The largest crowdfunded investigation by ABC’s Four Corners in September, culminated in the launch of a Royal Commission into Aged Care. While the incidents of shocking neglect and abuse covered by Four Corners highlight the abject state of our aged care system, the fact that the Royal Commission will be the twentieth review of aged care in as many years is a hallmark of the lack of leadership and a reluctance to fix the system over decades.
What is clear is that as a nation, Australia is failing its older and frail- some of the most vulnerable people in our society. Our aged care systems are inadequate in responding to the most basic needs of older people, with untreated or poorly managed chronic and persistent pain one of the sad realities for thousands of recipients of aged care.
Chronic pain is a common condition among residents of aged care facilities and effective pain management should be a core responsibility of all providers.
With an ageing population—the Australian Bureau of Statistics projects that by 2064 there will be 9.6 million people aged 65 and over, and 1.9 million aged 85 and over, constituting 23% and 5% of Australia’s projected population respectively—the issue of effective pain management in aged care is an issue that is in the interests of every Australian.
It is estimated up to 80% of aged care residents have chronic pain, however more than half of residents (52%) in aged care facilities in Australia have a diagnosis of dementia while two in three (67%) require high-level care to manage behaviour. This suggests a high proportion of people with chronic pain also have cognitive or communicative impairment and inability to report pain.
Evidence also shows that people with dementia in particular are living with pain and are being under-treated compared with cognitively intact persons, despite having similar levels of potentially painful disease.
People living with dementia have shared stories of an aged care system unable to meet their needs with reports of incidences that span physical, psychological and sexual abuse; inappropriate use of restraints; unreported assaults; and people in extreme pain at end-of-life not having access to palliative care.
Untreated or poorly treated chronic pain can perpetuate the pain condition and severely reduce function and quality of life. It impacts personal relationships and can have profound emotional and psychological ramifications.
For many people, feelings of anxiety, sadness, grief and anger related to the pain can create a burden that is difficult to manage and may lead to the emergence of mental health problems.
In our submission to the consultation to develop the detailed terms of reference for the Royal Commission into Aged Care Quality and Safety, Painaustralia recommends that the Terms of Reference include:
a specific reference to pain management across aged care, especially among people with cognitive and neurological conditions with reference to a Human Rights focus on understanding the needs of aged care recipients;
the need to empower consumers and carers to be at the front and centre of aged care;
appropriate education and training of the aged care workforce;
implications of the regulatory framework for safety and quality of care including the lack of consistent quality measures and the lack of publicly available information about providers and quality;