Tuesday, February 25, 2014

Aged care and what to do

I have recently been asked my opinion about aged-care facilities, and there are so many aspects to this line of questioning, that it is difficult to know if one has responded appropriately. It is not the first time that I have been asked such a question. Usually, those who enquire simply want to know my opinion on Place A vs Place B. But usually, a request for "advice" is attached. As it was on this recent occasion.

A person is "low care" if (let's say "she") she, can walk, can feed herself, can shower, and can dress, all unaided. The fewer of the things she can do, the more likely she is to be classified "high care". The classifying is the responsible by a State Government medical team known as ACAT - Aged-Care Assessment Team. Increasingly, Low-Care can be sub-divided into home-care or institutional care. Let's say that your aged relative has been classified as requiring "high care". You could, of course, choose NOT to put her into an institution. However, you need to be clear-eyed about the amount of physical and mental work that will be required of you, over an undefined period of time.
What is abundantly clear is that aged people requiring on-going care should not be cared for in a hospital. Hospitals are to make people well, not to care for them in their dying days/months/years. Yet our hospitals are full of aged-people. Emergency Wards are full of aged-people who have grown too much for their house-bound carers. On one of my numerous trips to hospital with my father during 2007, an ER nurse asked me why he had gone to hospital in an ambulance, and I had to tell her that I really had no idea. She smiled wanly, and said she had a fair idea. Old people get scared they are going to die. Their carers get scared that the old person is going to die. At least if she were to die in hospital, the carer can rest, assured she has done everything possible. Old people ARE going to die, and it is best they die at home. If that is not possible, they should die in an aged-care facility.

What sort of aged-care facility? For mine, there are two requirements: the facility should be as close as possible; and the facility should be prepared to follow the old person's (or their legally responsible person) medical wishes. If you agree to become the person "responsible" then you have to get a legally attested "Enduring Power of Attorney" and a legally attested AND registered Enduring Guardianship. The PoA enables you to make financial decisions on behalf of the person being cared for. The EG allows you to make health and lifestyle choices for her. If she is deemed incapable of making these decisions (as was my father), you apply to the Guardianship Tribunal under your state Attorney-General's Department. It is laborious and requires annual returns, so is much better if the person is compos-mentis. I am of the opinion that, if the aged person is incapable of making this decision, then the entire process has been left too long. But that is just my opinion. There is a lot of greed for more time as we age. It is our "entitlement". We have a right to life-saving intervention, no matter how old and how frail. If we want to live forever, then we should be given every chance to do so.

Why as close as possible? My father was in care from November 2007 until he died in May 2011. For the first two years, I lived 5 kms away. I visited him each Saturday morning for 3 hours. When I could no longer drive, I moved into an apartment about 200m up the street from him. He could no longer cope with three hours, indeed there were times when the visit was dun'ndusted in 15 mins. I went home and returned the next day when the chances were he was in a better mood. For the last week I was there 2 0r 3 times per day. Proximity is everything. My brother is currently in care, and he could very well outlive me! He lives just over 2.5 hours away. I visit him every two weeks for about 3 hours.

Why should the facility of choice agree to abide by the aged-person's medical wishes. Aged-care facilities do not wish to be sued for not doing everything possible to keep someone alive. Even someone very old, and terminally ill. Old-age is a terminal illness. If the facility thinks that a client has fallen, or is vomiting for an unknown reason, they immediately call an ambulance, They are NOT allowed to make any other sort of decision. They cannot say "Her time has come, let us respect her as a person, and allow her to die in peace and quiet".

How posh should a facility be? An aged-care facility is not a retirement village, nor a retirement home. It is a NURSING facility. It is full of people who are bed-bound. It is full of people who sleep most of the day. It is full of people who are incontinent. Each nursing assistant gets to look after, perhaps, two wards of 4 people in each. And aged-people are quarrelsome. They are bad tempered. They are demanding. They are scared. They are lonely. And yet, mostly, Australians want some money left over from an aged-pension, or its equivalent. To this extent, they strip assets from elderly people as they approach care, yet still demand modern, clean, up-to-date facilities.
I guess it is understandable that people did not want to hear all this from me. Rather, what they really wanted was a list of facilities, and my opinion of each facility on the list.


diane b said...

A well expressed opinion and facts about aged care. I remember having a problem selling my mothers apartment when she suffered dementia because we had not registered the power of attorney with the lands department.So that is important for carers to know. Luckily Mum summoned up the brain power to know what she was signing when the sale went through. I was so relieved.

Joan Elizabeth said...

I read this with interest. I often wonder who is going to pop me into the home when I need to go there.

Julie said...

mmm ... another post coming based on your comment, Joan. This post is very popular with unknown people searching for info.