Death swoon: how genocidal abuse of old people harms everyone
Our society is ageing. There are more old people among us, both numerically and as a proportion of the population, than ever before.
There are also more old people living in institutional care and the news is not good. Frankly, it’s brutally unbecoming of our civilisation.
Too often, the public discourse about older people laments the “burden” they place on the economy by virtue of their disproportionate reliance on welfare, social security and healthcare systems.
We also hear sniping across generational lines from politicians and pundits who criticise the “financially viability” of these arrangements, which is really code for their annoyance about their level of tax contributions and their anxiety about the adequacy of their future pensions and superannuation nest eggs.
But these are not normal times.
Since the onset of the global coronavirus pandemic there have been vastly greater numbers of deaths among older people in aged care facilities compared to people living independently. In the Unites States, 41 percent of all coronavirus deaths have been linked to nursing homes and long-term facilities. At least 68,000 elderly residents and working age carers in these settings have died from the coronavirus, according to a New York Times database.
Put another way, while 8 percent of US cases have occurred in long-term care facilities, deaths related to COVID-19 in these facilities account a disproportionate number (41 percent) of the country’s pandemic fatalities. As of August 13, the virus had infected more than 402,000 people in some 17,000 facilities.[i]
This figure jumps to 58 per cent in Israel and Norway and 66 per cent in Spain. Canada has the highest proportion in the world, with 81 per cent of all COVID-19 deaths in aged care centres. The OECD average is 42 per cent.
In Australia, COVID-19 related deaths among elderly people in residential aged care facilities are among the highest in the world. By August 9, more than 68 percent (203 of 290) of all COVID-19 deaths across the nation were among residents of aged care facilities.
Of equal or greater concern in Australia are the revelations of a Royal Commission into Aged Care Quality and Safety that has spotlighted the devastation experienced by older people living aged care facilities.
The Royal Commission also singles out the broader burden of disrespect faced by older people in the community:
“The Australian community generally accepts that older people have earned the chance to enjoy their later years, after many decades of contribution and hard work. Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people.” [ii]
Older people weren’t always considered a burden and why this is so is a point I’ll come to but first, here’s a summary of some relevant facts.
So many seniors, so few elders
We typically define people as old, elderly or senior when they’re 65 years or older. By that measure, four million, or one in six Australians, were aged 65 and over in 2019. In the 20 years to 2019, the proportion of elderly Australians increased from 12.3 percent to 15.9 percent of the population, a rise that will accelerate more rapidly over the coming decade.
By contrast, we have few elders, by which I mean people who aren’t focused on acquisition or achievement or profit or power. Elders aren’t necessarily old people. They’re wise people who bring a consciousness and acceptance that life has limits, that it winds down and ends. And in wearing out and making peace with these limits, elders breed sustainability and feed new life.
Elders don’t last, in the way we wished our grandparents had stuck around longer, but the example of their attitude, their embrace of ending lasts in the culture. Elders can therefore nurture us into more sustaining ways of being in relationship with ourselves, each other, and the way we live.
Something has happened to ageing
There were times when agedness was venerated because life experience and its lessons brought personal and cultural wisdom.[iii] This deepened a culture’s sanity and capacity for wise decision making. In the past, this was transmitted through practices such as storytelling, rites of passage, sustainable harvesting and reciprocity. Our modern-day institutional equivalents include education, training, internship and mentorship, except that eldership isn’t on the curriculum and our elder-teachers have disappeared.
One result is that is that ageing is feared, denied and reviled. Nobody, neither the young, the middle-aged or even the old want to be old. Another is a culture that fetishizes the preservation of youth, which amounts to a denial of death. So today’s smart money, which is being invested by 30- and 40-somethings, is a bet on eternity or a cancer-free life lived on Mars.[iv]
It’s also seen in our pursuit of limitless growth and its sequalae: environmental destruction, species extinction and global warming, to name a few. Some of us wring our hands at the desecration of the land, oceans and skies, but still we plunder and pollute like there’s no tomorrow.
For humans, and especially young people, it means we’re bereft of the civilising influence of elders. It means the lessons of ageing and eldership are vanishing. It means we have no way to challenge the lie that old people are a burden, that they have no value or dignity, or that if things were different, if ageing and its essence were venerated, we could more than break even on the deal.
Widespread abuse and sub-standard care in residential aged care
Another consequence of these attitudes and arrangements is that more older people live in gated over-55 communities and in residential aged care and assisted living facilities — places “better able to care for them,” which are set apart from the rest of us.
In 2017–18, 241,723 Australians lived in permanent residential aged care at some time during the year, an increase of 2,344 from 2016–17. A further 61,993 people received residential respite care. Altogether, these people were cared for by 886 providers that run 2,717 residential facilities across the country.
In principle, people living in residential aged care facilities can access 24-hour support and accommodation that includes assistance with everyday living activities such as cleaning, laundry, shopping and meals; clinical care such as wound and catheter care, medication administration and pain management; and help getting dressed and with grooming, eating and going to the toilet.
The Royal Commission is ongoing, but many of the findings contained in its Interim Report are as apalling as they are condemning. Here’s some excerpts:
“We have seen images of people with maggots feeding in open sores and we have seen video and photographic evidence of outright abuse.
“Dreadful food, nutrition and hydration, and insufficient attention to oral health, leading to widespread malnutrition, excruciating dental and other pain, and secondary conditions.
“Inadequate prevention and management of wounds, sometimes leading to septicaemia and death.
“Poor continence management — many aged care residences don’t encourage toilet use or strictly ration continence pads, often leaving distressed residents sitting or lying in urine or faeces.
“A high incidence of assaults by staff on residents and by residents on other residents and on staff.
“Common use of physical restraint on residents, not so much for their safety or wellbeing but to make them easier to manage.
“Widespread overprescribing, often without clear consent, of drugs which sedate residents, rendering them drowsy and unresponsive to visiting family and removing their ability to interact with people.
“The combined impact of the evidence, submissions and stories provided to the Royal Commission leads us to conclude that substandard care is much more widespread and more serious than we had anticipated.” [vi]
COVID-19’s impacts in Australia’s aged care facilities
As already mentioned, by early August of 2020, COVID-19 related deaths among elderly people in Australia’s residential aged care facilities accounted for nearly 70 percent of all COVID-19 deaths across the country.
The Joint Chair of the Royal Commission, the Hon Tony Pagone, QC described the impact of COVID-19 on Australia’s aged care sector as “a human tragedy.”
“At the moment, that tragedy is unfolding daily. Our inquiries may reveal, as seems likely, that there needs to be a fuller and more forensic inquiry into the impact of COVID-19 in aged care.” [vi]
Counsel assisting the aged care royal commission Peter Rozen, QC, said, “We should not be surprised at the results.” He said the death toll among aged care residents “starkly exposed all of the flaws of the aged care sector which have been highlighted during this royal commission”.
“While there was undoubtedly a great deal done to prepare the Australian health sector more generally for the pandemic, the evidence will reveal that neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector,” he said.
Responses to this travesty by the Commonwealth Minister for Aged Care, the head of the Commonwealth Department of Health and the Prime Minister were jaw-dropping.
On August 21 Aged Care Minister Richard Colbeck was asked a simple and predictable question: how many aged care residents had died of coronavirus?
What followed was an excruciating 35 seconds of silence — broadcast live on TV — of a minister fumbling through documents to find an answer that should have been at his fingertips.
Finally, his questioner, Labor senator Katy Gallagher, broke the awkward silence and asked a department official for the answer: 254.
That was the death toll in Victorian aged care homes by Thursday, August 20.
When Senator Colbeck was asked how many residents were currently infected with the virus, Senator Gallagher initially got the same response from the Minister. Silence.
The Prime Minister, Scott Morrison rejected suggestions the Aged Care Minister should be sacked.
“I’m sure the Minister regrets not being able to call those figures to mind,” Mr Morrison said. “On occasion, I can’t call every figure to mind.
“I do have confidence [in Senator Colbeck]. This is a very demanding environment in which to be working. I know those issues are not far from the Minister’s mind on a minute-by-minute basis.”
In mid-August, following mounting pressure and days of damaging evidence presented to the royal commission, the PM apologised for his government’s failings.
He said he was “deeply sorry” for failures in the aged care sector during the coronavirus crisis, but quickly defended the government’s overall response and backed health officials who disputed many statements made in the royal commission.
The head the Commonwealth Health Department, Professor Brendan Murphy, accused the aged care royal commission’s lawyer (Peter Rozen, QC) of using misleading statistics to criticise the Government’s response to COVID-19.
Counsel assisting the royal commission Peter Rozen, QC had repeatedly stressed the fact that aged care residents were over-represented in Australia’s COVID-19 death toll.
“Presently, 68 per cent of all COVID-19 deaths in Australia relate to people in residential aged care,” he said in his opening remarks to the royal commission on August 10.
“The evidence that you will hear is that this makes Australia the country with one of the highest rates in the world of residential aged care deaths as a proportion of deaths from COVID-19.”
By his closing statement on Thursday, Mr Rozen, QC said that proportion had increased to 70 per cent.
But a few days later, on August 14, Professor Murphy told a Senate committee that using those figures to suggest Australia was performing poorly was an “extraordinary interpretation of statistics”, labelling the conclusion “ludicrous”.
“When you have a very, very low death rate generally, then the aged care death rate as a proportion is high,” he said.
“Every death is an absolute tragedy and it’s been an awful situation, but to interpret a percentage of an extremely low death rate as an example of poor aged care management is simply not defensible.”
These remarks and other responses by government leaders reveal a cavalier disregard for the tragedy being wrought on old people in residential aged care facilities and on their families. But we shouldn’t be surprised. Their indifference reflects the deeper disrespect for older people in the culture.
Finally, it should be said that even though the Prime Minister went so far as to apologise (and then defend his government’s performance) by saying the buck stops with him, it doesn’t. There was no consequence apart from the fleeting embarrassment of a few days’ bad headlines. The buck really stops with defenceless older people who are losing their lives.
The case for elderhood
There are no easy solutions. Maybe there are none. It seems that we are in a terminal death swoon that expires with the end of civilisation, and maybe the end of life on Earth.
In the meantime, author Stephen Jenkinson has this to offer:
“The day will surely dawn when young people will come to you — as they have begun to come to me — and ask what you did about the troubles, and whether you knew how bad it was, or whether you handed over to them a diminished world with a shrug of compassion fatigue and a vacant wish of good luck, or whether you stood up for them.
“So I set before you a task, a pilgrimage of a kind. Let us see if there are enough among us who can grow sturdy and sorrowed from the labours of a deep and dishevelling contemplation of what has become of age in our time.
“We know what’s becoming of the old people in our midst. It is savagely unbecoming of a civilized people, and it passes for compassionate care, and it can bear no scrutiny without dissolving into the withering, ghosted sham of compassion that it is.
“I am making the case for elderhood, not for easy agedness. I’m doing so mostly by wondering what happened. Because something happened. Something happened to ancestors and elders and honour.
“There’s work to be done, and there’s an old wisdom to be learned where there used to be the wisdom of old, and you can’t fix what you don’t understand. That’s where we’re headed: to grievous wisdom. Let us see if we can bear the sound, the particular sound, of no hand clapping.
“This is a plea and a plot for elders in training.” [vii]
Dan Gaffney is a teacher and author. His book and podcast series, ‘Journey Home — Essays on Living and Dying’ was published in 2019.
[i] More Than 40% of U.S. Coronavirus Deaths Are Linked to Nursing Homes. New York Times, 2020, 13 August
[ii] Commonwealth of Australia, 2020. Interim Report of the Royal Commission into Aged Care Quality and Safety, p1
[iii] George Minois, 1989. History of Old Age: From Antiquity to the Renaissance, Polity
[iv] Jenkinson, Stephen, 2018. Come of Age: The Case for Elderhood in a Time of Trouble, North Atlantic Books. Kindle Edition, p43
[v] Commonwealth of Australia, 2020, Op cit, p5
[vi] July 30, 2020, Statement from the Hon Tony Pagone, QC relating to the COVID-19 outbreak in aged care facilities
[vii] Jenkinson, Stephen, 2018, Op cit, pp7–8
