Why do old folk go into aged care before it's necessary?

Many of the old people in Australia's nursing homes, where they are at such high risk if the virus gets in, should not have been in any nursing home at all.

So why are they there?

Some were blocking beds in acute hospitals; some were a worry to their children; some were alone in the world; some had a catastrophic illness.

Too many old people are not safe by themselves - they might fall and not be able to rise, they might leave the refrigerator door open, they might burn the toast, they might set off the fire alarms, they might let bathtubs run over. Such people need to be in care.

But too many people are forced to go into residential care against their own wishes. Their transfer represents the wishes and decisions of the children or the hospital social workers, and not the wishes and decisions of the older person themself.

A move to a nursing home often involves unhappiness for the person and for many other family members. It involves unhappiness with the decision, with the event itself, and often in the years to follow. Sometimes a catastrophic medical event makes a transfer to a nursing home the best option for an old person.

But sometimes it is not primarily to improve the life of the elderly person themself, but to ease the pressure on third parties. It is easier to remove old people to institutions than it is to take further steps to keep them in their own environments. But, as things are, too many elderly people go along with arrangements made by their children when such arrangements can result in sadness, loss and depression.

We segregate old people in special facilities in which they suffer until they die - and the present virus illustrates all too clearly just what fertile breeding grounds nursing homes can be for viral pandemics. The people we put in nursing homes are out of view and, too often, out of mind. We say we are doing it for their safety and for their welfare. We say we are doing it because they can no longer function alone or without supervision. We say we are doing it for their good. These are convenient statements - but they are only sometimes true.

This is the age of small homes, and many children just do not have the space to accommodate an old person. Then a decision to find a nursing home has more to do with the inabilities of children than it does with the needs of the elderly person.

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Sometimes children have nasty financial reasons for wanting their old parents dead - and admission to a nursing home is a first step to death. What has been called "inheritance impatience" is too common, and elder abuse is featured too often in newspapers and on television. Elders are sometimes forced to enter cheaper (and often worse) homes so that inheritances will be maximised. Wills are contested if children do not think they have received a fair share of the estate. A close friend, in legal practice, tells me that all these things are too common, and that she spends time protecting old people from their own children.

Even when children have none of these bad motives, they often want their parents in residential facilities so that they do not have to worry about the elderly parent every day. Sometimes those elderly parents are in the earliest stage of dementia - a time when they should be in their own home where they know the geography and have family and social networks. There is so much that can be done for early dementia if people are in familiar surroundings. In such circumstances, the parental move to a residential facility has helped the children more than it has helped the elderly person.

So some people have to receive institutional care - but for others it is a nasty and undesired experience.

The best place for many old people is their own home, perhaps with help from outside. They know people, they have networks, they know the shops, they know the geography of the area, they have more physical space.

Let us reserve nursing home care for the cohort that needs it, and encourage more older people to remain in their homes if they can possibly do so.