A new National Centre for Healthy Ageing-led review, in partnership with Monash University, has explored key issues facing the more than 500,000 older care leavers who are transitioning into the aged care support system, underscoring the importance of incorporating the voices and diverse experiences of care leavers into research to inform policy and practice.
Older care leavers, sometimes referred to as 'forgotten Australians', are individuals who have spent parts of their lives in out-of-home care, including orphanages, children's homes or foster care.
Through examining Australian and international literature on older care leavers' perceptions of and experiences with aged care services, including their specific fears and anxieties about institutional aged care, the review found older care leavers would prefer to remain in and receive support at home, maintaining the familiar comforts of their own homes and reducing their levels of distress regarding the prospect of reentering institutionalised care environments.
Published in the Journal of Gerontological Social Work, the review was authored by Professor Philip Mendes, Associate Professor Susan Baidawi, Ms Lena Turnbull and Ms Sarah Morris from Monash University's Department of Social Work.
"Older care leavers who spent their childhoods in institutional and other forms of out-of-home care are a vulnerable group," Professor Mendes said.
"Our narrative review of existing local and international literature identified that most of this cohort prefer to remain at home, assisted by services that respect their autonomy and personal history.
"Aged care services need to adopt trauma-informed approaches to meet their needs and advance their wellbeing and dignity in aged care settings."
The review also states the environments of aged care facilities can evoke distress in older care leavers due to their similarities with childhood institutions, with issues such as the lack of privacy, the nature of communal living, and certain physical triggers like corridors and architectural features reminiscent of past institutions, specific odors, and some institutions sharing the name of childhood orphanages.
Additionally, the review found that providing trauma-informed care within aged care is made difficult due to workforce challenges, including high rates of staff turnover, disparities in staff skill levels, and cultural and linguistic divergences between staff members and residents, particularly those from non-western backgrounds, constrained resources also further complicates the delivery of sensitive and effective care services.
Co-author of the review, Ms Lena Turnbull, said the team's review of literature recommends that all aged care services should be trauma-informed, care leaver-informed and person-centred.
"For older Australians who grew up in childhood institutions, their past experiences of trauma in these settings can deeply influence how they perceive and interact with other institutions – in this case, aged care services," Ms Turnbull said.
"Trauma-informed care recognises and responds to these traumatic experiences, ensuring that care environments are safe, supportive and respectful. It shapes how services look and feel and how staff behave, in an attempt to build trust, reduce re-traumatisation and provide the tailored support needed to meet the unique emotional and psychological needs of this vulnerable group.
"The existing literature emphasises the necessity for care leavers to be provided with additional, flexible funding to facilitate their ability to continue living at home. This alongside the need for sustained access to counseling and specialised services and the support of an advocate or guide to aid in their navigation of aged care support systems is important."
Case Study - Dr Frank Golding OAM
Dr Frank Golding OAM, grew up as a Ward of the State of Victoria in Australia and was in the 'care' of three foster mothers and three institutions.
When he was two years old, he was made a Ward of the State and sent to the Andrew Kerr Memorial Home at Mornington. Dr Golding said he has no memories of this home, which he and his brother Bob were taken to from the Children's Welfare Depot at Royal Park in Melbourne.
After nine months they were released "on probation" to their mother. Soon after they were sent to the Ballarat Orphanage – from 1943 to 1953.
In January 2018, he was honoured with an Order of Australia Medal (OAM). The citation is "for service to child welfare and social justice and to the community." In July 2018, he was inducted into membership of the Order of Australia Association.
Today, Dr Frank Golding is a Doctor of Philosophy, an author and historian. He is also a life member of CLAN (Care Leavers Australasia Network), the peak body of Care Leavers for Care Leavers run by Care Leavers.
"I think the most obvious challenge for older care leavers is the prospect of being put into an aged care facility where they fear a duplication of their childhoods in orphanages and homes. Instead of being better off in those places, which was the stated purpose of their being in 'care', many were actually worse off. They were abused and neglected, lost all contact with family and friends, and were treated without respect," Dr Golding said.
"They don't trust the people in charge to treat them with respect and dignity rather than to depersonalise them. I suppose it's a fear of losing the independence they have spent their whole adult lives building up. Media reports about elder abuse are alarming to someone who lost control of their lives as children.
"There are also fears about seemingly little things that might trigger them in aged care facilities – e.g locked doors, queues, religious icons, being touched by strangers, custard and porridge.
"Another concern is about fees and charges, rules and regulations. The information that many need for reassurance is often so complicated and confusing. Many older care leavers were not given a decent education, so aged care agencies have to do better in explaining what it's going to cost and how things work. Having care leavers acting as support people would be important."
