Ageing well is the elephant in the room when it comes to aged care

I recently came across a quote from philosopher Jean Jacques Rousseau, talking about what it means to live well:

“To live is not to breathe but to act. It is to make use of our organs, our senses, our faculties, of all the parts of ourselves which give us the sentiment of our existence. The man who has lived the most is not he who has counted the most years but he who has most felt life. Men have been buried at one hundred who have died at their birth.”

Perhaps unsurprisingly, I found myself nodding sagely along as I read. Because life isn’t something we have, it’s something we do. It is a set of activities that we can fuse with meaning. There doesn’t seem much value to living if all we do with it is exist. More is demanded of us.

Rousseau’s quote isn’t just sage; it’s inspiring. It makes us want to live better – more fully. It captures an idea that moral philosophers have been exploring for thousands of years: what it means to ‘live well’ – to have a life worth living.

Unfortunately, it also illustrates a bigger problem. Because in our current reality, not everyone is able to live the way Rousseau outlines as being the gold standard for Really Good Living^TM.

This is a reality that professionals working in the aged care sector should know all too well. They work directly with people who don’t have full use of their organs, their faculties or their senses. And yet when I presented Rousseau’s thought to a room full of aged care professionals recently, they felt the same inspiration and agreement that I’d felt.

That’s a problem.

If the good life looks like a robust, activity-filled life, what does that tell us about the possibility for the elderly to live well? And if we don’t believe that the elderly can live well, what does that mean for aged care?

If you have been following the testimony around the Aged Care Royal Commission, you’ll be aware of the galling evidence of misconduct, negligence and at times outright abuse. The most vulnerable members of our communities, and our families, have been subject to mistreatment due in part to a commercial drive to increase the profitability of aged care facilities at the expense of person-centred care .

Absent from the discussion thus far has been the question of ‘the good life’. That’s understandable given the range of much more immediate and serious concerns facing the aged care sector, but it is one that cannot be ignored.

In 2015, celebrity chef and aged care advocate Maggie Beer told The Ethics Centre that she wanted “to create a sense of outrage about [elderly people] who are merely existing”. Since then she has gone on to provide evidence to the Royal Commission, because she believes that food is about so much more than nutrition. It’s about memory, community, pleasure and taking care and pride in your work.

Consider the evidence given around food standards in aged care. There have been suggestions that uneaten food is being collected and reused in the kitchens for the next meal; that there is a “race to the bottom” to cut costs of meals at the expense of quality, and that the retailers selling to aged care facilities wildly inflate their prices. The result? Bad food for premium prices.

We should be disturbed by this. This food doesn’t even permit people to exist, let alone flourish. It leaves them wasting away, undernourished. It’s abhorrent. But what should be the appropriate standard for food within aged care? How should we determine what’s acceptable? Do we need food that is merely nutritious and of an acceptable standard, or does it need to do more than that?

Answering that question requires us to confront an underlying question:

 Do we believe aged care is simply about providing people’s basic needs until they eventually die? 

Or is it much more than that? Is it about ensuring that every remaining moment of life provides the “sentiment of existence” that Rousseau was concerned with?

When you look at the approximately 190,000 words of testimony that’s been given to the Royal Commission thus far, a clear answer begins to emerge. Alongside terms like ‘rights’, ‘harms’ and ‘fairness’ –which capture the bare minimum of ethical treatment for other people – appear words such as ‘empathy’, ‘love’ and ‘connection’. These words capture more than basic respect for persons, they capture a higher standard of how we should relate to other people. They’re compassionate words. People are expressing a demand not just for the elderly to be cared for, but to be cared about.

Counsel assisting the Royal Commission, Peter Gray QC, recently told the commission that “a philosophical shift is required, placing the people receiving care at the centre of quality and safety regulation. This means a new system, empowering them and respecting their rights.”

It’s clear that a philosophical shift is necessary. However, I would argue that what’s not clear is if ‘person-centred care’ is enough. Because unless we are able to confront the underlying social belief that at a certain age, all that remains for you in life is to die, we won’t be able to provide the kind of empowerment you felt reading Rousseau at the start of this article.

There is an ageist belief embedded within our society that all of the things that make life worth living are unavailable to the elderly. As long as we accept that to be true, we’ll be satisfied providing a level of care that simply avoids harm, rather than one that provides for a rich, meaningful and satisfying life.