Episode 15 – Baby Boomers’ Views on Aged Care Facilities & Retirement

Many Baby Boomers in their younger adult life went through the experience of placing their parents in aged care facilities when they became old. Since the Boomers are at the age of retirement themselves, a large number of them are not sure if that’s the way they want to live the rest of their lives. The Booms Day Prepping panelists join the program and discuss their thoughts regarding retirement and aged care.

Transcript

Wayne Bucklar:  00 – 00:44 seconds

You’re listening to our regular podcast for Baby Boomers, it’s called Booms Day Prepping, the preparations we need to make as Baby Boomers for the next stage in our life. And today we’d like to share our thoughts on aged care facilities. Many of us of course have the experience with our parents, they’re going into care and many of us are not sure that’s the way we want to do it. Today I’m joined my co-host Drew Dwyer and regular panelists – Amanda Lambros, Bron Williams, Glenn Capelli and Brian Hinselwood and we’re going to have a chat about aged care facilities and our thoughts on how that’s going to pan out for us. Drew Dwyer, why don’t you lead us off?

Bron Williams:  Thank you.

Amanda Lambros: Hi everyone.

Glenn Capelli:  Good day again from Glenn. A wonderful topic again, aged care services.

Dr. Drew Dwyer:  Thank you Wayne and welcome everybody and hello everyone. And today our discussion sits around the topic, again probably not most palatable topics to Baby Boomers and older people, but we’re going to have a discussion about care, residential care, moving into aged care, choosing aged care, or retirement care or community care. And we’ll focus a bit on the aspects of that, what it means, how we sit with it and again, a confrontational subject – one no one wants to talk about and I know this indicatively because it’s where I spend a large portion of my work dealing in the transitions of people who have had to make the choice or had the choice forced upon them to move into a residential a aged care facility or to have to uptake community care. So I will begin by outlining some things and we have a global audience, people listen to us from all over the world so much of our referencing will be from our panel in regards to the Australian aged care system. One that I regard is probably one of the best in the world if you were to look at institutionalized care and how it works and if you’re also to look at government funded or taxpayer funded care and how it works. So in Australia, we have a taxpayer funded system, we have a retirement system, an aged care system from the age of 68 – soon to be 70. People are able to enter the framework of social security and support for ageing they can give up work and they can start to receive the benefits of a healthcare card, increase in Medicare benefits and access to services that support older people to remain primarily independent at home and also if needed, have the choice to move into what is known as a residential aged care facility and formerly known across the planet as a “nursing home.” Being mindful that this is and we can’t avoid it and we must own it in emotional intelligence. It is institutionalization, it is institutionalized care, that’s what it is. We need to learn to adapt to have a positive feeling and look, and feel or connection with it because from working in it now, many, many, many years, nearly 30, I can assure you that for me, I am a pro institutionalized care person. I’m not pro as a first choice, I’m pro leaving people independently in their own home and empowering through services to remain there. But the unfortunate part is in our society in Australia, many people don’t have that choice, their support networks are not there. If we’ve discussed on this panel ‘lived the journey to get there’ and of course their choices are limited and they have to move in transition into institutionalization. Now we’ve come through great reform in Australia many times where we have been working hard to stop what we know is abuse and neglect or remove it, reduce it. We’re trying, it will not happen quickly. However, I can guarantee you from someone as a young nurse working in aged care 20 odd years ago to now a more mature older doctor or nurse working in aged care today, the platform of care has massively improved. It is an extremely different environment and it is the message we need to send our older citizens not to be afraid of this area of care, to plan this area of care if needed as a Plan B and to be really choosy about where you’re going to go if you have to go into institutionalized care. And I can guarantee you, I will. And I’ll begin by asking the panel. I’ll start with Brian because he’s in the group is actually our older member of the group so I’ll ask Brian what his personal thoughts are how he’s grown a connection with institutionalized residential homes care and looking at care and is it a factor Brian that you think about it with your family on a day-to-day basis now that you’re much older?

Brian Hinselwood:  Well yes, thank you for that introduction Drew. Look, I don’t think about it. The reason I don’t think about it is because I consider myself “touch wood” and to be very healthy and I’m able to get around and do things. And I work in my shed and fix things so I’m able to do all the things that I want to do. I go out with friends for dinner, etc., go to the theater, go to whatever. And so I don’t think about it on a day-to-day basis but I might just say that I have had some dealings with aged care facilities and one of them, in light of what you just said Drew, one of them was years and years ago. It was in Sydney, in the city in Sydney, I can’t remember the suburb, it doesn’t really matter. It was horrid, it wasn’t violent, and the people were all over the place – it was awful. I’ve had occasions to visit people years and years later that are in various facilities and as you pointed out Drew, the conditions in my opinion have improved almost out of sight. I’m sure there’s still lots of faults and we unfortunately hear about dreadful things that happen in various nursing homes around the world not just in Australia on a far too regular basis. But I think overall it’s improved massively. I think my one downside of it is I had a very dear friend that I knew for probably the last 10 years of his life. He died last, last Christmas. And he in the last 6 months of his life, he was put into a care facility by his family. Now this man was a multimillionaire so he could have been afforded to have a live-in nurse in his home which was what he wanted. The family decided otherwise, they put him into this care facility which was run by a very, very large organization. And I went to visit him there probably half a dozen times and you could see him drooping, you could see him because he was surrounded in his opinion quite old, he was 86 or something. So he was considering the other people old and infirmed and there were people in beds in the dining room and he hated it and he went down rapidly. Having said that, while he was at home before they put him into that aged care facility, he had a couple of falls, he needed somebody to be with him. He couldn’t anymore manage on his own in a house. But yes, so my dealings with care facilities go from “yes, they’ve improved out of sight” and I can understand why people don’t want to go into it.

Dr. Drew:  Okay, good. And it’s what’s your experience of it is very, very common and amongst older people, amongst families but what you’re also experienced and what your knowledge is how you’ve grown your knowledge from that is this is entrenched into elderly people, not they see. If I was to have the conversation with my own mother, she’d say “No, I’m not going into there, so they got to feed me cockroaches in porridge.” I know that’s how she sees it but anyway, we’ll have that. And Bron, how do you see this area of care in care need because of course Bron you’ve worked in aged care as a pastoral and spiritual guide for these people. Give us your lived experience quickly.

Bron:  Yes look, because I’m a people person I loved that role as Chaplin, being able to talk with people. Certainly, the facility that I worked in regional Australia again, run by a large not-for-profit. I couldn’t fault it, I’m sure there were things, nothing is perfect.

Dr. Drew:  Yes, nothing is perfect and particularly when we start working in these conflict zones.

Bron:  That’s right. And it was clean, the staff were good, people well-looked after. It has become much more personal for me because my mum who is 93 and has broken her leg and is in the hospital and now needs to go to the private hospital and then probably into, or where all her children are hoping, that she will go into an aged care facility because we don’t believe that she is well enough to even within home support which she’s had to stay at home. But because she is cognitively aware like she’s as bright as a button, we know it has to be her decision. So for us as the children, it’s not an easy time trying to navigate that with Mum.

Dr. Drew:  And Bron if I can, if you’ve got the courage and if not, please stop me but this is going to be a tumultuous time for Mum and it will be a confronting time for the family. My advice here because I deal with this issue on a regular basis is the advice here is to first and foremost the family – you, your siblings, the people who are closest to your mother’s inner circle – need to get together on your own without Mum first. You need to have a set line of rule and that first rule you’ve just placed out is that it is Mum’s choice. You also have to have the intrapersonal communication to understand mum’s awareness to know that she’ll probably say “I’m not going.” And then the family has to make a decision on who will speak whether it’s the eldest, who is the person mum listens to the most, who is the person who engages mum with the health literacy or the education for mum around our options and our choices and the reality. So I often say when I teach or educate or present publicly to the older cohorts of people that come and see me, I say a question. Here’s a question to everyone listening today, “Put your hand up if you want to die in your own home around the people you love.” So I put my hand up. “Put your hand up if you want to die in a hospital or a nursing home” and of course in general no one will put their hand up. “Now put your hand up if you want to win the lotto,” so we all put our hands up. And I’ve said this before but this is quite amazing when you do this in these great, in these halls of people. They all want to go stay at home and die at home, they all want to win the lotto, they don’t want to die in a nursing home hospital. Now the statistics clearly tell us today in Australian society, I know it’s worse overseas, only 14% of Australians get that opportunity and that’s an amazing statistic considering how we live as a society. And the reality is families who faces tumultuous and turbulent time have to clearly understand the outcome down line. It costs money to have home care, it costs more money to give home care to someone as frail as your mum is currently. And I have no doubt Bron at 94, is that what you said 94?

Bron:  Ninety three.

Dr. Drew:  Ninety three, that her decline now is end-stage. And her decline now, the family needs to focus on benefit and burden. They need to add benefit and get rid of burden. And there’s a whole range of things in that medications, mobility, who’s at home but of course, Mum will require probably 24-hour supervision particularly considering the mobility or the fractured aspect of her comorbidity. And so in some ways, someone in the family has to be able to find the right place, introduce the right place and not convinced but collaborate with Mum to understand the reality is, “Mum, your end-stage pathway has begun” and that’s a hard conversation to have with loved ones. But a person who has courage, probably someone like yourself Born who’s had these pastoral talks with patient – harder when it’s a loved one. But I generally found a lot of elderly when they face and confront this point in time, they realized the benefits and burdens. The first place is “I don’t want to be a burden on my family” and the second place is “But I want what I want.” And older people must understand they can have this in a nursing home. We just have to choose the right home, we have to understand what it costs to go into that home. The family has to be prepared to meet those responsibilities. And then the family needs to understand what the loved one is demanding if the accommodation changes and how we set up that accommodation and how we transition into that accommodation. Now these tough conversations have to be led by someone so my advice is start talking to your family. Do not leave her in that hospital Bron, I can assure you it is the worst place whether the private or public will be the detriment to her care.

Bron:  Yes. Probably since before Christmas, the three of us, we have our own Messenger group and whoever happens to be talking with Mum, we talk to each other about keeping things updated. Currently, my brother has flown down from Queensland, doing some things with mum, will be with mum as she goes from public hospital to a private hospital which is the next step that they want because of course, she has a staph infection now too doesn’t she? Just exactly what you were talking to.

Dr. Drew:  And her body will probably not heal from that very well without intense antibiotics and  at her age that is not a very smart move.

Bron:  It’s not, no. And we have since before Christmas started to have these conversations. I played the “What-if” game with Mum. Originally it was around because she was driving up until before Christmas last year and she was hoping to get her license renewed this year. We can’t see that happening, we couldn’t see it then so we started to say, “Now what if you don’t get your license? What do we do?” And so slowly Mum is starting to come around because I think we have the advantage.

Dr. Drew:  You’re lucky she has the cognition.

Bron:  We’re very lucky at that way but also my sister is a nurse. She is an aged care administrator and an aged care trainer and she has that inside understanding.

Dr. Drew:  And you’re also unlucky Bron that Mum has that cognition because she’s going to be fiercely holding on to her opinion and view on this.

Bron:  Yes, because my sister and I have enduring power of attorney. So Mum put that in place many years ago which is great. So we’ve got all these things in place, she is financially sound, she has the DVA Gold Card which is wonderful, that has removed a lot of worries for her and for us.

Dr. Drew:  For her choices, well above the general population.

Bron:  That’s right and we’re just so pleased.

Dr. Drew:  DVA dear listeners is Department of Veterans Affairs, so Bron’s mother is either an ex veteran or married and widow to a war veteran.

Bron:  Yes, my father was in the second World War. But it’s been a good lesson for me to learn to start to think yes, I’m in my early 60s but my early 90s will come before I know it.

Dr. Drew:  You better believe it.

Bron:  Because my early 30s weren’t that long ago. That’s what it seems and so it’s about thinking what is going to be my pathway.

Dr. Drew:  So in that position, I’ll ask Amanda for her thoughts now on her reaction to what we’ve been discussing.

Amanda: Now my personal view on aged care facilities and I get that this in my personal view but I think everyone’s had an experience that you’ve gone into visit a family or a friend who’s been in an aged care facility and in your head you’ve gone, “Oh no, I do not want this for myself or someone close to me.” And it could be a lot of different things, it could be the way it looks, the way it smells. There’s just certain things that you think “There is no way will I allow someone I love to live in this kind of environment.” I think it’s worthwhile holding on to those and knowing that if someone is needing to go into an aged care facility, to find the one that suits not only you but that person who’s going in the best that you can. Now there’s a huge spectrum around the world of different aged care facilities and one is compared to another and really you can’t just say, “This is one down the street, so this is the one you’re going to go into.” Have a look around and find the one that fits the person who needs to go into there the most. I think that’s a big thing.

Now living in a nursing home, there’s a lot of different variations that you can have living in a nursing home. So you can have a single room, a double room, you can have a room that connects. So there’s different things that you can do in different nursing homes. It would be worthwhile doing your homework so do your due diligence, find out what is and isn’t allowed. Also if you’re the caregiver, so if you’re the daughter or the sister or that loving friend who is helping your friend transition into a nursing home, I think you need to get to the point of having an honest conversation of how comfortable are they. What can you do to make it their own? So whether it be bringing photos in from home or you might want to just change the color of the room, you can do things like that. So do as much negotiation or basically do your due diligence to find out what you can and can’t do for the nursing home to make your friends or your family members as comfortable as they can when living in a nursing home.

Dr. Drew:  And Glenn what’s your reaction and thought around that?

Glenn: Many years ago, I actually got to present at a huge aged-care conference and what was inspiring about it was the kind of people that are attracted to aged care. Generally, I found the  convention audience and there were 500 to 600 of them were people of heart, were people of compassion. It was also interesting and this is I say a decade or so ago that there was this almost this bipolar thing about this nature of caring and then this nature of business. So some of the sessions that not only did I get to speak but I ran some workshops, now I went along with some workshops. And some of the workshops were very much about the business, the business, the business, aged care is a business. And I think the best presentations for me were when the “yes, it is a business and it has to run as a business and has to be successful as a business.” But when it never lost that the thread, the reason we have the business, the core, the essential essence of any care facility is care and human beings. And recognizing those human beings in care as individuals and creating the best environment for them to be able to as best as possible thrive in the oncore years of their life.

Dr. Drew:  And so my next question is based around “fear.” I personally have no fear because I’m so connected and deeply connected with nursing homes. I have no fear of be going into a nursing home. I have a personal fear that I won’t be able to choose. But of course, I have no fear of going into one when or if the time comes to go to one.

Brian:  Drew, is there a case for those who can afford it because obviously, everything cost money, but is the case for people going into retirement villages, retirement home, whatever you want to call them, sooner rather than later? So they get used to the regime.

Dr. Drew:  Well there is a case Brian and that’s why retirement villages are called “Set 55s.” So the actual entry and most contracts to retirement village is the person must be 55. I think in many facilities now or many accommodation sites, they have now reduced it to 50 because we have more wealthy people at 50 and some of them are choosing to retire in those positions and set their life up pretty well. But it’s a part of the Australian law, the Retirement Village Act where it is a set 55 and they have rules about this. Rules about who lives there, who doesn’t, and who can stay, and so forth and they’re always different, diverse depending where you go. And I agree with you, the more you can encourage people to move into these types of environments, the longer they have to plan and to set themselves up. They are changing set 55s or retirement villages now so that they are more approachable and affordable and things like you’ll see them now a retirement village where you buy your house in that village but next to your house is a massive carport for your RV. These are the retirement villages for the grey nomads who want a secure place to park the RV when they’re at home. And when they choose to get in the RV and nick off for 6 months or 12 months, there are the area is protected, maintained and looked after by the village managers. So this is becoming a big attraction item for many people. One of the things that is now creeping into the system which is very good, I do leave this to a number of organizations and that is retirement villages don’t do any care traditionally, they’re not interested in your care. You’re an independent person, you live your own, they just provide that security and comfort of having lawns, maintenance, facilities and utilities. Pay your rent or pay of whatever you do and then they move on and you move on. Now because of the time that people are living in them, they don’t want to transition out into residential care, they want the care given to them in their home, in their RV. So RV village managers and village businesses are looking now at how they deliver care into the RV. A few businesses have approached me over the years and I’ve built their policies, and processes and platforms with them to do this as a smart move, very smart business. So now businesses are opening up that they provide another business inside the business of RV where they will design, once a person becomes eligible for care packaging, it’s either fee-for-service or funded. They will then now supply that care to that package in your own RV and so that you can die in your retirement village home the way that you want to because it will probably would have been your home for some 15 to 20 years prior to your end stage. I believe that is probably still the best model available to build on. I also think that a tri-state center is good so at the back of that village function space, I get a block of land and put a little hospice up the back hidden in trees and garden where once a person becomes clinically difficult to manage and that end-stage pathway begins the suitability of putting them into a hospice or a very focused 24-hour clinical service probably 20 beds, 10 beds. They transition over, the family comes in and nurses care as an end-of-life and good palliative process and they die on the same site. If there’s a husband or partner down in the village, they’re close, they can be taken up. I love the community aspect of this, it’s more difficult to be in the general community and more expensive. And as we grow as Australia, we need to understand our Boomers, us, you guys much older Boomers than me. We need to start talking very openly about this, we need to start pushing this rhetoric to our government when is that driving our government to understand this, the more education and you all know I do agitate people with it but this is where we train, empower, teach and give a voice to Boomers. If we can build communities that look after older people and respect the way they want to have the end of their life transition, these need to be very heavily listen to the players in the politics, the government because it’s bloody expensive to stay at home and be cared for and I don’t care who you are. Bron will vouch for this, one trip, one fall, one broken leg, one flu, one urinary tract infection, one bad winter and all of a sudden you are on a downward spiral, things get very ugly. If you’re not planned, it affects a lot of people in a very bad way. And I don’t like watching this in our society anymore and it shouldn’t be that way. That fear needs to be taken out.

Amanda: Now my opinion on moving into a nursing home might be different to most. I think there’s some great ones out there and there’s some absolutely appalling ones out there. But if you get to the point in your life where you actually need a nursing home especially towards the end stages of life, that’s a big thing. You don’t want to be a burden to your family and I get that and sometimes your family is not even in the position to be able to help you out with your medications and moving from one place to another or something as simple as bathing. Bathing, most of us would think is simple – until you actually get into this stage of care that you need that they have hoists and lifts and all that kind of stuff. So I think the more open you are to it at a younger age, possibly the more open you will be to it at an older age and especially towards end stage of life. So if you’re at that fragile time where you know you’re going to need more medication for pain relief or even pain management, a nursing home is the best place. Not everyone can afford to live at home and bring in a team of doctors and nurses to help them manage their end care, their end stages of life and I think that’s important to know that where your money lies and where your support system also lies and not everyone is going to have children or family who can take care of them. And in those situations, that’s even more important to be able to choose a nursing home that can look after not only yourself but also your needs.

Wayne: Now I know it comes as no surprise to everyone but I’m a little cynical about some facilities. I see in the business model for some organizations a lot of real estate investment and not a lot of care for the aged. So I’m a little cynical and certainly, it’s not an experience that I would care to happen the same way that my parents experienced it. I’m much more interested in retiring overseas to somewhere nice and of course many people are investigating living in group homes overseas as well. But I don’t have a lot of expertise in it, I guess it’s one of those things that I find very easy to put off investigating.

Brian:  Well that’s why I raised the question Drew. I was thinking that if you went into a retirement village at 55, 60, whatever, you will get to know the people in there. The other retirees in there, they would become your friends and acquaintances. You’ve already overcome the fear of being there because you’re with these other people and I think as you get older the fear that people have is, “Oh what if nobody comes to visit me? What if I can’t do this? What if I can’t do that?” But if they’d been there for 10 or 15 years, then there’s no fear of that because they’re already doing that.

Dr. Drew:  Look, absolutely and I challenge you all. Amanda would be able to understand this better coming from Canada and North America but there’s some great documentaries listeners should go and Google or YouTube – done by Australian presenters like Trudeau, I don’t know what his name is, the funny fellow on the ABC with the glasses that goes into very challenging spaces. But anyway, Trudeau, he’s just recently made one on American retirement villagers. Now guys, these places are massive in Florida. People pay a fortune to get into them and they build communities, they know each other, and they all drive around their golf carts, they play golf, they have casinos, they have all sorts and they just build these communities. And they build these communities that they’re paying and they’re controlling to dying. And it’s amazing to watch, all they’ve got to do is put the care into them. So the fear factor is that place where I encourage anyone if you’re in the space of ageing and looking down the barrel, early planning and acknowledgement of it as I write in my book, “Ageing in the New Age” is the key. It is the more you’re emotionally intelligently aware and understanding you know, “Shit, am I gonna cope in another 10 years with this house? With this cleaning up and stairs? The car? The lawns? Can I afford and do I want to use my money mowing lawns, getting lawns mowed, following my children” my kids, my grandkids are busy, I don’t want to burden anyone. Stuff that, I really should be getting my head wrapped around going to a retirement village but the right one for me where I can get into a community and set myself up and probably for me cause a bit of havoc because that’s where I’d be focusing.

Amanda: Now the experiences I’ve had related to aged care facilities haven’t been so fabulous. They’re actually quite a dichotomy, I have the good and the ugly and not much in between. One of the very first aged care facilities I went into, I think as soon as I walked through the front door, it just hit me with a smell of urine and I don’t think many years later that I’ve ever been able to forget the stench within that facility and I just thought this is not the place that I want myself nor anyone else I know being in. Yet on the flip side of that, I walked into this place that looked like the Ritz-Carlton, it was like the most beautiful of beautiful places. It looked like a 6 star hotel, the beds were beautiful, the rooms were stunning, and large and comfortable and everyone had their own individual take on the room so they could have them painted in a different way and decorated, the food was outstanding. Now I’m well aware that the dichotomy between the worst and the best is probably has a little bit to do with what you’re able to afford. And so a few episodes ago when we were talking about your retirement nest fund, you might want to save some of that retirement nest fund for your nursing fund.  

Brian:  I think that’s a good aim to have that Drew, causing a bit of havoc. I like that.

Dr. Drew:  And they love it Brian, they do love it. I go into retirement villages and you meet them, I walk down the road, a lot of people know me in them. “Good day Brian.” “Hello doc, how you going? blah, blah, blah. I’m on me way to bingo to cause a bit right now.” “Oh let me know.” And off they go, they’re go up to annoy all the girls at the bingo hall and have a bit of fun or up the club or they’ll say to me, they’ll be out the front waiting for the bus. I’ll go, “Where are you girls off to? RSL? Raffle Mart? blah, blah, blah.” They’re into it, they know exactly what they’re doing. They’ve got a positive attitude about it. The community built around them has that positiveness about it and they’re continuously confronted with the environment that they’re in. And I think it’s a wonderful space, we should not be anti, this type of ageing community. We should be proactive in it and if we don’t, I can assure you, there will be great cost to the general community when we start trying to redesign footpaths, buildings, transport, access and all the things that this ageing population is going to demand on society as we want to remain independent, mobile, and committed and connected. To community, it’s going to cost the council and community a fair whack of money.

Brian:  Drew, do you have any kind of ballpark figures on the percentage of people that actually go into these places? Well as they’re going, I mean going volunteering as opposed to be wheeled in on a gurney or something. Because it seems to me, there’s an awful lot of older people even older than me just out in the general public and doing what they’ve done for their whole lives.

Dr. Drew:  Okay well, I know most of the statistics in the epidemiology around this, it does fluctuate. So I don’t like anyone quoting me, but currently in Australia, only of a population of 23 odd million nearly 24 million people, we have 290 nearly 300,000 people in a residential nursing home in a high care facility, nursing home. We have approximately let’s go six and a half million Baby Boomers between 52 and 72, we probably have approximately a million and a half people over the senior cohorts. Now these are the people I am concerned about because if we have 290,000 people in nursing home beds and we have roughly probably anywhere between half a million to a million people in the community who are aged over 72, these people are heading there or they’re looking down a barrel at going there. But currently because of stigma and stigma is something we need to drastically remove from society. The stigma that sits around these institutionalized processes or care domains is what prevents people. So I would roughly say Brian 50% of those, let’s say half a million people not in care at the moment and should enter care and are not entering care because of stigma, the stigma that sits around these buildings, the homes. And so I’d say we probably could have at the moment another 290,000 beds filled if we were providing a positive transition. Many of these people at the moment sit in hospitals and they are what is commonly termed a “bed blocker” by the system. Waiting to transition or waiting to pass away and I think that currently we have in our system we have Medicare so we know where these people are because everyone has a Medicare number. So we can see when you’re going to the chemist or the doctor or whatever you’re doing and the moment we tick you in the box, we see where you are. What we do know at the moment is on the epidemiology, there’s roughly around 300,000 people in the Medicare system over the age of 75 who do not have an ACAT Assessment. And for those listeners listening, that’s an Aged Care Assessment Team who people quite old or in quite in retirement years when we look at their needs for services, we get them assessed by the government to see what type of services they may need. You cannot enter the aged care system if you do not have an ACAT assessment. And in Australia we have a website and I’ll call it out, it’s called www.myagedcare.gov.au and that site is now a portal, a central portal for all people to go to get care. The government then takes your details and they vet you, contact you and then they start to assess you and categorize you on what your assets are, how much money you have and whether or not you’re entitled to care funded or care not funded. And then you’re vetted towards a service or a system where you get choice and control. So it’s nice in a perfect world but what I do know is there’s probably about 300,000 people in the Medicare system over that age that have never been vetted or seen by this filtering service. So it’s almost double our current or not double, it’s almost equivalent to our current nursing home bed ratio. Now Brian if you imagine and panel that we if had a very bad winter or a very bad season or a very bad cohort of these people that got unwell within a year and had to enter the system, they’d be filling up hospital beds like crazy and there’d be no services for the general sick population. So these are the risks we have in not catering and caring for our elderly properly and these are the risks in our elderly who don’t face these issues and address them so they can assist their own society in managing aged care. Bron?

Bron:  Yes look, I think that whole thing about assisting and it comes back to that emotional intelligence and I think that’s where I’m sitting at the moment having watched my mum, being part of her process of then going “Actually I need to start taking these things on for myself so that I don’t get to where my mum has got to and all of sudden, she’s having to make decisions that she really doesn’t want to have to make but needs to make for herself.”

Dr. Drew:  And so I have a question Bron. I have a question for you, I have a question for everyone on the panel and a question now I give out to listeners, answer yourself of course panel answer me with either a yes, no or I don’t know what you’re talking about. Do you have an advanced care directive?

Bron:  I don’t, no.

Brian:  No, I don’t.

Dr. Drew:  Amanda?

Amanda: Do I have advanced care directives? Absolutely. I have a “do not resuscitate” on myself and I think it’s really important. And I think more so than just having advanced care directives, I think you need to make everyone around you very well aware of why you have them, what they are and why they are important to you because I think that’s the step that’s missing. Most people have them, put them into place, yet never tell other people that they have them. And sometimes, they don’t even go that step further to say why it’s important to them. Usually when you understand the importance to somebody as to why they have advanced care directives, the people around you when they have to implement those are more open to those. So I think that’s really important not only to have them but to tell other people you have them, tell other people what they are and also, explain to those people why it’s important to you.

Dr. Drew:  And Glenn?

Glenn: I got to visit some of the nursing homes and care facilities as preparation for that particular conference. But I think care facilities really hit home for me when when Dad died and Mum and Dad had pretty well been doing everything in the household, cooking the meals, doing everything and Mum was then without Dad, without a carer. And the family have scattered, I’d live in a different state, my brother lived in a different town, my sister lived quite away so the edges of the city, so it was difficult for us to be able to and Mum didn’t want to go interstate, she didn’t want to move downtown, she had some pretty strong views. So my sister Karen and I got to take Mum to a half a dozen different care facilities and what really rang for me, it’s like when parents ask me what school should they send their child to. Is this a good school? Is this not a good school? You’ve got to visit the school with the child, different places, different spaces and what will work for one child doesn’t work for another. And I think it’s equally as true even more so with aged care facilities. Some of the care facilities we went into, for Mum that would have been horrific, it would have been a nightmare, it just would have been terrible. And then there are a couple which had some light to them, had some brightness to them which sort of seemed as if they might be okay and then there was one that was just the absolute right fit. It had a vibrancy and Mum still very vibrant or was still very vibrant at that stage. She wanted to do things, she wanted to have sociability in the last years with Dad. Dad wanted things to be quieter at home and didn’t want to be out and about so much but Mum really wanted people, and events, and things and she wanted the spotlight that could shine on her and that’s what we were able to find with the particular facility that she went into, her life for the last 18 months and she ended up sudden death. But for the 18 months that she was alive and living in a care facility, it was just quite amazing. But any of the others wouldn’t have been the right place. So I think we need diversity in our aged care services and facilities, we need different types of places for different kinds of people and essentially every single one of them has got to focus on the person and the individual. It’s not just got to be a numbers thing, and a business thing, and here’s some more and now they’re gone and here’s some more and here they come and now they’ve gone. It’s got to be a focus on learning that human being because every one of those people sitting in a nursing home, sitting in a care facility, they’ve lived a life, they’ve got a billion stories, they’ve got talents that abound, they’ve got things they still want to be able to do and to be able to create and provide that kind of facility for them. And I think some of the best things, there’s got to be sociability option, there’s got to be nature option, get out into the garden, grow stuff. At its best, it’s got animals around as well, and it’s got youngsters, some of the care facilities we saw in Europe, quite amazing the link to kindergartens, link to universities. So there’s a steady flow of other human beings in there that everyone in the care facility can mix with them and learn from and share with. And I think that’s that’s absolutely vital, that’s care at its best.

Dr. Drew:  Well I’m going to tell you, I do and I will send all my panel one today in an email and I’ll put a PDF of one up on the Baby Boomers or Booms Day Prepping website and Facebook sites so you can get a copy of one and I’ll just quickly explain. Much of what we’re discussing can be prevented, can be ameliorated which of course means “made better” and can be looked after better when a person, an individual chooses to face the facts and the reality of where they’re going and they create for themselves with their medical teams and their lawyer what is known as an advanced care directive. Now some people call this a “living will” and it’s not a living will, it’s a will, it doesn’t have any to do with finances. It’s to do about your healthcare. My wife and I have one in place, we review it every year with our legal people and our doctor and this year, because our children are old enough as adults, we sat down and we introduced them to our advanced healthcare directive. My wife and I travel a lot together and so if a plane went down or if we crashed in a car and I needed my children to understand my cognitive wishes, thoughts and wants, I’ve got them written down. So an advance care directive is a document. There is no legal format to the document. In an actual fact, you can write an advanced care directive on a piece of paper or a serviette so long as it has your signature and a witness’s signature, it’s all it requires. So it’s a document that says, “Right now cognitive me with capacity has gone through this list of things and I’ve made a very clear decision now on what I want my direction to be and how I want to control over my life and healthcare when at some point from here now down line, I am unable or incapacitated to be able to inform anybody of my wishes.” It’s a very simple document and it says, you tick a box: I do want to be resuscitated or I do not want to be resuscitated. I do want to be have fluids and food forced into me to keep me alive. I do want intensive therapy or I do not want to these things. I do want IV antibiotics or I do not want them. I do want to be transferred to a hospital for curative care or I do not want to be transferred to a hospital. I want to die right where I am or in my place at home blah, blah, blah, and do not resuscitate me. I want my organs donated or I do not want them donated. And I want this particular person, or advocate, or proxy to be the person that stands in front of me and make sure that my wishes are met and dealt with.” Now these are tough conversations. I can assure you but this document is so important particularly for the administrators of nursing homes. When I go to your bedside Bron, or Brian, or Amanda, or Glenn and I have this document at my disposal and you are non-responsive and you are frailing and I know clinically if I do not intervene, you will probably pass away and die. I need to talk to the GP with me and I need to know very clearly your wishes now that we’ve managed you to hear, it must be advocated for, respected and given dignity and quality and we must accept as health professionals, carers and nurses that this is the choice of the individual, they made this choice when they had capacity and we must respect that person first. We have the technology to meet their needs, pain free and the likes, let this person’s advanced healthcare directive control the pathway towards the end and we all need to learn, educate and have emotional competency around it because it is the essence if you ask anyone with capacity, what they want when they can’t respond. So I ask you all to think. I’ll ask this question again now panel, are you going to investigate putting down an advanced care directive in your life? Bron?

Bron:  Yes and I will email it to my sons today.

Dr. Drew:  Beautiful.

Brian:  Look Drew, I am looking forward to getting the email and I certainly give it a massive amount of thought. Can I just say one thing? If it’s not and I think you said it’s not a legal document. If the worst were to happen, you were in a car crash and whatever and you’re in hospital and somebody says, “Well we’ve got this piece of paper that says this.” Are they bound to work on that piece of paper?

Dr. Drew:  It is a good question, that’s a great question Brian and this is often the question I get from clinicians and from people, individuals, patients and their families. So I’ll put it in a context of a scenario. In Australia, we’re moving very heavily to electronic healthcare records. If it sits on there, there’ll be a notification that it exists and the healthcare professionals who make these clinical decisions on your behalf will have access to it. It will not prevent somebody who is specifically designed in the curative care sector, doctor, emergency department, very classically ambulance, their mandate is to resuscitate, paramedics, they will not acknowledge the document until they have tried every intervention they can and their clinical inference and their clinical decision-making which is guided by law and pathway and standard when they reach a point where they know there’s nothing more that they could possibly do then they will look at that document and follow that document but they will purely follow their pathway, their knowledge, their ethics, their ethos and their standards to save a life, to try to bring a person back or to resuscitate. Now in a deep curative emergency setting, I have to let that go because I I understand I don’t work in it, I understand the passion and the ethos and the standards for we have the technology and we can save a life. But they will reach a point in that pathway where they realize there’s nothing much that’s gonna happen here or if we do resuscitate this person, they’re going to be brain dead for the rest of their life in their bed or in a coma. As I said, tough language I’m using but tough decisions that go through the heads of clinicians. And so but they will reach a point Brian where they will ask a family, “Do you know the advanced care directive and what they wanted?” And if a family knows this, they go “Dad has always said if you can’t save him, don’t resuscitate him, let him die.” Then they’ll prepare that family for that. Now in the context of a nursing home, when you have made the decision in care, you’re aged and your frail and this is why I advocate this in the palliative sense of, let’s have the discussion now on euthanasia. In Australia they’re very big on the topic. Victoria just passed their legislations. These are not discussions I like to see in aged care, I will accept them on the table but I don’t like them because we palliate, we nurture and we allow people and we support their dying process as best we can with the science we have. The people in our domain of care which is palliative, we need to build better palliative processes that nurture and give quality to dying because that person has already come to us on that pathway and that we are respectful. Now in a nursing home environment, if you have an advanced care directive, when a carer or somebody says, “Excuse me Drew, Mrs. Jones is not responsive.” And I undertake my baseline observations and realize that they are probably going to die if I don’t intervene. I merely look for the advanced care directive to understand what this patient’s wishes were and if we have built an environment that it’s their home and they’re choosing to die in their home around and connected to the people who have whether it be short or long term have just warmed, connected and nurtured them on this pathway for maybe I think good decision is to respect that individual to put their wishes and choices first and to set up and provide the planned care that we are experts in that’s why they have paid the money to move in to our hospice zone. And this is again, if we were ambulance, if you call the ambulance, the ambulance is going to resuscitate that person in that bed straightaway or on the floor, it’s quite a horrible thing to watch actually. If we are good clinicians in that nursing home environment, we should know already, “Don’t call that ambulance, if it is not her request to do so. Let’s set up the pathway and let’s allow Mrs. Jones and her family to experience the warmth, it should be applied to the dying process.” Nurses are the midwives of death and it is our professional responsibility to holistically own it and to hold the hands of our clients and their families as they journey. The same with birth, the same with the sickness and health and well-being in their life, we do the same at death. And I hope that answers your question Brian but they are not a legal, they are a legal document but they’re not a legal document that if someone chooses not to follow it, they can’t get in trouble for it. It’s an ethical thing and we all professionals are trained here. There are some excellent websites to go to to look at this stuff. “My Choice Tool” is a good website to have a look, My Choice Tool” and it’s actually a website that takes you as a patient on a journey of learning. And so what do you think if you do or don’t have one, would you value if you are asked as a person who is entering aged care? Would you value somebody coming to you and saying, “I want you to stand up for my choices if I can’t speak for myself.” Panel?

Bron:  Absolutely. Because you want to know that somebody’s got your back.

Dr. Drew:  And who they ask you to stand up against Bron?

Bron:  Sometimes, family.

Dr. Drew:  Always family. I must say it’s an easier discussion to have with clinicians because when you stand up and say, “That’s the document, that’s her wishes and I’m advocating it” they will conversate with you. Some family immediately will go, “Who the hell do you think you are?” Brian?

Brian:  Look, I agree. I would love to have somebody there, I mean I’ve made my wishes very well-known for a lot of years both to my wife and my daughters and my sister. Everybody in my family knows how I feel. Having said that, I do see the benefit of the thing that you’re talking about Drew because the other thing that occurs to me is as you just said, you and your wife travel a lot together, should the plane go down, the car crash, you could both be dead. If she was the only one that knew your wishes, then there’s nobody to stand up. And equally of course, if you were in a horrendous accident on your own, the chances of the person who has the knowledge or the piece of paper being there at that time. So I guess they have to resuscitate you to find out what your needs are, what your your desires were, what your wants were because the chances are like if you had an accident interstate, obviously your wife is not going to be there within five minutes, she’s got to fly down, she’s got to drive, whatever she does. So is this something that you would carry with you like in your wallet?

Dr. Drew:  No. Not necessarily but once it’s on your medical records, they can see it. I advise all people to go and get an eHealth record and I advise all people to look at this because hospitals in Australia particularly very, very soon and I know people are not aware, it will be compulsory. Everyone will have one, your medical records will be available to everyone in the industry to be able to look at once they have permissions which I think is a good thing, that’s where I sit with it. And at the end of the day, it’s not something that you will have to carry but it’s something you need to be well-known amongst your family because when they do arrive at their bedside, the first thing they do, when they ask a question to anybody in an emergency setting, “Is mum or dad gonna make it? What’s the outcome?” Well the outcome may be bad blah, blah, blah, blah, but we don’t know, you could come out of a coma, you could come out with missing parts and pieces and dah, dah, dah. I know I would very clearly and I’ve been asked to be the executor for people of this place to stand there and go, “No, here’s a copy of their advanced healthcare directive, I want it followed. I want to talk to the clinicians to have this met.” And I will prepare the family for this trauma that they’re about to face. And so it’s hard, these are hard discussions. I want to finish off just quickly by asking Amanda if she counsels in this space and of course, what her thoughts on it are.

Amanda: In closing, I would say make sure you do your due diligence. If you’re gonna go into a nursing home or an aged care facility, go and have a look, explore them, don’t just go to the one down the street. Really search far and wide for one that fits with your values, fits with what you want and makes you or your carer, your loved ones as comfortable as possible. All the best.

Dr. Drew:  Last comment on going into aged care?

Bron:  Be prepared. Don’t let it creep up on you and surprise you.

Glenn: So my final comment would be that we do need more diversity and we need a lot of options and we really need to be able to make sure everything in care facility, the compassionate heart of all of the folk working in care facility is able to thrive because they see every individual in there as an individual who’s lived a life and now in there oncore of their life, the finishing times of their life, they’re able to lead it very, very well in a sense of care, and a sense of security, in the sense of a little bit of fun too.

Brian:  I think that’s a very good note to finish on actually I mean with anything, you should be prepared whatever you’re doing. But yes, certainly going into age care is something that you kind of need to think ahead of yourself on because as Drew pointed out, it’s something that’s probably going to happen to the vast majority of people at some stage.

Dr. Drew:  I totally agree. It looks like we’re all on board with the same line of thinking so I’ll end my little bit with a quote from my own book and a quote that comes from me “Prior preparation prevents a piss-poor performance.” Do not make that last stage act a very bad one. Take care everybody, happy ageing.

Brian:  Bye.

Bron:  See you.

Dr. Drew:  Bye.  

Wayne: You’ve been listening to Booms Day Prepping. We’ve been talking about and reflecting on aged care facilities. Today our panelists have been as usual, Brian Hinselwood, Glenn Capelli, Amanda Lambros and Bron Williams. Thank you all for being with us and my co-host is Drew Dwyer. You can listen to us on iTunes and SoundCloud and on our website. And as always, please if you’ve got a question, if you’ve got a comment, make it in the social media channel that you’re listening to us and we’ll get around answering them on air. My name is Wayne Bucklar, this is Booms Day Prepping.

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