Consumers, choice and voice in aged care

Ageism and discrimination against older people is ingrained in our society and this needs to be challenged if the potential for truly consumer directed care is to be realised, an audience of gerontologists has heard.

A panel of consumers, providers and researchers at the Australian Association of Gerontology (AAG) national conference in Sydney yesterday discussed consumers’ “choice, voice and control” in Australian aged care and the likely impact of the rollout of consumer directed care (CDC).

It heard that ageism was prevalent in societal attitudes and system approaches and as a result the voice of older people was often ignored.

Eliza Pross, acting CEO of Community Care Northern Beaches, said a key issue was how society viewed older people.

She referred to a book by African medicine man Malidoma Some which said that in many African tribal societies the word ‘young’ literally translated into “that which is still moist, which needs to be dried and cured in order to last.”

She presented the forum with a quote:

“An elder is one whom the village acknowledges as having reached not only a state of old age but also a state of maturity and wisdom. Elders are respositories of tribal knowledge and life experience, essential resources for the survival of the village, anchoring it firmly to the living foundation of tradition. The old and the elder are the most revered members of the village community and its greatest preservers and nurturers.”

Ms Pross posed the question: if we viewed older people this way, what conversations would we be having?

“We can have this debate about policies and programs but what does it mean for older people and their connection to the rest of their community,” she asked.

“Part of the problem here is that we exist in a broader social environment that has lost touch with the wisdom of age and the role of elders. This hasn’t just happened to older people, older people have been fundamental to shaping their own construction of ageing… The construction we’re faced with is relatively new and relatively confined to the west.”

CDC presented an opportunity to evolve and reconnect with older people, however there were some issues and potential risks which were not being sufficiently discussed and explored, she said.

“We must also remember that CDC was not the holy grail,” Ms Pross said, a point which was echoed by other participants who said it was simply one step in the evolution towards truly consumer driven care.

Pat Sparrow, director of aged care reform engagement at the Council on the Ageing (COTA), said assumptions about people were often made based on their age. “When someone gets to a certain age we often assume they need a certain type of service or somehow they don’t know their own mind or what they want.”

She put forward the proposition that ingrained ageism and discrimination meant older people were often not heard. “Older people are telling us things, we just don’t listen.”

Older people want information to enable them to make informed choices. They also want to have a voice and to have some control. “They want people to understand they have capacity to make decisions and want to be supported to do that,” said Ms Sparrow.

A respectful partnership with providers, in which they could have a conversation, was the preference of consumers, she said. “It’s not just that they want their voice to be listened to, they actually want to hear what the experts have to say. They want to have that conversation with providers and work with them to get the services they need.”

Ms Sparrow gave the example of a gentleman who, when asked how he would like to use his CDC funding said he wanted to get a girlfriend. “People think that’s a flippant example, but that was his goal and the provider was able to talk it through with him and unpack it. What that actually meant for him was dealing with social isolation, because he wasn’t going anywhere or meeting people, and it also meant dealing with some continence issues.”

She said this was an example of listening to what the person wanted, hearing it in their language and then working out how services could support that.