Compassion in Aged Care

This story appeared in The Saturday Age, The Sydney Morning Herald, Brisbane Times and WA Today, on Saturday 12 September. Warm thanks to artist Kathy Westfold for permission to use her watercolour image.

Like many families with frail elderly parents, I have been watching the unfolding COVID-19 crisis in aged care with concern. My mother died following a major stroke in January this year but that hasn’t stopped me wincing at the stories.

When, at the age of 92,  my mother moved into aged care, I see-sawed between relief and regret. For years I’d supported her quest to stay living independently, but it unravelled with Alzheimer’s – which by definition can be a disease you don’t recognise you have.  Mum agreed, and then forgot she’d agreed, to the necessity of going into care.

My brother and I arranged for her to be admitted to a nursing home that was in the  outer east of Melbourne where she’d spent much of her life, where she’d be not too far from people she knew, and where one of her oldest friends was a resident. Although this softened the blow, Mum insisted that she should have continued in her independent living unit. She never got over the fact that she hadn’t been allowed to “age-in-place.”

I was visiting Mum early one morning at the nursing home, when a staff member came through on her medication rounds. I witnessed an interaction of such emotional intelligence and agile problem-solving that I felt humbled. A combination of kindness and skill was shown when Mum couldn’t swallow properly, when she couldn’t remember what the tablets were for or why she needed to go through the bother of it. It is too easy to underestimate aged care. Over and again I saw nurses and care staff  demonstrate good-humoured coaxing and  a deft repertoire in persuading, encouraging and conversing with my mother.

Once I rushed in late at night when the facility let me know that Mum needed to be hospitalised and they had called an ambulance. When I arrived,  I found a nurse kneeling on the bathroom tiles holding my mother who was whimpering and yelping in pain. As I stood in the doorway aghast at Mum’s distress, the nurse looked up at me with tears in her eyes and said,  “This pain is worse than childbirth.” There are moments in life when we are like helpless animals; this nurse’s respect and compassion were palpable.

Nursing fragile elderly people can be confronting and challenging at almost every level  and can reveal the very heart of a person. Even without the duress and distress of COVID-19, the nature of the work is up close and personal and involves people we love dearly. But the furore is also about the structures of federal funding and it is disingenuous to look the other way.

Certainly, the ongoing aged care Royal Commission is uncovering significant flaws in the lack of specific response to COVID-19 in the sector. Until recently, there was no safety net for casual staff who needed to stay home with flu-like symptoms. This is a  false economy that has cost the state and the country dearly and the story repeats itself across poorly-paid casualised workforces.

Professor Charlesworth of RMIT was quoted in a recent article about the class divide made apparent by COVID-19. She describes the wages for aged care workers as ‘demeaning’. As 90 percent of aged care workers are women, Charlesworth notes the gender issue. “We undervalue this work because it looks like the kind of work women have traditionally done for free.”

The theme of gendered caring work that has been perpetually underestimated by western capitalism and extensively documented. Forty years ago, the prescient writer Ursula Le Guin (1929-2018) addressed a group of American college graduates and refused to spruik the American Dream on the grounds that most people lie wide awake in terrible poverty. “In our society, women have lived, and been despised for living, the whole side of life that includes and takes responsibility for helplessness, weakness, and illness, for the irrational and the irreparable, for all that is obscure, passive, uncontrolled, animal, unclean –– the valley of the shadow, the deep, the depths of life.”

Neither does the Australian dream narrated by the Prime Minister at his election, speak to the broken, chronic, disabled and painful parts of life. If his dream of -job- partner-house-children-retirement had any traction in May 2019, it will be on changed turf now.

The CEO of Meaningful Ageing Australia, Ilsa Hampton, reads the aged care issues with a wide cultural lens. She says  “I can’t help but wonder whether the poor pay for the majority of the aged care workforce is not only a question of gender but also of internalised ageism. If we thought of those people accessing aged care services as keepers of our truths, of representing a significant piece of who we are as a nation, perhaps this would be changed.”

Hampton wants to see models of care and funding that are better aligned to promote meaningful relationships, honouring both the care worker and the older person equally.

Describing the distress of care workers who confront the impoverishment of staff -resident ratios, she says, “I know some new care workers from migrant backgrounds who were so confronted by our models when they saw how little relationship was able to be offered to each older person (due to being so time-poor) that they cried and cried on their first shift.”  She adds that, “Despite this, I know others who offer care from a place of deep respect, thinking about their own distant grandparents.” It is too easy to underestimate aged care, and this is partly because our society often views ageing only in terms of diminished capacities.

Hampton says, “The ‘problem’ of the work not being highly regarded or reasonably remunerated is an old issue. It is clearly being considered by the Royal Commission into Aged Care Quality and Safety and we can only hope that that will lead to some change. Connected to this of course is how much we are willing, as a society, to contribute to paying what the work is ‘worth’.”

As Secretary of the ACTU, Sally McManus said last month, “There’s been a shift in consciousness in the public. ‘Is this actually what we want?’ At certain times in history, people say this can’t happen again. That’s possibly the start of the thinking now.”

Julie Perrin is the author of  Tender, stories that lean into kindness, MediaCom 2019.

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