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Hospice nurse reveals people's last words before they die

A hospice nurse has revealed the number one thing people say in their final moments before they die. Healthcare expert Julie McFadden, who makes online videos discussing death to help break the taboo around dying, has shared the three most common regrets patients share on their death beds. Speaking to NHS surgeon Dr Karan Rajan on his podcast, Julie said these final discussions tend to centre around what they've taken for granted. "The first one I hear all the time is that they regret not appreciating their health while they had it," Ms McFadden said, reflecting on her 15 years of working in the health sector. "That's the number one thing people say to me, I wish I would have understood how amazing it is to have a working body." The second regret she often hears is people admitting they "worked too much" and wish they hadn't worked their life away, and rather spent time doing things that brought them joy. Finally, she revealed in the clip shared to Instagram, that many dying patients have regrets about relationships. The nurse explained people either wish they had maintained certain relationships and friendships, or regret holding grudges. Dr Rajan responded to Ms McFadden's insight with a story of a young patient that made him realise we are not 'immortal' and we should not take our life "for granted". In the clip shared with his 1.5million followers he said, "A few years ago when I saw a young woman come in with pancreatitis in her 20s, within three hours this young woman is in the intensive care unit, she's intubated, ventilated, and the next day, she had passed away." "That just made me think wow, I'm in my 30s now, I'm 34, life can just go in a flash. So yes, truly don't take it for granted, we sometimes have this tendency to walk around like we're immortal." Image credits: YouTube

Caring

Man dies after months-long wait for at-home care

A man has died after his almost year-long wait to receive his government-approved at-home care. Cyril Tooze, 86, was <a href="https://oversixty.com.au/health/caring/man-decides-to-end-his-own-life-after-waiting-for-at-home-care" target="_blank" rel="noopener">approved</a> for a Level 4 Home Care Package in January, but almost one year on, he was still waiting for access to the money to fund daily assistance with physical, medical and social tasks. After sharing his story with 7News in October, Tooze candidly admitted that he was pursuing the avenue of voluntary assisted dying, saying at the time, "There is no hope." Just weeks later, Tooze has passed away. While in hospital after suffering a fall, Mr Tooze passed away on Friday, weighing just 46kg. Independent federal Mayo MP Rebekha Sharkie, who advocated for Mr Tooze to receive his government funding, said it had been an honour to have known him. "The man that I knew, he had such courage and such dignity to the very end," she said. "To the very end he wanted his situation to shed light and provide a human story for the 76,000 other older Australians who, just like him, are deteriorating, having accidents and injuring themselves while waiting for a Home Care package that they've been assessed as needing." "Despite a new Act being passed in the House of Representatives with urgency, there is no plan from the government to address the blown-out waiting list and the reality is that people are dying while they're waiting for Home Care." Federal aged care minister Anika Wells said her thoughts were with Mr Tooze's family and friends "as we mourn their loss but appreciate Cyril's life and his commitment to helping older Australians." Image credits: Nine

Caring

How to complain about aged care and get the result you want

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/jacqueline-wesson-1331752">Jacqueline Wesson</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/lee-fay-low-98311">Lee-Fay Low</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> It can be hard to know what to say, or who to talk to, if you notice something isn’t right for you or a loved one in residential aged care. You might have concerns about personal or medical care, being adequately consulted about changes to care, or be concerned about charges on the latest bill. You could also be concerned about theft, neglect or abuse. Here’s how you can raise issues with the relevant person or authority to improve care and support for you or your loved one. <h2>Keep records</h2> You can complain about any aspect of care or service. For instance, if medical care, day-to-day support or financial matters do not meet your needs or expectations, you can complain. It is best to act as soon as you notice something isn’t right. This may prevent things from escalating. Good communication helps get better results. Make written notes about what happened, including times and dates, and take photos. Try to focus on facts and events. You can also keep a record of who was involved and their role. Keep track of how the provider responded or steps taken to resolve the issue. Write notes of conversations and keep copies of emails. <h2>Who do I complain to?</h2> Potential criminal matters If you have concerns about immediate, serious harm of a criminal nature then you should contact the police, and your provider immediately. These types of serious incidents include unreasonable use of force or other serious abuse or neglect, unlawful sexual contact, stealing or unexpected death. The provider may have already contacted you about this. They are required to report such <a href="https://www.agedcarequality.gov.au/consumers/serious-incident-response-scheme">serious incidents</a> to both the Aged Care Quality and Safety Commission within 24 hours, and to the police. Other matters For other matters, talk to the care staff involved. Try to find out more detail about what happened and why things went wrong. Think about what you expect in the situation. Then talk to the most senior person in charge, to see if they can make changes so things don’t go wrong in the future. This person may be called the nursing unit manager, care manager or care director. Providers must acknowledge and investigate your complaint, tell you their findings and actions taken, and follow up to see if you are satisfied. If you would like support to talk to the provider, the <a href="https://opan.org.au">Older Persons Advocacy Network</a> can help. This free service provides independent and confidential support to help find solutions with the aged-care provider. The network can also help you lodge a formal complaint. <h2>How to I lodge a formal complaint?</h2> If you are not satisfied with the way your provider responded, you can lodge a complaint with the <a href="https://www.agedcarequality.gov.au">Aged Care Quality and Safety Commission</a>. Be prepared to submit the facts and events, plus emails and correspondence, you have already collected. Think about what you want to happen to resolve the complaint. Each complaint is handled individually and prioritised depending on the risks to you or your loved one. The commission will start its processes within one business day when complaints are urgent. The resolution process took <a href="https://www.agedcarequality.gov.au/sites/default/files/media/acqsc-annual-report-2020-21.pdf">an average 40 days</a> in 2020-21. You can complain confidentially, or anonymously if you feel safer. But the commission may not be able to investigate fully if it’s anonymous. Also, there are limits to what the commission can do. It cannot ask providers to terminate someone’s employment, or provide direct clinical advice about treatment. Sometimes the commission has issued a “non-compliance” notice to the provider (for a failure to meet quality standards), and action may again <a href="https://www.abc.net.au/news/2022-05-02/aged-care-complaint-about-southern-cross-care-young/101009716">be limited</a>. So it is a good idea to check the <a href="https://www.myagedcare.gov.au/non-compliance-checker">non-compliance register</a> beforehand to see if your provider is listed. <h2>What do others complain about?</h2> From October to December 2021, <a href="https://www.agedcarequality.gov.au/sites/default/files/media/acqs-sector-performance-data-oct-dec-2021.pdf">about a third</a> of Australian nursing homes had a complaint made to the commission against them. Some had more than one complaint. More than half of these complaints were lodged by family, friends or other consumers. The top reasons for complaints were about: <ul> <li> adequacy of staffing </li> <li> medication administration or management </li> <li> infectious diseases or infection control </li> <li> personal and oral hygiene </li> <li> how falls are prevented and managed </li> <li> consultation or communication with representatives and/or family members. </li> </ul> <h2>What if I’m still not happy?</h2> If you’re not happy when you receive the commission’s outcome, you can request a review with 42 days. You can also request the <a href="https://www.ombudsman.gov.au">Commonwealth Ombudsman</a> to review the complaint if you’re not satisfied with the commission’s decision or the way the commission handled your complaint. <h2>Remember, you have a right to complain</h2> The <a href="https://agedcare.royalcommission.gov.au">Aged Care Royal Commission</a> spotlighted the neglect and substandard care that can occur in nursing homes. Despite attempts to <a href="https://www.health.gov.au/resources/publications/concepts-for-a-new-framework-for-regulating-aged-care">lift the standard of aged care</a>, we know residents and carers still have concerns. Residents, and their representatives or families, have a legal <a href="https://www.agedcarequality.gov.au/consumers/standards/resources">right to speak up and complain</a>, free from reprisal or negative consequences. This right is also reflected in the <a href="https://www.agedcarequality.gov.au/consumers/consumer-rights">Charter of Aged Care Rights</a>, which providers are legally required to discuss with you and help you understand. <h2>Moving to another facility</h2> If you have exhausted all avenues of complaint or feel conditions have not improved, you may decide to move to another provider or facility, if available. This option may not be possible in rural areas. This is a difficult decision. It takes time, as well as financial and emotional resources. Starting again with a new provider can also be disruptive for everyone, but sometimes it may be the right choice. <hr /> Contact the <a href="https://opan.org.au">Older Persons Advocacy Network</a> on 1800 700 600, the <a href="https://www.agedcarequality.gov.au">Aged Care Quality and Safety Commission</a> on 1800 951 822 or the <a href="https://www.ombudsman.gov.au">Commonwealth Ombudsman</a> on 1300 362 072.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/180036/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jacqueline-wesson-1331752">Jacqueline Wesson</a>, Senior Lecturer (Teaching and Research), Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/lee-fay-low-98311">Lee-Fay Low</a>, Professor in Ageing and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-complain-about-aged-care-and-get-the-result-you-want-180036">original article</a>. </div>

Retirement Life

Hospice nurse shares what happens to the body after death

A hospice nurse has revealed the reality of what happens to our bodies in the minutes, hours and days after we die. In her efforts to break down the taboo around conversations about death, Julie McFadden, a hospice nurse from the US, posts candid videos about death and dying to help us be more informed and prepared. In Julie’s latest video, she explains exactly what happens to the human body in the moments, hours and days after someone dies. Nurse Julie said that in the immediate moments after death, the body completely relaxes, beginning the first stage of decomposition, called hypostasis. “All of the things in your body that are holding fluids in, relaxes. That's why death can be messy sometimes.” She clarified that because of how relaxed the body becomes, those who have just died may urinate, have bowel movements or experience bodily fluids coming out of their nose, mouth, ears or eyes. Nurse Julie added, “I like to talk about it so people aren't surprised if that happens - very normal and to be expected sometimes.” This is also when the stage of decomposition called autolysis, or “the self-digestion” stage, occurs and enzymes begin to break down oxygen-deprived tissue, also causing the body temperature to drop. As the body settles in the hours after death, Nurse Julie said the blood will begin to pool downward toward the ground. She said, “If you let someone lie there for long enough - which we do sometimes; you don't have to hurry up and make sure your loved one leaves the house - if you turn them you will notice usually the back of their legs the whole backside of them will look purple or darker that's because all their blood is pulling down.” “Gravity is pulling it down. So they will eventually get a darker colour tone of skin on their backside.” One to two hours after death is also when rigor mortis - or the stiffening of a body’s muscles - sets in and continues for about the next 24 hours Nurse Julie said, “I have seen people become very stiff almost immediately - like a few minutes - after death and other people, their body takes longer.” Additionally, about 12 hours after death, the body will feel cool to the touch. About a day to a day and a half after a person dies, rigor mortis subsides and the body will begin to loosen again, as Nurse Julie said the body's tissues relax and cause the stiffness to break down. By this time, the body is usually in the mortuary, which will prepare the body in whichever way the family has requested, whether it is for burial or cremation. She added, “In a world where people didn't have access to a mortuary or a healthcare system and they just died naturally, our bodies are built to, after death, decompose.” Image credits: Shutterstock / Instagram / YouTube

Body

How can I make summer style part of my self-care routine?

Taking care of yourself doesn’t have to be complicated. With summer just around the corner, it’s a great time to refresh your self-care routine with small changes that help you feel your best. One easy way to do this is by choosing clothing made from breathable Australian cotton and linen. They keep you cool, feel great against the skin and make looking put-together effortless. In this guide, we’ll show you how your summer wardrobe can fit into your self-care routine, featuring pieces from Sussan, a retailer known for easy, comfortable styles that last all season. Simplify your day with matching sets <img src="https://oversixtydev.blob.core.windows.net/media/2024/11/Sussan01.jpg" alt="" width="1280" height="720" /> A big part of self-care is simplifying your day as much as possible, and that includes your clothing choices. Summer is the time for relaxed, unfussy outfits that don’t require a lot of planning. <a href="https://www.sussan.com.au/clothing/sets" target="_blank" rel="noopener">Matching sets</a> are perfect for this because they take away the guesswork. Everything is already coordinated, which saves you time and makes your mornings easier. A soft denim skirt made from Australian cotton paired with a lightweight tee is breathable and practical for warm days. These pieces help you stay comfy when running errands or enjoying time with friends. Stay cool all day in linen dresses <img src="https://oversixtydev.blob.core.windows.net/media/2024/11/Sussan04.jpg" alt="" width="1280" height="720" /> <a href="https://www.sussan.com.au/clothing/linen/linen-dresses" target="_blank" rel="noopener">Linen dresses</a> are an easy go-to for keeping cool and comfortable during hot summer days. The fabric is light, breathable and perfect for warm weather, which is why it’s a great fit for everything from weekend barbecues to beach walks. With styles like shirt dresses, minis, midis and maxis, there’s plenty of variety to match whatever the day calls for. Styling a linen dress is also simple and practical. With the right accessories, it can easily shift from a casual daytime outfit to an evening look. Style it with a hat for an easy brunch outfit or a trip to the markets. To dress it up, add a light jacket and some jewellery, like a pair of earrings or a statement necklace. Unwind with breathable loungewear <img src="https://oversixtydev.blob.core.windows.net/media/2024/11/Sussan03.jpg" alt="" width="1280" height="720" /> Practising self-care through summer style can be as simple as choosing clothes that help you relax and feel comfy all day long. This is easy to achieve with loungewear made from pure linen and linen blends. Look for lightweight loungewear tops, pants and shorts that feel soft on the skin and keep you cool as you move through your day. For a summer-ready look, pair a linen top with matching shorts for warm afternoons, or switch to linen pants for a little more coverage on cooler evenings. End your day in Australian cotton sleepwear Winding down at the end of the day feels easier when you’re wearing clothes that make you feel calm and cosy. <a href="https://www.sussan.com.au/shop-the-edit-sleepwear/australian-cotton-sleepwear" target="_blank" rel="noopener">Australian cotton sleepwear</a> in soft, breathable fabrics is a great option as it sits lightly on the skin and keeps you comfortable during warm nights. You can mix and match Australian cotton pyjama tops, tanks, shorts and pants or wear nighties to match your mood and comfort level. These versatile let you settle in and enjoy quiet evenings at home. Wear what feels good this summer <img src="https://oversixtydev.blob.core.windows.net/media/2024/11/Sussan02.jpg" alt="" width="1280" height="720" /> Updating your summer wardrobe with comfy, breathable pieces is an easy way to bring self-care into your routine. With matching sets, linen dresses, loungewear and soft Australian cotton sleepwear from <a href="https://www.sussan.com.au/" target="_blank" rel="noopener">Sussan</a>, you can have more time to focus on yourself and enjoy the season your way. Start refreshing your wardrobe with these pieces that feel good to wear, and use your summer style to prioritise self-care! Images: Sussan This is a sponsored article produced in partnership with Sussan

Beauty & Style

Man decides to end his own life after waiting for at-home care

A terminally ill man has made the heartbreaking decision to end his life after waiting 10-month for end of life care. Cyril Tooze, an 86-year-old from South Australia's Fleurieu Peninsula, was approved for a Level 4 Home Care Package in January. The package - which is the highest available care for individuals with high-level needs under the federal government’s MyAgedCare scheme - would give Mr Tooze up to $59,594 annually for daily assistance with physical, medical and social tasks. But almost one year on from the approval, his funds and support have yet to be delivered. It’s understood his family, who live interstate, contacted the government to enquire about receiving an urgent reassessment, and were told he could be waiting another three to six months. Independent MP Rebekha Sharkie told reporters that his family were also told a reassessment “could delay it even longer”. While waiting for his vital funds, Mr Tooze - who suffers from terminal heart and lung conditions and regularly requires morphine for pain relief - has worsened and has been hospitalised after suffering a fall at home. Tired of waiting for help to arrive, Tooze has started the process of ending his life through South Australia’s voluntary assisted dying scheme. “There is no hope ... I don’t want to live my life laying in a bed waiting for something to happen,” he told <a href="https://7news.com.au/news/terminally-ill-mans-heartbreaking-decision-to-end-his-life-after-10-month-wait-for-home-care-in-australia-c-16471785" target="_blank" rel="noopener">7News</a>. “You can’t live like that, that’s unfair, we don’t deserve that in such a country as Australia.” Following the media coverage of his case, Tooze was contacted by the Aged Care Department, who said the package could temporarily be made available. Sharkie said Tooze’s situation was “shameful”, saying, “What devastates me is that Mr Tooze feels voluntary assisted dying is the only course available to him, and that is because we as a nation have failed him." “I would say, if Mr Tooze had that package in a timely manner, as he should have, he would probably be sitting at home now, making himself a cup of tea.” Anglicare Australia’s <a href="https://www.anglicare.asn.au/2024/09/20/life-on-the-wait-list-report-shows-older-australians-are-going-without-support/" target="_blank" rel="noopener" data-link-type="article-inline">Life on the Wait List report</a> revealed that as of May 2024, 68,109 Australians had been approved for a Home Care Package but were facing wait times of up to 15 months to access it. Image credits: 7News

Caring

Mother and son reunited after rigid aged care rules divided them

An elderly woman and her disabled son are celebrating after they successfully beat a bureaucratic blockage that threatened to <a href="https://oversixty.com.au/lifestyle/family-pets/red-tape-threatens-to-remove-a-man-with-down-s-syndrome-from-his-elderly-mother" target="_blank" rel="noopener">split</a> them up for good. Anne Deans, 81, and her 56-year-old son, Mark, who suffers from Down's syndrome, were hoping to live together in Anne's aged care facility, but the pair were met with countless hurdles when trying to get Mark a room of his own. Now, Mark's sister Sharon shared the happy news that the mother and son are to be reunited. "We're very happy today. We've got a great result," Sharon told <a href="https://9now.nine.com.au/a-current-affair/melbourne-mum-and-son-living-with-downs-syndrome-reunited-in-aged-care-facility/ff023844-be2d-4ab8-be95-75bf91f17b4a" target="_blank" rel="noopener">A Current Affair</a>. "I'm so grateful that people understood and they listened. That's all I ever wanted through this whole thing, was someone to listen." The problems began when authorities originally refused Mark's request to move into Anne's aged care facility, with federal government policy saying that aged care is "not appropriate for people under 65". But Mark's relatives argued that given the life expectancy of people living with Down's syndrome is 60 years, an exception should be made. A new assessment was done and Mark has been granted a place at the same nursing home as his mother, as Mark's other sister Michelle said, "We got what we wanted. Everything worked out perfectly, the way it's supposed to." After Anne received the exciting news, she said, "I'm feeling great. He's staying with Mum!" Sharon and Michelle hope that their experience will assist other families with unique circumstances. "My advice is to keep pushing," Sharon said. "Only you know your family and you have to be their voice. "There's a lot of difference out there and a lot of people who are individuals [and] they need to be looked at individually." Image credits: A Current Affair

Legal

Offering end of life support as part of home care is important – but may face some challenges

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/jennifer-tieman-378102">Jennifer Tieman</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Earlier this month, the government announced <a href="https://theconversation.com/the-government-has-a-new-plan-for-residential-aged-care-heres-whats-changing-238765">major changes</a> to aged care in Australia, including a A$4.3 billion <a href="https://theconversation.com/what-the-governments-home-care-changes-mean-for-ageing-australians-238890">investment in home care</a>. Alongside a shake up of home care packages, the Support at Home program will include an important addition – an <a href="https://www.health.gov.au/sites/default/files/2024-09/support-at-home-fact-sheet.pdf">end of life pathway</a> for older Australians. This pathway will allow access to a <a href="https://www.health.gov.au/our-work/support-at-home/features">higher level</a> of in-home aged care services to help Australians stay at home as they come to the end of their life. Specifically, it will provide an extra A$25,000 for palliative support when a person has three months or less left to live. This is a positive change. But there may be some challenges to implementing it. <h2>Why is this important?</h2> Older people have made clear their preference to remain in their homes as they age. For <a href="https://journals.sagepub.com/doi/10.1177/0269216313487940">most people</a>, home is where they would like to be during their last months of life. The space is personal, familiar and comforting. However, data from the <a href="https://www.abs.gov.au/statistics/research/classifying-place-death-australian-mortality-statistics">Australian Bureau of Statistics</a> shows most people who die between the ages of 65 and 84 die in hospital, while most people aged 85 and older die in residential aged care. This apparent gap may reflect a lack of appropriate services. Both palliative care services and GPs have an important role in providing medical care to people living at home with a terminal illness. However, being able to <a href="https://grattan.edu.au/wp-content/uploads/2014/09/815-dying-well.pdf">die at home</a> relies on the availability of ongoing support including hands-on care and assistance with daily living. Family members and friends often provide this support, but this is not always possible. Even when it is, carers may <a href="https://pubmed.ncbi.nlm.nih.gov/38533612/">lack confidence and skills</a> to provide the necessary care, and may not have enough support for and respite from their carer role. The palliative care funding offered within Support at Home should help an older person to remain at home and die at home, if that is their preference. Unless someone dies suddenly, care needs are likely to increase at the end of a person’s life. Supports at home may involve help with showering and toileting, assessing and addressing symptoms, developing care plans, managing medications, wound dressing, domestic tasks, preparing meals, and communicating with the person’s family. Occupational therapists and physiotherapists can assist with equipment requirements and suggest home modifications. End of life supports may also involve clarifying goals of care, contacting services such as pharmacists for medications or equipment, liaising with organisations about financial matters, respite care or funeral planning, as well as acknowledging grief and offering spiritual care. But we don’t know yet exactly what services the $25,000 will go towards. <h2>What do we know about the scheme so far?</h2> The Support at Home program, including the end of life pathway, is scheduled to start from <a href="https://www.health.gov.au/sites/default/files/2024-09/support-at-home-fact-sheet.pdf">July 1 2025</a>. We know the funding is linked to a prognosis of three months or less to live, which will be determined <a href="https://www.abc.net.au/news/2024-09-15/new-payment-aims-to-make-it-easier-for-people-to-die-at-home/104347984">by a doctor</a>. Further information has indicated that an older person can be referred to a <a href="https://www.health.gov.au/our-work/support-at-home/features">high-priority assessment</a> to access the end of life pathway. We don’t know yet what this means, however they don’t need to be an existing Support at Home participant to be eligible. The pathway will allow 16 weeks to use the funds, possibly to provide some leeway around the three-month timeline. Although more details are coming to light, there are still some things which remain unclear. Home care providers will be looking for details on what can be covered by this funding and how they will work alongside primary care providers and health-care services. Older people and their families will want to know the processes to apply for this funding and how long applications will take to be reviewed. Everyone will want to know what happens if the person doesn’t die within three months. <h2>Some challenges</h2> Ready availability of appropriate supports and services will be crucial for older people accessing this pathway. Home care providers will therefore need to assess how an end of life pathway fits into their operational activities and how they can build the necessary skills and capacity. Demand for nurses with palliative care skills and allied health professionals is likely to increase. Providing end of life care can be <a href="https://pubmed.ncbi.nlm.nih.gov/33096682/">especially taxing</a> so strategies will be needed to prevent staff burnout and encourage self-care. How pathways are implemented in rural and remote areas and in different cultural and community groups will need to be monitored to ensure all older people benefit. Effective coordination and communication between home care, primary care and specialist palliative providers care will be key. Digital health systems that connect the sectors could be helpful. Family engagement will also be very important. Escalation pathways and referral pathways should be established to enable appropriate responses to emergencies, unexpected deterioration, and family distress. Finally, <a href="https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-023-01155-y">accurately determining</a> when someone will die can be difficult. Knowing when the last three months of life starts may not be easy, particularly where frailty, cognitive issues and multiple health concerns may be present. This might mean some people are not seen as being ready for this pathway. Others may not be willing to accept this prognosis. An older person may also be expected to live with a terminal illness for many months or years. Their palliative care needs would not be met under this pathway. Despite these challenges, the announcement of an end of life pathway within the home care program is timely and welcome. As a population we are living longer and dying older. More details will help us be better prepared to implement this scheme.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239296/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jennifer-tieman-378102">Jennifer Tieman</a>, Matthew Flinders Professor and Director of the Research Centre for Palliative Care, Death and Dying, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/offering-end-of-life-support-as-part-of-home-care-is-important-but-may-face-some-challenges-239296">original article</a>. </div>

Retirement Life

"We all come to an end": Beloved comedian's heartbreaking message from palliative care

Scottish comedian Janey Godley has made an emotional announcement to her social media followers, sharing that she is now in palliative care. Godley was forced to cancel her tour after developing sepsis from her cancer treatments, and is now receiving end of life care after a years long battle with ovarian cancer. "So I'm now in palliative care and I am at end-of-life care now in the hospital," the 63-year-old said in a video posted to Instagram. "The chemo ran out of options, and I just couldn't take any more of it," she continued, adding that the "has spread, so it looks like this will be getting to near the end of it, and it's really difficult to speak about this and say it to people." <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/DAWJ3Qgt-Rx/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/DAWJ3Qgt-Rx/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Janey Godley (@janeygodley)</a> </div> </blockquote> She went on to thank the hospital staff for their efforts, and family and friends for supporting her and husband Sean Storrie and their daughter Ashley through her illness. "It is devastating news to know that I'm facing the end of life but we all come to an end sometime," she continued. "I don't know how long I've got left before anybody asks. I'm not on TikTok so I just want you all to know that I appreciate all the love you've given me." She wished everyone a "lovely Christmas", adding, "I might be here, who knows? But I just want you to know I'm sending all my love to people living with a life-limiting disease." The news comes just weeks after Godley was forced to cancel her tour after developing sepsis while undergoing treatment. An official statement shared, "Janey has been living with stage four ovarian cancer for the past few years and the treatment from the wonderful Scottish NHS has kept the disease at bay, but sadly in the last few weeks the cancer has returned and there have been a few added complications." Image credits: Instagram

Caring

Red tape threatens to remove a man with Down's syndrome from his elderly mother

An elderly mother and her disabled son are at risk of being separated over the woman's aged care home's red tape. Anne Deans, 81, moved into an aged care facility in July and hoped that she would be able to bring her son, Mark, who suffers from Down's syndrome with her. Mark, 56, has always lived with his mother, and despite his disability, has lived a full life and has dabbled in acting, appearing on Aussie TV hit Blue Heelers. But now, the mother and son have been left in limbo by a bureaucratic battle. Despite the family's history and Mark's disability, the government refuses to fund a place for Mark at Anne's aged care home, stating that aged care is "not an appropriate service for people aged under 65". "People with Down's syndrome have a life expectancy of 60 years. That's if we're lucky. So Mark is experiencing all of the age issues that my Mum is," Mark's sister Sharon said. Sharon and her sister Michelle have been lobbying on Mark's behalf, with Michelle saying, "I don't know why it's so hard. There's so much red tape." "There's so many hills to jump, just to have a mum and a son together. It doesn't make any sense." Anne is digging in and appealing to the Minister for Aged Care Anika Wells for help. "I brought him up all these years, and all of a sudden someone's going to walk in and take him out," Anne told <a href="https://9now.nine.com.au/a-current-affair/victoria-red-tape-threatens-to-tear-man-with-disability-from-his-mum/df4ef75b-6df1-4507-8a73-dfae0b258e08" target="_blank" rel="noopener">A Current Affair</a>. "It is damn ridiculous. They should open up their eyes and see what it's doing. He's not going anywhere. I don't know how I'm going to stop it, but I will." In a statement, Ms Wells said, "While Aged Care is generally not suitable for people under the age of 65, we recognise there are exceptional circumstances where people may need to enter aged care before this age, including when there is no suitable accommodation for them." "The New Aged care Act includes exceptional circumstances for people to enter Aged Care before they turn 65, including when they would otherwise be at risk of homelessness." "There are processes in place to support people to explore their options and ensure they have safe and appropriate accommodation." "We encourage Mark to continue to work with Ability First Australia and the Aged Care Assessment Teams to explore all the options." Image credits: A Current Affair

Family & Pets

Is it worth selling my house if I’m going into aged care?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/colin-zhang-1234147">Colin Zhang</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> For senior Australians who cannot live independently at home, residential aged care can provide accommodation, personal care and general health care. People usually think this is expensive. And many assume they need to sell their home to pay for a lump-sum deposit. But that’s not necessarily the case. Here’s what you need to consider. <h2>You may get some financial support</h2> Fees for residential aged care are complex and can be confusing. Some are for your daily care, some are means-tested, some are for your accommodation and some pay for extras, such as cable TV. But it’s easier to think of these fees as falling into two categories: <ul> <li> an “entry deposit”, which is usually more than <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/eighth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2020-eighth-report-on-the-funding-and-financing-of-the-aged-care-industry-may-2020.pdf">$A300,000</a>, and is refunded when you leave aged care </li> <li> daily “<a href="https://www.myagedcare.gov.au/aged-care-home-costs-and-fees">ongoing fees</a>”, which are $52.71-$300 a day, or more. These cover the basic daily fee, which everyone pays, and the means-tested care fee. </li> </ul> To find out how much government support you’ll receive for both these categories, you will have a “<a href="https://www.myagedcare.gov.au/income-and-means-assessments/#aged-care-home">means test</a>” to assess your income and assets. This means test is similar (but different) to the means test for the aged pension. Generally speaking, the lower your aged-care means test amount, the more government support you’ll receive for aged care. With full support, you don’t need to pay an “entry deposit”. But you still need to pay the basic daily fee (currently, <a href="https://www.myagedcare.gov.au/aged-care-home-costs-and-fees">$52.71</a> a day), equivalent to 85% of your aged pension. If you get partial support, you pay less for your “entry deposit” and ongoing fees. <h2>You don’t need a lump sum</h2> You don’t have to pay for your “entry deposit” as a lump sum. You can choose to pay a rental-style daily cost instead. This is calculated as follows: you multiply the amount of the required “entry deposit” by the maximum permissible interest rate. This rate is set by government and is currently at <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/schedule-of-fees-and-charges-for-residential-and-home-care-schedule-from-20-march-2021_0.pdf">4.01%</a> per year for new residents. Then you divide that sum by 365 to give a daily rate. This option is like borrowing money to pay for your “entry deposit” via an interest-only loan. You can also pay for your “entry deposit” with a combination of a lump sum and a daily rental cost. As it’s not compulsory to pay a lump sum for your “entry deposit”, you have different options for dealing with your family home. <h2>Option 1: keep your house and rent it out</h2> This allows you to use the rental-style daily cost to finance your “entry deposit”. Pros <ul> <li> you could have more income from rent. This can help pay for the rental-style daily cost and “ongoing fees” of aged care </li> <li> you might have a special sentimental attachment to your family house. So keeping it might be a less confronting option </li> <li> keeping an expensive family house will not heavily impact your residential aged care cost. That’s because any value of your family house above <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/schedule-of-fees-and-charges-for-residential-and-home-care-schedule-from-20-march-2021_0.pdf">$173,075.20</a> will be excluded from your <a href="https://www.servicesaustralia.gov.au/organisations/health-professionals/services/aged-care-entry-requirements-providers/residential-care/residential-aged-care-means-assessment">means test</a> </li> <li> you can still access the capital gains of your house, as house prices rise. </li> </ul> Cons <ul> <li> your rental income needs to be included in the means test for your aged pension. So you might get less aged pension </li> <li> you might need to pay income tax on the rental income </li> <li> compared to the lump sum payment, choosing the rental-style daily cost means you will end up <a href="https://www.smh.com.au/money/super-and-retirement/seek-help-when-weighing-up-how-to-pay-for-your-aged-care-20191202-p53g16.html">paying more</a> </li> <li> you are subject to a changing rental market. </li> </ul> <h2>Option 2: keep your house and rent it out, with a twist</h2> If you have some savings, you can use a combination of a lump sum and daily rental cost to pay for your “entry deposit”. Pros <ul> <li> like option 1, you can keep your house and have a steady income </li> <li> the amount of lump sum deposit will not be counted as an asset in the pension means test. </li> </ul> Cons <ul> <li> like option 1, you could have less pension income, higher age-care costs and need to pay more income tax </li> <li> you have less liquid assets (assets you could quickly sell or access), which could be handy in an emergency. </li> </ul> <h2>Option 3: sell your house</h2> If you sell your house, you can use all or part of the proceeds to pay for your “entry deposit”. Pros <ul> <li> if you have any money left over after selling your house and paying for your “entry deposit”, you can invest the rest </li> <li> as your “entry deposit” is exempt from your aged pension means test, it means more pension income. </li> </ul> Cons <ul> <li>if you have money left over after selling your house, this will be included in the aged-care means test. So you can end up with less financial support for aged care.</li> </ul> <h2>In a nutshell</h2> Keeping your house and renting it out (option 1 or 2) can give you a better income stream, which you can use to cover other living costs. And if you’re not concerned about having access to liquid assets in an emergency, option 2 can be better for you than option 1. But selling your house (option 3) avoids you being exposed to a changing rental market, particularly if the economy is going into recession. It also gives you more capital, and you don’t need to pay a rental-style daily cost. <hr /> This article is general in nature, and should not be considered financial advice. For advice tailored to your individual situation and your personal finances, please see a qualified financial planner. Correction: this article previously stated the amount of lump sum deposit will not be counted as an asset in the aged-care means test, as a pro of option 2. In fact, the amount of lump sum deposit will not be counted as an asset in the pension means test.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/161674/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/colin-zhang-1234147">Colin Zhang</a>, Lecturer, Department of Actuarial Studies and Business Analytics, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/is-it-worth-selling-my-house-if-im-going-into-aged-care-161674">original article</a>. </div>

Retirement Income

What the government’s home care changes mean for ageing Australians

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/tracy-comans-696663">Tracy Comans</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/frances-batchelor-2209350">Frances Batchelor</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> The Albanese government has this week announced it will introduce one of the <a href="https://www.health.gov.au/ministers/the-hon-anika-wells-mp/media/once-in-a-generation-aged-care-reforms">largest reforms</a> to Australia’s aged-care sector to date. The package includes a A$4.3 billion investment in home care, now called “<a href="https://www.health.gov.au/our-work/support-at-home">Support at Home</a>”, to come into effect from July 2025. This reflects both the desire of many people to remain living at home as they age, and the government’s desire to reduce the costs of residential aged care. So what changes is the government making to home care packages? And what will these changes mean for ageing Australians? <h2>Reducing waiting times</h2> One of the major complaints about the current home care system is the long waiting times. Estimates suggest there’s a <a href="https://www.gen-agedcaredata.gov.au/getmedia/447b425c-63d6-4b96-a1fc-4dac805066ba/Home-Care-Packages-Program-data-report-1-January-%E2%80%93-31-March-2024">6–to-12-month wait</a> for the higher level 3 and 4 home care packages. For people with the highest needs, this is far too long. As of March this year, around <a href="https://www.gen-agedcaredata.gov.au/getmedia/447b425c-63d6-4b96-a1fc-4dac805066ba/Home-Care-Packages-Program-data-report-1-January-%E2%80%93-31-March-2024">45,000 people</a> were waiting for any level of home care. An additional 14,000 were already receiving a package, but on a lower level of home care than they were entitled to. With additional funding, the new system will <a href="https://www.health.gov.au/ministers/the-hon-anika-wells-mp/media/once-in-a-generation-aged-care-reforms">support more participants</a>. It aims to shorten wait times to <a href="https://www.health.gov.au/sites/default/files/2024-09/support-at-home-fact-sheet.pdf">an average of three months</a> from July 2027. <h2>Changes to services</h2> The new system will replace the current four levels of home care packages with <a href="https://www.health.gov.au/ministers/the-hon-anika-wells-mp/media/once-in-a-generation-aged-care-reforms">eight classifications</a> of funding for services. When participants are assessed, they will be assigned the most suitable category. There’s currently very limited information on what these classifications are, but the idea is they will provide more targeted services. A number of short-term supports will also be available. These include assistive technology (such as mobility aids) and home modifications. Some people will be able to access 12 weeks of restorative care – a more intensive program designed to build function after injury or illness – as well as palliative care support. The way different types of services are subsidised is also changing. Previously, the same means-tested co-contribution applied regardless of the type of service. Under the new system, services are categorised into clinical care (for example, physiotherapy or wound care), independence (such as help with bathing or cooking) and everyday living (for example, gardening or home maintenance). The new reforms fully subsidise clinical services regardless of income, whereas independence and everyday living services will attract co-contributions based on means testing. For example, <a href="https://www.health.gov.au/sites/default/files/2024-09/case-studies-support-at-home.pdf">a self-funded retiree</a> would pay nothing out of pocket for physiotherapy, but would pay 50% for help with showering and 80% towards gardening costs. A full pensioner would also pay nothing for physiotherapy, but pay 5% for help with showering and 17.5% of the cost of gardening. This is a positive change. Our research has previously highlighted a tendency for people with home care packages to choose everyday living services <a href="https://onlinelibrary.wiley.com/doi/full/10.1155/2023/4157055">such as gardening</a> and cleaning and refuse clinical care such as allied health and nursing as these types of services were more expensive. These changes should make older people more likely to choose allied health and clinical care services, which will help them maintain their function and stay fitter for longer. <h2>Some challenges</h2> For the government’s reforms to deliver faster and better support at home, a number of issues need to be addressed. As people stay at home for longer, we also see that these <a href="https://academic.oup.com/ageing/article/52/5/afad058/7147101">people are frailer</a> and have more health conditions than in the past. This requires a different and more highly skilled home care workforce. The current <a href="https://www.health.gov.au/sites/default/files/documents/2021/10/2020-aged-care-workforce-census.pdf">home care workforce</a> consists largely of personal care and domestic support workers alongside a much smaller skilled workforce of registered nurses and allied health professionals. But with the changing profile of people receiving care at home, there will need to be a greater focus on maintaining functional capacity. This might mean more allied health input will be required, such as from physiotherapists and occupational therapists. It’s difficult to source an appropriately skilled workforce across the sector, and almost impossible in <a href="https://www.ruralhealth.org.au/sites/default/files/publications/fact-sheet-allied-health.pdf">rural and remote areas</a>. Alternative models, such as training personal care workers to act as allied health assistants, and effectively using technology such as telehealth, will be necessary to meet demand without compromising on quality of care. One example of the need for upskilling in specific areas relates to caring for people with dementia. The majority of people who are living with dementia at home receive care from family carers, supported by home care workers. It’s vital that these care workers have adequate knowledge and skills specific to dementia. However, research has shown the home care workforce may <a href="https://pubmed.ncbi.nlm.nih.gov/31646701/">lack the knowledge and skills</a> to provide best-practice care for people living with dementia. Specialised <a href="https://onlinelibrary.wiley.com/doi/10.1002/gps.6140">dementia training</a> for home care workers is effective in improving knowledge, attitudes and sense of competence in providing care. It should be rolled out across the sector. <h2>What about unpaid care at home?</h2> Unpaid carers, such as family members, provide <a href="https://www.pmc.gov.au/resources/draft-national-strategy-care-and-support-economy/goal-1-quality-care-and-support/support-for-informal-carers">significant amounts of care</a> for older people. The value of this unpaid care is estimated to be in the billions. As older people stay at home for longer, this is set to increase even further. However, carers with high care burdens are particularly vulnerable to <a href="https://www.sciencedirect.com/science/article/pii/S2352827316300283#s0025">poor physical and mental health</a>. Without adequate support, we may find extra caring pressures lead to a breakdown in caring relationships and an increase in other health-care costs for both the carer and care recipient. So we need to ensure carers have adequate financial, psychological and practical support. But the currently available detail on the reforms doesn’t indicate this has been adequately addressed. With careful implementation and ongoing evaluation, these reforms have the potential to significantly enhance the home care system. However, their success will depend on addressing workforce challenges, ensuring adequate support for unpaid carers, and maintaining a focus on the holistic needs of older Australians. More information about Support at Home is <a href="https://www.health.gov.au/our-work/support-at-home/about">available online</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/238890/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tracy-comans-696663">Tracy Comans</a>, Executive Director, National Ageing Research Institute; Professor, Centre for Health Services Research, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/frances-batchelor-2209350">Frances Batchelor</a>, Director Clinical Gerontology & Senior Principal Research Fellow, National Ageing Research Institute, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-the-governments-home-care-changes-mean-for-ageing-australians-238890">original article</a>. </div>

Legal

Landmark aged care reforms set to benefit millions of Aussies

The federal government has reached a deal with the coalition for the long-awaited aged care reforms including $4.3 billion for in-home services. This means that senior citizens will be given more support and choice to live their golden years in dignity, as they intend to help them live at home for longer and improve conditions and protections for those in aged care facilities. "$4.3 billion will be invested in Support at Home, to come into effect on the first of July next year," Prime Minister Anthony Albanese announced at Parliament House on Thursday. The Support at Home package is expected to help 1.4 million Australians live independently at home with support, before going into aged care by 2035. It will provide support for nursing, occupational therapy and day-to-day tasks like cleaning, showering, dressing and shopping, with wait times for packages cut from 12 to three months. The government will also pay all of the cost of clinical care services, with a lifetime contribution cap of $130,000 for non-clinical care costs. Those using the Support at Home program could also get $25,000 in aid to spend their final three months at home, instead of the hospital. The $5.6 billion reform package is also set to affect the availability of funding for residential aged care, including a "no worse off" assurance that people currently in aged care won't be asked to pay more for their care. New aged care quality standards will also be implemented to improve the sector and drive higher-quality care. The government also promised more resources to investigate and penalise bad behaviour by providers. Albanese said the reforms will be the "greatest improvement" to the aged care sector in 30 years. “This is about caring for the generation that cared for us,” he said. “We will deliver historic aged care reforms to ensure the viability and quality of our aged care system and support the growing number of older Australians choosing to retain their independence and remain in their homes as they age.” Aged Care Minister Anika Wells said the changes would lead to more services for older Australians. “Our reforms will create better and safer care, help reduce the fear of a system that has been neglected for far too long,” she said. The reform has been welcomed as the number of Australians over the age of 65 is expected to double and those older than 85 are predicted to triple in the next four decades. Images: Shutterstock

Caring

Hospice nurse shares the four physical stages of dying

A hospice nurse has shared the four things that happen to your body in the months, weeks and days before you die. Julie McFadden, who specialises in end of life care, shares videos about death and dying on social media to open up the conversation on the taboo topic, to help better prepare people for death. In her latest video, a viewer asked Julie what the dying process actually looks like, as the nurse explained that it all depends on how, when and why you pass away. However, she said there are four things that happen to the body as the end draws near. The first stage of dying is slowing down, which can happen up to six months before you die, with the symptoms being very "generalised". Julie says, "For instance, you’re just going to be generally tired, generally lethargic, not eating and drinking as much, probably being less social." According to Julie, the second stage is a sharp decline in strength, as she explains, "The closer you get to death – let’s say three months out – you’re going to be more debilitated." "It’s going to be difficult for you to leave the house, you probably are eating and drinking very little throughout the day, and you’re sleeping more than you’re awake." <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">Before the last stage of life, Julie describes a period of "transitioning" which happens around a month before death and can include a phenomenon known as "visioning". <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">The nurse says, "This is when people will start seeing dead relatives, dead loved ones, dead pets, things like that." She says that typically, someone "can be up and having a normal conversation with their family", all the while "saying they’re seeing their dead father in the corner who is smiling and telling them he’s coming to get them soon and not to worry." <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">According to Julie, this final stage of death is considered the most "distinct time in the dying process" when the body starts to fully shut down. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">"The actively dying phase is what scares people, because they’re not used to seeing it and they don’t know what the heck’s going on," she says. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">‘Metabolic changes’ such as a difference in skin colour, high and low temperature, or the ‘death rattle’ – a gurgling noise (also known as terminal secretions) caused by a buildup of fluids in the throat and upper airways – follow before they later pass on. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">However, while it’s natural to find these things upsetting, Julie assures people this stage is a "normal part of death and dying", and "it’s not hurting your loved one." "It’s important to be educated about what death actually looks like. Movies and television don’t do it justice, then people see it in real life when it’s their loved ones and they freak out," she said. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">Image credits: YouTube / Instagram

Caring

Our research shows 4 in 10 Australians in aged care are malnourished. What can we do about it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/jonathan-foo-1551045">Jonathan Foo</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/marie-claire-oshea-1373994">Marie-Claire O'Shea</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> In the next 40 years <a href="https://treasury.gov.au/sites/default/files/2023-08/p2023-435150-fs.pdf">in Australia</a>, it’s predicted the number of Australians aged 65 and over will more than double, while the number of people aged 85 and over will more than triple. If you’re not really interested in aged care, you should be. Given these figures, you will almost certainly be engaging with aged care services at some stage – either for yourself, or supporting family members or friends seeking aged care. One service you are likely to encounter is residential aged care homes. In the past few years this sector has been under more scrutiny than ever before. Changes to legislation, workforce and funding are in motion. But the question remains as to whether these changes can happen fast enough to meet our ageing population’s needs. One area of need not being adequately met at present is nutrition. In a <a href="https://www.mdpi.com/2227-9032/12/13/1296">new study</a>, we’ve found four in ten older Australians living in residential aged care are not receiving enough of the right types of nutrients, resulting in loss of weight and muscle. This is known as malnutrition. <h2>Good nutrition is essential for healthy ageing</h2> Malnutrition in older people is <a href="https://www.agedcarequality.gov.au/providers/food-nutrition-dining/why-meals-matter">associated with</a> poorer overall health, such as increased risk of falls and infections. This can accelerate loss of independence for older people, including the need for extra assistance with basic activities such as bathing and dressing. Older people are at increased risk of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02612-5/abstract">malnutrition</a> for a range of reasons. These can include decreased appetite, difficulties with chewing and swallowing, and the presence of other chronic diseases such as Parkinson’s disease or dementia. Importantly, ensuring adequate nutrition is about more than just offering healthy foods. We eat not only to meet nutritional requirements, but for enjoyment and socialisation. We each have different preferences around what we want to eat, when and with whom. Food provision poses a challenge for residential aged care providers who must navigate the range of residents’ preferences together with dietary restrictions and texture modifications. This must also be balanced against the practicalities of having the right number of appropriately trained kitchen and mealtime assistance staff, and working within funding constraints. Understanding more about who is malnourished in aged care can help providers better address this problem. <h2>Malnutrition is an ongoing problem in aged care</h2> We looked at more than 700 aged care residents in New South Wales, Queensland and South Australia. We assessed participants for malnutrition using a screening tool that collects data on medical history and dietary intake, and includes a physical examination of muscle and fat. We found 40% were malnourished, including 6% who were severely malnourished. This likely underestimates the true rate of malnutrition, as residents with dementia were excluded. International <a href="https://www.mdpi.com/2072-6643/15/13/2927">studies</a> have shown an average of 80% of aged care residents with dementia are malnourished or at risk of developing malnutrition. Our findings are broadly in line with a synthesis of <a href="https://www.sciencedirect.com/science/article/pii/S0378512219301148">38 international studies</a>, which reported an average malnutrition rate in residential aged care of 52%. In Australia, malnutrition was highlighted as <a href="https://www.royalcommission.gov.au/aged-care">a priority</a> for immediate attention in the 2021 Royal Commission into Aged Care Quality and Safety. Its report cited <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/dairy-food-supplementation-may-reduce-malnutrition-risk-in-institutionalised-elderly/52E93ADD586C634A3913A2AFE9D07847">an Australian study</a> of 215 residents, published in 2017, which found 68% were malnourished or at risk of malnutrition. It’s difficult to directly compare malnutrition rates between studies due to differences in diagnostic measurements. But it’s clear malnutrition is an ongoing challenge in aged care. <h2>What can we do about it?</h2> Since the royal commission, we’ve seen the strengthening of the <a href="https://www.agedcarequality.gov.au/providers/quality-standards/strengthened-quality-standards">quality standards</a> to be included in the new Aged Care Act, anticipated to be introduced to parliament in 2025. The strengthened quality standards provide an important framework to guide action by aged care providers on malnutrition. Key requirements include partnering with residents to design food options, regular assessment and reassessment of resident nutrition requirements, developing systems to monitor and improve satisfaction with food, designing pleasant dining environments, and providing staff with the training they need to achieve all of the above. However, achieving these standards will require investment of money and time. At the moment, <a href="https://kpmg.com/au/en/home/insights/2023/09/australian-aged-care-sector-analysis.html">64% of residential aged care providers</a> in Australia are operating at a financial loss. While we know carers and facility managers want to provide the best care possible, it’s difficult to achieve this when contending with underlying financial problems. As such, our teams at Monash and Griffith universities are focusing on strategies that minimise the burden on staff and providers. We are working on automating malnutrition screening. Current tools take 10–15 minutes and should be used when a new resident moves into an aged care home and regularly during their stay. But anecdotal evidence suggests providers lack the staff and funding needed to routinely carry out this screening. Instead, we aim to use existing data from aged care providers, including quarterly reports from the <a href="https://www.health.gov.au/our-work/qi-program">National Aged Care Mandatory Quality Indicator Program</a>, to detect malnutrition automatically. This will allow staff to focus more on care. Given the complexity of malnutrition, it’s likely that addressing the issue at a national scale will take some time. In the short term, for those with loved ones in aged care homes, we encourage you to be actively involved in their care, including noticing and speaking up if you think more can be done to optimise their nutrition.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/235507/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jonathan-foo-1551045">Jonathan Foo</a>, Lecturer, Physiotherapy, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/marie-claire-oshea-1373994">Marie-Claire O'Shea</a>, Senior Lecturer, School of Health Sciences and Social Work, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/our-research-shows-4-in-10-australians-in-aged-care-are-malnourished-what-can-we-do-about-it-235507">original article</a>. </div>

Body

We have too few aged care workers to care for older Australians. Why? And what can we do about it?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> In a country like Australia, we all expect that when we get old, we’ll be able to rely on a robust aged care system. But aged care providers can’t find staff and a crisis is brewing. If the problem isn’t fixed, there are serious risks to quality and access to services for older people who need support. There are also broader social, economic and political consequences for undervaluing the rapidly expanding health and social assistance workforce. Aged care <a href="https://www.health.gov.au/sites/default/files/documents/2021/10/2020-aged-care-workforce-census.pdf">employs</a> around 420,000 people. Around 80% of those are front line staff providing care and demand for them is increasing rapidly. <h2>Australians are ageing</h2> The number of people aged 80 and over is <a href="https://treasury.gov.au/sites/default/files/2019-03/IGR_2010_Overview.pdf">projected to double</a> by 2050. At the same time, informal family care is becoming less available. In the next 25 years, <a href="https://www.australianageingagenda.com.au/executive/shortfall-of-400000-aged-care-workers-predicted-by-2050/">twice as many</a> aged care staff will be needed. Currently, about 1.4 million older people <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/aged-care">receive</a> aged care services, including basic and more intensive home care and residential care. Health care and social support job vacancies and ads are the highest of any industry. Between 30,000 and 35,000 additional direct aged care workers a year are already needed. By 2030 the <a href="https://cedakenticomedia.blob.core.windows.net/cedamediacontainer/kentico/media/attachments/ceda-duty-of-care-3.pdf">shortfall</a> is likely to be 110,000 full time equivalent workers. <h2>Why don’t enough people want to work in aged care?</h2> Despite recent <a href="https://www.health.gov.au/topics/aged-care-workforce/what-were-doing/better-and-fairer-wages">pay increases</a>, it is difficult to attract and retain aged care workers because the work is under-valued. The Australian workforce is undergoing profound change. A generation ago, manufacturing made up 17% of the workforce. Today it has fallen to 6%. By contrast, the health care and social assistance workforce has doubled from 8% to 16%. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/607090/original/file-20240716-17-hup1e8.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>The manufacturing workforce has declined, while health, aged care and social assistance has risen. ABS 6291.0.55.001 Labour Force, Australia.</figcaption></figure> Manufacturing jobs were <a href="https://australiainstitute.org.au/wp-content/uploads/2020/12/Manufacturing-Briefing-Paper-FINAL.pdf">mainly</a> secure, full-time, reasonably paid jobs dominated by male workers. By contrast, jobs in aged care are often insecure, part-time and poorly paid, dominated by women, with many workers coming from non-English speaking backgrounds. Since moving to take over aged care in the 1980s, the federal government has over-emphasised <a href="https://arena.org.au/a-genealogy-of-aged-care/">cost constraint</a> through service privatisation, activity-based funding and competition, often under the cover of consumer choice. The result is a highly fragmented and poorly coordinated aged care sector with almost 3,200, often small and under-resourced providers centrally funded and regulated from Canberra. This has <a href="https://www.health.gov.au/sites/default/files/a-matter-of-care-australia-s-aged-care-workforce-strategy.pdf">led to</a> high levels of casualisation, low investment in training and professional development, and inadequate supervision, particularly in the home care sector. Aged care is facing a perfect storm. Demand for care and support staff is increasing dramatically. The sector is poorly coordinated and difficult to navigate. Pay and conditions remain poor and the workforce is relatively untrained. There are no minimum standards or registration requirements for many front-line aged care staff. <h2>What are the consequences?</h2> An understaffed and under-trained aged care workforce reduces access to services and the quality of care and support. Aged care providers <a href="https://www.agedhealth.com.au/content/compliance-and-governance/news/troubled-outlook-for-aged-care-reforms-1224428737#:%7E:text=Its%20report%20found%20that%2053.8,was%20%22impossible%20to%20achieve%22.">routinely report</a> it is difficult to attract staff and they can’t meet the growing demand for services from older people. Staff shortages are already having an impact on residential care occupancy rates falling, with some regional areas now down to only 50% occupancy. That means older people either don’t get care or they are at increased risk of neglect, malnutrition, avoidable hospital admissions and a poorer quality of life. Inevitably, lack of aged care workers puts pressure on hospital services when older people have nowhere else to go. <h2>What needs to be done?</h2> Addressing these challenges requires a multifaceted approach. Australia will need a massive increase in the number of aged care workers and the quality of the care they provide. Wages have to be competitive to attract and retain staff. But better pay and conditions is only part of the story. Unless aged care becomes a career the community recognises, values and supports, it will continue to be difficult to train, attract and retain staff. The recent <a href="https://www.royalcommission.gov.au/aged-care">Royal Commission on Aged Care Quality and Safety</a> highlighted the need for a more skilled workforce, emphasising the importance of ongoing professional development for all staff. To date the federal government’s aged care workforce initiatives have been underwhelming. They are a limited and piecemeal rather than a coherent workforce strategy. In the short term, skilled migration may be part of the solution. But progress to bring in skilled aged care workers has been glacial. Currently only about 1% of providers <a href="https://theconversation.com/overseas-recruitment-wont-solve-australias-aged-care-worker-crisis-189126">have agreements</a> to bring in staff from overseas. At best, overseas migration will meet only 10% of the workforce shortfall. Registration, qualifications and training for direct care work have to become mandatory to make sure care standards are met. Much more significant and systematic incentives and support for training will be needed. Supervision, career progression and staff development will also have to be dramatically improved if we are to attract and retain the workforce that is needed. “Learn and earn” incentives, including scholarships and traineeships for aged care, are needed to attract the future workforce. At the same time, a much broader investment in upskilling the entire workforce through continuing professional development and good quality supervision is necessary. Like manufacturing a generation ago, aged care needs to become valued, skilled, secure and well-paid employment if it is going to attract the staff that are needed to avoid a looming crisis.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/232707/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, Emeritus Professor of Public Health, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/we-have-too-few-aged-care-workers-to-care-for-older-australians-why-and-what-can-we-do-about-it-232707">original article</a>. </div>

Caring

Doctor shares her holy grail tips for overcoming eye sensitivity

As the chill of winter sets in, many people find that their eyes become more sensitive and prone to dryness. This can be particularly challenging for those who already suffer from dry eye syndrome. Dr. Jacqueline Beltz is a leading Australian Ophthalmologist and the founder of <a href="https://www.okkiyo.com" target="_blank" rel="noopener">OKKIYO</a>, a beauty brand that makes PRIORITEYES mascara for people with sensitive eyes. Dr Beltz has shared her insights into dry eye syndrome and how winter can exacerbate symptoms, also sharing her top tips for managing eye sensitivity during the colder months. Understanding Dry Eye Syndrome The surface of the eye is covered by a delicate layer of tears, essential for comfort, vision, protection, and nutrition. The tear film comprises two main layers: an outer lipid (oily) layer and an inner aqueous (watery) layer. The lipid layer, produced by oil glands in the eyelids, prevents tears from evaporating too quickly, while the aqueous layer, consisting of water, electrolytes, and proteins, spreads tears evenly across the eye and helps them adhere to the surface. When the balance of tear production, evaporation, absorption, and drainage is disrupted, it can lead to dry eye syndrome. Symptoms may include redness, irritation, a gritty sensation, tired eyes, itching, excessive watering, and fluctuating vision. In severe cases, dry eye can be painful and significantly impact daily life. How common is dry eye syndrome? Dry eye syndrome is a widespread issue, particularly among older adults. According to the Blue Mountains Eye Study, 57% of adults over the age of 50 experience some degree of dry eye. This condition is notably more prevalent in women, with higher rates observed compared to their male counterparts. The increased prevalence in women is often attributed to hormonal changes, particularly during and after menopause. A more recent study, Optometry Australia’s 2022 Vision index found that over 85% of Australians are estimated to have experienced dry eyes at some point in their lives. Of those affected, 55% say they only developed the condition following the beginning of the pandemic in 2020. They reported that almost 1 in 5 (18%) of people experience dry eye symptoms frequently. These statistics highlight the importance of understanding and managing dry eye, especially as we age. DEWS II Study and Treatment Approaches The DEWS II (Dry Eye Workshop II) study provides a comprehensive framework for understanding and treating dry eye syndrome. According to the study, dry eye is a multifactorial disease characterised by a loss of homeostasis (or balance) in the tear film, accompanied by eye symptoms. Factors such as tear film instability, hyperosmolarity (increased saltiness), inflammation, and neurosensory (altered feelings or sensations) abnormalities play significant roles. There are two primary types of dry eye: aqueous deficient and evaporative. Most individuals have a combination of both. Aqueous deficient dry eye occurs when there is insufficient production of the watery layer of tears, often due to aging, hormonal changes, or certain medications. Evaporative dry eye is typically caused by environmental factors or conditions affecting the lipid layer, such as meibomian gland dysfunction (MGD). Winter's Impact on Dry Eyes Winter poses unique challenges for dry eye sufferers. Cold, dry air, indoor heating, and wind can all exacerbate symptoms. Here's how to combat these winter-specific issues: 1. Humidify Your Environment Indoor heating reduces humidity levels, leading to increased tear evaporation. Consider using a humidifier to maintain moisture in the air, especially in bedrooms and living spaces. This helps keep your eyes hydrated. 2. Protect Your Eyes Outdoors Cold winds can strip away the tear film. When outside, wear wraparound sunglasses to shield your eyes from the elements. This not only protects your eyes from the wind but also from UV rays, which can be strong even in winter. 3. Stay Hydrated Dehydration can worsen dry eye symptoms. Drink plenty of water throughout the day to maintain overall hydration, which supports healthy tear production. 4. Optimise Your Diet Certain foods can promote eye health. Omega-3 fatty acids, found in fish like salmon and flaxseeds, have anti-inflammatory properties that can help manage dry eye symptoms. Incorporate these into your diet for added benefits. 5. Use a Warm Compress A warm compress can help improve the function of the meibomian glands, which produce the oily layer of the tear film. This is particularly helpful for those with meibomian gland dysfunction, or MGD. Gently apply a warm, damp cloth to your closed eyelids for 10-15 minutes, followed by a gentle massage of the eyelids to encourage oil secretion. It is important to avoid rubbing or compressing the eyeballs. 6. Use Over-the-Counter Lubricant Eye Drops Artificial tears can provide temporary relief by supplementing the natural tear film. Choose preservative-free options to avoid further irritation, and use them frequently. 7. Remember to have regular eye checks In Australia, Optometrists provide our primary eye health check ups. Dr Beltz recommends adults over the age of 40 see their optometrist once a year, but if you’re struggling with symptoms of dry eye in winter, an extra check up might help and your optometrist will be able to help you to come up with an individualised treatment plan. 8. Invest in Quality Eye Products For those who wear makeup, using products designed for sensitive eyes is crucial. <a href="https://www.okkiyo.com/products/protect-and-preserve-mascara" target="_blank" rel="noopener">PRIORITEYES</a> mascara by OKKIYO has been specifically formulated to be gentle on sensitive eyes, avoiding common irritants while providing excellent performance. Managing Dry Eye in Winter: A Recap Winter can be tough on our eyes, but with the right strategies, you can manage dry eye symptoms effectively. Maintain a humid environment, protect your eyes from cold winds, stay hydrated, and incorporate eye-healthy foods into your diet. Regularly use warm compresses and opt for gentle, high-quality eye products like PRIORITEYES mascara. Dry eye syndrome may be a common condition, but it doesn't have to dominate your life, especially during the harsh winter months. With these tips, you can keep your eyes comfortable and healthy all season long. For personalised advice and treatment, always consult with your eye care professional. Stay warm, stay hydrated and take care of your eyes this winter! Image credits: Shutterstock

Body

Hospice nurse reveals the key to a peaceful death

Hospice nurse Julie McFadden has shared her best advice for ensuring a peaceful death, after learning from her patients in their final moments. The healthcare professional, who is known for her YouTube channel where she shares information about death to break the taboo of conversations around dying, shared a video about what you can do in life to ensure a peaceful passing. In the recent clip, she shared what you can do in order to have a peaceful death, and she says it comes down to preparedness and acceptance. "That's one of the biggest things I see," she explained. "People who plan for death will tend to have a more peaceful death than those who do not plan for death." "A prepared death versus a non-prepared death - that's the one thing that I've seen in all of my patients," she explained. Julie said she noticed the patients that were "willing to talk about the hard stuff" had a more peaceful death. <iframe title="YouTube video player" src="https://www.youtube.com/embed/qoFvKkfIo00?si=Ba5BnxuaKsBVaGAe" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> "[That means] willing to ask the questions about, 'how long do you think I have? What can I expect? What should I do before I die to make this easier for my family?'" she listed. Julie went on to share a story of when a patient of hers died peacefully surrounded by his family, explaining that the patient was in hospice and had started to decline around 20 minutes after she arrived. "He started having weird changes in breathing, so this was a sudden decline and it looked like he may suddenly die," she recalled, adding the abrupt change was "uncommon actually" in hospice care. "What I noticed was because this family - and him - were so prepared, instead of the family [being] chaotic and reacting in an emotional way - which is very normal - they flipped along right with him," she explained. "[They laid] in bed with him. They understood immediately what was happening. They didn't panic," she shared. Julie said the man was surrounded by his loving family and it was an overwhelmingly emotional experience. "It makes me cry every time I think about it - that vision of them all being able to understand what was happening, even though it was a change they didn't want," she explained. "By the end of that visit he died, so he went from kind of looking okay to dying which is hard - but that family made it a beautiful moment," she said. Image credits: YouTube

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New proposal would see child care cost just $10 per day

In an incredibly promising step towards affordable and high-quality early childhood education, families in Australia could soon benefit from a significant reduction in costs – potentially paying just $10 a day for three days a week of high-quality care. This development is part of a broader push to reform the current, troubled system, driven by the Centre for Policy Development (CPD) and supported by various early learning and parenting groups. The CPD has introduced a comprehensive plan aimed at overhauling the existing system, proposing free or low-cost early learning for all children three days a week. A key aspect of their proposal includes replacing the current childcare subsidy with a "child-centred" funding model that directly finances early education centres. Prime Minister Anthony Albanese has endorsed the initiative, highlighting its significance in the national conversation on childcare, stating, “Universal child care provision, as it is in a range of other countries, is something that is a valued national asset. Early education is good for children, it’s good for families, but it’s also good for our economy.” Countries like Denmark, Germany, Sweden and Norway have successfully implemented legislated entitlements for early childhood services. Research indicates that where universal or low-cost education is available, participation rates are high, suggesting similar potential outcomes for Australia. Economic modelling by CPD suggests that universal or low-cost early learning could increase tax revenue by up to $3.2 billion annually and boost economic growth by $6.9 billion as more parents, particularly mothers, are able to work additional hours. The federal government is awaiting the final report from the Productivity Commission before making further decisions. Preliminary findings from this body and a separate investigation by the Australian Competition and Consumer Commission have identified the current system as complex, costly and inconsistently available across the country. Andrew Hudson, CEO of the Centre for Policy Development, labelled the existing system as "broken", noting that about 22% of children start school developmentally vulnerable and over 120,000 children miss out on early learning entirely due to stringent activity test rules and other barriers. Hudson also pointed out that enabling more women to return to the workforce represents the "single biggest productivity gain" for the country, describing the proposal as a "classic win-win". As momentum builds, this initiative promises a brighter future for Australian families, making high-quality early childhood education more accessible and affordable, while delivering significant economic and social benefits. Image: Shutterstock

Family & Pets

Hospice nurse reveals six unexplainable "death bed phenomena"

Hospice nurse Julie McFadden has lifted the lid on six unexplainable "death bed phenomena" that occur within a person's last weeks of life. The LA-based nurse, who specialises in end of life care, explained that as a person nears the end of their life, they will experience a range of unusual things, including hallucinations, random bursts of energy and even choosing when they're going to die. McFadden once again took to her YouTube channel to educate people on what happens when you're on your death bed, detailing each of the six strange occurrences. Julie explained that patients often experienced "terminal lucidity", "hallucinations", "death stares", and more in their final weeks. She began by explaining the first wild thing that happened at the end of life was terminal lucidity, in which people get a "burst of energy" in the days before they die, sharing that it happens "very often". She said, "Just enjoy it and expect that maybe they will die soon after because that's the kicker with terminal lucidity, it looks like someone's going to die very soon then suddenly they have a burst of energy." "They maybe have a really great day, they're suddenly hungry, they're suddenly able to walk, they're suddenly very alert and oriented, and then shortly after usually a day or two they will die, so that can be the hard part if you're not ready for it, if you don't know what's coming you can think they're getting better and then they die, which can be very devastating." Julie then described how most people in their final days will encounter "death visioning" or "hallucinations", as many people describe seeing the ghosts of loved ones in their final days. "I wouldn't have believed it unless I saw it for myself over and over again," the nurse admitted. "Number three, this is really crazy - people choosing when they're going to die. I have seen some extreme cases of this, people just saying, 'Tonight's when I'm going to die I know it, I can feel it,' and they do. There's also a time when people will wait for everybody to get into town or get into the room arrive at the house whatever it is and then they will die," the nurse explained. The fourth phenomena is known as the "death reach", according to Julie. She explained, "It's when the person's lying in bed and they reach up in the air like they're seeing someone or they're reaching for someone either to hug them or to shake their hands. A lot of times they'll hold their hands up for a long time, like they're seeing something that we're not seeing and they're reaching for someone that we can't see." Julie then listed "number five is the death stare," explaining that the death stare and the death reach often "go together". "It usually looks like someone is staring off into the corner of the room or the side of the room basically looking at something intently, but if you're snapping your finger in front of their face or trying to say their name to kind of snap them out of it, they won't," she said. The last wild thing the nurse has seen is known as a "shared death experience" and is "most impactful", according to Julie. She explained, "A shared death experience is when someone who is not dying feels or sees or understands what's happening to the person who is dying." "It's kind of like the dying person gives you the sensation of what they're going through. From what I experienced, it was a very good feeling. It was like the person was giving me these feelings of freedom and joy and kind of telling me that they were okay." "At the time, I was shocked, I didn't know what was happening, but I've come to find out that that's called a shared death experience." Image credits: YouTube / Instagram

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