Older people ageing at home face the highest risks

All eyes are on aged care facilities, but more focus needs to be on ageing at home.

old man in a medical mask in the open air

While all attention has been on aged care facilities during the pandemic, those who wish to age at home may not be as safe as they think, according to findings from the aged care royal commission.

Around 3.6 million people will want to age at home by 2050.

Many say they don’t trust aged care facilities. Some say they can’t afford them. Others just prefer to live their lives for as long as possible at home.

However, people ageing in place are at higher risk of health complications, neglect, injury or even death at home, says NSW Ageing and Disability Commission chairman Robert Fitzgerald.

He told the commission that the absence of oversight meant the highest risk for older people in the aged care system was within the home.

“I know all of the attention focuses in on the residential settings and there are high risks in those,” he said.

“It's not to say that people are more harmed or more damaged in the home, but without the line of sight that exists, the risks are higher.”

With insufficient advocates for older Australians; a high risk of elder abuse and neglect, and an absence of quality indicators or checks, successful and safe ageing in place will be a major challenge for the healthcare sector and the government in coming years, he told the commission.

“The reality [as we] get older is that not only do we become invisible, but our voice becomes unheard ... It’s critical that the voice of the individual is heard and their preferences are acknowledged," said Mr Fitzgerald.

The number of older Australians ageing at home will more than triple from the current count of one million to around 3.6 million by 2050, says an article in the Brisbane Times.

Add to that number three times as many in residential care – rising from 200,000 to 600,000 in the same period.

Based on current spending and support, Australia will not be in a position to support people with dementia and other vulnerable people in care at home without re-engaging the community, said Mr Fitzgerald.

“The notion that the community itself is part of the solution is something that Australia has lost. COVID has demonstrated, beyond any shadow of a doubt, that a society doesn’t function well when that’s gone,” he said.

“In the case of older people ... neighbourhood connectedness is very important.”

Currently, the monitoring of aged care quality indicators in the home “simply doesn’t exist”, said principal research fellow with the South Australian Health and Medical Research Institute, Associate Professor Gillian Caughey.

Assoc. Prof. Caughey and her team are developing a set of quality indicators, which could be implemented within six months.

Former NSW Police deputy commissioner Rosemary Milkins used her 95-year-old mother Dorothy Urch as an example of why it pays to plan ahead for ageing in place.

When Mrs Urch developed dementia in her 70s, she told her family she wanted to “retain her dignity and her ability to live her own life” in a familiar environment.

She was able to stay at home for 17 of the 20 years she lived with dementia.

Her mother's experience led Ms Milkins to understand the importance of planning a home adequate for older age.

Ms Wilkins said this included becoming familiar with available services early on, installing brighter lights in the home to cater for ageing eyes, and getting used to having helpers and carers around earlier so that doesn’t come as a shock after cognitive decline or eventual admittance to an aged car facility.

“I'm starting to, if you like, age-proof my home now, in the same way that you child-proof your home when you've got children around,” said Ms Milkins.

“We need to think about ageing before it gets to the crisis point.”

Have you started preparing your home for your later years? What types of arrangements or additions have you made to cater for ageing in place?

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    9th Sep 2020
    My wife is 78 and has a degenerative neurological condition (CBS). She is continuing to live a good life at home, with limited support from a not for profit aged care provider and some privately organised support as well. As far as we are concerned the last thing that we need is some external oversight intruding into our lives, undoubtedly with increased costs that we will have to cover. Leave us alone - apart from her CBS my wife enjoys good health, has excellent medical support and engages with our community as she sees fit. Please, no unnecessary regulation and PLEASE, no intrusion of the unregulated private profit making aged care industry into our lives.
    9th Sep 2020
    Excellent response Buggsie.
    9th Sep 2020
    The loneliness that many people have due to nursing homes is very real. I work in the industry and I’m so pleased to read your story.
    Unfortunately not all homes are like yours. Unless there is some kind of “ intervention” abuse including financial psychological, neglect Of basic needs will continue. As a carer who visits the homes we are bound by law to report any of this.
    So there still needs to be a form of monitoring to keep our most vulnerable safe.
    And as the theme goes if you are doing the right thing then you will be left alone.
    Ted Wards
    9th Sep 2020
    There in fact does exist quite strict monitoring of the home care system and there has been for quite some time. All the standards apply to all approved providers. The issue in the home care system is the fact that for many years the standards required for PC to work in this industry has been watered down to the point where they don't really exist. Fast tracked courses for immigrants to get work has seen a marked decline in the home care industry and that is solely the government's fault because they have allowed it. Then there are the laws which allow workers to get away with things like theft. We had a client who has had personal items stolen several times by different workers and the company did not report the worker or had her charged, but simply shifted her to a different area. The worker should be fired and in jail. So we also ensure through not enforcing companies to standards the voicelessness to increase! This ever increasing round of talk fests and finger pointing must one day surely end up in action?
    9th Sep 2020
    What about the fact that significant sums allocated to home care are in fact being skimmed off through "management fees". In many cases the bulk of funding is going to those fees.
    This is yet another case of privatisation not delivering to the community but only to a few.
    9th Sep 2020
    Given the state that all aged care services are in, due largely to the influence of profits to be made at the expense of the taxpayer, it is little wonder we oldies resist trying to access those services.
    A huge overhaul is sorely needed but given that the current party in power in Canberra put most of the aged care systems in place don't hold your breath waiting.
    9th Sep 2020
    You say people resist trying to access home care services. There are literally thousands of old people who are waiting for those services and many die before they get them!
    Have you not read the papers or seen comments on this on tv?
    This does not mean that I am advocating for the services. As far as I aware, most are a total rip off.
    9th Sep 2020
    Excellent! Now I have a choice between dying in misery at home, or dying in misery in a Home. Nobody plans for death as it is a forbidden subject.

    If you all stopped voting for right wing greed oriented governments, we might have some decent state-run facilities. For those on the Right who dismiss this, have a quick look at the Covid related deaths in State-run facilities, then check the private-run facilities. Not convinced? Then refer to the federal minister, and his agreement that the private facilities are definitely run for profit, not for care, and that is the Liberal policy.

    The politics of Greed, or the Politics of Compassion. Take your choice.
    (An unpaid advertisement from the moderate Left...)
    9th Sep 2020
    Most people don’t plan in life.
    Situations change life happens. We make mistakes and rebuild our lives. Unfortunately elderly people when young never thought they wouldn’t be able to dress undress turn on the tapsIn shower not burn themselves dry themselves running out of puff just doing simple tasks but that’s what happens.
    Only when you care for the elderly do you get first hand insight into these things.
    As we age we become people with disabilities poor eyesight / hearing weakness of limb / muscles, poor memory.
    I’m preparing because I work in the industry.
    Getting a stair lift to my second floor moving washing line closer to the house organising easier access to my house. Throwing out unnecessary items. Buying safer newer car.
    This is the age where you need to prepare or family members will take over and we can’t stop them!!
    9th Sep 2020
    Dying in misery at home or in a home are not your only choices Janus. There are other options besides succumbing to greed and politics, you just need to explore them.
    9th Sep 2020
    My partner has just secured a job in an Aged Care facility after more than 12 months trying to do so. Combination of age discrimination and no one wanting to give her a start due to 'no experience'. Of course one follows the other, but hard to get someone who would give her a chance. She is a natural and connects well with residents. She has a very kind and caring disposition and has been an immediate hit with residents.
    It is a shame that 'narrow minded' personnel cannot see the 'forest for the trees', new ideas and new enthusiasm are always needed. Where she works are very professional and she is snowed under with study units at the moment, but will be a very skilled worker when finished.
    From what I can see, there is a turn around in the mind think of facility administrators.
    Nan Norma
    9th Sep 2020
    I am eligible for Home help, and my husband for a package 3. I have piles of information forms, booklets etc. All which I realize cost money. But at the end of the day the service is only as good as the actual service we the receive. Maybe because we did so much of our own house repairs etc etc, I find the charges way over the top. To me it does not matter that I don'tpay for these services, because someone does.
    9th Sep 2020
    My wife is in aged care for over one year now. Accommodation is adequate, very much shortage of staff, blend food but because of her total blindness caused by severe macular degeneration she can not participate in most of the activities.
    One month ago a man came in ton her room at 2 AM and severely attacked her and left her with bruises on the face and upper body. Because he was a dementia patient nothing could be done about it.
    9th Sep 2020
    Further to my earlier posting, we paid $550,000.00 to get her in and on top of that around $140.00 per day. You would expect something more for that sort of money.
    The facility manager in a meeting admitted "that the man had problems, but he was improving.
    The geriatrician specialist at the hospital where he was sent to made the decision that he was not allowed to return and that is all that was done.
    Aged care, it stinks!
    9th Sep 2020
    I agree Beaky. I hope I never need to go into a nursing home.
    9th Sep 2020
    There is no other way for me other than aging in place. I live in a church independent living unit and if by any chance I am unable to get the services I will need I am prepared to go into the nursing section at the very end of life. This will only happen if I have extreme dementia. Our family has no record of having ordinary dementia. My great grandmother was at home untill she died at 98 in the middle sixties.
    9th Sep 2020
    My Mum died last year at home, at my sister's place, at 96 years of age. Went to see her every year and she just got weaker. Refused any more medications towards the end and died as she wished. Hope we all can go a similar way.
    9th Sep 2020
    Yes I've started the process of modifying my home for myself in old age; raising the level of elctrical outlets, grabrails in the bathroom and so on. However our local 'tradies' seem to see the elderly as an easy meal ticket, ripe for plucking; down here the smiling bastards are as vile as our politicians in ripping us off.
    9th Sep 2020
    My sympathy Neil
    - we are doing the same using local handymen and plumbers. We are getting good service as long as we pay in cash. They do not to see a credit card or a checkbook but everything is done to our satisfaction. Stimulus money in action!
    9th Sep 2020
    My home was built for the elderly and even the young family members love it. All homes shou k d be built this way.
    9th Sep 2020
    Aged care is not for me and the day I am told I need it is the day I leave this mortal world.
    9th Sep 2020
    I remodelled the main bathroom about 3 years ago. Tradies quoted up to $16,000 and some refused to follow my design for an accessible wet bathroom. Did all of the work myself except for the tiling - new vanity, dual shower system, plenty of grab rails, better lighting, total cost including tiles and tiling was $5,000. Yes, plenty of ripoff tradies out there! Been quoted $6,000 for 2 small ramps - instead I found another solution that works for us.
    9th Sep 2020
    Buggsie. I find the same problem. Tradies don't want to do what people want them to do even if you can get them to come and give a quote. It took me 6 months to get a fence replaced last year. I need to get some painting done and another fence replaced The stress levels are up just thinking about it.
    9th Sep 2020
    I can see the attraction of living at home as long as possible, with assistance. I’d like that myself. But often there comes a time when the person needs more care and may need to move into aged care. This may happen very suddenly and the need is very great. Like, NOW. That’s the problem that many older people and their families face.
    9th Sep 2020
    It’s hard to give up independence but as we age it happens to a lesser or greater extent. I remember a doctor in his seventies telling me that he found it very difficult to age. We were walking up a mountain and he couldn’t go at the pace he used to, though still walking up the mountain at a commendable pace. Of course he’s seen many lose independence in his working life ( he was still working then), but found even that amount of deterioration difficult for himself.
    Currently I have a friend in her eighties with back problems which have ended up with her having surgery. She’s finding it difficult to accept using a walking stick and would not dream of sitting in a wheelchair. As she can only walk a short distance with the stick, I offered to take her for walks along the river in a chair for the enjoyment she’s missing. Even suggested that I could make it look like she’d broken her leg with a fake cast. No way!
    So people are different and the most independent seem to have the hardest time adapting to change. I suspect that goes for those who need to give up living at home. It also doesn’t help that our society avoids discussion about death which we are all going to face.
    10th Sep 2020
    Unfortunately there's a little thing called 'money' involved in any changes you might make to your habitat when you get older. If you want, or have to go into aged care, and don't have sufficient savings to get a place in a 'decent'? aged care home you are in for a horrendous ride for the rest of your life - that is, unless you have dementia and don't know what's going on most of the time.
    Other than if you can afford it and have plenty of savings (and from your 'deposit' is deducted daily costs of residence), your family won't get much of a legacy from your house because, if you are an aged pensioner, Centrelink won't pay you a pension while you are in an aged care facility if you own a house without a mortgage. Your house is then declared as an 'asset' and would probably be above the allowable sum to have a pension. So you will have to sell it and pay for your aged care facility with the money. If you don't have any savings and are renting a home you can get into an aged care facility of doubtful repute and end up losing most of your fortnightly pension to pay for your 'board and lodging'.
    The medical centre I attend has a 'Care Plan' system where you are interviewed each year to see how you live; what medication you take; if you have enough safety in your home and aids for any disabilities; and help with advice about getting even more assistance if you want to stay in your own home. I don't know where their reports go, but I suspect it is to the Government to assess how many aged pensioners are still living in their own homes as related to how many might soon need aged care facilities.
    For the above reasons, with no savings behind me, and a comfortable (although old), home, mortgage free, behind me, I plan to stay in it as long as I possibly can and will adjust to safety measures as required. After all, I worked hard to get my house 60 odd years ago.
    13th Sep 2020
    I haven't but my mum has just forked out her bonus covid money to get rails put in her toilet and front and back steps. She wants to stay home as long as possible, but I said no way are you going it an aged care home, I will look after you when and if the time comes with some home help if needed.
    I think Mr Fitzgerald is just trying to get more people to consider aged care considering people have recently lost faith in them, and pushing people out of their homes with rules and regulations is just pure draconian. Let old people and their families make up their own minds and choose what is right for them.