drug for her blood disease (myelodysplastic syndrome) that reduced her body's ability to fight infections. This combination eventually led to her death. On one occasion when I had taken her to the hospital to get her treated for an infection one of the nurses there said something about cleanliness in nursing homes, in a way that made me understand that she wasn't surprised by mum's dilemma.

During the period of time mum was in the nursing home I would usually go to see her two or three times a week. The place is in Epping in a leafy suburb and there is a park next-door to the nursing home where mum and I would go to watch dogs being walked by their owners. There are big eucalypts and pine trees in the park and sulphur crested cockatoos would come in flocks to nestle in the trees. There were magpies as well, who would stalk along on the grass looking for food.

Mum loved going to the park and I would sign her out in the logbook kept on the counter of the nurse’s station on her floor, and we would take the lift downstairs before walking out the front entrance with its ramp and guardrail. One of the residents who lived on the ground floor of the building was in the habit of feeding the cockatoos and often one of the big, white birds would be perched on her balustrade waiting for her to emerge. If she was sitting on her balcony mum and I would wish her good morning and comment on the bird that had chosen to sit there on that day, before heading to the street which we would cross to reach the park.

We would sit there on a bench in the sun for thirty minutes or so until it was time for lunch, then we would head inside again. Sometimes near the lifts on the first floor, the floor of the building where mum’s room was located, we would bump into the bubbly and intelligent manager of the institution, who always had a chat with mum about this or that when they met. She was a tall Anglo with dark hair and she had been the one to sign me up to the contract in the beginning, in 2015. She knew the names of all the residents and took time each day to talk with those of them she met during her sorites from her office, which was located near the nurse’s station, and share things with them. Eventually she was poached by another part of the company and went to work somewhere else and a new manager, also an Anglo woman, replaced her.

The floor staff were separated into the regular staff and the registered nurses, who were the ones who had gone through additional training and who were responsible for administering the types of care that required medical knowledge. There were also regular visitors to the building who brought special knowledge with them, such as the physiotherapist who told me to get rid of mum’s three-wheeled walker and buy her a four-wheeled one. On another occasion, a footwear company sent a saleswoman to fit special shoes that would go on mum’s often swollen feet.

One of the regular staff in the nursing home mum lived in undertook RN training and became a registered nurse during the time I was visiting the establishment. She had a round face and a high-pitched voice that was so small you had to concentrate to catch what she said to you. She was from a Chinese background, and spoke English with an accent. Other staff in the nursing home were migrants or 457-visa holders from India or the Philippines and some of them had elderly parents of their own back home whom they were unable to care for because they were looking after the parents of Australians. The staff were all familiar with the residents’ medical needs, and understood their cognitive and physical deficits intimately. Paying for this kind of care is expensive but the majority of the people who work in nursing homes are dedicated and responsible.

The thing about financing nursing homes is that the government has been trying for some time to get families to look after their elderly parents at home because it is cheaper that way. As part of the government’s campaign to reduce the costs it incurs that are associated with aged care, in 2015 the law was even changed so that people would have their assets assessed by Centrelink as well as their income before their nursing home fees were calculated. This was a bipartisan policy designed to capture more of the wealth of the elderly, who are usually asset-rich but who mostly do not have much in the way of an income.

The form that you fill in to declare assets and income runs to about 30 pages and it is a struggle even for a person who is able-bodied and whose mental faculties have not been reduced by common age-related conditions such as dementia. My accountant filled in the form for me when it came time to submitting the form. How an elderly husband or wife would cope with this stubborn bureaucratic hurdle is beyond my understanding.

The other thing that needs to be noted in relation to nursing homes is that your position as a relative of an elderly person who is looking for a place in a nursing home is delicate. You are not working from a position of equality vis-à-vis the nursing home. If you find a place in a nursing home you have to take it straight away in most cases because places don’t often come up. So you jump at the chance offered and you will sign away assets without looking in too much detail at the terms of the contract you are given.

The government’s attempts to reduce the cost that looking after the elderly places on it has fed into decisions it has taken in recent years. These decisions reflect the uncomfortable reality that the baby boomer generation is ageing and that its members will, at some point in the not-so-distant future, require looking after in a way that costs a lot of money. Most of the medical expenses you will have in your life, if you are a typical westerner, are incurred in the final six months of your existence on the earth.

The idea of living in a nursing home might put some people off but the reality is that in many cases older people have multiple health problems, each of which would make it difficult for them to be properly looked after at home, even if you provide services that involve professionals visiting during the day to do such things as bathing, physiotherapy, housecleaning, laundry, maintenance, and cooking. The burden will rest with carers, who are usually part of the person’s family.

In the US, where the government provides fewer funds for aged care, it is very common for the elderly to live with sons or daughters, possibly in a spare room in their house, possibly even in the basement. During the day, who looks after such elderly citizens if their child works in an office? Sometimes children have to give up a job in order to be at home during the day. We don’t want that kind of system to evolve here. The collective must pay to look after the old and the frail.

To get a better settlement in this sector of the economy we need to work from a position of informedness. But that probably won’t happen soon. Even with the two-part ‘4 Corners’ program the Australian Broadcasting Corporation has made, most of us are not able to know all the details of the case unless we have lived through it ourselves, and even then our knowledge will necessarily be partial and incomplete.

I was reminded of the level of ignorance about nursing homes in the broader community when I saw the other day a cartoon by David Pope, who draws images for the Canberra Times. In his cartoon, the prime minister is shown standing facing a wall in a dingy-looking corridor, dressed in a hospital gown (with the back open) and holding a cup of what looks to be tea. The implication is that the PM has dementia and has forgotten that he had defunded the sector as part of a previous government. But hospital gowns are never worn in nursing homes, it is purely a piece of fiction. Similarly, most commentators who will be talking about the royal commission in the near future will not understand the conditions that exist in most nursing homes in Australia.

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