The Covid episode has brought forth many ironies. One relates to the way we (don't) look after our aged, especially the frail aged. Many governments have implemented a euthanasia regime, yet pretend to care now for the health of the aged. But governments have actually abandoned the aged for whom they claim to care in their efforts to place the rest of us under house arrest. No dignity - anywhere. It is almost a soft euthanasia program by another name.
The fictional Humphrey Appleby in the 1980s claimed that the British Government should actually like smoking and smokers, and not only for the sin taxes collected therefrom. Premature deaths from smoking saved the government money!
It has been shown that if those extra one hundred thousand people had lived to a ripe old age, they would have cost us even more in pensions and social security than they did in medical treatment. So, financially speaking, it’s unquestionably better that they continue to die about the present rate.
… We are saving many more lives than we otherwise could because of those smokers who voluntarily lay down their lives for their friends. Smokers are national benefactors.
Fast forward to 2020.
The cruel ironies of the Covid panic in Western countries are almost ceaseless. Often these relate to our “care” for the aged and infirm.
A society should consider the degree to which it can be said to be “civilised” by the way it treats its innocent, the helpless and the inherently deserving – the unborn, the frail aged, companion animals, animals that we eat, and veterans.
Infanticide-on-demand laws in most states indicate the degree to which we care for the unborn. Euthanasia is coming to a state or territory near you. Dying with dignity, apparently. Routine, mass cruelty to animals witnessed most clearly in the live export trade, but not confined to live exports, continues unabated. So much for animals. The veterans do ok on the face of it, but this hasn’t always been the case. Ask any Vietnam vet what life was like in the 1970s and 80s.
What about care for the frail aged in our enlightened age?
By any reckoning, we are all failing, miserably and repeatedly. Yet it sometimes takes a meteor-like, exogenous event like Covid to show up the fault lines, to expose the fallacies, the short cuts, the buck passing, the hypocrisy, the unmitigated tosh.
Anyone who has had even the most casual interaction with the aged care system would know of the sheer awfulness of these institutions. The appalling staff to patient ratios, large number of staff for whom English is a very foreign language, relentless neo-liberal short-cutting to save money, whatever the consequences of this, the lack of adequate skills training in proper care for the infirm, the readiness of doctors to prescribe morphine and other potentially life-ending drugs as a default solution, whether or not they are warranted. Neglect, abuse and preventable death, are par for the course, as the Australian Medical Association has noted. I know all this, too, from personal experience.
The increasing foreign component of the aged care workforce is nothing new. A Western Australian report in 2012 suggested the following:
West Australia’s aged and community care industry should look overseas for its future workforce, according to Aged & Community Services Western Australia (ACSWA).
ACSWA CEO, Stephen Kobelke, released the statement yesterday evening in response to remarks made last week by the WA Premier, Colin Barnett, that mining companies should be able to recruit unskilled workers from overseas.
“It is not only the mining sector that requires thousands of additional workers in the short to medium term, the aged and community care sector desperately needs workers too,” Mr Kobelke said.
“The reality is that health and aged care is WA’s single biggest sector, employing more than 141,000 workers, and yet our ageing population needs thousands more paid caregivers to cope with demand for future services.”
One sector that needs more overseas workers like a hole in the head is aged care, one might think. Aged care is also scaling up through mergers and acquisitions. Aged care is increasingly run by larger and larger companies. As one M&A consultancy has noted:
The aged care sector in Australia is a $20 billion industry with an annual growth rate of 5.1 percent, much above that of the broader economy. Key drivers of growth in this sector include government assistance, the increase in Australia’s ageing population and the need for age-appropriate accommodation services.
Merger, acquisition, and consolidation have increasingly occurred in the aged care sector over the past 5 years. Many operators have recognised the benefits of economies of scale that are available through acquisition, whilst other operators have exited the industry due to lack of capital or scale.
There are a number of factors that have a direct impact on the valuation of businesses in the aged care sector, such as:
- The potential for scalability;
- The ability to take advantage of government subsidies and grants;
- The implementation of quality systems, procedures, and protocols;
- The ownership of more than one facility and optimal capacity utilisation, and
- The high demand for services in a geographical area.
A multinational, corporatised sector, then, growing as an “industry”. Aged care is big business.
According to another consulting firm:
The ‘new world’ of aged care will likely see a greater prevalence of larger players, creating tangible, current opportunities for those contemplating sale.
Historically, the limited access to subsidies and heavy Government regulation had restricted new private sector investment in residential aged care. However, investment is becoming more attractive as consumers are required to contribute more toward the cost of services and subsidies have increased to meet higher levels of need.
The most notable change in investment appetite took place in the 2000’s as groups such as Macquarie Bank, AMP Capital, Japara and BUPA started to secure market share by acquiring thousands of beds across Australia.
Then there is the almost manic turnover of ownership of aged care facilities.
A review of aged care facility ownership shows that around 17,000 beds have either changed hands or are currently changing hands since 2010, representing almost 10% of a very thinly spread sector.
… The departure of smaller providers is most notable over recent years. Around 30 single home or small portfolio, operators have been assumed by the remaining private for-profit operators.
… The classes of investors being actively observed include Private Equity, foreign investors (private organisations and sovereign wealth funds), and institutional investors (property REIT’s and superannuation funds).
Each investor class has a distinct risk appetite, return expectations, and investment approach.
Increasingly, councils are outsourcing their aged care assets. Not that you would normally like incompetent, increasingly corporatised, often corrupt local governments running the care for our aged.
Yet in the context of the epic Covid fail of Australia’s aged care sector, I wonder how many Australians think all this is a good thing.
Aged care seems to be a classic case of industry capture of the bureaucracy – the completely ill-named Aged Care Quality and Safety Commission – as fully explained by the public choice theorists. Like higher education, when aged care ceased to be a “service” and became an “industry”, the inevitable slide to mediocrity and worse became inevitable. Oh, and who has political responsibility for aged care? The Commonwealth, not Daniel Andrews nor his fellow premiers. And who has been in power in Canberra for the past seven years, with oversight of this national disgrace?
Aged care was a disgrace before the current crisis needlessly emerged. It is now that Marxian combination of tragedy and farce, all at once. In September 2019, the AMA had this to say, pre-Covid:
The Australian Medical Association (AMA) and the Australian Nursing and Midwifery Federation (ANMF) are today jointly calling on the Federal Government to act now to guarantee quality and safety in aged care, and not wait till the conclusion of the Royal Commission in late 2020 to deliver much-needed new funding and reforms.
The Royal Commission into Aged Care Quality and Safety has already identified serious and dangerous shortcomings in the system, and more concerns will surface before the Commission delivers its final recommendations in November 2020.
The AMA and the ANMF fully support the work of the Royal Commission, but older Australians in aged care, and their families and loved ones, cannot wait another year for Government action to fix aged care.
Care can’t wait.
The AMA and the ANMF want the Government to take urgent measures to improve the situation in aged care, and bring comfort and confidence to our parents and grandparents who have given so much to their families and the communities throughout their lives.
The relative costs of providing care to an old person in a “care” home as opposed to a hospital are revealing, and explain a lot in these economically rational times, where cost cutting, whether in government or in business is the default policy position and a euphemism for “strategy” (cost cutting a euphemism for strategy or vice versa?). The relevant numbers are about $300 per day versus about $1200 per day. Guess why those dying of Covid weren’t sent to hospitals but left to rot and die in their misery and loneliness.
Oh, and take a look at the figures on the breakdown of grants announced by the Morrison Government for enhanced Covid care. The money allocated to training for emergency aged care workers was almost non-existent, while those lucky enough to be furloughed have been rolling in cash-splash clover.
The apparent policy stance of Australian and other Western governments during Covid might best be described as euthanasia-lite. We are saving them from Covid by … killing them! Who needs a formal regime of euthanasia when you’ve got Covid? Informal euthanasia.
We (the rudely healthy) are all meant to be submitting to house arrest and wearing muzzles in order to protect the old and infirm. Yet, in relation to actually protecting those few among us who are actually at risk from Covid, governments stand idly by, while they do precisely nought to provide even the most rudimentary care for the old and infirm. Without parliaments sitting and absent any real media scrutiny, making idiot rules, fiddling figures, cluelessly flip-flopping, moving goalposts, extinguishing freedom, generating hysterical fear, abusing the sceptical, hunting down whistle blowers, destroying wealth and generally running around like headless chooks – but not looking after the sick.
Is this meant to be some sort of joke by the government, at our expense? Endlessly appealing to the objective of looking after the aged, through ministerial pressers, media releases and puke-making infomercials while in actual fact sentencing them to death.
They could scarcely have done a worse job if their actual intent was to kill the elderly. I suppose we should be grateful that our own governments at least haven’t gone down the path of New York’s Governor, Andrew Cuomo, America’s biggest ever serial killer, who literally shipped the sick elderly from hospitals to nursing homes already known to be Covid petri dishes. Perhaps our governments are so stupid that this didn’t occur to them. On the other hand, one might plausibly take the view that by refusing to ship the Covid-infected elderly to hospital, our governments were, in fact, being de facto Cuomos.
The forced separation of the dying aged from their loved ones during Covid has been unconscionable, both in Australia and in other Anglosphere countries. Especially as governments have watched on while Covid mercilessly colonised aged care homes. And the response of Senator Colbeck, the Aged Care Minister, was to send out a few memos. Mercifully, the Turnbull supporting Senator Colbeck is in his sixties and hopefully won’t have to wait too long to experience directly the fruits of his and his predecessors’ minimalist labours, in the form of pathetically inadequate aged care.
About the only high risk group in this period of ersatz pandemic is … old people!
Virtually no one else dies, even gets sick, from Covid. Yet what have governments done? They have been disdainful of the old and (at best) annoyed the crap out of many of the rest of us, delivering themselves powers normally used, even then tentatively and reluctantly, in war time.
The unavoidable conclusion is that our democratic governments don’t give a rat’s about the old. We know that those who, like Daniel Andrews, most Greens, the NSW Nationals and plenty of ALP and Liberal parliamentarians, actively support radical euthanasia laws, are already in the camp that believes the old can be dispensed with, with minimal fuss. We might have expected more during Covid, though, from those who are not in that camp. Like Scott Morrison, for instance.
The irony – yet another irony of these times – is that those who favour euthanasia appeal to an argument for “dignity”. (Not my definition of dignity, by the way). Where is the dignity for the tens of thousands of old people who have been totally abandoned these past months, both in Australia and overseas?
Dignity? Here is a report on conditions by some of the military sent in to support the aged in homes in Canada:
- Unsanitary practices with parenteral (tube) feeding including liquid food that has curdled.
- Unsanitary catheter practices, and leaving them in too long (3 weeks in one patient).
- Fear of using supplies in a cost-conscious private facility.
- Wound changes that do not preserve sterility.
- Lack of wound care supplies, and consequent delayed changing of bandages.
- No mouth or eye care supplies.
- Poorly trained staff.
- Lack of staff (1 RN for 200 residents in one case).
- Patients sedated just because they are anxious, sad or depressed.
- Aggressive and rough treatment by staff.
- Forceful feeding and hydration leading to choking and aspiration.
- Leaving food in the mouth of a sleeping patient.
- Insufficient turning of patients in bed to prevent bed sores.
- Patients left in soiled diapers.
- Putting diapers on patients instead of letting them go to the toilet.
- Patients crying for hours without getting attention.
- Not putting patients in wheelchairs but leaving them in bed continuously.
- Taking mobility aids away from patients so they don’t wander.
- Cockroaches and flies.
- Trays stacked with rotten food.
- Lack of feeding and hydration.
- No way to receive personal supplies from outside, such as magazines, snacks, shampoo, and soap.
One would like to think that none of these things happened in Australia. But why would anyone assume that? These have been the brutal experiences in UK nursing homes during Covid:
- Workers will be scared to death of being infected by their patients and therefore will keep contact to a minimum.
- Some workers will quit resulting in others being overworked.
- Other workers will test positive by the flawed COVID-19 RNA test and will be quarantined instead of working, for up to two weeks.
- The role that visitors play in ensuring that their loved ones are not neglected, not treated in unsanitary ways, and not abused will be removed.
- The assistance that visitors give the staff, in feeding their loved ones, helping them dress, and so on, will be gone.
- Any resident who is suspected of being infected will be confined to their room.
- Eating together will be banned.
- All social events will be cancelled.
- All outings will be cancelled.
- All non-essential health services, such as physiotherapy or exercise classes will be cancelled.
In the UK, the number of excess deaths (non Covid related) deaths in care homes has been huge over the Covid period. 30,000, to be precise. This is a shocking indictment of all concerned in the running of UK aged care residences. As Toby Young states:
One likely explanation is that some of the excess is comprised of care home residents with other diseases who were not admitted to hospital when they should have been.
In Australia, the story has been similar in its utter sadness. A huge chunk of the deaths from Covid here have occurred in nursing homes.
According to the Australian Parliamentary Research Service:
Aged care recipients accounted for 1.4 per cent of all COVID-19 cases in Australia, but 29.4 per cent of COVID-19 deaths [as at 19 June].
As reported in The Guardian:
An aged care expert has told the royal commission examining the sector that Covid-19 is “the worst disaster that is still unfolding before my eyes”, and warned that hundreds of residents will die prematurely because of a failure of authorities to act.
Prof Joseph Ibrahim, head of the health law and ageing research unit at Monash University’s forensic medicine department, also told the aged care royal commission on Wednesday morning he believes Australia’s rate of death in residential aged care is more than 68% – the second-highest in the world behind Canada at 80%.
… Ibrahim criticised “people in governance positions” within Australia’s aged care sector, and governments, for not recognising “the magnitude of the problem staring them in the face” and said the fact different federal and state government bodies and regulators hadn’t taken responsibility for aged care issues was causing confusion.
“The human misery and suffering must be acknowledged. This is the worst disaster that is still unfolding before my eyes and it’s the worst in my entire career,” Ibrahim said.
“In my opinion, hundreds of residents are, and will, die prematurely because people have failed to act. There’s a lack of empathy, a lack of urgency. There’s an attitude of futility which leads to an absence of action.”
A lack of urgency? Contrast this governmental undergraduate insouciance over aged care homes with the sheer panic governments and their supine mates in the corporate media have generated for the healthy rest of us. You couldn’t make this stuff up.
On Covid planning, Professor Ibrahim had this to say:
This health sector emergency response plan does not address what needs to happen in aged care. It simply says aged care is a high-risk area.
Such is the stuff of policy failure on the very grandest of scales. Not one single ministerial resignation. Instead, towering popularity revealed in the polls for the current crop of leaders.
Almost unbelievably, staff cuts have continued during Covid. Staff CUTS! This is, of itself, appalling. But wouldn’t you think this would encourage decision makers to put the nursing home patients infected with Covid into our virtually empty (Jim Hacker like) hospitals?
The Canadian David Crowe has observed:
I believe that the isolation of patients in nursing homes has not prevented deaths, but has caused deaths. Elderly, infirm people have nothing to live for any more, and poor care and abuse can no longer be observed, and stopped, by visiting friends and relatives. Underpaid staff, those who have not quit or been put in quarantine, are even more overworked than normal, resulting in poor care, frustration and abuse. Hospitals do not want nursing home patients, and the recommended alternative for the nursing home is to sedate and, if that doesn’t work, sedate some more.
Illness unattended. Loneliness. Isolation from loved ones. No deathbed consolation from family. No last rites. Pain. Suffering without end. Misery. Death. Yesterday, today, tomorrow. Continuing unabated. Why is there not rioting in the streets over the scandal of lost current, aged lives, rather than over inflated, long dead issues now mercifully resolved in most countries and of marginal (and mainly ideological) relevance to most of us?
Covid may have proven to be the perfect storm for aged care problems. But it isn’t just the number of deaths from Covid that have occurred that is at the heart of our aged care scandal. Nor is it just the system wide failures of the aged care sector, Covid or no Covid. It is also the ghastly treatment meted out to the sick and the healthy in our aged care homes, and to their families during Covid. Covid has delivered “next level” hideousness to aged care facilities already regarded as awful.
Here is one case reported to the Royal Commission from Western Australia, pre-Covid.
Direct evidence was heard from Noleen Hausler, the daughter of Mr Clarence Hausler, who suspected her father with dementia was being mistreated and placed a camera in her father’s room for eight days in 2015, recording terrible instances of abuse.
The Royal Commission saw some of the footage of the rough care and abuse experienced by her father including one example of a carer force-feeding him, pinning his arms down, and even holding a napkin over his nose with excessive force, all within a 25 minute period.
So much for ageing with dignity. So much for dying with dignity. Unlike those who choose to go down the suicide path, these poor folk have had little choice this Covid year.
We should be ashamed of our governments, and of ourselves, for this wilful neglect of our vulnerable aged. Less selfish cultures than ours, which routinely care for aged family members in multi-generational households rather than outsourcing their care to those clearly ill-equipped to provide care during the good times, have suffered, sadly and ironically, for their caring, in-home approach to aged care during the Covid bad times. Italy comes to mind.
We can only hope that the Royal Commission into Aged Care Quality and Safety, chaired by Tony Pagone QC and Lynelle Briggs AO, will make findings that not only comfort the aged and their families but that also make our governments fully accountable for their failings this year. In more traditional times when ministerial responsibility meant something in our democracies, and where virtue was rendered more than lip service, heads might have rolled over the sheer shame of our aged care during Covid.
Australia’s aged care homes are characterised by privatisation, corporatisation, for-profit operation, overseas ownership and tax avoidance. The top six for profit aged care companies account for about a fifth of Australia’s aged care beds.
As a recent (2018) report by the Tax Justice Network pointed out:
BUPA’s Australian aged care business made over $663 million in 2017 and over 70% ($468 million) of this was from government funding.
BUPA, of course, is an insurance company.
The oversight of these providers by Canberra is clearly of a light and totally ineffective touch, to the considerable benefit of the providers, and older Australians and their families suffer much from this neglect. Yet the subsidies to these places of third world service levels keep on rolling. In short, the care of our aged is in the hands of venal providers not especially experienced in aged care, unskilled staff and incompetent governments and leaders who have completely lost the plot, in the age of an epidemic that demands the very best care imaginable for the most vulnerable among us. Those who control the day-to-day care of the aged and those whose job it is to ensure the providers perform appropriately seem to be in the business of self-preservation, blame shifting, cost cutting, petty politics, cover-ups and public relations. What an unholy mess, utterly exposed by the Covid scare.
No country for old men and old women, this one. Sir Humphrey would, no doubt, be pleased.