Skip to main content

National Aged Care Alliance February 2014 Meeting

Discrimination Age Discrimination

Introduction

I would like to acknowledge the Ngunnawal people, who are the traditional custodians of this land. I would also like to pay respect to their elders, both past and present and extend that respect to other Aboriginals present.

I thank you for the invitation to address this meeting.

Context

All of you present today have worked for many years on aged care policy and in delivering services to older people. You will be more than familiar with the scale of aged care provision, the cost of it, the unmet demands and the pressing need to see more and better care, more widely available, and more sustainable and equitable funding for this significant and deserving area.

You already know the demographic trends: that Australians are living 25 years longer than they did a century ago, that Treasury projects that the number of Australians aged 85 years and older will more than quadruple over the next 40 years[1] rising from 400 000 to 1.8 million.[2]

You also know that the number of years individuals live in good health has also extended significantly, for most of us, well into our eighth decade.

We should welcome these statistics, representing as they do a victory for human kind.

I endorse the observations of the World Health Organisation that “Population ageing is one of humanity’s greatest triumphs”.[4]

But to make sure that as individuals and as a society, as a world, we reap the benefits of this amazing advance in healthy longevity, we need to recognise and plan for the increased need for health service provision.

This as an urgent and critical challenge for Australia: if we don’t provide properly for aged care, we will have a human rights disaster on our hands.

If we do meet the challenges, and that is at the core of this meeting today, we will secure a major advance in the protection of rights for all Australians.

 

What should be the guiding principle in developing services that will avoid the disaster and reap the achievements?

All aged care services, ranging from modest assistance for ageing in place, to acute, intensive highly specialised care for very old, very ill people in residential facilities, must be developed and implemented with a firm and clear recognition of the human rights of people as they age. The moral and philosophical basis for the provision of services for older people goes well beyond the traditional concept of welfare, of merely providing government resources to those who are struggling.

It goes to the enjoyment of basic human rights throughout our lives, rights to which Australia has long been a signatory through international conventions and rights which in many cases have been built into national and state laws.

I believe this incorporation of human rights based approach is what distinguishes the current age care reform package from previous policies and programs for older people.

The National Aged Care Alliance has been core to the consultations that resulted in the Living Longer Living Better Package – now retitled the aged care reforms, one of the last pieces of legislation to pass the previous Parliament prior to the election, and one of the most significant achievements of that period of government.

I know that some tough negotiations occurred between stakeholders to design that package and I know that some thorny questions still haven’t been answered. With a change of Government, inevitably comes a change of emphasis. However, it appears that the aged care reform framework will, for the most part, remain in place. Most importantly, the shift to a consumer directed care model, which allows older Australians greater choice and control, appears to be supported by all sides of politics. It is in this aspect that we can see the impact of human rights thinking.

The test of the reforms will be of course, in implementation.

To provide aged care in a way that is fully respectful of the rights of older people is a challenge faced by the entire aged care sector, and of course of the public policy makers who determine the rules on which they operate.

The role of the Commission

At the Australian Human Rights Commission, our President, my five, soon to be six, Commissioner colleagues and I are committed to the protection of human rights, for everyone, everywhere, every day. That commitment applies to everyone, no matter how old they are.

Growing awareness of the need to affirm and protect human rights for older people is now the subject of intense consideration in the international community.

Despite the existence of various human rights treaties, older people are not recognised explicitly under the international human rights laws that legally oblige governments to realise the rights of all people. Hence, there is increasing support for a convention focused on the rights of older people.

It is not yet clear what position the Australian Government will take on the proposed new convention.

The Australian Human Rights Commission, as an independent body, supports the Convention and I am playing an active role in progressing it. If this convention goes ahead, I expect that the National Aged Care Alliance will contribute to setting out the ways in which older peoples’ rights to health and support may be articulated.

In any case, the development of a convention will take time. For now we must rely on the existing international and domestic human rights frameworks and national law.

Australia’s human rights position is in many ways a strong one, starting with our support in 1948 for the universal declaration.

The Universal Declaration of Human Rights sets down in Article 1 that “All human beings are born free and equal in dignity and rights.” This right to freedom and equality does not change as we grow older. Older people have the same rights as everyone else.

Australia has ratified a wide range of international human rights instruments which contain important provisions relevant to older people.[5] The provision of aged care must align with the principles and obligations Australia has under other binding treaties. These principles underpin the realisation of all human rights of recipients of aged care services, and include “non-discrimination and equality, participation, monitoring and accountability mechanisms and remedies”.[6]

Australia’s domestic framework is strong. We have the Age Discrimination Act 2004 which protects the rights of people of any age to be free of discrimination based on age in areas and services defined in the legislation.

My own role, as a dedicated Age Discrimination Commissioner, is a world first.

In this role my approach to the provision of aged care is based on the recognition of the rights of older people to have their dignity and choices respected as they are cared for in their later years.

When considering whether our aged care system is broadly consistent with human rights, we should ask four basic questions:

  • First, is aged care and are other services sufficiently available?[7]
  • Second, is aged care accessible to everyone requiring care?
  • Third, are the services provided acceptable and is service delivery respectful of difference and diversity?[8]
  • Finally, and most importantly are the services provided deemed to be of an acceptable quality and are they delivered with respect and dignity by appropriately skilled professionals?[9]

The aged care system must also include rights to information, privacy, choice, to active and informed participation, and to accountability.

The move towards consumer directed care in the aged care industry is a significant shift. As I understand it, this is the first time a consumer directed care model has been developed specifically for older people.

Giving older Australians more meaningful participation in their own care, as now provided for in the reforms, is consistent with a human rights approach.

Who are older Australians?

We are a diverse lot.

At the beginning of our lives, as infants, we all develop at roughly the same pace – there’s a smile in the first two months, crawling at about nine months, and the first few words at one year.

However at the other end of our lives, we are all very different. There is massive variance in the ageing process. Older Australians are a particularly diverse cohort. As individuals, we are products of the influence of genetics, birthplace and circumstances, decades of lived experience.

Currently our culture, as expressed thorough the media, through community attitudes, in the labour market and through commercial practices, fails to recognise and provide for this diversity.

Media reporting of older people can create the impression that most are in residential care facilities. There is an implication that residential care is the inevitable destination for all of us, that our independence will inexorably be sacrificed as we grow older, and that we will all succumb to dementia.

These messages are wrong.

The facts are very different.

What are they? First, where are we? 94 per cent of Australians aged 65 and over live in private dwellings; 77 per cent of people over 85 years live at home.[10]

A 2011 Galaxy Poll found that more than 90 per cent of Australians want to stay in their own homes, even after the negative effects of ageing begin to set in.[11]

The challenge is to ensure that services take account of these facts and meet the diverse needs of older people ageing in-place.

We are on track. It is to be welcomed, that with a new awareness of this diversity, the aged care reforms included funding over five years to better support people with special needs.[12] These groups include;

  • Aboriginal and Torres Strait Islander people,
  • culturally and linguistically diverse people,
  • lesbian, gay, bisexual, transgender and intersex people,
  • older veterans,
  • women, and
  • People experiencing homelessness or with substance misuse problems.

In 2012–13, the Government committed to providing an additional 200 aged care places over four years in Indigenous communities under the National Aboriginal and Torres Strait Islander Flexible Aged Care program.

Older Australians from culturally and linguistically diverse populations require care sensitive to their needs. For example, some older people who suffer dementia revert back to their first language. Demographic projections indicate that the proportion of older people from CALD backgrounds is increasing at a faster rate, reflecting the ageing of the post-war migration wave. Approximately one in five Australians in care come from CALD backgrounds and the numbers of this cohort are expanding rapidly.[13]

The National Ageing and Aged Care strategy: For People from Culturally and Linguistically Diverse (CALD) Backgrounds was published in 2012, which addresses these issues.

It is important that aged care providers that cater for specific cultural or ethnic groups are awarded the appropriate number of places. This will ensure that people from CALD backgrounds have real choice in their care provider.[14]

It is estimated that up to 11 per cent of the population is of a diverse sexual orientation. The National Lesbian, Gay Bisexual Transgender and Intersex Ageing and Aged Care Strategy was also launched in 2012. While LGBTI people are themselves a diverse group, the strategy recognises that older LGBTI Australians share the experience of having lived through a time which they suffered stigma, discrimination, criminalisation, family rejection and social isolation.[15] The strategy contains the principles of “inclusion, empowerment, access and equity, quality and capacity-building”. [16]

Sensitivity training for the aged care sector specific to the needs of older lesbian, gay, bisexual, transgender and intersex people has been rolled out.

Last year an amendment was made to the “religious exception” provision of the Sex Discrimination Act 1984. This amendment prevents discrimination being allowed for religious organisations providing Commonwealth-funded aged care services. My Commissioner colleagues and I had advocated for this change.

This amendment was a win for LGBTI older Australians and for human rights generally.

Who are the carers of older Australians?

The biggest implementation issue for the whole program as well as the diversity elements now comes down to the carers.

Who are they? How are they trained? How are they rewarded? Do we have enough?

Will we have enough when we have in our midst over 1.8 million Australians who are over 85?

We do not have enough now and unless we introduce new thinking, we won’t have anywhere near enough in 40 years. In that sense we have a human rights disaster waiting to happen, but able to be avoided if we take the right steps now.

The extra workers: where are they to come from?

There are two main sources and both need review and upgrading.

First they come, in many cases, from immigration. There is great potential to do more and do better here.

Aged care we all agree must be appropriate.

Care from family members or an aged care worker of the same cultural background greatly improves the quality of life for older Australians from culturally and linguistically diverse populations. Through more targeted immigration initiatives, Australia could increase the numbers of skilled aged care workers available to deliver these improvements.

I have written to the Minister for Immigration requesting him to consider whether the occupation of “aged care worker” could be included on the skilled occupation list. This would allow more skilled worker migration and help to meet the growing shortfall in these skills.

The second major source is our own changing labour market.

Increasingly aged care workers come from other parts of the labour market, from second or third career moves, or people coming from declining sectors. Again, this is a trend calling out for incentive, support, promotion and encouragement.

I frequently point to age care as a strong possibility for older workers having difficulty finding jobs. There is less age discrimination against workers in aged care.

Workers in the aged care sector are generally older than the national workforce; the median age for residential direct care workers is 48 years while for community direct care workers it is 50 years.

Of course, significant retraining will be required as workers move from one sector to another, and it is for such training I would like to see more incentives.

I have made it an important priority in my own work to encourage training institutes such as TAFEs to consider promoting aged care courses to older Australian workers who may want to retrain in aged care.

I would like to give as an example of appropriate actions in this area.

In relation to the quality of training, the Australian Human Rights Commission partnered with TAFE through the South Western Sydney Institute, Granville College – to produce the Human Rights Framework in Community Service project. This aimed to embed human rights into vocational training. It was trialled over six months in 2013 with learners and workers employed in the aged, multicultural, disability, refugee and mental health services sectors and was well received.

Later last year the Commission partnered with the SWSi TAFE to plan and promote a pathways to employment expo, targeted at people over 50 in this most disadvantaged region in NSW who were interested in accessing some training make them employable. This too was a highly successful initiative, generating hundreds of enrolments by over 50s, of whom many were newly arrived refugees and migrants, and others long term unemployed.

I hope the TAFE system generally will take up these challenges.

Stereotypes and aged care

Aged care is a profession that matters. Indeed it is an increasingly essential service, but it has been undervalued both in terms of remuneration and public perception. Aged care professionals must be rewarded with decent pay for the work they do and offered meaningful career pathways and prospects.

The devaluation of aged care as a profession, is, I believe, tied to the negative attitudes held towards older people more generally, and their “invisibility” and stereotypical portrayal in the media.

Recent research that I commissioned has shown the prevalence of negative stereotypes about older people in the media and the discriminatory attitudes that they can entrench.

Older people are vastly underrepresented in advertising and the media. 14.2 per cent of the population are aged 65 years or over. However, people aged 65 and over feature in only 4.7 per cent of advertising and 6.6 per cent of editorial media content. Many of the representations of older people reflect only the negatives of ageing, such as isolation and ill-health.[17]

Such widespread negative stereotypes lead to negative attitudes. Younger Australians are more likely to associate ageing with the concept of loss and find it extremely difficult to identify any benefits associated with ageing. Forty four per cent of Australians feel sorry for older people as they are perceived often to have complex health problems.

This common attitude of pity for older people is not conducive to an environment where they, or their carers, are given the respect they deserve.

While older people who have entered the aged care system will have experienced deterioration in their health, the positive attributes of individuals should still be recognised.

I like to refer here to the approach of Professor Desmond O’ Neill, from the Centre for Ageing, Neuroscience and the Humanities in Dublin. He encourages an inclusive view of ageing. We need to think about ageing as a process in which there are both gains and losses.

He says “...most reviews of cognition and ageing focus on what we have lost, and fail to include the wisdom, strategic thinking, and highly developed social cognition of older people.”

Applying this enlightening approach to the contentious issue of older drivers, he observes:

“...understanding this balance is integral to understanding counterintuitive erotological insights, such as how older drivers, despite an array of age-related disability, remain one of the safest cohorts on the road through their strategic and tactical gains of later life”.[18]

This reminder of the benefits that ageing can bring to balance the deficits is a welcome correction to widespread overly negative approaches which undermine human rights.

It is vital that we break down negative attitudes and stereotypes both for the sakes of the older people who are discriminated against, but also to ensure that more quality workers of all ages, young and older, are attracted to the profession of aged care.

Concluding remarks

We are all challenged here.

If we are to achieve a sustainable aged care system with an embedded culture of non-discrimination and respect for human rights, it is vital that all stakeholders, all of you in this room today, take steps towards that goal.

I thank you again for inviting me to speak to you today and wish you well in navigating the challenges that lie ahead at this time of change and opportunity.


[1] Australian Bureau of Statistics, Life Expectancy Trends, 4102.0 Australian Social Trends, (March 2011). At: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Mar+2011 (viewed 24 January 2012)
[2] The Treasury, Australia’s Ageing Population, Intergenerational Report 2010. At: http://www.treasury.gov.au/igr/igr2010/Overview/html/overview_04.htm (viewed 24 January 2012)
3 Deloitte Access Economics ‘Increasing participation among older workers: The grey army advances’, Deloitte Access Economics, (2012), p 2.
[4] World Health Organisation, Active Ageing: A Policy Framework, WHO/NMH/NPH/02.8 (2002), p 6. At
http://www.who.int/ageing/publications/active/en/ (viewed 21 June 2012). Referred to in Respect and Choice p 3.
[5] Including the International Convention on the Elimination of All Forms of Racial Discrimination, the International Covenant on Economic, Social and Cultural Rights, the International Covenant on Civil and Political Rights, the Convention on the Elimination of All Forms of Discrimination against Women, and the Convention on the Rights of Persons with Disabilities.
[6] Respect and Choice p 7.
[7] The Australian Human Rights Commission, Human Rights Approach to Ageing and Health - Respect and Choice (2012). At 10.
[8] The Australian Human Rights Commission, Human Rights Approach to Ageing and Health - Respect and Choice (2012). At 11.
[9] The Australian Human Rights Commission, Human Rights Approach to Ageing and Health - Respect and Choice (2012). At 11.
[10] Source: Australian Institute of Health and Welfare, ‘Ageing and Aged care’, Australia’s Welfare, Australia’s Welfare series no. 10, Catalogue No AUS 142 (2011). At: http://www.aihw.gov.au/publication-detail/?id=10737420537 (viewed 18 July 2012). Referred to in Respect and Choice p 5.
[11] S Lunn, ‘Older Australians keen to age at home’, The Australian, 25 February 2011. At
http://www.theaustralian.com.au/news/nation/older-australians-keen-to-a…-
1226011617585 (viewed 24 July 2012).
[12] Commonwealth of Australia, Living Longer. Living Better: Aged Care Reform Package, Department
of Health and Ageing (2012), p 75. At
http://www.health.gov.au/internet/main/publishing.nsf/Content/aged-aged-care-review-measurestechdoc (viewed 8 May 2012). Referred to in Respect and Choice, p 19.
[13] Petra Neeleman, Cam Ansell, Leading Age Services Australia, Culturally and Linguistically Diverse (CALD), Cost Impacts in Residential Aged Care, Summary Report, June 2013.
[14] Golden Years article on the Aged Care Approvals Rounds, Prepared by DutchCare November 2013, Aged Care Approvals Rounds and ethno-specific providers
[15] Australian Government Department of Health and Ageing, National Lesbian, Gay, Bisexual, transgender and Intersex (LGBTI) Ageing and Aged Care strategy (2012), p 4.
[16] Australian Government Department of Health and Ageing, National Lesbian, Gay, Bisexual, transgender and Intersex (LGBTI) Ageing and Aged Care strategy (2012), p 4.
[17] Australian Human Rights Commission and Urbis, Fact or Fiction? Stereotypes of older Australians (2013). At: http://www.humanrights.gov.au/publications/fact-or-fiction-stereotypes-older-australians-research-report-2013/key-findings (viewed 22 October 2013).
[18] Desmond O’Neill, The art of medicine, The art of the demographic dividend, Published Online
May 6, 2011. Vol 377 May 28, 2011, At: www.thelancet.com (accessed 28 October 2013).

The Hon Susan Ryan AO, Age Discrimination Commissioner