AGED CARE – BETTER HERE THAN THERE?
Australian politicians like to parade their nation’s welfare and medical credentials, claiming a world-class government-funded system ensures the disadvantaged get the attention they need.
That was the story in the years BC (Before Covid). It’s different now. The pandemic has exposed policy flaws – particularly with aged care.
If the quote ‘the measure of a civilization is how it treats its weakest members’ often attributed to Indian statesman Mahatma Gandhi (1869-1948) remains apt, then Indonesia is doing better than its Ozzie neighbour.
Here in Indonesia looking after retirees is not a big government responsibility. Only former public servants, the military and employees of major corporations get pensions, and they’re small. Just two per cent of the national budget goes on social welfare, while Vietnam and Thailand allocate five per cent. To fill the gap families are expected to protect, watch and provide, and to do so as their cultural duty.
Readers familiar with kampong and village life will know traditional communities are a mix of newborns, those soon to depart and everyone in-between, students, parents, workers, retirees – every cohort of humanity together.
About 40 per cent of Indonesians live in rural desa (hamlets). Come dawn the old folk can be seen easing the younger generation’s workload with cleaning and cooking, washing and bathing, much of it in public.
They move slowly, can be forgetful and maybe need a stick for support. But they’re essential, wanted, not a nuisance. Those too weak to labour can nurse a babe and expand the littlie’s day with lullabies.
They see neighbours readying kids for school, the mums checking uniforms and satchels. Be tidy, be polite. Never be ashamed.
In this mystical mix of ancient traditions, Indonesians show respect for age, the place where we’re all heading. A quarter of Australians are reported to be lonely. Chance are there’d be only a few Indonesians suffering solitude.
When the old-timers breathe no more, the houses they inherited are passed to the next generation. They’ll lie at the edge of the desa alongside those who’ve shared their lives, like Australians once did in village church graveyards, not a huge and distant impersonal urban cemetery run by a government department.
There are downsides. The elderly can get grumpy and annoying, especially when criticising young parents’ modern childcare techniques. The facilities are often sub-standard. Most desa have electricity but not potable piped water, leaving rivers to wash, bathe and defecate, which is how President Joko Widodo spent his early years in Solo.
These villages are nothing like the newer suburbs Down Under where homes commonly house working parents and a couple of kids. So where are the Grans and Gramps?
In ‘clean, modern, well-supervised residential care’, more commonly known as Old Folks’ Homes. These began mid last century as a response to women entering the workforce, so no longer available to help aging parents. At first, the OFHs were small and run by non-profit organisations, often associated with churches and staffed by untrained volunteers.
Then commercial operators moved in. Eldercare has now become big business – and costly. Entry and exit fees, maintenance charges and other imposts often drain savings despite government subsidies.
Now the dangers are physical. In one Queensland facility, 100 residents and 82 staff caught the virus. Although the Federal government says victims with other ills are dying ‘with Covid, not from Covid’ the crisis is so bad Army medics have been called in to help with OFH staff shortages.
In Australia Omicron has killed 566 old people and infected 30,000 OFH staff and residents since the first case last November. More than 145,000 coronavirus-related deaths have been reported in Indonesia since the pandemic began two years ago, but we don’t have age data.
We’re all living longer. The numbers of Indonesians over 60 increased from 4.5 per cent in 1971 to 9.6 per cent in 2019. World Bank stats show Indonesian women’s life expectancy is now 74 years and men’s 69.4. Add a decade for the Australian figures.
The Medical Journal of Australia reports Australia has ‘the highest proportion of older people living in institutional care compared with 11 other nations.’
In Australian residential homes, the workers are a rapidly diminishing force. Many are migrants, carers from cultures vastly different from the cared, taking the low-paid jobs Australians reject. So the occupants are much the same age.
A few Indonesians who’ve lost contact with their families sometimes complete their span on earth in ‘nursing homes’. Sounds caring, but a 2020 report from Yogyakarta’s Gadjah Mada University said the term has become ‘embedded in Indonesian society as a place to live for elderly who are poor, are neglected, and do not have families, so it shows unfavourable stigma.’ In brief – putting elders in care is considered shameful in Indonesia.
Maybe this should happen in Australia as Covid reveals the wrongs. A two-year Royal Commission found shocking deficiencies in residential aged care prompting Commissioner Lynelle Briggs to write:
"Life is to be lived. No matter how old we are, how frail or incapacitated we might be, how rich or poor, we all have the fundamental right to wellbeing, enjoyment and fulfilment as we age.
‘In order for this aspiration to become reality, our aged care system must be founded on the principles of unfailing compassion — care, dignity and respect.’
In Indonesia, these necessities are provided by families, not agencies. Maybe something Australians need to accept if their Lucky Country is to be fortunate for all.
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First published in Indonesia Expat 4 March 2020: https://indonesiaexpat.id/outreach/observations/aged-care-better-here-than-there/
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