Why our residential aged care system does not consider the emotional needs of older people

These needs are not often met by people who live in Australia’s residential care facilities for the elderly.

The majority of residents don’t feel loved or like they belong at the facility. Neda Borenstein was filmed singing the Australian National Anthem while waiting for more than three hour to be changed. ABC Four Corners broadcasted the footage. Neda Borenstein told her caregiver when she returned to assist her in getting up, “I’m only a number.”

We asked residents if they knew another resident and found that less than a third of them said yes. Most people don’t get the social support that comes with friendships. The majority of residents reported feeling socially isolated. This is linked to poor health.

In a study from 2016, many residents felt that they had no dignity, autonomy, or control. People with dementia tend to spend the majority of their time alone and very little or doing nothing.

A study of interactions between residents and their caregivers found that residents were left alone 40 percent of the time. Staff members did not interact verbally, physically, or emotionally with residents when they were present.

Residents of aged-care facilities may also feel psychologically unsafe. Residents with dementia can be physically restrained or locked up in secure facilities.

Sometimes, residents don’t get on. Residents may argue, yell, swear, or pinch each other. There are no good statistics on how frequently resident-to-resident verbal or physical aggression occurs, but it could lead to injury and even death.

Read more: Violence between residents in nursing homes can lead to death and demands our attention.

What are the consequences of unmet needs?

When their needs aren’t met, residents can have negative reactions. They can become angry, violent, anxious, depressed and depressed.

We used to refer to these reactions as “behavioural and psychosocial symptoms of dementia.” People with dementia point out that these are normal responses to neglect and not symptoms. Nearly all aged-care residents (90%) display at least one of these negative responses.

Many facilities “manage” these reactions by using sedating antipsychotics. Clinical guidelines suggest that people should first address the reasons they may be acting out and then consider medication.

Read more: Needless treatments: antipsychotic drugs are rarely effective in ‘calming’ dementia patients.

Half of nursing home residents have symptoms of depression, and a third have symptoms of anxiety. More than half of residents have been found in studies to behave in ways that might suggest they no longer wish to live. This includes refusing food or medication , one-third of residents having suicidal thoughts, and a small number of nursing home residents actually taking their own lives .

We may not be spending enough money on aged care, which would allow providers to meet basic human needs. Australia spends less than the OECD’s average of 1.5% on long-term health care – about 1%.

The private investment in aged-care is increasing, and so are residential aged care profits. However, it’s a hard industry to make money. Insufficient funding leads to a shortage of staff and a lower level of skill. Our system rewards dependence, and there are no incentives to provide providers with funding to improve residents’ psychological well-being or to go beyond this to help them thrive.

Healthy ageing is a result of friendships. Shutterstock.com

The people looking for nursing homes don’t get any independent information to compare the quality and performance.

The National Quality Indicator Program, a program that measures care in residential aged care facilities and began in 2016, was designed to give information to people comparing facilities on clinical indicators.

However, providers are not required to participate in the program. The suite of indicators does not include indicators for emotional or quality of life (even though a particular indicator has been tested and proven to be effective). Also, we don’t yet know when or if the data will be released.

What is required?

It is time for a fundamental change in the expectations of community, government, service providers, staff, and regulators about what residential aged care can do. Our aged care model is primarily about clinical care while neglecting emotional support.

In particular, friendships can be a valuable social interaction for aging well . However, many residents have told us the social opportunities available in their nursing homes do not meet their expectations.

Read more: Loneliness is a health issue and needs targeted solutions

We need our model of care to be a model of a home. In a home everyone contributes, has a say in what happens in the home (such as the menu, interior design, routine and functions), is able to invite their friends to their home for a meal, and can leave during the day and come back at night. A home is a safe place where people are loved and nurtured and where they can be active and fulfilled.

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