Showing posts with label aged care. Show all posts
Showing posts with label aged care. Show all posts

Saturday, 17 October 2020

Tweet of the Week

 


Friday, 9 October 2020

Scott Morrison still denying responsibility for the elderly Australians in aged care who died of COVID-19

 

Snapshot of Australian Prime Minister Scott Morrison during a 7 October 2020 television
interview on the ABC program "7.30". Image: @OzLady0


This is a face Australian Prime Minister & Liberal MP for Cook Scott Morrison tries not to show to the general public - a narrowed, steely-eyed gaze with set lips - one of his 'if looks could kill' moments.


This is what brought forth that particular look......


ABC Television, 7.30 program, transcript, 7 October 2020:



LEIGH SALES: Prime Minister, I would like to spend quite a bit of time tonight talking about aged care. Three-quarters of the COVID-19 deaths have been in this country, in aged care facilities, that is 673 people.


Those facilities are the responsibility of the Federal Government. In the past, gastro and flu epidemics have ripped through aged care facilities. We knew from Newmarch House in April how horrific coronavirus in aged care could be.


How did the Federal Government fail so comprehensively to prevent this tragedy?


SCOTT MORRISON: Well, Leigh, first of all, on a couple of points. The Commonwealth Government put in $1.5 billion extra in support to deal with everything, from workforce support to PPE and training and equipment to assist the aged care sector as it dealt with the COVID-19 pandemic.


Now what we saw in particular ...


LEIGH SALES: And there are still 673 people dead ...


SCOTT MORRISON: Leigh, if you could just let me finish, if you could just let me finish.


LEIGH SALES: As long as you address the question, I'm very happy for you to finish.


SCOTT MORRISON: Well, I am talking about what we have been doing to address the COVID pandemic in aged care. 


LEIGH SALES: I'm asking why you have failed?......


The full interview video can be accessed at:

Saturday, 3 October 2020



Monday, 28 September 2020

The dramatic increase in COVID-19 deaths in Australia’s aged care homes begs the ethics around our treatment of people in aged care, says a UNSW expert


MediaNet Release, 24 September 2020:

Treating our elderly people ethically and with transparency

UNSW’s Richard Hugman says it is time to stop treating elderly people as objects, as the Royal Commission into Aged Care and Safety continues.

The dramatic increase in COVID-19 deaths in Australia’s aged care homes begs the ethics around our treatment of people in aged care, says a UNSW expert. In less than four months, deaths from COVID-19 in aged care have increased from 28 to 580, at the time of writing.

UNSW Emeritus Professor Richard Hugman, a social worker who specialises in the aged care professions, says Australia’s service provision needs to treat older people as human beings rather than objects.

"To use a similar ethos in caring for human beings that you would use in producing physical things for sale, I think is an unfortunate way to think about the world,” the former professor of social work at UNSW Arts & Social Sciences, says.

"The way policies are framed around running these [places], it is as if they are running a factory. I understand good management techniques are transferable across settings, but you also need to understand the content of what you're managing.”

Causes of the COVID outbreaks in aged care

A range of factors have been blamed for the outbreak of COVID-19 in care facilities, including a lack of training in the use of Personal Protective Equipment and supplies available for care staff.

Melbourne’s aged care homes have been the worst hit, with all but five of the 115 aged care homes affected by the virus in Victoria. St Basil’s recording 44 deaths, Epping Gardens 36 deceased and Twin Parks Aged Care in Reservoir with 21.

In Sydney, Newmarch House recorded the state’s highest death toll in aged care with 19 cases, including two residents who had COVID-19 when they died from other causes. And the numbers are growing.

Newmarch and St Basil’s had alarming numbers because they decided not to transfer patients to hospital, Prof. Hugman says.

"I haven't seen the detail, but the question I would be asking is, ‘were those homes actually using established infectious disease control methods?’” he says.

The decision not to transfer patients is exacerbated by the fact that today there are very few qualified nurses in nursing homes, Prof. Hugman says.

"Some nursing homes don't even actually have a nurse on duty at all times. If they’re looking after 100 people and they’ve got one nurse on duty to supervise other people, then they might have somebody who has a certificate from TAFE administering drugs and medications.

"Whereas in a hospital, someone would actually have to be a qualified nurse to be doing that.”

Care staff working across multiple sites during the pandemic have also reportedly been a likely source of COVID-19 transmission. Prof. Hugman says staff have to work between homes just to earn enough to survive on.

"It's not just in Victoria, despite what the government says. These are all reflections of the broader ethics of the social value that is placed on [ageing] people, so that they seem to be less well cared for than they could be otherwise.”

Early findings from the Royal Commission’s interim report

The Australian Royal Commission into Aged Care Quality and Safety (RCACQS) is looking at better financing models, including regulation of aged care providers, in its latest hearings expected to run until September 22.

It comes after a survey by the University of Queensland for RCACQS estimated it would cost $621 million per year to improve the quality of all aged care homes to better standards. In its October 2019interim report, the RCACQS’ scathing review stated that aged care is a “shocking tale of neglect” in Australia that fails to meet the needs of our elderly people.

Australia’s aged care sector is “unkind and uncaring” towards older people, it does not deliver uniformly safe and quality care and often neglects them, according to the interim report.
Prof. Hugman says while the Royal Commission creates an opportunity for people to speak up, the real challenge lies in the government’s response and how it then permeates into the wider society.

A lack of transparency

Prof. Hugman says there is a lack of transparency in how government funding is spent by management in aged care facilities in comparison to community-based social services where monitoring is stringent.

He says claims by some aged care homes, particularly those from the for-profit sector, that they have to spend less on staff relative to residents in order to cover their costs just doesn’t stack up.

"And those claims about non-profitability do not explain how or why the [aged care] for-profit sector remains [in operation],” he says.

For-profit aged care homes have reported more cases of COVID-19 than facilities operating on a not-for-profit framework, heightening concerns about staff numbers, training and supplies.

Raising the social value of elderly people

The Victorian Aged Care Response Centre has since been set-up to coordinate efforts to stabilise any further COVID-19 outbreaks across the private and public aged care sectors, with an infection control officer now stationed in each facility.

And the Royal Commission is set to release its final report by 26 February 2021.

Prof. Hugman recommends the government respond to the Royal Commission by not only providing sufficient funding but by also ensuring older people are treated with dignity and care.

"[The government needs to] focus on improvements to the aged care sector that are not reflective of a sense that older people needing care are a burden on society,” Prof. Hugman says.

[Instead, they need to focus on the fact] that older people are part of society and that a good society is one that values all its members.”

Prof. Hugman also says there needs to be an emphasis placed on the expression of positive values about how to treat and view elderly people as human beings.

"Frankly, there are some places I've visited in the last few years, either because I've had friends or relatives who are living in them or I've gone to visit for professional reasons,” Prof. Hugman says.

And they’re places, “I wouldn't go anywhere near”.


Sunday, 6 September 2020

Opposition Leader Anthony Albanese invites Australian voters to "Tell Morrison to fix aged care"


A 31 August 2020 email Opposition Leader and Labor MP for  Anthony Albanese is sending out:

Tell the Morrison Government to fix aged care

Neglect. That’s the legacy of the Morrison Government when it comes to aged care.

People with open sores left unattended. A woman with ants crawling from her open wounds. Aged care residents left hungry, alone in their rooms.

Our most vulnerable Australians are dying without their family by their sides.


You’d think the Government’s response would be to take responsibility?

You’d think the Minister would stick around to answer questions?

But no.

All we see from the Morrison Government is running away, passing the buck, and refusing interviews.

The Morrison Government has no plan to fix the aged care system.

But we do. We want the Government to take these eight steps.
  1. Minimum staffing levels in residential aged care
  2. Reduce the home care package waiting list so more people can stay in their homes for longer
  3. Ensure transparency and accountability of funding to support high quality care
  4. Independent measurement and public reporting as recommended by the Royal Commission this week
  5. Ensure every residential aged care facility has adequate personal protective equipment
  6. Better training for staff, including on infection control
  7. A better surge workforce strategy
  8. Provide additional resources so the Aged Care Royal Commission can inquire specifically into COVID-19 across the sector while not impacting or delaying the handing down of the final report

The problems in aged care were around long before the coronavirus. The pandemic has been like an x-ray. It’s shown us what was broken.

Older Australians built this country ­– and they deserve so much better than this.

Thanks and stay safe,


Anthony Albanese

Australian Labor Party 
Authorised by P. Erickson, ALP, Canberra.

Thursday, 3 September 2020

Morrison Government believes that warehousing older Australians until they die is the appropriate function of aged care in Australia?


An estimated 221,300 people in Australia entered aged care services between 2009–10 and 2018–19. 

Months before the COVID-19 global pandemic hit, in fact on 31 October 2019, the Royal Commission into Aged Care Quality and Safety published an interim report titled "Neglect" which stated in the foreword:

As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities. Sadly, this failure to properly value and engage with older people as equal partners in our future has extended to our apparent indifference towards aged care services. Left out of sight and out of mind, these important services are floundering. They are fragmented, unsupported and underfunded. With some admirable exceptions, they are poorly managed. All too often, they are unsafe and seemingly uncaring. This must change..... 

We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them.

A little over nine months later this is the Prime Minister & Liberal MP for Cook Scott Morrison's opinion of the aged care system his government administers. 

 Financial Review, 14 August 2020:

"On the days that the system falls short, on the days that expectations are not met, I'm deeply sorry about that. Of course I am," the Prime Minister said.

"I know that everyone who is involved in the process who is trying to meet those expectations is equally sorry.

"I think we’ve got to have a reality check about this. I think that it’s great that Australians have high expectations.”….

Mr Morrison said the cohort of Australians seeking aged care had changed significantly since Howard government-era controversies, including revelations of residents being bathed in diluted kerosene.

"We're dealing with a system that is now dealing with a very different demand.

"It is very much at a stage of pre-palliative care. And that is a very different proposition in terms of the facilities, the workforce, the clinical needs, to what it was 10 years ago.

"The system needs to be adjusted to meet that."

This is what his Minister for Aged Care and Senior Australians & Liberal Senator for Tasmania Richard Colbeck stated on the floor of the Senate on 31 August 2020:

"There are about 60,000 Australians who die in residential aged care on an annual basis unfortunately, but that's one of the functions of residential aged care." 

Here are some social media comments from older Australians and their families concerning the predominately for profit wharehousing being endorsed and funded by the federal government:

"As older woman something struck me after conversation with other local women in my age group. Everyone expressed horror of residential aged care. Some have told children they do not want this to happen, some expressed an intention to suicide - active or passive. Australia 2020".

"So agree".

"Exactly my sentiments, I've told my children not to ever consider putting me into residential care. I'd rather find a good drug dealer or Euthanasia Medical Specialist to take care of things."

"My 87 year old Mum agrees. Been in the family home for over 50 years, says the only way she'll leave is feet first."

"I certainly will if faced with the prospect of incarceration in one of these hellholes".

"Told my sister and her kids to take me up the back paddock and shoot me before going this way."

"Absolutely, older women I know are all going to "take care of it" for themselves, when the time is right and won't be told what to do and when by others but are afraid they may not have the capacity or the means to do it for themselves they are afraid."

"I’ve had this conversation with my mother. She begged me, in tears, and told me she’d ‘sort it out’ if it came to that."

"Nearly 70 and still in own home. Will NOT go into aged care. Am first generation that can see what “living forever” via meds etc looks like and really has little appeal for me. Voluntary end of life must be looked at but anyone choosing nursing home has absolute right to decency."

"I'm 40, and have worked in an aged care home. I have also told my kids not to put me in a home, that I would rather die with some dignity."

"My mum told me to knock her on the head with a frying pan. I told her I wouldn’t go to jail for her, she could just live with me. Aged care has been a disgrace for decades. It is a genuine fear for seniors & a heartache & fear for families with no other choice."

"Once I'm passed looking after myself is when it's time to go. Seen to much damage done by evil neglect to those who are forced to live past their "best before" date." 

"My parents, who are in their 80s, have both said that they would rather suicide than go into an Aged Care home. I have told them that they can move in with us and we will get the in-home care that they need, but they won't consider this. It makes me sad, but I understand them."


BACKGROUND

Residential aged care for the 221,300:

More than two-thirds of these were an admission into residential care—this was split between permanent (almost 70,000) and respite care (over 83,500).
Of all people entering aged care, around 1 in 5 people were admitted to home care (almost 43,800) and 1 in 10 were admitted to transition care (over 24,000).
Almost 60,800 people were admitted to permanent residential aged care for the first time in 2018–19. [Australian Institute of Health and Welfare, GEN aged care data]

In 2017-18:

More than 3,000 aged care providers in Australia deliver care through nearly 9,000 services (outlets). The sector comprises private (for-profit) providers alongside community-based and charitable providers, and state and territory and local government providers. The mix of ownership type varies across programs, with the largest proportion of for-profit services in the residential care program (41% of residential aged care places are managed by for-profit providers).

Collectively, these services supported the care needs of more than 1.2 million people in 2017–18, at a total cost to governments of $18.4 billion. Consumers may also be asked to contribute to the cost of care. In residential aged care, for example, the cost to governments in 2016–17 was $12.1 billion, and residents contributed a further $4.7 billion (ACFA 2018). [AIHW , Aged Care Snapshot, 11 September 2019]
  • In 1997-98, the average age of entry into residential care for females was 82.8 years; by 2008-09 this had increased to 84.3 years. For males, over the same period, the average age of entry into residential care increased from 79.5 years to 81.6 years.
  • In 2000-01, the average age of people admitted to Community Aged Care Packages was 79.7 years. By 2009-10, this had increased to 81.4 years. Between 2003-04 and 2009-10 the average age of people admitted to Extended Aged Care at Home Packages increased from 80.8 years to 82.2 years.
In June 2018 the majority of older people in residential aged care were 75 years and over – 81% of all men and 90.5% of all women [Australian Institute of Health and Welfare, GEN aged care data]

Fourteen years ago the bi-annual proportion of persons over 65 years of age dying in residential aged care in Australia was estimated at between 34% (high level care only) to 53% (including both high and low level of care plus respite care). [Broad, J.B. et al, 2015, Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison, p.3]

The Minister:

The Sydney Morning Herald, 30 August 2020:

Colbeck was appointed to the Senate in 2002 to fill a vacancy. In 2016 he lost his seat after being demoted to fifth place on the Coalition ticket in Tasmania, but unexpectedly returned in February 2018 after the parliamentary eligibility crisis forced Stephen Parry, a dual British citizen, to resign.

The Prime Minister:

The Sydney Morning Herald, 26 October 2009: 

Towke won easily. On the first ballot, he polled 10 times as many votes as Morrison, 82 votes to 8, who was eliminated in the first round. His victory meant that a Lebanese Australian would represent the Liberal Party in the seat where the Cronulla riot and revenge raids had taken place 18 months earlier, in December 2005. ''The campaign against me started four days after preselection,'' Towke said.....

Though Towke would eventually win his legal war, the damage had been done. The adverse media coverage set in train a reaction within the party to get rid of him. A second ballot was ordered, in which the balance of power was shifted away from the grassroots in Cook and to the state executive. The second ballot gave the preselection to Scott Morrison. Amazing. He had been parachuted into the seat over Towke's political carcass. Morrison clearly had backers who wanted him to get the seat. ''These guys were prepared to ruin my life,'' Towke said.

Thursday, 30 July 2020

Fair Work Commission shuts the door after COVID-19 has bolted


In April 2020 the Fair Work Commission was aware of a need and varied 99 modern awards to support the inclusion of "unpaid pandemic leave".

At the time it was also aware that there was a need to consider paid pandemic leave in respect of “health care workers” covered by a number of awards.

However, on 8 July the Fair Work Commission dithered and refused to vary identified “Health awards” to provide for paid pandemic leave.

This refusal came despite the strong suspicion that some private sector aged care workers in insecure employment were not declaring COVID-19 symptoms as they could not afford to stay home without suffering financial hardship and possible loss of ongoing employment.

The inevitable began to occur. COVID-19 infection numbers began to rise again in private sector aged care facilities in Victoria where there are now at least 440 active cases in 61 aged care facilities and the death toll for those in residential care stands at 47 elderly people.

In addition these 61 aged care facilities appear to be associated with another 78 COVID-19 cases.

Although Victoria has the highest death toll New South Wales is not far behind, with 29 elderly people in residential care dead since the start of the pandemic.

The national COVID-19 death toll in residential care stood at 78 on 29 July 2020 according to the Australian Government Dept. of Health. 

It was only on 27 July that the Fair Work Commission decided it was convinced there was a need for paid pandemic leave in the aged care sector*.

ABC News, 28 July 2020:

Aged care workers employed under three awards will be entitled to two weeks' paid leave if they are required to self-isolate due to having coronavirus symptoms or being a close contact of a confirmed case, following a ruling from the Fair Work Commission.

The amendments will come into effect from Wednesday, July 29, and last for three months.

Conditions attached to the paid leave include:
  • Workers must be aged 17 or older and be likely to have worked during the self-isolation period
  • Cannot be receiving any income — including other leave or JobKeeper — during their time in quarantine
  • If workers test positive to the virus they will be provided with workers compensation leave, which will supersede the pandemic leave
  • If the direction to self-isolate comes from a doctor, and not come the Government or employer, the worker must provide a medical certificate
  • The entitlement extends to casual employees "engaged on a regular and systemic basis" and the payment would be based on their average earnings over the past six weeks.....
In its ruling, the FWC stated "it cannot be assumed that the current outbreak will remain confined to Victoria".

"The recent events in that state demonstrate how rapidly circumstances can change," the full bench of the commission found.

"Recent developments in New South Wales are not encouraging. The award of the entitlement remains necessary notwithstanding that the current locus of the pandemic is in Victoria."…...

Key points:
  • The Fair Work Commission ruled the paid leave was necessary nationwide due to recent events demonstrating "how rapidly circumstances can change"
  • The ruling follows submissions from the Australian Council of Trade Unions, the Health Services Union and the Australian Nursing and Midwifery Federation calling for paid pandemic leave to apply for all staff in aged care across the country until the end of September
  • Only casual employees who can have been employed on a "regular and systemic basis" will be entitled to the paid leave
  • The commission's ruling grants paid pandemic leave to staff working in residential aged care under the Aged Care Award, the Nurses Award and the Health Professionals Award.
NOTE
* See Fair Work Commission, Decisions, Health Sector Awards—Pandemic Leave, (AM2020/13), 27 July 2020

Tuesday, 2 June 2020

Council managed Clarence Care & Support service capacity and staff moving over to the Wesley Mission


The federal government's National Disability Insurance Scheme 
(NDIS) continues to limit choice for the frail aged, chonically ill or those with disabilities, as yet another another local service agency changes hands.

Clarence Care + Support - accredited for aged care service provision and a registered NDIS service provider - which has been helping people in their homes in the Clarence Valley since the early 1990s is being transferred from Clarence Valley Council management to that of the religious charity, Wesley Mission.

The Daily Examiner, 30 May 2020:

Mr Linsday said the arrival of NDIS made it difficult for CCS to operate under council management. 


“It was also the decline in profit margins for all of the aged care sector, competitor threats including the private sector and the amount of government change that has occurred and those planned to occur,” he said.  
“Council has observed that there has been a growing ­consolidation of organisations since 2014 and with the NDIS and the aged care sector ­becoming more competitive council’s model of delivery was not financially sustainable.” 

The council voted to ­transform the service from a council entity to an outside-council not-for-profit organisation. 

Earlier this month Wesley Mission became the successful tender for CCS. 

However, Mr Lindsay stressed that this change-­over was not a sale of CCS but a transfer of the community care services offered by the service. 

“A key requirement for council in transferring the services to a not-for-profit organisation was that the services provided by CCS would be continued to be provided in the Clarence Valley with as many of the existing CCS staff transferring to the new organisation as possible,” he said.

Wednesday, 12 February 2020

Shorter Residential Aged Care Industry Message in 2020: If you personally pay us more we will treat you better


"If we expect people to pay more [in the future], we have to deliver much better care" [Catholic Health Australia chief executive Pat Garcia quoted in The Sydney Morning Herald, 9 February 2020]

ABC News, 9 February 2020:

Sydney's streets were thick with smoke as the blazes took hold on December 5 last year. 

That may explain why few noticed or cared about the final sitting day in Canberra.

But what happened in the Senate that day shows just how strong the ties that bind the aged care lobby and government really are.

At 9.30 that day, some crucial amendments to aged care legislation were introduced which would force nursing home to reveal how they spent their $20 billion of taxpayer funds each year — specifically, how much went to staff, food and "the amounts paid out to parent bodies".

Unlike hospital and child care centres, aged care facilities can employ as few staff as they like because there are no staff-to-resident ratios in nursing homes.

When it comes to food, a study of 800 nursing homes shows the average spend is just $6 a day.

The Senate vote was taking place just five weeks after 
the scathing interim report from the Royal Commission into Aged Care Quality and Safety.

Among its findings of a "sad and shocking" system which was 
"inhumane, abusive and unjustified", the commissioners also commented on the lack of transparency in aged care, with the numbers of complaints, assaults and staff numbers all kept secret from the public.

"My amendments are all about transparency and accountability — 
and, boy, do we need more of this," said Senator Stirling Griff from Centre Alliance, who proposed the amendments.

When the crucial vote came, Labor, the Greens, Centre Alliance and Jacqui Lambie supported it. But the Government voted against it and, with the help of Pauline Hanson, the reform was defeated.

It might seem an odd choice for Pauline Hanson, who has previously rallied against the aged care sector for "rorting and malpractice", but it shouldn't be surprising that the Government voted it down.

The influence of lobbyists

The aged care industry has been successfully lobbying governments for years. The influence of the industry through government committees, think tanks and policies is well known and is being rightly questioned at the royal commission.

For example, when the Queensland Government proposed laws requiring nursing homes to publish their staff numbers last year, the federal Department of Health sent a six-page document arguing against it, saying it might "confuse or mislead" families and "appears to create a reporting burden on providers with no clear benefits to consumers".

If you think the Federal Government's objections sound a lot like those of the aged care lobby, you wouldn't be wrong.

In fact, the industry group Leading Aged Services Australia (LASA) argued in its own submission that few families would be interested in accessing a website with such information and that the numbers could be used "to push a particular medically based care model (which may be contrary to the preferences of residents)".

That's an argument LASA has been using for years. It's code for arguing against more registered nurses for fear it spoils the "home-like" atmosphere of an aged care facility.

Others might argue that the hundreds of stories told to the royal commission of poor wound care, misdiagnosis and failure to send sick residents to hospital may have something to do with that lack of a "medical model".

Currently there's no requirement, except in Victorian state run facilities, for an RN to be employed at a nursing home.

The aged care lobby doesn't want that to become a national trend.

Why can't we know how many staff there are?'

The industry and Federal Government's opposition to the argument against making the staff numbers public didn't wash with the Queensland Government.

"We report the number of teachers to students in classes, educators to children in child care, why the hell can't we know how many staff there are in aged care facilities?," said Queensland Health Minister Stephen Mills, who successfully passed the legislation and says he will "name and shame" nursing homes which refuse to make staff numbers public.

Prime Minister Scott Morrison will argue that the Government voted against the federal moves for financial transparency because it doesn't want to introduce any major reforms before the final report from the royal commission.

However, that excuse didn't stop the Federal Government from its massive reform of putting the publicly funded Aged Care Assessment system out to tender last year.

The move to privatise it was widely denounced by state ministers (including from the NSW Liberal Government), advocates and the medical profession.

But the aged care lobby groups are big supporters of the change…...

Read the full article here.


The Sydney Morning Herald, 9 February 2020:

...the federal Health Department revealed it was yet to implement key recommendations of the Australian Law Reform Commission's 2017 report on elder abuse. 

Responding to a question taken on notice at a Senate estimates hearing, Health Department bureaucrats this week said a "scoping study" was being done on a register of aged care workers, while "preparatory work" was under way on a serious incident response scheme for assaults in care. 

Labor's aged care spokeswoman, Julie Collins, said older Australians at risk of abuse deserved "immediate action, not years of inaction and delays". 

Official data shows there were 5233 assaults in residential aged care facilities in 2018-19. 

Catholic Health Australia outlined its proposed new means-testing rules in a pre-budget submission to the federal government.

There is a question begging to be answered here. 

If Scott Morrison and his Lib-Nats cronies go down the path of attempting to permanenltly conceal what amounts to institutionalised elder abuse, allows residential aged care providers to further entrench differing levels of care based on an ability of the frail aged to pay and goes ahead with further aged care services privatisation in order to avoid accountability - has Morrison himself calculated just how many elderly Australians will be likely to commit suicide soon after being told they will be entering residential aged care?