practical living
Better off dead ?
If we don ’ t get busy living we get busy dying .
By Mike Rungie
Why are so many aged care professionals pushing for older people to have a ‘ good death ’? But not a good life ? What is this fascination with dying well after three years of living poorly as a frail older person , now well exposed by the Royal Commission ?
And why doesn ’ t this fascination extend to older people themselves where only 10 per cent have completed Advanced Care Directives , despite endless advice that this is a sure way to a ‘ good death ’.
Older people are telling us it ’ s not their death that they are worried about but the years of suffering before it . Strangely , this suffering has never bothered the rest of us enough to do much about it , yet we can ’ t abide the suffering in the process of dying .
So strongly do we feel about this , and in the face of doctors not providing us with a ‘ fix ’, making people ‘ comfortable ’, extracting them from their homes for end-of-life care , and a sense that people would be ‘ better off dead ’ are now the norms for relieving end-of-life suffering ( ours and theirs ).
But it gets worse ; it seems we don ’ t die reasonably quickly anymore . Instead , we ’ re counselled to accept the ‘ reality ’ that we are dying for the whole of those three
24 agedcareinsite . com . au years that the health services data tells we will be frail with very high use of their medical services ( and even longer if we ’ ve got dementia ).
So , just as retirement requires us to be old , frailty now requires us to be dying . But biologists have never been clear whether ‘ over-ripe ’ is dying . Older people just think they ’ re wearing out . And the rest of us should be in no doubt that being categorised as dying is very risky .
In fact , the Royal Commission lifted the lid on practices in aged care that are deathhastening whether we ’ re dying or not . The sustained abuse and neglect in aged care homes ; the removal of most of peoples ’ life-sustaining habits and possessions on moving in ; meals that hardly entice you to eat ; surrounding people with dying imagery that leave us in no doubt that all residents are dying ; grouping healthy people with dying people ; and the dangerously long wait times for home care .
A clue to just how much providers are enmeshed in hastening residents ’ death came recently in their response first to the Royal Commission findings and then to Covid .
When the Royal Commission exposed that neglect and abuse weren ’ t isolated incidents but endemic to the sector , providers responded , not with shock , apology and determination to protect their residents , but by asking for more money and relegating the problem to ‘ poor ’ providers . Two years later they apologised , but we are still waiting for their urgent response to protect .
When Australian aged care homes were shown to have some of the highest Covid death rates per head of population in the world , providers sought to respond with infection controls , already shown to be dubious in ships and medi-hotels , and still haven ’ t moved to design much safer facilities .
Perhaps the saddest aspect of deathhastening practices in aged care are the suicide rates , probably the highest of any group and increasing . Difficult to measure due to the hidden ways people suicide . The empire wants us to think that this might be a reasonable response from people who ’ ve had enough of suffering .
But the suffering that comes with being frail can be either unavoidable or imposed with the two becoming so intertwined that people can no longer see the difference , or imagine one without the other . No-one any longer notices the way providers rush to relieve end of life suffering with one hand , while causing much of it with the other .
“ I ’ d rather die than live in a nursing home ,” the universal catchcry of older people , tells us just how much they resent the imposed suffering ( can you think of anything imposed on the rest of us where