The new Aged Care Standards make for sober reading. The care of our frail, vulnerable elders is a serious responsibility – and sometimes we have failed badly. The new Standards set a high bar, and rightly so. Perhaps there should be daily readings from the Standards in our aged care organisations – much like the Rule of Benedict has been read in monastic communities since the sixth century! It too has a focus on care and community.
On second thoughts perhaps not. The Standards have a legislative and regulatory function, and the language used in the document reflects this. Sadly, in my view, the term most used to describe the people in our care is ‘consumer’. In one sense the motivation for selecting this term is admirable: the intention is to shift power from the provider to the receiver of care. The language of consumerism has long been used in the Australian health care system, and has been strongly defended, for example, in the mental health sector as language which, while imperfect, destigmatises and empowers those who use its services.
But reading through the new Aged Care Standards I find myself stumbling over the constant use of the word ‘consumer’. It often sounds so awkward that I want to shout: what’s wrong with ‘person’. Standard 1, for example, talks about the significance of the ‘consumer’s sense of self’. I imagine myself standing bewildered and alone in a supermarket isle looking for my ‘sense of self’. ‘Sense of self’ and ‘consumer’ just don’t seem to be on the same page.
Even death and dying are couched in consumer terms.
Standard 3 recognises that end of life care needs to be underpinned by ‘an understanding that dying and death are part of each consumer’s human experience, not just a biological or medical event’. The unintended implication is that we are consumers first and humans second. Or that our ‘human experience’ is somehow separate from our lives as a whole.
Standard 1 rightly advocates timely, careful conversations around end of life planning, but concludes by warning that the failure to do this might be ‘that the consumer does not have the end of life experience they would have wanted.’ Is our end of life experience a final product to choose? The language of consumer unfortunately implies this.
Overall, the language of consumer pulls against the values that underpin most the organisations working in aged care. A person becomes a unit of consumption—and most dangerously, a ‘burdensome’ consumer of ‘finite resources’.
I wonder too if, ironically, being considered a consumer bestows less agency upon each person. The relationship between consumer and provider still feels one way – a transaction rather than a relationship – robbing the person of the capacity to be a giver as well as a receiver. They are robbed of the opportunity for reciprocity, the very quality of relationships that makes for a meaningful life.
Interestingly, the word ‘compassion’ appears in only two of the Standards. In Standard 4 where providers are encouraged to promote “empathy, compassion and connection between the consumer and members of the workforce in their day to day interactions” as a means of promoting the ‘consumer’s emotional, spiritual and psychological well-being’. And in Standard 7 where providers are required “to consider value-based requirements such as a caring and compassionate nature” in their staff recruitment processes” (Standard 7 (3) (b)). ‘Consider’ is a very weak verb. Employers need to regard these qualities as fundamental!
By contrast the brand new Scottish Health and Social Care Standards: My Life, My Care names compassion as one of the five principles underpinning the standards. (The other four are dignity and respect, be included, responsive care and support, and wellbeing.) The word consumer is nowhere to be found.
Perhaps, for my proposed Rule of Benedict style daily readings from the new Aged Care Standards (or indeed for staff training purposes) we will need a translation reminding us that the frail, vulnerable elders in our care are simply people with whom we have a privileged relationship. Meanwhile, I’m thinking of making a button to wear should I finish my days in aged care: I’m not a consumer, I’m a person!