Carolyn Moynihan: Quality often lacking in care of the aged

This week, according to a recent Perspectives article, sees the beginning of a new organisation, Healthcare Providers NZ. The umbrella group, representing more than 650 residential-care homes and private surgical hospitals, aims to solve what it says is a funding crisis that threatens the future of aged care.

Since it is election year, it may be lucky in its negotiations with the Government. But even if the providers were to get everything they wanted in the way of funding, there would still be a crisis to address in their service to the elderly.

Any organisation with "care" in its title or mission statement has a lot to live up to. Care means more than seeing to a person's bodily needs and functions at set times during the day. It implies concern, attentiveness, compassion, accompaniment, an effort to meet and even anticipate the needs of the person. It means bringing a spirit of service to one's duties that lifts them above the level of mere duty and into the realm of personal relationship.

This is what any of us would want when beset by illness or frailty, whether of body or mind. But care of this quality is in short supply in facilities for the aged, especially for those heavily or totally dependent people living in hospital wings.

Many of us, no doubt, have had the experience of visiting some aged relative or friend in long-term hospital care (if you have not, it is time to take remedial action) and being moved to pray that we may never end up like that.

Part of this reaction comes from the underlying condition of the dependent person: the stroke that has taken away the ability to walk or even to speak; the extreme weakness and confusion of advanced old age; the dementia that makes a person unable to communicate his or her needs except by restless movement or cries of distress. It can be truly depressing to see so much human frailty gathered in one place.

But what is worse is the sense that these poor souls are largely on their own. The television set might be emitting images and sounds (to which, on the whole, they are indifferent) but that is often the only company they are likely to have in between meals and other services the staff are scheduled to perform. People in this condition cannot keep one another company.

There are many good people working in private hospital wards, and I have met some of them while spending up to 12 hours a week for more than two years with my older sister, who lives in one such facility, and visiting elsewhere. Some have been especially kind to my sister, whose Parkinson's and dementia can make her difficult to deal with.

It is unusual, however, to see patients receiving much attention beyond what is strictly scheduled: extras such as having someone check whether they are comfortable, whether they are restless and perhaps need toileting, whether they have drunk their afternoon tea or need to be encouraged. Generally, caregivers are not available to sit with someone for five minutes to relieve their loneliness, or wheel them out in the sun for a spell.

Staffing levels being what they are, lack of time is a factor, especially during morning shifts when patients are being showered and dressed. But time is not the whole story - not when it is squandered in unnecessary conversations at the nurse's station, and not, as I have seen at one hospital lately, when caregivers read magazines while half a dozen of their charges sit in morbid silence in the dayroom for want of someone to try to cheer them up.

Inclination and, to be fair, capacity are also wanting. Some people working in these wards seem unable to relate well to the confused, lonely, distressed - and, yes, difficult - old people who inhabit them. They take on the work because they need it and there is always a shortage of people to do it, but they do not really like it and they resent the scandalously low pay for what is really quite a demanding job.

Better wages and recruitment might help to remedy this.

Meanwhile, it is hard to accept that bells should not be answered promptly (a friend's mother tore a lump out of her shin one night while waiting for someone to answer a bell); that someone who can scarcely move a muscle without help should be left to call out for 15 minutes or more at a time; that people who are desperate to go to bed after tea should have to wait half an hour for their caregiver to come back from her break.

There has to be something better for our mothers and fathers, uncles and aunts, sisters and brothers at the end of their lives than the sort of bare-bones operations that most geriatric hospitals apparently are.

Best of all, of course, would be for families to care for their own elderly members at home as long as possible. Much more could be said and done on that score, but when home care is no longer feasible, families should be generous with the time they give to their relatives in care.

"I want them to come regularly," said one lady tearfully to me.

If families are not attentive to their own needy members, how can we expect strangers to be?

On the other hand, attentive relatives - and I see some fine examples - can be models for the staff and are in a strong position to advocate for better in-house care.
But advocacy, like money, will get us nowhere unless providers lift their vision and decide to provide a really humane and personal service to the dependent and helpless aged members of the community.

Any one of us could end up in a geriatric hospital. So long as that thought appals us we should not think they are good enough for anyone else.

* Carolyn Moynihan is an Auckland writer and editor of the email newsletter Family Edge.