by Kath Brewster for the Connecting our Community, NSW HACC & COMMUNITY CARE CONFERENCE, 25 August 2009

I appreciate the opportunity, Ladies & Gentlemen, to be here with you today.   I have been asked to provide a ‘consumer perspective’ – whatever that might mean!

I want to challenge the way older people are defined, treated and considered (or not) in our rapidly changing environment.

‘The Land of Faerie – where nobody get old’ is The Land of Heart’s Desire in the poem by W B Yeats.   Today, this is what everybody seems to desire: not to grow old. Or is it that in our rapidly ageing population the whole notion of “old”, has been taken to a new level? Forty is the new thirty; 70 the new 60 and so it goes.

A Continuum of Heath and aged Care

I identify essentially three broad groups along a continuum which ranges from those of 50 or so, who still are actively employed, or seeking employment – but at the same time preparing for retirement (essentially the baby Boomers).

Then there are those in the early years of retirement, active still in the community, pursuing their chosen retirement activities, but many also volunteering in the service of others in the community.  

We come then to those who are more elderly – some of whom may be frail and/or in ill-health, and of whom some 5.24%  may require access to residential aged care.  

But - older people cannot be lumped together in homogeneous groups.    Even within each of these three groups, no two people are alike; while essentially they may wish for the same outcomes, the optimal means of providing that for each one may be totally different. 

It is impossible even to ring around these broad groupings with parameters of age – for we all know that there are some people who are never old, and some who are never young!  

To me, and I  believe to the vast majority of people, age is a psychological not a chronological phenomenon – until the realities of the physical catch up with us; and even then, a certain accommodation between the two may be achieved.

Our real challenge is a seamless progression along this continuum of retirement and aged care, in which people are treated as individuals, not stereotypes.

Stereotyping of Older People

I want to ask “What is this all-pervading  penumbra which mysteriously descends as soon as one ticks a box labelled  retired/widow/widower/over 65?”

This shadow which generates invisibility – and the need to communicate with relatives or friends, rather than the person themself, or requires an immediate rise in the decibel level of communication, and a stringing together of words appropriate to  a Kindergarten class?

I think it’s called stereotyping: a way of fitting into a pre-conceived mould - which is already in the mind - all of the people of any one group – and which in this case engenders ageism.  

I hasten to add that this phenomenon is not confined to any one community or even nation; it appears to be universal.

Whilst there are some elderly people who suffer a physical or mental impairment which requires them to be addressed in this manner, to stereotype all older people in this way regrettably results in discriminatory attitudes against the majority of older persons who retain their physical and mental capacities into ripe old age.   

Some definitions

It may be that we need to define better what we mean by some of the terms we use:  ‘retirement’, ‘old’, ‘ageing’, so we all are heading in the same direction;  for as Humpty Dumpty said to Alice well over a century ago:

“When I use a word, it means what I choose it to mean – neither more nor less”

Looking to my Macquarie Dictionary for a definition of ‘retirement’:   I found:

‘Retirement:   the state of being retired’

‘To retire: to withdraw from office, business – or active life’!

Some people may wish to retire from active life: do you know any?  

And what do we mean by ‘ageing population’?   Everybody is ‘ageing” from the time they are born.    By 2020 some 25% of  the Australian population will be aged over 65 , and in fact right now 25% of the NSW population is aged over 55 . According to the media (and public opinion?) the framing is alarmist: we use language like “a drain on our economy … our health system    our environment  …  our services.”  or the ‘tsunami of the elderly”.

Older People as a burden on our Society

I question the language of older people as a burden to the economy.

Older people are not simply existing in an unsustainable vacuum of decrepitude and senility:  there are many pieces of research to show that they continue to contribute more to the economy than they take out.

We speak of our ageing population as if somehow they have landed on our planet – aged, frail, in need – destined to drain our resources, our economy, our services.   Yet it is  these same  people who built the Snowy Mountain scheme, the Harbour Bridge, our cities and our rural economies. They were the architects of social and economic policy, the ambassadors and politicians, the agenda setters who helped create the UN, UNESCO, the WHO and much, much more. They have contributed 40, 50, 60 years of their lives paying taxes, buying goods and services, raising families, caring for less fortunate family members,  volunteering.    It is, in fact, they who designed, toiled and launched the world we now live in and enjoy here in Australia.

One could say that growth in the economy should be shared by everyone; that the gains made now were built on the foundations and infrastructure created by older people when they were younger – and indeed, those foundations continue to be strengthened by the spending of their retirement incomes.   It can also be said that the way we treat older people reflects on our integrity as a nation.

My Choice

So how does this reflect in the shopping list of the Older Person who finds themself (either from chronic or acute need) at the point of needing to access some form of aged care?

I want to know that I will be recognised as a valued member of my community (be that in my own home or a residential facility) treated with dignity and respect whatever my age, cultural background or state of health.

I want to know  that in the community in which I live, Older People may expect to find policies, practices and services that will:
- advance their welfare and well-being;
- enable them to make  a positive contribution to their own well-being;
- contribute to a positive community understanding of ageing;  and
- enable all sectors of the community to plan for positive ageing through information, education, advice and activity programs;

This, to me, is positive ageing.   Remember Humpty Dumpty?   “When I use a word, it means just what I choose it to mean – neither more, nor less”.    Choices!  Older People living out their lives to full potential,  with appropriate support - whatever that might be – which enables them to do just that.

But I want to know also, that, as I age and my needs may change, I can expect
- to receive  quality care,
- delivered with dignity and respect,  by
- competent and committed professionals.

To me – this is the concept of quality care: policies, practices and services which promote a healthy and active life-style – but which also provides quality care as and when needed, and in which the consumer is allowed to participate and contribute as a valued partner in the making of decisions about the person at the centre:  themself.

I want to know that – as far as possible and for as long as is feasible – my choices include the option of staying in my own home, with the support that that implies, but that if I do have to take the option of seeking residential care I will not be incarcerated in a ghetto for the elderly.

I want to know that  - if I choose to live in a certain environment,  that environment is going to retain those qualities which drew me there in the first place.

I want to know that my retirement income, be it from any one or a mix of the three pillars of superannuation, savings or pension, will be sympathetically protected and supported to the full extent possible by all levels of government.

I want to know that the  dispensation of Commonwealth, State and Local services on which I may have to draw at some time are  dispensed  efficiently, effectively and with sympathy - and  without any stigma being attached to their acquisition.

Change

As for the change that all this implies:  any system - be it human or environmental – must respond  to  the variables of change if it is not to stagnate to the point of disintegration.    But I speak of perceptive and informed change, which encompasses progress with sensitivity both to the physical environment and the social expectations of the community.  

Working together

Our real challenge as a community in addressing the needs of so diverse a population is how the bottom line adds up on the shopping list.

Even if to-day you are here as a service provider, or a representative of a service provider, many of you are – or will be - touched not only in your professional lives, but one day experiencing community or residential care from a consumer’s perspective.

We are told that if we reach the age of 65, 28% of men and 46 % of women are likely to experience residential care at some time .  Others may bear in mind that 78% of older people suffer from a chronic illness and are unlikely to experience a romantic or extraordinary death which will keep them out of some form of care.

So it is in the interests of us all to consider how we can work together to produce quality care – either in a facility or in the community - which shows genuine continuous improvement for the person at the centre. 

Your Challenge?

I have challenged the way older people are defined, treated and considered in our society.

I have identified essentially three broad groups along a continuum of ageing, but point to diversity between and among those groups

I have challenged the stereotyping of older people – which generates ageism.

I have challenged the idea of older people as a burden on society. 

I have challenged society to look to the opportunities our older demographic offers.
 
I have suggested that our real challenge as a society is to find a means of seamless progression along the continuum of health and aged care for each individual.

I have challenged you to include the consumer in your decision making.

I defend the right to compile a shopping list of goods and services to support older people in their later years, but acknowledge that the right to do so does not come without reciprocal responsibility.

I have suggested that our real challenge as a community in addressing the needs of our diverse population is how the bottom line adds up on the shopping list.

I have suggested that it is in the interests of all parties that we work together to achieve quality services and facilities, which show genuine concern and continuous improvement for us all.

A final challenge