Age has wearied nursing homes and their residents — a sprightly vision is needed

Countless Australians visit older relatives in nursing homes — but how many of us still hesitate before we walk through the door, ready to recoil? 

The pungent smell of humanity, the antecedents of death — so often associated with nursing homes — offer a grim truth: facilities built for the gradual decline into old age cannot be retrofitted to manage the clinical care needs of an older population with increasingly compressed morbidity.

Aged care, nursing homes and residential care are all synonymous in the eyes of the community, the sector and the government. This could be because residential care receives 60% of all aged care funding. It could also be because it presents the highest operational (and reputational) risk. 

Without change, residential aged care will morph into a substandard backstop for the nation’s acute care system. And either we, or the people we care for, will have a system no longer fit for purpose.

The level of complex and clinical care needs for nursing home residents will continue to rise, driven by the ever-tightening entry criteria for aged care and the desire of people to stay in their homes longer. Over the next decade, residential facilities will be compelled to move closer towards pseudo-hospital settings as demand increases. Proper ventilation will be the least of the federal government’s worries.

We’ve had the horror of our grandparents’ fate reflected back at us, publicly, indisputably. And yet there is nothing to demonstrate their fate will not be ours.

If we are going to demand better, then integrating residential care with hospital services and elevating clinical governance, safety standards and infection control are desperately needed. 

Better aligning residential care with hospital systems, and home care with primary health, could save $21.2 billion over four years, according to the Australian Medical Association, which estimates these savings would only increase from 2025 as the population ages.

One of the first policy positions NSW Premier Dominic Perrottet eagerly pursued was his desire for the federal government to cede its responsibility for early childhood education to state governments to make the early education system more accessible and affordable. If Perrottet is willing to take such radical steps for the nation’s youngest citizens, is he willing to do the same for the oldest?

In the necessity-based environment of modern politics, the temptation has been to look for a quick solution to specific problems. In this environment, “health reforms” have been more likely to involve marginal change because of the pressure for an expeditious resolution. 

Bounded by the traditions of our Westminster system of government, healthcare policies often give little consideration to how best to facilitate local resource-pooling, improve service coordination and navigation, and simplify local decision-making — which leads to an inefficient allocation of resources. 

Policies narrowly constructed within one part of a portfolio — such as aged care — cannot meet the needs of every older person and nor should they be expected to. It would be cost-prohibitive. But when Australians can’t get the care they need, when and where they need it, in their local community, the elderly in particular end up in emergency departments, placing even more pressure on a stressed hospital system. 

As national cabinet commences a year-long discussion on how to address problems plaguing the health system, the question remains: are our nation’s leaders bold enough to construct a square deal for better public health?

When Health and Aged Care Minister Mark Butler said, “We can’t just add more money to existing systems … It’s about getting the settings right; it’s about getting the policy right,” last Friday, that must include addressing the fragmentation within his portfolio. 

Aged care programs initiated without deep consideration as to how they fit into the existing pattern of health and disability care (at a minimum) will continue to adversely affect the quality, cost and outcomes across all care service systems.

To counter the impact of our ageing population on the health system, we will need to elevate comprehensive primary healthcare (endorsed by the World Health Organization) as an equal partner to the dominant biomedical model, so that all citizens and healthcare organisations can be engaged in a collective and collaborative effort to improve population health outcomes.

Much has been said and much has been promised in healthcare reform, and while transformation takes time (and additional effort), only time will tell whether national cabinet is willing to properly ventilate the current intergovernmental dichotomy on healthcare, or whether we will just be expected to breathe in more hot air. 

Given our rapidly ageing population, more time is not something we all have.