In the light of the Royal Commission into the Aged Care Sector, there have been some damning recommendations into a rather robust overhaul of our aged care system. Standards of care and how we look after our ageing population needs a complete makeover and restructure and it is obvious that the nations policy makers need to look at how to support a more beneficial and productive aged care service to our citizens.
One of the aspects to come out of this report is the continued argument of Ageism in our health care system and the issues of allocation of funding, resources and working infrastructure to our aged care sector. Unfortunately, there exists debate in the health care sector that does look at our aged care as a damning sector that may not be worthy of investment or consideration owing to it’s outcomes of providing beneficial care. I use that word precisely as beneficial in this instance is being used as a negative measure… ie how much use do older persons get out of the allocation on our health care system resources
This view of our older citizens being perhaps denied access to medical care and assistance based on the premise that it may be better served sending these resources to other sectors where they may have more of a positive impact on others is sadly where some protagonists are addressing their argument. The platform is one of “how much benefit will be derived for an older person if they are only expected to live a year longer can be achieved”. It seems a tasteless and vulgar perspective to consider.
Unfortunately, with a health system that seems to be overtaxed and perhaps underfunded, these considerations are real arguments in the Australian health sector. The United Nations 17 Sustainable Development Goals (released in 2016) lists Good Health and Well Being as the No.3 goal on its list of what is necessary to banish social ills and ensure fair and equitable quality of life for the global population.
So why should our older persons be denied access to necessary services simply on the basis of age and the assumption that they may not provide beneficial life outcomes? Essentially are we saying that the quality of life for our older persons does not impact on our social conscious? Do we not hav a duty to ensure older Australians have access to health care in the latter stages of their life? “They are going to die anyway so why bother?” It’s a regrettable rhetoric but these arguments are being waged in our political debates and decisions regarding allocation of resources.
Lets set one thing straight though. The assumption that as our ageing populations grow, it is taxing our health system beyond its capability is false. Yes we are ageing longer and our population is getting ‘greyer’ but as Leanne Wells, Chief Executive of the Consumers Health Forum of Australia states “there is respectable evidence suggesting ageing of the population is not the primary cause of increased health expenditure. The main drivers of rising health costs are changing patterns of care, including increased use, costly technology and higher quality care. In essence we can do more and so we do – for everyone and not just older people.“ This perspective offers that health care itself is changing and that we need to address the overall shift in what resources we do have and how they are used.
There has been some criticism of the Australian System of over allocation of resources and unnecessary testing, procedures and allocation of resources for non essential outcomes. According to Wells, only 60% of allocated resources are being allocated on evidence based factors. In reality, unnecessary testing and procedures being allocated and subsidised in the health care system. Where those services could be directed elsewhere and maximised. It is not for me to make any suggestions about taking services away from one population group to be spent on another, but this ageism bias does exist in the system today. “Many clinicians have their own ageist bias about what is appropriate ‘for older people’ and so do not follow the evidence. This bias needs to be made more transparent and efforts made to move clinicians to a more evidence-based practice.“ (Wells 2019).
Even the Australian Department of Health cites maldistribution as a top issue when relating to improving the health care system and facing the challenges on health care. (Systemic National Challenges in Health Care – 2013). Sam Shortt (Venerable or Vulnerable: Ageism in health care). published an article in 2001 citing the Ageism bias that exists in the culture of health care in the western world and how it impacts negatively on our senior population, denying them access to treatments on the basis that they may not have the indicators to make interventions (treatments or even assessments) a ‘good rate of return’ on investment.
Essentially our resources need to be allocated an an evidence-based assessment ,regardless of ageist limitations that may inhibit people from getting access to treatment, simply because they have reached an age where someone else deems the treatment or assessment ‘unworthy’.
Shortt raises an interesting point in his article in 2001 where in the mid nineteenth century, the “the elderly enjoyed respect as a repository of society’s wisdom,“ One would hope that as we move forward in our society we do not forget to develop and grow our societal obligations to caring for those most vulnerable and in need.
We need to be mindful that in the changing face of resources and allocation, we assess according to what is necessary and vital, for all persons and all demographics regardless of perceived expectations in how effective the treatment may or may not be. Denying access to health care on the basis of demographics is not the way forward for a fair and equitable society.
