A glass of wine or quality of care

On the 21st January, the Productivity Commission’s Caring for Older Australians draft report was released recommending an extensive overhaul of the aged care sector. In just under 40 years, there will be almost four times as many Australians, or 3.6 million people, in need of aged care. The Productivity Commission has the job of finding ways to fund such a large increase in older people who will need aged care. The Productivity Commission’s deputy chairman Mike Woods is in favor of shifting the cost burden to wealthy older Australians through a new co-contribution scheme. This would appear to be acceptable but on other points the draft has drawn criticism especially by those who do the caring.

According to the Australian Nursing Foundation, the draft report ignored the important issues of quality of care and workplace conditions. With more older people requiring care, there will be a substantial need for more staff and a better skill mix. Patients in nursing homes today are sicker; they often have feeding tubes, urinary catheters, and complex wounds that require specialised nursing care.

How then have we arrived at this state of affairs where the number of nursing home residents will shortly quadruple? Why are these residents sicker and older than previously? There has been no discussion about the fact that as a resident of a nursing home you can be old and crumbly and possibly in nappies, but have a high-tech pacemaker implanted in your chest? Why don't we discuss the fact that we are living past our use-by date?

Our lifetimes have seen great advances in medical technology; vast industries have been built around our dependence as health consumers who swallow pills and line up for treatments until we die. For example, the lucrative pacemaker industry is part of the huge US Medical Supplies and Devices industry that includes 12,000 companies with a combined annual revenue of about $50 billion. Modern medicine is increasingly obsessed with technology, intended to extend a person’s quantity and quality of life. More than 1 million persons in the United States have implantable pacemakers, and the majority of this population, is older than 65 years. In 2005, a survey revealed that the total new pacemakers implanted in Australia was 11,850, up from 9,498 in 2001.

Another feature of the Productivity Commission’s draft report was the reference to choice. Mark Butler, the Minister for Mental Health and Ageing suggests that ’a lot of older Australians want to be able to consider choices about having a glass of wine at night, or a different range of bed arrangements, ensuites.’ One wonders if the minister has stepped inside a nursing home. Does choice in the form of wine at night and a private toilet and shower really matter when you are in the last days of your life and possibly demented and incontinent? Aged care is about quality and caring, not about lifestyle choices. Few people choose to go in to a nursing home – choice doesn’t really come into it.

Helen Lobato



There is no end to pollies wanting to wring every last drop of ethanol tax out of the bottle. Or is it to anesthetize the elderly Mr Butler?

What about euthanasia? Is this article alluding to that Sister Lobato?

Let's talk about it for a moment. About attitudes to death. In the present moral climate of prohibition, a common attitude is to neglect the care of the elderly until they die of 'natural' causes. For example, ignoring the antibiotic resistant infections that infest nursing homes. Or not giving physio after surgery. Or making them rattle with tablets that synergically interact causing drowsiness, irritability and confusion leading to more medication...

If euthanasia were to be allowed under the strict code of law suggested by The Greens, for example, attitudes would change. the care of the elderly would improve because a demarcation would exist. All care and treatment would be given to all equally regardless of age and infirmity. The heroic struggle to rehabilitate would apply unhesitatingly to all of those with a use by date. When that date arrives the person can be taken off the shelf of life and go to sleep forever knowing they had the best care.

Currently, we have zoos of medical experiments gone wrong, shitting themselves to death, and an army of dissociated, bad tempered, underpowered doctors and nurses trapped in a state of ambivalence.

We have families members at war over care. Where the real choice is disallowed and suicide is the the only rational alternative to an incontinent insanity.

We can thank our religious fanatics and spineless governments for this mess.

But sovereign patients in charge of their own painkiller dosation do not need deadlines.