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Passionate about aged care.

Nurses who stay working in aged care do so because they love the people they care for. We should all be very grateful.

As I leave NZNO after seven years as a professional nursing adviser, I find myself reflecting on aged care --where it was when I started, where it is now, and where it will be in another seven years' time.

It is difficult to write about aged care in one page, when there is so much to say and when so much is being said. Sadly, none of this is very positive. The media, health information sites, journals and general health sector conversation are all painting a picture of a sector in crisis. The reasons have been well explained: an underfunded, poorly staffed sector where nurses are not well paid and are leaving in large numbers to work at district health boards (DHBs) and elsewhere.

Nurses who have stayed in aged care are incredibly stretched in their roles and responsibilities: supervision, direction and delegation, interRAI, doctors' rounds, communication with residents and families, wound care--the usual nursing list, but they may well be the only nurse for up to 60 residents.

This is not to say the caregiving staff are not also extremely busy. Working in aged-care facilities is hard: physically challenging, emotionally draining; it can be repetitive and unpleasant. Residents now are more often acutely unwell, are more likely than previously to exhibit challenging behaviours, are more varied in their profile (they might be under 65 years, have mental health issues or are bariatric/obese patients). More of them have dementia or some form of dementing illness, and many are nearing the end of lives.

My picture may not sound any better than that of the commentators I mention above. Yes, it could be read as bleak. So why am I so passionate about aged care? Why have I worked my whole clinical career in aged care and taught in the area for many years? Because I love it and, unfashionable as it may sound, I don't mind working in institutions at a time in society when they are viewed with disdain --health care should take place in the community, older people should age in place, people should stay well and not need to "end up" in institutions.

If United Kingdom gerontologist Sarah Harper is to be believed, we should all keep working well into our old age. (1) We should age well and positively and for a very long time. I am being cynical, but policy-makers and strategy writers are clearly not planning to get sick or develop a need for care in their later lives (another unfashionable notion).

I am not trying to exaggerate difficulties in older age; I am simply being realistic. I have spoken with many older people over the years who have not been happy about growing older--they can no longer do the things they used to, or they are living with pain or a chronic illness and disability. Older people who feel and think this way should not be made to feel they have "failed" or have not met positive ageing targets.

Society (all of us) views old age differently, depending on where we are standing. From a youthful perspective, old age is too distant to be a possibility. From middle age, it just might happen, and from late middle age into old age ... it is happening. Most people manage their older years in their own homes, with or without help, but some need to be cared for in an aged-care facility.

That is where nurses and carers come in. Despite all the political (funding) constraints and the societal (attitudes) distancing, these marvellous workers carry on regardless. And I know why. What makes their jobs worthwhile are the residents themselves. Not "our elderly", as politicians and media love to say, but because of the real people they are. Mrs Mableton, a short Scottish woman as tall as she was wide, merrily singing her way through her life and dementia; Mr Jones, who was in the Boer War but didn't think he was a hero; Mrs Young, who lived in constant pain from her rheumatoid arthritis and had lived for many years in lighthouses, isolated from social contact. She had a very sharp tongue but was always thankful.

There are endless, ordinary, extraordinary residents out there who deserve the best care and attention, simply because we live in a humane society and, when it comes to the later years, months or days of one's life, aged care is a good place to be.

Aged care may be subjected to endless political change, but on a human level, it has not changed. Any of us may one day become a resident in an aged-care facility. We are fortunate to have nurses and carers who will be there for us, who will love and care for us, in all our glorious humanity.


(1) Radio New Zealand. (2018). Professor Sarah Harper--the ageing population. Saturday Morning, October 13. Retrieved from www.

By professional nursing adviser

Lorraine Ritchie

Lorraine Ritchie's clinical career has always been in aged care.
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Title Annotation:professional focus
Author:Ritchie, Lorraine
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Report
Date:Nov 1, 2018
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