Ageing with dignity is a basic right

Support for our ageing population needs to be cost-effective but attractive.

Professor Jenny Carryer.

By Professor Jenny Carryer.

Recently, a close friend observed a proud and dignified elderly woman in care request a trip to the bathroom, only to be told by a caregiver, “Just go in your pull ups dear… we are too busy.” This is a spectre that haunts us all; the notion of having all of our faculties but having lost every shred of dignity and independence. It is a grim thought and we only deal with it by refusing to believe it “could happen to me”.

At about the same time other similarly elderly friends returned elated and glowing after a planned extreme adventure overseas. This is why we now say that age is just a number – and for many people it is. But ageing is also emerging as one of the greatest areas of inequality.

The Dunedin Multidisciplinary Health and Development Study has revealed that stress and disadvantage as a child lays the foundations for chronic disease. A life of poverty further ensures that lifestyle choices are limited, stress is maximised, and the scene is set for early onset of chronic illness and disability as a precursor to the ageing process. Ageing, when compounded by disease and disability, is an even more challenging prospect.

The growing bulge of older people in our population is too well recognised to require further description. At the simplest level, the number of people available in the workforce will progressively become disproportionately smaller than those who have retired, regardless of whether they are living independently or receiving care. Available workforce is an issue for the provision of high quality residential care, high quality hospital care and the support systems that allow the elderly to remain independent and living in their own home.

As a country, we need to be giving considerable thought to cost-effective, workforce-sensitive and attractive ways to support an ageing population. It is certainly in our interests to do so. Such planning needs to accommodate the societal changes that have occurred, such as the need for families to have both parents working in order to survive, the rapidly rising costs of housing, the increasing levels of homelessness and the low level of personal savings held by many people at retirement. All this impacts on how we structure services to older people and what people can afford in their golden years.

In a recent visit to the Netherlands to explore some of their innovations in aged care, a number of things stood out to me. One stunning example was De Hogweyk, a village for the care of people with dementia. Founded 23 years ago, the village is resourced in the same manner and to the same level as all residential facilities, and receives people with severe dementia for permanent long-term care until death.

However, the person-centred approach to dementia care sets this facility apart from others both in the Netherlands and worldwide. The village uses the notion of back stage (all mechanisms for the care of the residents) and front stage (their life, home, entertainment and autonomy). The back stage is kept entirely invisible and residents live in houses of six or seven, which function independently in terms of food, laundry, gardening and resident engagement.

One to two caregivers are stationed in each house between 6am and 10pm, and manage the care of the residents alongside the cooking and laundry, assisted by any residents that choose to do so. The character of each house is based on the previous lifestyle of the residents who are assessed prior to entry. This influences the choice of art on the walls, the music and even whether beer or wine is served at 5pm!

Residents respond to the normality of the environment with a major reduction in many of the distressing characteristics of dementia. They wander freely, socialise, some recognised that we spoke English and responded in kind, they sleep in normal beds and have a busy social life. The village contains a supermarket, pub, restaurant, a full theatre for musical shows and other normal amenities.

Further intentions for the village include a greater integration with the local community and increased freedom for residents. This would be interesting in the context of our health and safety regimes. Normal life incurs risk but reducing risk removes freedom and choice, forcing dependence. Normal life means having a range of ages present and the Dutch have some experiments with housing students cheaply in residential care settings or establishing childcare centres next to to elderly residents.

Whether we experience ageing as an opportunity to be experimental, to travel and spend our kid’s inheritance, or whether we are living on a very reduced income or have major health challenges, older people should always be entitled to the essentials. These include dignity, autonomy, respect, feeling needed and useful, feeling connected and part of a wider social sphere.

As the pressure of an ageing population increases, along with rapid social changes, we will need to change the way we build residential settings and support ageing at home. We need to have some significant conversations about the widespread adoption of advanced care planning and we must become more focused on putting people, themselves, in the driving seat to determine how and where they live as they age.

Professor Jenny Carryer is the Professor of Nursing at Massey University’s School of Nursing and executive director of the College of Nurses.

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