“Staring into the abyss.” Those are the words of an elderly gentleman participating in a recent focus group we held in a leafier suburb of Melbourne. The same sentiments echoed around the room – not only that night, but during other focus groups we held in Perth in December and many more before that. Other persistent phrases include, “it’s death’s waiting room”, “you’re cut-off from the real world” and, of course, “it’s the last place you want to end up”. Probed for associations, poor food, stressed nurses and underpaid carers round out the vision.
The other sense pervading much of the group research we undertake in aged care is one of division: the sense “us and them”. We often speak to people who are pushing 80 and are clearly keen to know more about aged care, perhaps to influence the development of a facility they may enter one day, but talk about aged care residents like they are of another world: “they can’t taste anything any more anyway”, “wouldn’t be able to get out much” and “I don’t think they’d care much about how the place looks”.
Where does this vision of a black hole come from? What is it that makes aged care such a bleak, dark and, often, terrifying place for people?
Although the sentiments are varied, there are some key reasons. There are also some scape goats that need dispelling. Understanding the reasons for negative visions of care will enable providers to connect with communities, changing perceptions of their service and, more broadly, aged care over time.
As the Agewell Campaign gets underway, we share our thoughts.
The older we get the close the spectre of death draws near.
Thanatophobia, or fear of death, is a relatively complicated phobia. Although not experiencing a phobia in clinical terms, many, if not most, people are afraid of dying. Some people fear being dead, while others are afraid of the actual act of dying. The fear of ill health and death becomes more present as people age. Aged care represents the “end of the line” to people with older parents, particularly those who are approaching ‘retirement age’ (without getting too philosophical or political, we’ll call this 60+).
So perceptions are coloured by fear and anxiety. Fear for a parent or good friend; anxiety for oneself.
Although people can fear death if sitting in a park, at home or in a medical centre waiting room, for some an aged care facility makes it final.
Cutting corners to cut costs.
The government doesn’t fund aged care well enough: the staff are underpaid, the accommodation is built on the cheap, the food’s prepared on a budget.
True or false, these perceptions have been firmly entrenched in the psyche of many Australian community members as a result of the campaigns of the sector, the unions, opposition politicians and the stakeholders they engage.
Although quality may vary in any industry, the standard of service and accommodation are extremely high in aged care. The issue with funding is complex and the objective is sustainability not quality.
But the message is simple in the minds of consumers: under pressure things are fall apart. And, if you believe everything you read (barring Canberra press releases) everyone appears to be in furious agreement.
Man bites dog.
To sell more advertising, you have to sell more papers/attract more viewers, which means a shocking headline or eight (if you can keep the story running that long), and nothing shocks like a kerosene bath.
As we explain to any client when commissioned to undertake crisis management work, the media is but one source of information for community members (and one with low and ever declining trust). What your key stakeholders – families, employees, residents, local community members – think about you matter most and there are many ways to reach them.
Blaming the media for giving aged care a bad rap is scapegoating. If a provider’s under-performance is revealed by a journalist we should not be surprised. However, every aged care provider is responsible for its reputation and a commitment to community engagement, like a commitment to quality or customer service, will result in a resilient company and employees when issues threaten a good reputation.
Behind locked doors.
Anyone who has not had a relative or friend in aged care or does not provide a service to the sector will have very limited knowledge of the activities, accommodation and sophisticated care systems of aged care providers. Even those who do are met with a locked door upon walk-up to the facility entrance.
When people have a lack of knowledge, they are easily persuaded. A negative media story, the advice of a neighbour during the difficult transition of her mother into care, a national scare campaign about low funding. When emotions are involved (fear of death?), our critical thinking skills often fail. We react intuitively.
Unless aged care providers invite the community in, rethink the design of entrance ways, place their services in a community context, and ensure visibility of residents in community life, the information vacuum will allow negative and incorrect perceptions to fill the breach.
We are community.
Aged care is government funded in a complex way making dialogue at the time of admission very difficult. However, for the many people who are not at that point of interaction (that is, the overwhelming majority of community members), the message should be clear: “we are community”.
We are part of the local community. Our residents are valued members of the community who, through a lifetime’s work, have shaped the great place we call home. Like the library, the local footy club and the church, we are a seat for community life – an active, vibrant and soulful place in which community life continues as it has, with more care and attention.
For organisations with genuine long term growth objectives, the last point is the most important. By focusing on community dynamics around each facility, a company will:
- ensure the correct perceptions of aged care are dominant;
- match services and accommodation design to community need;
- play a role in helping people face a fear of ill health and death – a common feeling shared by almost everyone to some degree and thus an important point of engagement (an opportunity for leadership); and
- achieve a host of other business objectives such as recruitment, fundraising and 100% occupancy.
If Australians are to Agewell, the aged care sector needs to place itself at the heart of community life and lead dialogue beyond the mandate of the Productivity Commission Caring for Older Australians inquiry
Community engagement as a core business strategy.
We hold focus groups for providers at pivotal times in their evolution, and when an important investment and hard earned reputation is at stake. Commonly when:
- the company is expanding by building a new facility in a new neighbourhood, or extending existing accommodation
- community engagement is acknowledged as important for the sustainability of the business
- the brand, visual identity and market positioning are tired and need revisiting in line with the company’s current scope of services, specialties and customer profile
In all these cases, the insight we gain guarantees the care provided and the communication to support it, reflects the make-up, needs and expectations of the community.
What we have learned is that, in aged care, community engagement is marketing is core business strategy.
Those who do it well make decisions with confidence and build resilient organisations.