Webdiary - Founded and Inspired by Margo Kingston

Let's celebrate a few of those heroes …

The parent of a child with severe health problems or learning difficulties, who has to find the resources, every day, to cope with the crushing demands of caring for someone with special needs. It's not just the physical demands, of course, it's also the emotional challenge of watching so-called normal kids — and their parents — get on with lives that seem like a breeze by comparison.

The woman whose husband suffers dementia and has finally, against her will, seen him admitted to a nursing home. Every day she visits him, usually to find him in a state of blissful ignorance of who she is or why she's there. Like thousands of such sad spouses, she is only occasionally rewarded by a flicker of recognition. She still loves him, and she has known for years that love's work is hard work.

The man who once had aspirations to be a leader in his profession but who finally realises that in the eyes of his peers, he is an also-ran. Having a wife and children to support, he sticks gamely to his job, year after year, sees his children through university and hears his wife lavishly praised for going back to the workforce in her 50s. He finds contentment in having helped make all that possible.

The couples, countless in number, who learn to swallow their disappointments in each other, and discover the rich meaning of "for better, for worse".

On Anzac Day each year, we hear those evocative words of English poet Laurence Binyon: "They shall grow not old as we that are left grow old./Age shall not weary them, nor the years condemn." Only as we grow older do we get the point: age does weary; the years do condemn; the process of ageing is a struggle that dead heroes will never have to face, one that calls for its own kind of courage.

About 15% of Australians are over 65, a figure set to rise steadily to 25% over the next 35 years or so. Lots of ageing; lots of weariness; lots of courage needed to cope with increasing frailty.

Hugh Mackay in The Age is correct: many real heroes in our society go unrecognised. Working in aged care I have come across numerous heroes.

The 99 year old mother still caring for her 66 year old son who suffers from cerebral palsy. A 88 year old woman who saved her 92 year old husband from an attack by a wild pig, using only a chair and a brave heart. I have lost count of the people who visit their loved ones daily in aged care to feed and comfort loved ones who often don't even know they have had a visitor. We can all be heroes and many are showing courage daily.

Aged care industry leaders have told the Federal Government that, without sweeping changes, the nursing homes we need to cater for an ageing population will not be built.

They called on the Government to match the Opposition's preparedness to look at new ways of financing aged care buildings.

"We need fresh thinking on this issue. We have had a series of patch-up solutions to the problems of charging for aged care accommodation. These date back to the former Government's back down on refundable accommodation deposits in 1997," commented Aged and Community Services Australia chief executive officer (CEO), Greg Mundy.

"None of these patch-ups, including the measures that came into effect this March, address the two fundamental issues of raising sufficient capital to cover the cost of buildings and seeking contributions from residents on an equitable basis.

"We need a system in which the combined contribution of Government and residents to the cost of their accommodation reflects the cost of that accommodation in different parts of Australia," added Rod Young, CEO of Aged Care Association Australia.

"Whether people pay this in the form of a weekly rental or through the refundable deposit system known as accommodation bonds is less important than the principle of an adequate and equitable payment." Mr Young said.

"We could envisage an option of deferred payment, where people paid for their accommodation from their estate if the interest cost could be included." Mr Mundy stated.

"A 'safety net', for those who can't afford to pay, must remain an integral part of the system too."

This issue has been made sharper by the ending last month of a temporary interim accommodation payment from the Government of $3.50 per day. Industry fears that subsides for care will not be properly indexed this year, with no commitment having been made to continuing a 1.75% 'top up' payment after June this year.

Funding for aged care buildings is a mess. How can people who are deemed to be high or low care, often in their eighties or nineties, understand this very cumbersome system? The system is a financial nightmare. We do not ask people in hospitals to pay for the hospital building. Why do we ask a person suffering from sever dementia to pay for the building he or she will spend the last year or so of his or her life? A co payment from the resident is fine possibly a portion of the aged pension. But the building should be paid for by the government and aged care providers should not have to be real estate developers.

Those involved in ageing issues have prepared a paper arguing for a greater focus on ageing and aged care issues in the health stream at the 2020 Summit starting in Canberra tomorrow, 19 April.

Gerontologist Dr Anna Howe from Victoria and Dr Catherine Yelland from Queensland have coordinated the preparation of a submission identifying ageing and aged care priorities.

It was circulated to other delegates interested in ageing issues and took into account views of the Australian Association of Gerontology, and submissions to the summit lodged by a number of not-for-profit agencies and peak bodies.

It points out the lack of attention to aged care in the background paper prepared for the health stream group discussion and calls for ageing and aged care to be recognised in all elements of a national health strategy for the future.

It identified seven priority areas but acknowledged that the list was 'by no means exhaustive'.

The priorities are:

1. Make ageing and aged care a priority in a National Health and Aged Care strategy for the future (addressing attitudes towards older people as users of health and aged care services, and also addresssing disadvantages, as well as recognising diversity in ageing);

2. Promote active and healthy ageing;

3. Enhance access to assistive technology;

4. Extend the scope of aged care in a long term national health and aged care strategy (including the changing roles and potential of aged care providers, filling in gaps and extending the range of services, and
workforce development);

5. Implement measures to ensure efficient and sustainable funding;

6. Involve stakeholders in policy development; and

7. Dementia - acknowledging the need to expand existing range of dementia care services, funding levels, research and support for carers.

It is good to see our senior citizens have not been forgotten at the 2020 Summit.

How generous, Fiona. Thank you.

John Pratt, I take the life expectancy tables with a great pinch of "Murray River Salt Flakes...assist in solving the inland salinity problem".

Why?  Because it doesn't reflect my life experiences, where there were plenty of older people sitting around on verandahs checking up on passers by, or that all my friends had grandparents to an advanced age. 

And, because I don't understand how on earth they account for such as men who died in the war, or, more particularly, from war related injuries.  Or, for the fact that life expectancy must surely have been increased by such as the triple antigen injections given to babies - if not, what is the point of it?

I would like to speak of some of my family members:  John, who died at 85 years, his wife Elizabeth, died at 87 years.  Their children died at the ages of 76, 73, and 80....except for those two who died at 27 and 2 - who really pull the average way down.  All these people were born in the 1700s.

 I suspect that the "increased life expectancy" is a bit of a myth, going hand in hand with an "it's my time" advertising spruik, encouraging the old to act like young consumers.

Oh, and life expectancy is now dropping, is it not?

I am sure high quality palliative care significantly reduces the number of people who want to bring a premature end to their life. However, even with best palliative care in the world, I find it hard to believe that there would not still be some people, even if only a small number, who come to a fully considered, informed and rational decision that they still want to bring their life to an end. The question really boils down to whether or not such people should have a legal right to seek and receive assistance for this, or whether providing such a right creates some sort of unacceptable risks to other more vulnerable people.

Bob Brown and Andrew Bartlett still have the courage to discuss the issue.

I still believe in free speech.

Cheers

Fiona, I have been struck dumb by the realisation that my comment  could easily be construed as doubts about your legal expertise.  Please forgive me, please understand that this was not my intention, and please try to blame it on the grape's distorting effect on my  Winston Smith alter ego....(I think that I was given prof. Currie's 750 ml glass)

I misunderstood John Pratt's comment .  I understood him to be speaking of some kind of bedside vigil, rather than a Jonestown scenario.  Because one does, of course, die alone.  There is no other option.

The Australian Government has run newspaper advertisements on 12 April calling for applications and releasing the timetable for Stage One of its election commitment for $300 million zero real interest loans to build or expand aged care beds in areas of high need.

The plan is expected to create 2,500 permanent residential aged care places in areas of high need such as regional and undersupplied areas.

The three-part delivery plan comprises:

Stage One: an initial $150 million zero real interest loans for up to 1,250 residential aged care places provided by the Commonwealth; a review and evaluation within 18 months* – to determine the implementation arrangements for the remaining 1,250 places; and

Stage Two: providing the second set of 1,250 places - $150 million zero real interest loans.

(*The 18 month review will take into account the effectiveness of the plan and the definition of areas of high need)

Stage One loans timetable

12 April 2008 - Providers of residential aged care invited to submit proposals

6 June 2008 - Applications close

Early August - Announcement of loans/places

Another election promise is being kept as the Rudd government makes available $300 million in interest free loans to build aged care facilities in regional areas. Still a lot of work to be done but certainly a step in the right direction.

The sale of Cairns airport will fund a $450 million expansion of the city's existing hospital and eventually a new facility.

Construction is expected to start in the first half of next year on Cairns Base Hospital’s long-mooted Block D, allowing a 60 per cent increase in bed numbers to 540, a dedicated day surgery unit and expanded services for heart, elderly and cancer patients, including radiation treatment facilities.

The existing hospital’s Block B will also get a major makeover within the five-year construction timeframe to provide a new home for specialist clinics and pathology, with four floors to be freed up to provide for future expansion and the car park moved across the road.

The mental health unit will be expanded into the existing Block A on the southern side of the hospital.

Some of the money will also be used to buy a large land parcel on the city’s southside for a future new hospital, with the search to start immediately.

"This makes sure Cairns gets what it deserves," Premier Anna Bligh told The Cairns Post.

At last someone in Brisbane has acted: Cairns Base Hospital is to get a major upgrade. This will make a big difference to the level of care people in Far North Queensland will have access too. We also have a commitment to a second hospital. What a difference labor is making a both federal and state levels.

Minister for Ageing Justine Elliot has announced the appointment of actor, Noeline Brown, as the Ambassador for Ageing, to promote positive ageing.

Noeline Brown is a well respected media personality, an active community member and an Australia Day Ambassador.

The Federal Government created the Ambassador for Ageing to ensure that older Australians have a strong voice, a direct link into Government and a person to promote positive and active ageing....

The Ambassador will undertake a range of functions and responsibilities including: promoting internationally recognised principles of positive and active ageing; promoting healthy and active ageing messages within the community; leading promotional activities to ensure our communities value and respect older people; being spokesperson for respecting and recognising the continuing contribution made by older people to our nation; explaining Government programs and initiatives to the public including assisting older people to be aware of programs and how to access them; encouraging older people to plan for the future; representing the Australian Government at conferences, meetings and media engagements; and attending meetings with key Commonwealth, state and local government stakeholders on positive ageing issues.

Noeline Brown will be a good spokesperson for older people. Another election promise by the ALP has been kept.

Fiona, I looked at your link (and have immediately forgotten it - Saturday night should in duty bound carry a hint of saturnalia, should it not?)

I do not understand what you see as our possible breach, unless stating the word "suicide" is itself an offence.  Is it? [Fiona: stating it in a way that could be seen to encourage suicide might be an offence - but then, I'm not a judge.]

Fiona, with your permission. I will put this scenario:  viz, the last two comments, plus your own, to young legal practitioners, and others,  to see their take ...  Is that OK with you?

Fiona: Sure, F Kendall - after all, I haven't been in fulltime practice for a shade under 20 years. However, given the rather interesting ways in which several (non-judicial) bodies have purported to operate under certain legislation passed in the latter half of the Howard years, I just don't want to put myself personally, or Webdiary more generally, at risk. OK, then, calling all young legal eagles...

John Pratt, so do I understand that this is (1) a mutual suicide strategy, (2) a hope that you both die simultaneously,  or, the most probable, (3) a suggestion that if you die first your partner has to endure the "dying alone is no fun" bit?

Fiona: F Kendall and John Pratt, please realise that this is, if not a direct breach, perilously close to being a breach of the Criminal Code Amendment (Suicide Related Material Offences) Act 2005 (Cth). No more, OK? (Just don't want the AFP, let alone the Right to Lifers, knocking on the door this evening.)

Have you got a strategy in place to deal with your own ageing, John Pratt?

Currently more than 75 per cent of people living in aged care homes have some form of dementia or some other form of cognitive impairment. A small minority can behave aggressively or inappropriately towards other residents or staff.

The matter has been highlighted by recent events at Makk & McLeay Nursing Home in Adelaide – where a death occurred on February 28. Another resident – who is 85 years old – has been charged with murder.

Makk & McLeay is a State government–run aged care facility in Adelaide which primarily accommodates older people with dementia, with a few compounded by other ageing diseases and psychiatric disorders.

As the population ages so the number of people with psycho-geriatric disorders will increase. This is the case because diseases of old age which cause mental illness will be more prevalent as the number of older people increases.

Currently, there are 1.9 million Australians aged 70 and over, comprising 9.3 per cent of the population. Within 40 years the number of people aged over 65 will almost triple.

According to Mr Glenn Rees, National Executive Director, Alzheimer’s Australia: ‘With the first wave of baby boomers commencing retirement in 2005, the number of Australians affected by dementia is expected to reach the half million mark in the next 40 years.

• The dementia epidemic has arrived with over 162,000 people with dementia in 2002, and more than 6,600 Australians aged less than 65 experiencing ‘young onset’ dementia.
• Dementia is the 2nd largest cause of disability burden in Australia after depression. It will become the largest by 2016, continuing to outpace other chronic illnesses.
• Dementia is the 4th biggest killer of adults after heart disease, cancer and diseases of the respiratory system.
• Approximately 50 per cent of people in their 90s suffer dementia.
• Dementia is more common than skin cancer, yet with significantly less investment in public health initiatives.
• Research into dementia is currently severely underfunded.
• Australia needs a national strategy to address the dementia epidemic.
• A future national strategy for dementia should centre on a significant investment in research for cause, prevention and care; early intervention strategies; comprehensive provision of support, education and respite services; quality residential care; and provision for special needs groups including people with behavioural and psychological symptoms of dementia, indigenous Australians, those from diverse cultural and linguistic backgrounds, and those living in rural and remote areas.

As the Australian population ages the prevalence of dementia will also increase many of the people who suffer from dementia will need high care facilities to care for them. If we do not have appropriate accommodation and trained staff we will be facing an enormous problem.

Many parts of Sydney were facing a "rude shock" from insufficient stocks of affordable housing to meet a significant future demand of an ageing population, the Benevolent Society believes.

"Based on existing stocks of appropriate housing, many people wanting to live out their lives in their local neighbourhood will be forced to go elsewhere," said the Society's general manager, ageing, Barbara Squires.

"The other side of the coin is the additional upward pressure this scenario will have on taxpayer funding for aged care. The fact is, Australia's older population is growing at an unprecedented rate. In 2006 there were 2.7 million people over the age of 65. During the next 30 years, the older-old group is expected to increase most rapidly, as the Baby Boomer generation enters late old age."

There are limited housing options for older homeowners on low or moderate incomes whose home does not allow them easily to "age in place" (because of unsuitable design and/or location), but is of insufficient value to enable them to trade down to more appropriate housing in the same area.

Even in the capital cities there are not enough residential options for the elderly. Many will have to move from locations where they have formed social networks to area where they most likely will have no social network. That is if than can find suitable accommodation anywhere.

Hospital admissions at Cairns Base Hospital have been on the increase over recent years. The growth is reflected in both overnight and day only admissions.

Although the population is expected to increase by 21%, the admissions to Cairns Base Hospital are projected to increase by 41%. This will have significant impacts on health care services.

As in many areas in Australia, there has been an epidemiological transition in Far North Queensland from infectious diseases to chronic conditions. Chronic disease tends to be clustered in aging populations and as Far North Queensland has an older population compared to previous decades, chronic diseases are increasing significantly. Disadvantaged persons, particularly Aboriginal and Torres Strait Islander peoples, are also indicated in high rates of chronic disease. This trend is unprecedented and will have far reaching consequences. Future health systems will necessarily need to focus on primary and community health care in prevention and early intervention programs to ease the burden of chronic diseases on the acute care system. This will need to occur in tandem with the development of acute hospital services. Informed decisions surrounding the costs and benefits of health services are required.

...

The current high bed occupancy rates at Cairns Base Hospital results in major pressures on inpatient services. This includes ramping, access block, elective surgery cancellation and mixed gender bays. The Plan identifies the need to increase acute medical beds to meet the future demand, commence the development of models to address the needs of longer stay older patients to access alternative and more effective services and to ensure capacity for the growing medical services for diabetes, renal and oncology needs.

...

Aged, palliative and rehabilitation services pose a substantial requirement for additional services in the future. Redesign of current models of care is essential in assisting people to remain in the home and it is recommended that transitional care programs are enhanced to assist with this process and effectively improve the health outcomes of this population. Aged care places will require significant enhancement to meet demand. A priority for the Northern Area Health Service is to improve services designed to cater for people requiring rehabilitation through formalised clinical and service networks. This will be staffed by clinicians who are highly skilled in rehabilitation and who operate as an interdisciplinary team. This ensures that people receive the appropriate care in the appropriate setting (inpatient, outpatient, day hospital or community facility) and that their care is managed as effectively as possible. The Plan recommends the establishment of separate but dedicated sub-acute care areas within Cairns Base Hospital for aged care and rehabilitation services.

...

There are many reasons for the significant strain on the Cairns Base Hospital. As highlighted, these include:
• the ageing of the population and limited aged care services in the community has substantially increased the numbers of longer stay people in hospital acute beds
• a high proportion of Aboriginal and Torres Strait Island people in the catchments
• projected population growth and ageing.

...

It is recommended that further development occurs to identify alternatives to hospital admissions and appropriate models of ambulatory and transitional care. This is particularly focussed on the needs of older patients occupying acute hospital beds due to limited community support to remain at home or in supported care

Extracts above are from a recent report put out by Queensland Health. The ageing population will be placing a heavy burden on our hospitals and hospital staff.

More than 57,000 people have been infected in a dengue fever outbreak in Brazil's Rio de Janeiro state, with 67 fatalities recorded so far, regional health authorities say.

The tourist city of Rio was worst hit by mosquito-borne epidemic, with 44 of the deaths and 36,600 of the infections occurring there.

Another 58 deaths are being investigated to see if they were caused by dengue fever, whose symptoms are high temperatures and muscle aches.

In extreme cases, haemorrhage and death can follow. Children are especially at risk and no vaccine is yet commercially available.

57,000 people have been infected with dengue fever in Brazil. With Australia's hospitals already overflowing how would Australia cope with an epidemic on this scale?

 Doctor Graeme Horton says that includes more cases of heat stroke, mosquito-transmitted diseases and gastroenteritis outbreaks.

He says its important for the health system and the community to be prepared to cope with the strain.

"Climate change is clearly much, much more than an economic inconvenience - it is a threat to our life support systems," he said.

He says the elderly, children and those living in coastal and rural areas will be among those worst affected.

"For Australian communities we're expecting in coming years more heat waves, more effects of heat stress and more days of high to extreme fire danger," he said.

"We're expecting more storms and extreme weather events and the health impacts of these will include flooding and trauma and infectious disease outbreaks."

Climate change is likely to put more pressure on our health system. Already in Cairns many of our senior citizens suffer from dehydration in the summer, especially when the are living alone. Most of the older homes in Cairns do not have air conditioning.  Many of the admissions to hospital are due to heat stress and dehydration. There also a greater risk of tropical diseases such as dengue fever.

More rainfall in certain areas and warmer temperatures overall are providing optimal conditions for mosquitos—which spread the virus that causes dengue—to breed and expand into new territories.

By 2085 climate change will put an estimated 3.5 billion people at risk of dengue fever, the United Nations's Intergovernmental Panel on Climate Change (IPCC) said in March.

Minister for Ageing Justine Elliott says the plan is aimed at getting proven providers to establish aged care services in areas of high need.

"We've got about 1.9 million Australians over the age of 70 and that number's expected to double in about 20 years," she said.

If we use the government target of 88 aged care beds for every 1000 of the population over 70, 1900 x 88 equals 167,200 beds needed now and 334,400 beds need by 2028.

Aged Care in Australia – the facts
The Department of Health and Ageing oversees more than 2870 accredited nursing homes with 167,070 aged care beds across Australia.

Australia is facing a demographic shift. Australians now have one of the world's longest life expectancy rates, outliving Swedes, Norwegians and Finns. Australia will change forever.

An Australian born today can expect to live to reach 80.9 years of age; it is 78.5 years for a man and 83.3 for a woman.

Currently, there are 1.9 million Australians aged 70 and over, comprising 9.3 per cent of the population. Within 40 years the number of people aged over 65 will almost triple, from 2.8 million today to around 7.2 million in 2047, or from around 13 per cent of the population today to over 25 per cent.

For the last 12 years, the previous Government neglected aged care and the needs of older Australians.

As the figures above show we need to build another 2870 nursing homes to provide an extra167,000 aged care beds in the next twenty years. That is, we need to be bringing 8350 beds on line every year for the next 20 years. Any idea where the staff to look after these extra beds is going to come from? If we don't start building and training today our health system will collapse.

Back to John Pratt in Cairns.

I would be interested to know how many elderly are already in care in Cairns - I do not believe that there is such a crisis where I am.

Fiona, I would like to amend my recent post to say:  "A composite number.  How apt".

Dear, dear, dear...pedants all around, insisting on mathematical accuracy. 

I'm quite sure that 51 must be a prime number on at least one of those galaxies, or parallel universes out there.

Maybe F Kendall is correct; it's just that once again we don't get it.

Douglas Adams would be tickled pink.

The answer to  life, the universe and everything was, in Douglas Adam's case, sadly, 51. A prime number. How apt.

Fiona: Umm, F Kendall, try dividing 51 by 3 ...

Eliot, I'm glad you brought this up. I have been saying for yonks that one day I will die of starvation, not from an empty larder, rather from the inability to open just about any packaged food item. I had no idea that the problem was so widespread.

I suppose when you get idiots putting poison in packaged food stuffs and medicines etc it is no wonder manufacturers package them so securely.

Sadly that's life, the majority of honest punters including the manufacturerers end up paying for the stupidity of the very few.

At least the packaging industry must be doing well.

"More than 50 per cent of patients in NSW hospitals are malnourished, with many not eating because they are unable to open packaged food, dieticians working in public health have told an inquiry."

Makes you proud to be Australian, doesn't it?

Established American sitcom actor, Doris Roberts, who plays the meddling Mum in ‘Everybody Loves Raymond’, becomes extremely annoyed when talking about 'ageism' in TV, and bemoans the fact that although the over 55s watch more TV than any other group, the TV stations prefer to concentrate on an 18 to 54 age market.

 

Ms Roberts, 77, said that “ageism is rampant and it is wrong. There is no reason for the mature not to be working.  We are living longer and taking better care of ourselves.  We are having more sex than in the history of the world and that’s a good thing.  In fact it’s a great thing, and I look this good because of it.”

 

On holiday in Melbourne, Ms Roberts told the Herald Sun newspaper that ageism was “the last bastion of bigotry.  Nobody protects older people.  I’ve been doing a lot of comedy, but I also won an Emmy for playing a bag lady on ‘St.Elsewhere’ and I’d love to do more drama, but nobody is writing it for older people.  They seem to airbrush us out of society.”

 

“I’d like ‘old’ struck from the vocabulary and the word ‘older’ used instead, because from the moment you are born you are getting older.  So call me older, but don’t call me old”, Doris Roberts said.

Why is that we tend to airbrush our older population out of society?

Many in their seventies, eighties and nineties still have a lot to offer. I know of a 100 year old who celebrated his 100th birthday by skydiving. This fantastic record was set yesterday.

Eight seniors have jumped into the record books south of Sydney this morning by skydiving from a plane at 14,000 feet.

The previous record was six people over 60 jumping together.

New South Wales Minister for Ageing Kristina Keneally visited Wollongong for the event to mark the start of New South Wales Seniors' Week.

Ms Keneally says she could not think of a better way to demonstrate living life to the fullest.

"It's a new Australian record for people over 60, it's a fantastic effort and it kicks off Seniors' Week with the theme 'Live Life'," she said.

Sorry Scott but you are wrong; Douglas Adams would agree. You see the answer to life the universe etc. is number 42, as we all know.

But to arrive at the answer we first had to know the question. The question was 6 times 9 if memory serves me well.

This does not make sense but so does life the universe and everything, as far as human comprehension goes..

I suspect the point of the exercise was lost on some but don't worry the white mice are still experimenting on us.

 Richard: Memory serves you well.  If mine serves mine, the answer took millennia

seven  nines = 63

six nines = 42

Moral of the story; if we knew the answer it would not make sense anyway.

Fiona: True, o albatross. BTW, your revised email address still isn't working. I understand from various sources that hotmail is having problems - maybe you should consider flying over to gmail?

Sorry John, just one more from Gilly. Then I will desist. And to protect the elderly dead, the names have been changed.

Secure in the knowledge that her own grave had been secured, Gilly was nonetheless keen to point out that that nothing is certain in death.

There was this dear old lady I knew down in Hereford. Mrs Crichton Jones. She was over 80, lived alone, having lost the love of her life many years back. I  didn't know her very well and nor did many others. But I thought I should go to her farewell.

There were just a few of thus there, a rather motley group in fact. It was a nice little service in the village church, and there were just enough of us to form a small circle at the graveside. So we all felt included.

The Parson was holding his hands up to heaven as he uttered those final words - ashes to ashes, dust to dust. It was time to let the old lady go. Suddenly the Parson stopped and peered at the coffin. The undertaker was whispering urgently in his ear. So we all peered and there on a little brass plate it was: Lady Somerset-Jones.

The undertaker hurried off clearly agitated and we were all quietly ushered away.

But it was too late. Mrs Crichton Jones had had a right royal send off in the big Catholic cathedral in the city. Hundreds of elegantly dressed mourners, I am told, quite a few from the Establishment. And she had been well and truly laid to rest in the Lady's plot when they finally tracked her down. She would have loved that, Gilly said. I can just hear her laughing.

It never reached the papers. The Home Office did not oppose the exhumation and Mrs CJ and Lady SJ did a quiet swap, in the dead of night I suspect.  

So no, nothing is certain, even in death.

I am sorry Gilly has gone. I have never laughed so much as I did in that day. We shared our youth. Maybe we will get to share some of our old age as well.

I hadn't seen Gilly since we walked out of the gates of that Presbyterian girls school fifty years ago. She had married a Pom and gone home. But she was back for a flying visit to 93 year old mum, so we reckoned it was time we caught up.

How was your mother when you saw her, I asked.

Gilly had lots of stories, fifty years' worth in fact, so that question got her going.

Better than me I think. I was doing some arithmetic and couldn't remember what seven nines were, so she volunteered. When I come out she always likes to give me a little something to take back with me, but this time she said she couldn't think of anything. So she asked me: Would you like a grave?

A grave mother, that sounds different. Do you have one spare?

Well, there's one next to Aunt Jane that's empty.

I didn't really like Aunt Jane much mother.

Well, there's one next to Grandma and Grandpa. Would that do?

Yes, that would be lovely.

That's settled then. It's yours.

But what about you mother?

Oh, there's one vacant next to your father, and I've bagged that.

Well thank you mother, that's very kind of you. I accept.

Waste not want not. They lived by that rule, that generation.

It was time to part again. We huddled on the Goulburn railway station, as only Goulburnites know how to huddle. We're told it is the coldest railway station in the country and I won't argue with that.

The train came in and Gilly was gone. I may never see her again. But at least I know that one day she is coming home to stay.

I forgot to give her my tip for seven nines. I was never much good at seven nines either but I figured if you locked onto seven tens you only had to knock off seven and you got there. Or else, you could gear up the brain and start reciting like you did a hundred times to get it cemented in all those years ago. I start reciting at seven sevens and the rest fall into place. It's all there. You just have to know how to access it in a hurry. These days, of course....

Changing the nursing home culture is a recently released report from the US.

In resident-centered organizations, including the Green Houses and other small house models, the direct caregivers are trained differently and have more control over how they do their jobs. In culture change homes, aides may perform tasks such as cooking, serving food and cleaning in addition to traditional tasks; and nurses may have less authority than in traditional facilities. Direct caregivers, including nurses, aides and others consistently assigned to one or more residents, participate in the care planning process with and for those residents. Consistent assignment, an important principle of resident-directed care, means that the same team of nursing staff and front line workers works with the same residents regularly.

They get to know residents better, making their jobs more meaningful. This leads to workers who stay on the job longer, thereby reducing turnover. Dr. Kantor explained:
“What we see are staff that are very happy and who stay much longer, so turnover is less.” Meaningful work and increased job satisfaction also aid recruitment of workers into a field that is suffering from a staffing shortage.

The top down approach of a typical nursing home, along with overwork due to staff shortages and a very bureaucratic system, are combining to cause many to leave the aged care industry. A cultural change in needed. If we move to the Green House alternative the need to build large purpose built nursing homes would be eliminated as the average large family home (perhaps modified to suit wheelchairs and other requirements for the frail and elderly) would house small numbers of elderly, perhaps only five to ten to a home, with one live in carer on a 24 hour roster.  Life long friends may  join together to share the latter years in an Green House style home.

The Eden Alternative™ is a different model of providing residential aged care that seeks to modify the care environment for elders.

The Eden Alternative™ has identified the three plagues; Loneliness, Helplessness and Boredom as the main causes of suffering for elders in an aged care environment.

The Eden Alternative™ seeks to eliminate these three plagues by changing the physical and social environment of an aged care facility.

"Edenising" of a facility is a long-term commitment to changing its care philosophy. It should not be seen as a project or a program but more of a journey to creating a human habitat that contains variety and spontaneity, companionship and meaning.

Many people see the animals, children and gardens of an established Eden facility and think "Edenising" is just about introducing these facets of life into a facility.

However, "Edenising" goes much deeper and needs to include a change in philosophy and understanding of what "to care" means in the context of an aged care facility. It includes a mission and a vision developed to encompass the change to a true care environment.

This also means a shift in decision making to focus closely on the elders' needs and a commitment to changing the day to day life for the elderly and staff.

I learnt about the Eden Alternative while working with RSLCare.

Founded in 1991 by Dr. William Thomas, a Harvard-educated physician and board-certified geriatrician, The Eden Alternative has trained over 15,000 Eden Associates and now claims over 300 registered homes, in the U.S., Canada, Europe, and Australia. The staff and management of these homes continue to work towards meaningful culture change through ongoing training and a continued dedication to creating a life worth living for those in their care.

The Eden Alternative is also about changing the culture of long-term care organizations. The departmentalized, task-orientation of the current institutional model has created a culture that is characterised by pessimism, cynicism and stinginess. By moving away from the top-down bureaucratic approach to management and moving decision making closer to the Elders, Edenizing organizations are helping to support a meaningful life for their Elders.

The Green House model creates a small intentional community for a group of elders and staff. It is a place that focuses on life, and its heart is found in the relationships that flourish there. A radical departure from traditional skilled nursing homes and assisted living facilities, The Green House model alters facility size, interior design, staffing patterns, and methods of delivering skilled professional services. Its primary purpose is to serve as a place where elders can receive assistance and support with activities of daily living and clinical care, without the assistance and care becoming the focus of their existence. Developed by Dr. William Thomas and rooted in the tradition of the Eden Alternative, a model for cultural change within nursing facilities, The Green House model is intended to de-institutionalise long-term care by eliminating large nursing facilities and creating habilitative, social settings.

The Eden alternative and the Green House model I believe are the future for aged care, smaller facilities with a much more personalised approach. Specialist staff such as doctors, nurses visiting as required.

Richard Tonkin, the (astonishing, ghastly, or whatever suits you) Fay Weldon says that the dead always visit those still here ...not always immediately as in your case...in fact, you can be a little miffed to find yourself years down the order of precedence. I collect anecdotes such as yours. May I collect it?

You obviously have dreadful dilemmas, John.  (Btw, I remember that you were going to resign last year.  You are too necessary?)

I cannot suggest any solution, other than that we spend money where we say our hearts lie.  At present, we don't do this.

Good on ya Richard. My Gran would have got on famously with your Gran I'm sure. Looks like they had similar "green" interests, but that's another story.

I could tell many a story about my Gran for we did a bit of traveling together when I was young. She was about 65 at the time going on 16. Sadly my Gran visited some friends in London some 30 years ago and had a stroke. I was in Europe at the time and immediately got back to find her completely different. 

It broke my heart for we had lots of fun times together and now she was just like a little kid, unable to remember what she did a few minutes before; but still as sweet as ever.

Gran then lived with my Mum and Dad until she died early one morning in Mum's and Dad's arms. Just the way it should be.

An ex of mine got their dad into a nursing home ASAP.  He won 1.5 million dollars about a year before his wife died of cancer. He had two daughters who could have looked after him. He even offered to pay them for he was very very lonely, but they had better things to do.

One even wanted to rent his home out while he was in the nursing home; I told them they we pathetic and would regret their behaviour.

Shortly after one of his daughters visited the home and found him lying in his bed "all blue". The staff had not bothered to check on him for yonks. They had better things to do. He died a few hours after.

Now his daughters are rich but feel like shit; how can some get it so wrong?

Life is not money.

I don't hear many good stories about nursing homes, especially when  a couple of ex friends worked in them. A poorly paid job and no time to care for people in the manner you would like a loved one to be cared for.

Personally I don't think things will improve, though we baby boomers will have the numbers to push things in our favour, probably at the expense of our kids who will be too busy working to pay the taxes for our government subsidised nursing homes rather than helping to look after us.

The older inner area of our town has become fashionable, as I expect has happened elsewhere, and rates have risen by several hundred percent. As the very old die and their homes come up for sale, it is quite shocking to see the deeply cracked walls, threadbare floor coverings, and kitchens from the 1940's, reflecting desperate poverty. One is aware that the $13000 (or thereabouts) single pension is utterly, insultingly, inadequate; and that rates are a tax that takes no account of income or ability to pay. I think that the rate relief is around $250 – a farcical amount.

That these elderly could have sold to their advantage, and moved, is not a humane response. That they presented themselves to the world with dignity and cheer is a tribute to them.

The very old should not have the anxiety and pressure of rates, power and telephone bills and other basic expenses. The government contribution to power bills should be a right, not a grant. How much do these worries contribute to their deteriorating physical and mental state?

As for squalor, there is the unacceptable squalor caused by poverty. There can also be a chosen carelessness – (perhaps a life long habit, exacerbated by failing eyesight and increased frailty) – which one largely needs to ignore. Many elderly can feel and indeed be quite competent, although they may not appear to be so to others.

Families, from loving concern, and to quiet their own consciousnesses, can urge the elderly into nursing homes when they could happily totter along in their own happy way.

If your tottery ancient p. wants to go to Paris, which trip you feel that they will not survive, they should still, (to my mind) be supported in their wishes. They are going to die one day: better to die happy. There do not appear to be many happy people in nursing homes. In fact, in their time-tabling, their lack of food choice etc it has been said that the life within all except the very expensive is similar to that of gaols, except that in gaol you are allowed to smoke.

I realise that this seems off topic, John. I agree with what you say. However, I think that with or without family, many elderly could be well supported outside nursing homes. All my family died, at advanced ages, in their own homes. Age takes many things, but autonomy, the acknowledgement that you are a competent, experienced adult with a right to make your own choices, must be the hardest one to lose.

Fiona: Not off topic at all, F Kendall. The way we treat the aged says a lot about what we are as a society.

The projections suggest that the shortfall of nurses by 2022 could be as high as 7,000 in the absence of intervention. Increased recruitment would be required to address the imbalance, however, it is not altogether certain that there will be an adequate supply of skilled nurses to make up the shortfall. The current public sector nursing workforce would need to grow by around 2.3 per cent per annum to keep pace with anticipated demand, as shown in Table 6.3. This is consistent with other research by Karmel and Li29 into the demand for registered nurses for Australia in acute care hospitals which revealed an increase of around 2.4 per cent per annum. It is significantly higher in other care types, such as nursing homes, while projections of growth in demand for enrolled nurses are around 2.8 per cent per annum for acute care facilities.

Further modelling of demand and supply of nurses by Karmel and Li29 points toward the potential for a critical shortfall of nurses in Australia by 2010. Given expected demand, exit rates (taking into account the age-structure of the nursing workforce) and the graduate supply of registered nurses, this shortfall could be in the order of 40,000 by 2010. They estimate that the graduate out-turn (of nurses) would need increase in the order of 120 per cent on projected graduate nurse supply to match anticipated demand by 2020.

A critical shortfall in nurses is putting more and more pressure on nurses currently working in the health system with many opting out after about five years. The health system needs a thorough overhaul and things are only likely to get worse unless we radically change how we are currently doing things. Better pay and conditions may help but a good look at the administration of the system is required.

Edit my post did you Fiona??  Shees and you expect me to remember what I wrote in the first place.

Probably why my Mums hide me bottle.

Fixed the e-address, had to change the old one cause I could not remember my password, and my clues or whatever.

Hell, how many bloody passwords do we have to remember these days? The brain space could be used for better things.

Anyway all should work now; just have to remember to check the mail box.

If it don't then just yell.

Hey you gunna send me a red herring?

I rather liked them smoked ;-)

Now where did I leave that bottle.

Actually me Mums don't hide me bottle; I just can't remember where I leave it,  but I have to blame my stupidity on someone.

Me and me bruv looked after Dad till he died and now we take it in turns to stay and look after Mum. She does however like one night a week on her own; I reckon she has a toy boy; she hides my scotch for being rude.

My wife and I also look after her Mum who lives with us. She reckons I speak Mandarin with excellence (eat your heart out Rudd). Wish I knew more than just asking "where is my bottle of scotch."

What is it with Mums and alcohol?

Regardless they aint going into no nursing home. Period.

Life is beautiful (although lonelier without Dad) but the stuff that make it work is family co-operation and money. We lack neither; as such have a ball.

Not so for many others; life is a bastard and from what I can make out aged care will increasingly become just another money making opportunity, and a way to relieve the ageing sick and vulnerable of their life savings or their miserable pension.

A caring family and a bit of cash makes all the difference, but aged care and western capitalism don't mix. The family united in this day and age has fragmented for many reasons (usually financial) ; this does us no good.

Fiona: Had to do some slight editing there, Justin. Hope I did no disservice to your (IMHO) positive message. BTW, would you mind updating your email? I (as an editor) have been trying to get in touch, but keep getting a reject message...