Caring for forgotten Australians

Are aged care services appropriate for the so-called Forgotten Australians, asks Dr Monica Cations.

During the 20^th century, it is estimated that up to 500,000 Australian children were placed in out-of-home care in orphanages, homes, and institutions run by the government, religious groups, and charities.

The 2013 Royal Commission into Institutional Responses to Child Sexual Abuse and other inquiries have highlighted the neglectful and abusive conditions children endured in these settings.

Most were isolated from their extended families, received little education or adequate nutrition, and their labor was often relied upon for the institution’s financial sustainability. Experiences of physical and/or sexual abuse and neglectful care further compounded the trauma of their disrupted and dislocated childhoods.

Many members of this group, sometimes collectively referred to as Forgotten Australians, are approaching or have entered older age. In their 2017 submission to the South Australian Joint Committee on Matters Related to Elder Abuse, the Care Leavers Australasia Network note that the majority of their members are over 55 years of age. The ongoing effects of childhood trauma mean that Forgotten Australians experience an accelerated ageing and reach older age in poorer health and with fewer social supports than the general community. As such, many are currently accessing aged care services or will do so in the near future.

But how appropriate are aged care services for Forgotten Australians? And, how can care be delivered in safe and accessible ways for this group?

Research

We sought to answer these questions with our research funded by the Australian Association of Gerontology RM Gibson Research Trust and the Flinders Foundation. We interviewed a group of older Forgotten Australians, as well as family members or friends who provide support to older Forgotten Australians. We also conducted focus groups with professional stakeholders to better understand how the aged care industry can adapt to improve the safety and quality of care for Forgotten Australians.

The research findings, soon to be published in the Australasian Journal on Ageing, emphasise the importance of home and community care for this group. Our participants reported a profound aversion to entering residential aged care, a concept they call ‘re-institutionalisation’. Many were especially distressed by the prospect of accessing residential care delivered by the same organisations as those of their childhood. In this context, home and community care providers can have a powerful and positive impact in the lives of older Forgotten Australians.

Home as a safe space

Forgotten Australians, like most older people, prefer to stay living in their own home. Participants spoke of their lifetime of cultivating their home as a safe space, one that protects them from re-traumatisation and further disempowerment. Many have preferences, customs and rituals that may be difficult for community care providers to understand; Forgotten Australians should be invited to set boundaries about how the provider should behave in their home.

Allowing a care provider into the home requires a level of trust that can be difficult for a Forgotten Australian to generate quickly. The aged care provider can help to build trust by working in reliable ways, for example keeping appointments and doing what is expected. An introductory contact to build report before services start can help the person feel safe.

Assessment services have an important role to play in creating positive aged care experiences for Forgotten Australians. The assumption that the person has informal supports such as family or friends to ‘top up’ their home care package is not appropriate for this group as many are isolated. In addition, our participants spoke of lifelong challenges with literacy meaning that they may need extra support to access and navigate aged care services.

Forgotten Australians will vary in their ability and willingness to disclose about their childhood experiences and/or current triggers. Training in trauma-informed and Care Leaver-informed care will ensure that staff can identify needs and amend care accordingly.

Overall, our Forgotten Australian participants described safe and accessible aged care as the antithesis of the ‘care’ they endured as children. From this perspective care inherently refers to an absence of cruelty, patronising attitudes, and being treated without dignity. Care organisations that adopt these fundamental principles will be well-placed to deliver high quality and inclusive care.

We have used the research findings to develop pragmatic recommendations for aged care providers about how to deliver safe and accessible care for Forgotten Australians and other Care Leavers. These will be publicly available from November 2020 and details will be included in a future edition of Community Care Review.

For more information about this research, contact study director Monica Cations on (08) 8201 3058 or monica.cations@flinders.edu.au.

Dr Monica Cations is a Research Fellow and Lecturer at the College of Education, Psychology and Social Work at Flinders University. She is supported by a Hospital Research Foundation Early Career Fellowship.