Is living in aged care in Australia bad for your mental health?

An estimated 10–15% of older Australians who live in the community experience anxiety or depression (Haralambous et al. 2009). However, research has shown that certain sub-groups of the older population are at higher risk of experiencing poor mental health. For example, just over half (52% or 86,736) of all permanent aged care residents at 30 June 2012 had mild, moderate or major symptoms of depression when they were last appraised (AIHW 2013). [Australian Government, Australian Institute of Health and Welfare, Australia’s welfare 2015]

The Sydney Morning Herald, 7 January 2017:

Tens of thousands of elderly Australians are being  denied effective public health treatments because they live in nursing homes, with experts labelling it a "disgrace" and "blatantly discriminatory".

A Fairfax Media investigation has revealed the mental health of aged-care residents suffers as a result of widespread neglect that legal and health experts attribute in large part to a   "ridiculous" Medicare rule.

Under the rule almost all nursing home residents are denied GP mental health treatment plans and associated psychological therapies provided to other Australians under the Better Access Medicare program, because the government deems residents not to be patients "in the community".

Despite extreme rates of mental illness in nursing homes – with about 82,000 of 176,000 residents estimated to suffer a mental illness (excluding dementia) or significant mental distress – the Turnbull government reaffirmed the regulatory exclusion late last year.

While the government says its funding mechanism assesses depressed residents' care needs, a Fairfax Media investigation has discovered the homes almost never pay for clinical mental health treatments and experts say the government has neither legally compelled nor adequately funded them to do so.

Audits by Sydney and Deakin universities have repeatedly found that fewer than 2 per cent of residents suffering depression have received psychological treatments, such as cognitive-behavioural therapy,  that are clinically recommended for most depression experienced in the aged-care setting…..

Royal Australian College of GPs president and University of Tasmania clinical professor Bastian Seidel agreed the denial of treatment was "systematic" because "the data is out there" and he called for the removal of the Medicare exclusion.

Researchers have found only about half of all residents with depression receive treatment of any kind, whether from psychologists or other clinicians, and that almost all of those are put on antidepressants by GPs, despite their use in the elderly being linked to serious adverse effects, including falls and fractures.

Stigmatising attitudes and ignorance about mental healthcare have also been found to be widespread among nursing home staff, with unpublished Swinburne University survey data suggesting staff commonly dismiss depressed residents as "attention seeking" and lack basic knowledge about mental illness.

While many residents arrive in homes with depression or other mental disorders, others struggle mentally due to challenges experienced in care, such as chronic pain, disabling and terminal medical conditions, progressive loss of brain function and the loss of social role and sense of identity.

"There are commonly acute adjustment disorders … [involving] bereavement, grief, loss," said Adelaide older persons GP Johanna Kilmartin, who described the Medicare restriction as ridiculous.

"You lose your family home [for] … one tiny little room … so you've lost all your material possessions; you've lost your health, because that's why you've moved in; often you've lost your spouse as well.

"This is when you need [psychological help] … [but] we've got the opposite"……

A spokesman for the Department of Health said while Commonwealth-funded residents – understood to be all or almost all aged-care residents – were not eligible for Better Access services, the government's aged-care funding instrument "assesses residents' care needs, including in relation to depression".

He said approved homes were required to "facilitate … access" for residents to health practitioners of their choosing and gave as an example "arranging transport".

But the dean and head of the University of South Australia's law school Wendy Lacey slammed the "weasel words" of the Aged Care Act's care "principles", saying there was "a complete absence of any positive and mandatory legal obligation on the part of facilities to take proactive measures to promote mental health and wellbeing of their residents".

There was "no legal obligation on the residential care provider to pay" for mental health services, and the "current exemptions" –  arising from the Aged Care Act and Medicare regulation – were "a blatant denial of human rights involving discrimination on the basis of age and infirmity".

Australian Catholic University senior research fellow Tanya Davison, whose research has found that half of all clinical cases of depression received no treatment of any kind, cited funding "that runs out very quickly" as among contributing factors to the "critically low" psychological therapy levels…..

The Conversation, 28 July 2015:

More than half (52%) of aged care residents have symptoms of depression, compared with 10-15% of older people living in the community. As well as feelings of sadness and low mood, aged care residents with depression feel uninterested in activities, hopeless about the future, guilty about the past and may desire death.

Some actively contemplate taking their own lives. The prevalence rate of suicidal thoughts in residential aged care settings can be as high as 46%. This is more than three times the rate found in older adults who are housebound but in the community.

People entering residential aged care facilities are, on average, older than those living in the community. They have more complex care needs due to physical and cognitive difficulties. They may also have difficulties adjusting to their loss of independence and routine. These factors all increase their risk of depression and suicidal ideation.

However, mental illness often remains undetected among aged care residents.

There are several reasons for this. People living in residential aged care usually have complex care needs, making the identification of depression difficult, as the emotional symptoms become confused with those of other conditions. Older people are also less likely than younger people to recognise their own symptoms, often attributing them to normal ageing.

Further, although facility-based carers are in a position to act as informants, they often lack the training to detect symptoms of depression and do not routinely screen for suicide ideation.

Depression is a manageable condition and the symptoms can be improved or managed through therapy and medication. Medications are effective but are often associated with side effects, and for older adults may not be recommended alongside some other medications and conditions.

Yet, when residents are recognised to have symptoms of depression, they are often only prescribed medications (particularly antidepressants) despite the effectiveness of non-medication approaches. Research shows interventions such as cognitive behavioural therapy (a talk therapy that addresses how you think and act) are at least equally effective as anti-depressants for improving late-life depression.

BACKGROUND

National Ageing Research Institute, Depression in older age: A scoping study, Final Report, September 2009:

4.1 Depression and anxiety in older people

It is a common misconception that depression is a normal part of ageing, but the evidence shows that multiple health problems often account for any initial association between depression and older age (Baldwin, 2008; Baldwin, Chiu, Katona, & Graham, 2002). Depression is essentially the same disorder across the lifespan, although certain symptoms are accentuated and others are suppressed in older people. For example, older people with depression typically report more physical symptoms and less sadness compared to younger people with depression (Baldwin, 2008; Chiu, Tam & Chiu, 2008). Additionally, psychotic symptoms, melancholia, insomnia, hypochondriasis, and subjective memory complaints are more likely to occur in older people with depression compared to younger people with depression (Baldwin, 2008; Baldwin et al., 2002). A recent review found that when confounding variables are controlled (for example, age at study entry), remission rates of depression in patients in late-life are not different from those in midlife, although relapse rates appear higher in older people (Mitchell & Subramaniam, 2005).

Anxiety disorders are also common among older people. However, research in this area is less compared to research undertaken in other mental disorders in older people, such as depression (Wetherell, Maser, & van Balkom, 2005). Of the anxiety disorders, phobic disorders and generalised anxiety disorder (GAD) are the two most common in older people (Beyer, 2004; Bryant et al., 2008; Rodda, Boyce, & Walker, 2008). There has been a certain amount of clinical interest in post-traumatic stress disorder (PTSD), because the survivors of the Second World War and the Holocaust are now well into old age. Moreover, Vietnam Veterans are also approaching old age with well-documented high levels of psychopathology (Owens, Baker, Kasckow, Ciesla, & Mohamed, 2005) that can also have serious effects on the mental health of family members (Galovskia & Lyons, 2003). Prevalence data on PTSD, however, are very limited (Sadavoy, 1997). American studies of Holocaust survivors have found that up to 46% meet criteria for PTSD (Sadavoy, 1997). Weintraub and Ruskin (1999)’s review emphasises the similarities between PTSD in older and younger groups. Other authors have disputed this, and further research is required to establish how different the presentation of PTSD is in older adults from that in younger people.

A recent Australian study found that 11.6% of men and 8.6% of women aged over 65 reported re-experiencing symptoms associated with past events (DSM IV criteria), and concluded that quality of life may be significantly affected in this group (Creamer & Parslow, 2008). This study highlights some of the difficulties in the application of the DSM IV criteria to older adults.

Research on interventions for older people with PTSD is very limited indeed. A recent review of assessment and treatment of PTSD in older combat veterans identified only five studies of psychotherapeutic intervention (Owens et al., 2005). All of these were case studies. A literature search carried out for this review did not identify any randomised controlled trials of psychological intervention for older people diagnosed with PTSD.

Comorbidity of depression and anxiety disorders is highly prevalent (Beekman et al., 2000). A community-based study in the Netherlands found 47.5% of older people with major depressive disorders also met criteria for anxiety disorders, whereas 26.1% of those with anxiety disorders also met criteria for major depressive disorders (Beekman et al., 2000). Mixed anxiety and depressive disorders (where symptoms of both anxiety and depression do not reach diagnostic criteria for either disorder) also frequently occur in older people (Chiu et al., 2008; Rodda et al., 2008). Older people with depression have a 35% lifetime and 23% current prevalence of a co-morbid anxiety disorder (Beyer, 2004). Furthermore, when anxiety symptoms first occur in a person over 60 years of age with no history of anxiety, it generally suggests underlying depression (Baldwin, 2008; Chiu et al., 2008). Indeed, it is quite uncommon that people develop late-onset anxiety disorders for the first time in later life (Chiu et al., 2008), although there are researchers who disagree with this (Wetherell, Maser et al., 2005). Older people with co-morbid depression and anxiety typically have more severe depressive symptoms, an increased likelihood of suicide ideation, lower social functioning (Beyer, 2004; Rodda et al., 2008) and poorer outcome (Schoevers, Beekman, Deeg, Jonker, & van Tilburg, 2003)…..

The 2007 National Survey of Mental Health and Wellbeing found that the 12-month prevalence for depression and anxiety was 2% and 5%, respectively for older people living in private dwellings (Australian Bureau of beyondblue depression in older age: a scoping study. Final Report - National Ageing Research Institute (NARI), September 2009 - 13 - Statistics, 2008). Another Australian study found that the prevalence of depression was 8.2% among a sample of 22,252 community-dwelling older people (Pirkis et al., 2009). However, the prevalence rate is much higher in residential aged care facilities and a recent Australian study found that 34.7% of aged care residents suffered from depression (Snowdon & Fleming, 2008).

Turnbull Government fails to think through aged care funding cuts

Another example of the monumental cock-up that that is the Australian Federal Government under Malcolm Turnbull & Co.

Australian Financial Review, 6 September 2016:

The Turnbull government has agreed to review $1.2 billion in aged care cuts after the sector presented modelling showing the effect would be much greater than anticipated. 

As ASX-listed providers blamed the funding squeeze for a 30 per cent drop in the value of their shares, Aged & Community Services Australia president Paul Sadler said modelling revealed the cuts would reduce support per resident per year by 11 per cent, or between $6655 and $18,000. 

He told The Australian Financial Review that the government had indicated it was willing to talk about alternative ways for find the $1.2 billion in savings to what is known as the "aged care funding instrument" announced in the May federal budget. Labor had already given a similar commitment. "The government has started the process of talking to the sector about alternative approaches," Mr Sadler said.

Aged & Community Services Australia is among a number of groups and representatives that have told the government there are better ways to achieve the savings. 

The government concession comes as the trio of listed companies operating in the aged care space – Estia Health, Regis Healthcare and Japara Healthcare – experienced a sharemarket slump that they said was driven by restrictions on what they can charge residents.

The federal Department of Health clarified last Friday that providers could not charge building refurbishment or capital replacement fees on top of existing accommodation charges. 

"It's like you or I paying rent and then being charged extra to fund the cost of maintaining the building in the future," said Grant Corderoy of Stewart Brown, an accountancy firm that conducts a quarterly survey of aged care financial performance……

Aged care funding is complex.

Costs are split into two parts: healthcare and accommodation.

In the first category, funding is largely provided per resident by the federal government based the level of support required according to health needs.

Separately, accommodation is paid for via a refundable loan (paid by the resident), an equivalent daily payment (which is either covered by the government or the resident, depending on capacity to pay) or a combination of both.

There has been bipartisan support in Canberra to deregulate the accommodation part of the equation.

While the amount that can be charged for accommodation has a regulator to monitor pricing levels, residents can agree to pay extra for higher standards of food or services; a glass of wine in the evening or massage therapy, for example.

Some providers have added levies of up to $18 a day for building maintenance and building replacement.

But last Friday the department said these charges should be included into the base accommodation pricing – they could not be charged as "added extras".

The end result is a potential loss of revenue per resident of $4000 to $5000 a year depending on the extent of the additional charge……

TO WHOM IT MAY CONCERN: Uniting Care Australia calls for halt to funding cuts targeting fail older people

United Care of Australia calls on the government of the day (whomever that may be) to halt funding cuts.....

Australian Federal Election 2016: Abbott shafted the frail aged in New South Wales, Turnbull ignores their predicament and now Baird has turned his back

The profits of aged care homes surged 40 per cent in the past year as operators cut hours of nursing care while claiming higher payments from the federal government for servicing more of the most frail patients. The earnings boom in the sector comes after the government introduced widespread reforms of aged care in 2014, including deregulating fees and lifting restrictions on the accommodation bond that nursing homes can levy on residents. [The Sydney Morning Herald, 1 January 2016]

In 2014 then Prime Minister Tony Abbott amended the C’wealth Aged Care Act 1997 with the Aged Care (Living Longer Living Better) Act 2013.

The amendments impacted on the requirement under s104 of the NSW Public Health Act 2010 to have a registered nurse on duty at all times in a nursing home.  

The Baird Government initially grandfathered its Public Health Act until December 2015 and then awaited a report by the NSW Legislative Council General Purpose Standing Committee No. 3’s parliamentary inquiry established on 25 June 2015.

On 29 October 2015 the Committee’s Final Report was tabled with the following recommendation:

On Friday 29 April 2016 at 3.15pm the NSW Baird Coalition Government responded to the Final Report’s 17 recommendations by washing its hands of any responsibility for staffing levels NSW nursing homes:

So three days before the 2016-17 federal budget details are revealed, possibly less than 32 days until the federal government enters caretaker mode ahead of a 2 July 2016 double dissolution federal election, and at the end of a working week, this Liberal-Nationals state government announces that it is very willing to place the lives of every frail aged resident in New South Wales nursing homes at significant risk.

Perhaps he and his government are hoping that the media will quickly lose interest and, that older voters and their families will forget that they will now be playing what could possibly be a cruel game of Russian roulette if they decide to spend their remaining years in aged care.

Failure to maintain staffing numbers and nursing care levels in Australian aged care facilities is a disgrace

In June 1999, a little over a year into the first term of the Howard Coalition Government,  there were an estimated 132,420 older Australians in residential aged care facilities, with 61 per cent having “high care” dependency status.  

Between 1994 and 1999 there was a 13.9% decrease in the number of registered nurses and a 26.0% decrease in the number of enrolled nurses, so that by 1999 there were 19,517 registered nurses employed full-time in residential aged care facilities and 13,818 enrolled nurses.

A decade later and the percentage of registered nurses working in residential aged care facilities fell from 11 per cent (or 18,313 individuals) in 2003 to 8 per cent (or 16,431 individuals) in 2009 and the number of enrolled nurses fell from 29 per cent (or 12,933) to 21 per cent (or 10,030) in 2009.

In 2011 the number of permanent residents in aged care numbered an est. 165,032 people.

By 2012 the percentage of the residential aged care workforce being registered nurses or enrolled nurses working in residential aged care had only risen to 14.7 per cent (or 13,939 individuals) and 11.6 percent (or 10,999 individuals) respectively, which is an actual fall in total numbers of RNs & ENs in the aged care workforce.

During the course of the 2013–14 financial year 270,559 people were admitted to age care facilities either on a permanent or respite basis. Nationally in March 2014 registered nurses comprised 15.3% of the residential aged care workforce and enrolled nurses made up 21.9% [Aged and Community Services NSW & ACT].  By June 2014 the “high care” dependency level of aged care residents had risen to 83 percent.

However, in 2014 the Abbott Government changed the federal Aged Care Act 1997 in such a way that allowed residential aged care operators to reduce the number of registered nurses employed in their nursing homes, as well as deregulating fees charged and accommodation bonds levied. 

In response the NSW Government effectively grandfathers facilities subject to the current NSW Requirements for a period of 18 months in order to block any moves to reduce state legislated provision of a minimum of one registered nurse on duty 24/7 in nursing homes containing “high care” beds.  This reprieve appears to come to an end around February this year but the state government’s formal response to the NSW Legislative Council report it ordered is not due until 29 April.

Meanwhile The Sydney Morning Herald reported on 1 January 2016 that: The profits of aged care homes surged 40 per cent in the past year as operators cut hours of nursing care while claiming higher payments from the federal government for servicing more of the most frail patients. The earnings boom in the sector comes after the government introduced widespread reforms of aged care in 2014…Yet while nursing homes report they are looking after more needy residents, the time spent caring for them declined by 7 per cent over the past year. In 2015, hours by care staff (nurses, care assistants and therapists) fell from 42.71 hours per fortnight to 39.80 hours per fortnight. At 2.8 hours a day, the average is well below the minimum of 4.5 hours per day of nursing care mandated in the US, said Lynda Saltarelli from the Aged Care Crisis advocacy group."Australia has no recommended levels for staffing," she said. "Over half of all nursing homes in Australia have nursing levels so low that most residents suffer harm."

Australia currently has about 2,800 residential aged care facilities providing care to more than 160,000 elderly people. Over the next ten years, the number of residents is projected to reach more than 250,000 and the highest area of growth will be among residents aged 95 or over. During that same ten-year period the number of registered nurses and enrolled nurses employed in aged care facilities is expected to further decline, according to Health Workforce Australia.

Prime Minister Malcolm Bligh Turnbull and his Cabinet need to take a long hard look at this mess and use legislation and regulations to raise these staffing levels and hours of care received before the next federal election.

The issue is not going unnoticed by voters……

Letter to the Editor, The Age 3 January 2016:

Low nursing levels, low level of care

It is outrageous that nursing homes do not have recommended staffing levels. Elderly people with dementia or Alzheimer's disease – and who, in some cases, have paid bonds of hundreds of thousands of dollars as well as continuing monthly payments – deserve the best possible care. By law, childcare organisations have staff ratios yet children are able to learn and notify carers if they are in pain, hungry or need to be toileted. Dementia patients cannot do this and will only become more in need of care as their condition worsens. Thankfully my mother, who has late-stage Alzheimer's disease, is in a wonderful facility. However, in my search for a good home, I saw many where up to 15 dementia patients were cared for by one staff member. With an ageing society, the number of people entering nursing homes will increase, profits will continue to soar and our most vulnerable citizens will suffer. Staff ratios must be put in place.

Annie Jones, West Melbourne [my red bolding]

Will 'grey power' be a factor as New South Wales goes to the polls on Saturday?

COTA NEW SOUTH WALES

MEDIA RELEASE

Monday 23 March 2015

POLL SHOWS OLDER VOTERS CAN NO LONGER BE TAKEN FOR GRANTED 

IN NSW ELECTION

A poll conducted by COTA NSW during Seniors Week showed that 65% of respondents do not believe that they’re a priority for politicians in the run up to the New South Wales (NSW) election on 28 March.

“We surveyed hundreds of people attending Seniors Week events and found a high level of dissatisfaction among older voters. For too long the major parties have tended to assume that older voters are ‘rusted on’, and their votes can be taken for granted. This is no longer the case.”

Over 43% of the State’s electorate is aged 50 and over, which translates to almost 2.5 million people.

“Once again we’ve seen few election commitments targeting older voters,” said Mr Day. “We were pleased to see the Premier commit $343 million to extend vital concessions for seniors. But aside from this, we’ve seen little focus on older people’s needs.”

“Older voters helped make NSW the great state it is. They want to continue to be able to participate in the society and the economy. This means they want politicians to tell them what they’ll do so they can continue to participate in paid employment, and to have access to appropriate housing in well-planned communities. They want to know how politicians envisage a transport system that will meet the needs of all voters, and a health system that recognises the needs of people at every life stage.”

“Politicians need to appreciate that an ability to recognise the priorities of older voters is a sign of basic political understanding. If you can’t understand 43% of the NSW electorate, whose interests are you serving?”

“Older voters want substance. They want to be presented with long-range plans that set out a vision for an age-inclusive society, where older people are able to continue to participate in every aspect of life.”

“They also want to see Ageing Strategies that indicate political parties have a clear sense of how they would undertake co-ordinated, whole-of-government action to ensure such a society is achieved. Sadly, we’ve seen nothing like this from either major party in the run up to Saturday’s election.”

Letter to the Editor in The Northern Star, 13 March 2015:

Mention dementia

A number of candidates standing at the forthcoming state election have mentioned mental health services and cancer treatment as issues important to their electorates, but I have yet to hear any express an opinion on the subject of dementia.

According to Alzheimer's Australia: "Dementia is the third leading cause of death in Australia".

Dementia prevalence projections by NSW electorates on the Far North Coast expects the number of people suffering from this devastating disease to rise by 2020 to 6,903 [nsw.fightdementia.org.au, August 2014].

Broken down by electorate this comes to Ballina 1623, Clarence 1697, Lismore 1565 and Tweed 2018.

The prevalence projection for the number of people with dementia within North Coast Area Health Service boundaries in 25 year's time is 27,661.

It's time all state election candidates in NSW North Coast electorates considered the social and economic implications of these figures and inform today's voters how they will begin the task of attracting federal and state government funding for increased health and support services in the region.

Because some of today's voters may find themselves in families affected by this devastating disease tomorrow.

Judith M. Melville

Yamba

Norma’s Project: A Research Study into the Sexual Assault of Older Women in Australia

Excerpts from Norma's Project:  A Research Study into the Sexual Assault of Older Women in Australia, June 2014 (Authors Rosemary Mann, Philomena Horsley, Catherine Barrett, Jean Tinney):

The idea of older women as victims of sexual assault is relatively recent and little understood. However, it is becoming increasingly evident that, despite the silence that surrounds the topic, such assaults occur in many settings and circumstances. The lack of community awareness can be partly attributed to commonly held assumptions that older women are asexual. How, then, can they be the target of sexual assault? What is unimaginable and unacceptable becomes unsayable or invisible.

* In Australia in 2011, there were 3.08 million people aged 65 years and over. There are higher proportions of older women than men over 65 years, with significantly more females than males aged 80 years and over (ABS 2012).

The overwhelming majority of older people live in private dwellings in the community – only 6% live in non-private dwellings, which include aged care homes and hospitals. Among those aged 85 years and over, 74% live in private dwellings (AIHW 2007).

Over 50% of women aged 65 years and over need some form of assistance to help them stay at home.

Among those receiving assistance, 83% received help from informal providers (including family and friends), and 64% received help from formal

providers (including government organisations as well as private for-profit and private not-for-profit agencies) (AIHW 2007).

Around two-thirds of permanent residents in aged care facilities are women (AIHW 2007).

* However, it is widely accepted that around one in five women (17% – 21%) over the age of 18 years have experienced sexual violence since the age of 15 (ABS

2013, 2006; de Visser et al. 2003, 2007). This rate has not changed over the past six years (ABS 2013).

In 2012, an estimated one percent (87,000) of adult women had experienced some form of sexual assault in the previous 12 months, excluding unwanted sexual touching (ABS 2013).

Women over the age of 45 years represented nearly 1 in 5 of this group (ABS 2006).

In the vast majority of cases (88%), the perpetrator was known to the victim (ABS 2013).

* All Government-subsidised aged care homes must report to the police and to the Department of Health and Ageing within 24 hours of receiving an allegation or suspicion of 'unlawful sexual contact' or 'unreasonable use of force'. In the last 12 months there has been a 14% increase in reports of alleged physical and sexual assaults: 349 reports of unlawful sexual contact and 29 reports of unlawful sexual contact and 'unreasonable force' (Commonwealth of Australia 2013). In both Australia and New Zealand, surveys of aged care managers have identified cases of sexual assault of residents (Sadler 2009; Weatherall 2001).

* The available research in relation to the sexual assault of older women suggests that:

offenders are primarily men, although women should not be excluded as potential offenders, particularly in residential aged care settings (Ramsey-Klawsnik et al. 2008; Holt 1993)

male offenders range in age from teenage males to elderly men (Jeary 2005)

a significant minority of convicted male offenders also have previous convictions for assaults against children and younger women (Lea et al. 2010; Del Bove et al. 2005).

* Research on the impacts on older women of recent experiences of sexual assault (or other forms of violence) as an older woman is far more limited. Some researchers characterise service providers' 'lack of sensitivity … to the gravity of the assaults' as striking (Burgess et al. 2000, p.14), while other researchers attest to the 'long-term, life-changing effects' on elderly victims despite efforts to put the trauma behind them (Jeary 2005, p.335)

* Medical literature indicates that older women who experience sexual assault are more prone to trauma and injury to the genital tract, compared to younger women (Muram et al. 1992; Ramin 1997; Jones et al. 2009; Templeton 2005; Morgan et al. 2011) and more likely to be admitted to hospital (Eckhert and Sugar 2008).

Importantly, experiences of sexual assault can also result in a decrease in both the quality and the length of older women's lives. For instance, one case analysis of 20 older people who were sexually assaulted, most of whom were over 70, indicated that over ½ died within a year of the assault (Burgess et al. 2000).

The full report can be read here.

Some 2014 media reports of sexual and/or physical assaults on older women

The Daily Telegraph 30 January 2014:

AN elderly woman has been sexually assaulted after answering a knock on her door of her unit on the NSW far north coast.

Police said about 8pm (AEDT) on Wednesday the 75-year-old opened the door of her Kingscliff unit to a man who forced his way in and sexually assaulted her before fleeing.

treatment.

The Sydney Morning Herald 13 April 2014:

A registered nurse faces prosecution by health authorities after he allegedly sexually assaulted an 89-year-old patient inside a Sydney public hospital.

The man will appear before a Health Care Complaints Commission (HCCC) tribunal after an elderly lady complained he entered her bed space, woke her up and inappropriately touched her in the Emergency Short Stay Ward at Nepean Hospital, in July 2012.

It is understood the HCCC will also analyse the role of senior staff who several months previously, chose to handle internally - and dismiss - a carbon copy complaint from another elderly woman relating to the same nurse.

NSW Police confirmed that three days after the second alleged incident took place, Nepean Hospital alerted them to ''an allegation of sexual assault''.

On Friday, the patient's two daughters confirmed a decision was made not to press charges because it would have been too traumatic for their mother, who has since passed away in February.

Nswcourts.com.au 12 May 2014:

A 57-year-old former Blue Mountains nursing home worker has been charged with six counts of indecent assault in nursing homes. He was fired after the facility management received complaints from seven elderly women between 2011 and 2014.

The Daily Telegraph reported that seven elderly women had complained about the man for offences that allegedly took place between 2011 and 2014.

He was given strict bail conditions and ordered to appear before Katoomba local court.

Within a month of the Blue Mountains worker being charged, a Wollongong man was jailed for sexually abusing a vulnerable and disabled patient at a nursing home. The woman was suffering from Alzheimer’s disease and a stroke, which left her speechless and with very limited movement, requiring 24 hour care.

The Courier Mail 13 May 2014:

A COMMUNITY in Mackay is reeling after the callous sexual assault of an elderly woman on her property.

The Courier-Mail understands the 80-year-old lady – who lives alone – was attacked after she had been walking her dog.

A source close to the victim said her friend had just been for a walk to the local shops before the incident occurred.

Reports suggest a man approached her in the front yard of her Finch St property about 7pm and asked for directions to Lamberts Beach.

Police said he then forced the woman into the backyard where the sexual assault took place.

The assailant then fled the scene on foot.

The Sydney Morning Herald 7 July 2014:

A 46-year-old nurse will appear in court on Tuesday in relation to the deaths of two elderly women and an assault on a third at a Ballina nursing home.

Victorian police arrested the woman in Seaspray, Victoria, 240 kilometres south-east of Melbourne, about 11am on Monday, with warrants issued last week by the NSW Police Force’s Homicide Squad.

The woman had been employed as a nurse at the St Andrew's Village nursing home in Ballina.

UPDATE

The Daily Telegraph 9 June 2014:

A registered nurse accused of killing two elderly patients and assaulting another was investigated for similar offences in 2008.

Australian Opposition Leader Tony Abbott suffers a bout of dangerous stupidity

This was Opposition Leader Tony Abbott during the 11 August 2013 televised and transcribed Leaders Debate:

Well, I accept that it was quite a detailed set of changes and it was largely based on a report by the Productivity Commission. I thought that the Productivity Commission report was a good report, as did my Shadow Minister, Senator Concetta Fierravanti-Wells. On this issue there isn't an enormous difference between the Coalition and the Government but we do need to try to ensure that the providers, that the nurses, that the other workers in these aged care centres who do such a terrific job, such a terrific job, and are so helpful to very vulnerable Australians, don't have to spend as much time on paperwork as they currently do under a paper-based accountability system. [my red bolding]

Perhaps Mr. Abbott might like to explain what paperwork he would eliminate?

Would it be daily observation charts, case notes, individual treatment plans, outcomes of multidisciplinary case management conferences, filling in accident/incident registers, or more simple tasks like placing patients/residents on lists for podiatry treatment and filling in weekly menus for those who can no longer do such tasks for themselves etc?

Or would it be paperwork proving staffing levels, that all staff were suitably qualified for the positions they hold and that emergency medical equipment is tested/serviced regularly?

A paper based accountability system is there for a reason – to protect the wellbeing and rights of older Australians living their final years in nursing home care.

Tony Abbott’s slick promise to cut-the-red-tape, which he frequently throws into press conferences on all manner of subjects, is dangerously stupid.

Growing old in the Lucky Country

ABC News 3rd October 2012

Who's afraid to say lesbian, gay, bisexual, transgender and intersex?

The following media release from the Hon. Mark Butler MP meant nothing at first until I decoded his slavish adherence to a little known acronym. One could be forgiven for suspecting that the Minister for Mental Health and Aging, as well as Social Inclusion, was uncomfortable with the use of plain English.

Apart from that – well done, Minister.

MEDIA RELEASE

24 July 2012

The Gillard Government will develop a National LGBTI Aged Care Strategy to support the implementation of Living Longer Living Better.

Minister for Ageing Mark Butler said he had acted on the advice of the Productivity Commission as well as groups like the ACON Health Ltd, the National LGBTI Health Alliance and the GLBTI Retirement Association.

“We are predicting a large increase in the demand for aged care by this group,” Mr Butler said.

“And there is a broad community consensus that it is important to recognise people who are LGBTI in the same way as we recognise the needs of other diverse groups such as people from culturally and linguistically diverse communities and Aboriginal and Torres Strait Islanders.

“Ultimately it’s about recognising difference and ensuring equality.

“We will work with the National LGBTI Health Alliance to develop a comprehensive strategy to make sure the needs of LGBTI Australians are addressed in the implementation of our $3.7 billion aged care reform package,” Mr Butler said.

Mr Butler said the strategy builds on the support already announced Living Longer Living Better package already provides support for LGBTI Australians.

“In April, I announced $2.5 million to support staff training that is sensitive to the specific needs of these older Australians,” Mr Butler said.

“This funding supports aged care providers to work with their staff to continually improve how they respond to the diverse and complex needs of the older Australians they support.

“The National LGBTI Aged Care Strategy will provide direction for providers and better articulate and coordinate our aims.

For all media enquiries, please contact the minister’s office on (02) 6277 7280

Australian Government now has full responsibility for Home and Community Care (HACC) services

Department of Health and Ageing media release 1 July 2012:

From 1 July 2012 the Australian Government has full responsibility for Home and Community Care (HACC) services that support more than 500,000 older Australians to live independently in their own homes and communities.

Minister for Ageing, Mark Butler said the transfer of responsibility for HACC services for older people to the Australian Government rationalises the system and paves the way for the reforms outlined in Living Longer Living Better.

“Supporting older Australians to remain living in their own home is a key focus of our recently unveiled Living Longer Living Better aged care reform package.”

“We’re investing an extra $880 million over the next 5 years for 40,000 new home care packages to help older people stay living at home,” Mr Butler said.

“The HACC Program provides a foundation for future aged care reforms and is one of the first steps in the development of a consistent aged care system covering basic care at home through to high-level care in aged care facilities.”

The Commonwealth HACC program replaces the former joint Australian Government and state government-funded HACC program in all states and territories except Victoria and Western Australia, where basic community care services will continue to be delivered under the old arrangements.

State and territory governments will continue to fund HACC services for people under 65 (or under 50 for Aboriginal and Torres Strait Islander people).

HACC consumers will continue to receive services from their current provider and remain in the most appropriate care setting regardless of their age.

The Australian Government has allocated more than $1 billion for the Commonwealth HACC program and will continue to support the joint HACC program in Victoria and Western Australia.

More information on the Commonwealth HACC program is available at: www.health.gov.au/hacc

Gawd 'elp us all if we grow old, frail and alone in the Land Downunder

This is part of the Gillard Government response to Australia's aged care needs:

"To make it easier for older Australians to stay in their home while they receive care, we will:
Increase the number of Home Care Packages- from 59,876 to almost 100,000 (99,669).

Provide tailored care packages to people receiving home care, and new funding for dementia care.

Cap costs, so that full pensioners pay no more than the basic fee." and

“care recipients with higher than average care needs, an indexed annual cap of $5,000 for single people on income less than $43,000”
A positive policy move. Except Maud Up The Street tells me you need at least six hours care in the home per week and a family member coming in, or living in, to pick up the rest of the care hours to take the pressure of the lack of available dementia-dedicated nursing home beds on the NSW North Coast.

Not every older person has the luxury of children and grandchildren or of having them live close by if they do. In fact, in some areas around 30% of the 50 years plus population is probably childless if ABS stats are any sort of guide.
The Prime Minister and Health Minister speak a lot about "older Australians and their families" - without recognizing that the norm is changing more than they realise and this welcome move which will allow more people to stay in their home as they receive aged care may accidentally exclude the elderly without families.
Even the announced extra aged care beds may not always materialise in regional areas such as the NSW North Coast, because nursing homes sometimes display a reluctance to take up available residential bed quotas.

Prime Minister and Health Minister Media Release 20^th April 2012

A new national aged care policy is barrelling down the track towards Australia's baby boomers

The Gillard Government is assuring Australia’s baby boomers that the concerns bolded in red below will not occur:

Under this market price option, accommodation costs to high care recipients and taxpayers (the accommodation subsidy for supported residents) are likely to be higher, but consumer choice and industry sustainability would be enhanced. Care recipients, however, would continue to be charged differently according to the level of assessed care need (high or low care) not the standard of accommodation they have chosen. There is also a concern that, as providers could charge what the market would bear, care recipients could be exploited and those with a lower capacity to pay would miss out. This is a greater concern in the short term, particularly in areas where there is limited competition. [Productivity Commission,June 2011,Caring for Older Australians,Vol Two]

If you live in rural and regional areas perhaps it is time to carefully read the report and make up your own mind on what aged care policy should be before federal politicians make up theirs.

Caring for Older Australians - Overview (PDF - 1065 Kb)

Volume 1 - Caring for Older Australians - Inquiry report (PDF - 1558 Kb)

Volume 2 - Caring for Older Australians - Inquiry report (PDF - 3134 Kb)

If Baby Boomers were worried aged care might be stuffed by the time they turned 75 - worry no more

Read and enjoy current aged care recommendations in the Caring For Older Australians: Draft report presented to the Gillard Government by the Productivity Commission and released on 21 January 2011.

Less direct accountability for government, less transparency if that is actually possible, a freer hand for aged care providers (including the ability to palm-off aged care bed categories with low profit margins) and the potential for all manner of agencies to increase costs on a whole range of services (including removing the cap on high care accommodation charges), ‘supported’ beds for low-income frail aged eventually assigned to the lowest tenders, a more market-driven provision of aged care services for special needs groups, and as an added bonus, the continuing option of being faced with no nursing home bed available in the area in which you live in your retirement – I give you A framework for assessing aged care: draft recommendations.

However, as has been the case down the centuries, if you enter old age with significant assets and investments you will still be able to afford the best on offer and probably do a little better out of those same proposed aged care provisions.

The entire report can be found here.

We have all been invited to examine this report and make written submissions to the Productivity Commission by Monday 21 March 2011.
Email agedcare@pc.gov.au for further information

Good news for the frail aged and carers in the NSW Northern Rivers region

Federal Member for Page Janelle Saffin’s media release on 9 December 2010 brings some good news for older residents in the Northern Rivers region and their families :

Older people in Page will benefit from a total of 80 new aged care places allocated across the electorate by the Australian Government.

Page MP Janelle Saffin said the new places allocated under the Aged Care Approvals Round for 2009-10 include 39 residential care places and 41 community packages for care in the home.

“The new allocations reflect the need for varied types of aged care in our local community.

“While there is a growing demand for residential places, there are also many people who prefer to remain in their own homes.

“The allocations are for 32 high care residential places, 7 low care residential places, and 41 community aged care packages,” Ms Saffin said.

Local providers receiving the new allocations:

Baptist Community Services Northern Rivers: 5 Community Aged Care Packages

Ex-Services Home Ballina; 32 Residential Places High Care

Southern Cross, St Catherine’s Villa, Grafton: 2 Residential Places Low Care

St Michael’s Apartments, Casino 5 Residential Places Low Care

Frank Whiddon Homes Grafton 13 Community Aged Care Packages

Frank Whiddon Homes Kyogle 13 Community Aged Care Packages

Uniting Care Yamba 10 Community Aged Care Packages

The Aged Care Approvals Round for 2009-10 for Page is worth an estimated $2.34 million.

In addition, the Australian Government will provide the aged care sector nationally with $147 million in zero interest loans to build 819 places, along with more than $41.6 million in capital grants.

What NSW Northern Rivers social priorities are in 2010 for local community services

From Northern Rivers Social Priorities 2010 Report:

In early 2010 Northern Rivers Social Development Council (NRSDC) conducted a survey amongst the regions’ community service providers to gauge their views on social priorities. The results from the survey will be used to inform NRSDC in its advocacy role. It will also stand as a resource for other community services to gain an insight into the key social issues faced by the Northern Rivers community and community service system.

Since 2001, initially the Northern Rivers Interagency and now NRSDC have conducted research, consultations and surveys with service providers. The aim has been to identify common social priorities across the region, flag new issues as they arise and monitor the state of those priorities.

Responses from community services of the Northern Rivers to the 2010 Social Priorities survey has revealed that the region’s social priorities, as identified in 2002 and revisited in 2006 remain hot issues in the community.

Data from the survey may be considered in different ways. An indication of what responding services had the strongest feelings about can be found by looking at which issues had the most respondents rating them as 9 out of 9 ie the highest level of concern.

Ranking of the social priorities is as follows on a scale of 1 to 9:

1. Youth 7.72
   
2. Complex needs 7.64
   
3. Transport 7.58
   
4. Housing 7.08
   
5. Ageing 6.92
   
6. Community based management 6.52