The Australian Dental Association (ADA) wants to turn the tide on poor oral health in aged care, and was satisfied with the Royal Commission supporting its proposed alternative to funding oral care for certain seniors.

In creating such a scheme, the ADA outlined the singular necessity for a Senior Dental Benefits Scheme, and its advantages in relation to other models. The Senior Dental Benefits Scheme required serious consideration because of the urgency in developing vastly improved oral health among the elderly.

In the aged care system it’s critical; and recommendations need to be followed through.

In its 2018 submissions to the Royal Commission, the Australian Dental Association proffered under its proposed policy, that without imperative action, and without the funding mechanism, private dental practitioners cannot provide necessary screening and treatment.

Aged Care is an industry in perpetuity. Its first foray has been with the Greatest Generation (born 1901-1927) and the Silent Generation (1928-1945). It is an industry run by Boomers, Xers and Millennials – the three generations who’ve had more money, more access to science, medicine and technology, more opportunity and whose parents and grandparents (now in care) were financially more secure.

Thousands of individuals with first hand experience of the deficiencies in our dealings with the aged, both in hospital and residential facilities, have wanted vastly improved services for a very long time. Little has been achieved. Lots on paper; it just never seems to translate well enough.

The 2018 Royal Commission into Aged Care has the words ‘Quality’ and ‘Safety’ in its official title. Maybe the underlying consideration was that the power of those words would take the heat off the lip service that is ultimately the result of most of these inquiries. In formal terms, it’s ‘Royal’ because of the Letters Patent issued from the Crown: that ancient form of law-making brought to the colony from England along with the pigeons.

Essentially it’s power of the Crown, unimpeded by parliament.

Interestingly, in 2009 the Australian Law Reform Commission found that ‘royal’ should remain only ‘for reasons of status and perceptions of independence. ‘

Clearly the operative words here are ‘status’ and ‘perception’ – both inherently subjective, and debatably questionable.

Our elderly and most vulnerable, are the generations that even during their most productive and happiest of times, did not have the governmental assistance and rights expected and afforded us now. Even being aware of the generally easier life we live, even empathising with those finding themselves in a facility where they’ll be until they die, still we continue dragging our feet on urgent and necessary changes for the unprotected we’re supposed to be protecting.

These are people who deserve more respect. They’ve lived longer than most. They’ve buried almost everyone they know. They need to be cared for; it’s the promise we make and never deliver.

Old people haven’t been old all their life. It’s an unfamiliar and disconcerting end journey for them, and we do little to help have them feel appreciated and valued as a fellow human being. Mostly we pretend they’re under the best care possible. Then at some point they’re usually moved into palliative care and people vigilantly wait around with platitudes and justifications of how much better of they’ll be.

Of course they will. Aged care is a necessary evil, and we’re not necessarily good at it.

It takes a village to raise a child. Then the whole village can ignore them once they’re finally ensconced in the village of the village. Indeed the village of the damned, really. It’s generally upon impending death that the elderly are surrounded by the truly vigilant.

For that we should remain utterly ashamed.

There certainly hasn’t been any vigilance over 25 years for proper, quality, accessible, dental care for Boomers’ ageing parents and grandparents.

Capitalism and consumerism have insidiously put a dollar value and a worth on every life. We are no longer people but products: age is just the incremental obsolescence that superficially begins at 35. We prop up the idea of immortality with all kinds of unworthy pursuits: genetically improbable parenthood, cosmetic surgery; and completely ignore the fact that when Louis Armstrong was born, the average life expectancy was 47.

What a wonderful world. BC. Before care.

The 1928 discovery of penicillin is the Mighty Mouse that saved the day in terms of knocking tuberculosis and diphtheria off the perch as the biggest reasons people fell off theirs; and in our usual Homo sapien form we wrecked that too.

Promiscuity is long and broad in our history and it most certainly extended to the use of penicillin. Our alarming rate of overuse was apparent after a mere 32 years.

It didn’t even make it to 35.

60 years from that, we’re pretending that the self-created consequence of some highly resistant bacteria is the result of some hapless misfortune, or the thawed blue ice of intergalactic travellers. Sure, we talk a lot about not taking antibiotics unnecessarily, and finishing the whole course etcetera, etcetera, etcetera.

The reality is we leave all that up to everyone else because dammit, there’s work tomorrow.

We view ourselves as clever with many, many Google degrees, yet few understand the difference between bacterium and virus, and its uncertain whether pharmaceutical companies really want us to. We’re cruel to the earth and we’re cruel to its critters because we want Tasmanian smoked salmon all year round.

Even when it’s not native to Tasmania.

It’s what we do. We create what we want to be used to. An enduring zeitgeist where as long as it’s said that it is, it is; and if you say it enough times, then it’s always been that way.

So, Australia’s Seniors Dental Benefits Scheme: Will It Work & How?

We’re living the 4.0 version of Descartes’s Cogito, ergo sum where the thinking part is taken out because it makes it 21st century faster. Upgrades are not always about efficiency. Just speed.

Speed is what ultimately got Mighty Mouse into big trouble. Not just the gay abandon with which we scattered penicillin, but good ol’ Mighty Mouse himself.

In a three-second scene in the 1987 episode The Littlest Tramp Mighty Mouse snorts pink crushed flower powder; it’s all he has of Polly Pineblossom. Under the power of their own fabrication, these incensed and pious whiners of the American Family Association decided that kids would think their hero snorts cocaine.

CBS ordered the scene cut.

Seems the AFA had no problem with Polly Pineblossom being ‘deflowered’ by a lecherous, rich stalker, Mighty Mouse putting cheese in his pants, reference to Marilyn Monroe’s subway scene, or a spanking; or indeed Polly’s Stockholm Syndrome and subsequent marriage to Big Murray that passes the pub test on an abusive relationship.

Most notably is the complete lack of outrage and objection to Big Murray’s line, ‘One good lie is worth a hundred truths.’

That, it appears, is an A.O.K influence according to the American Family Association, on cartoon-watching kids.

It’s fine to take things as you find them, and often the reason we find them that way is because we’re not looking hard enough.

We’re uselessly subjective with everything. It’s the mouse that overturns the mighty. It’s why such little progress is made with things that could be changed overnight; and we’ve even altered that plain and simple definition. As Eddie Cantor once said, “It takes 20 years to become an overnight success.”

We’ve had an aged care industry in Australia for more than 20 years – since 1997 to be exact – and there are no overnight success stories in it. Plenty of heartbreaking ones. About inadequate personal care, neglect, abuse and negligence.

And plenty of political, beaurocratic and provider hyperbole to go with it.

The relentless assurance that the majority of Australian aged care facilities are ‘world-class’ might mean something if there was empirical evidence to support this dubious claim. There isn’t, and we’re just taking it as we find it. As long as it’s said that it is, it is.

One lie is worth a hundred truths and John Howard’s government should swing for what they did with the Aged Care Act 1997.

Indeed it would have at least been an act of integrity (most certainly not probity) had it been legislated as the Disgracefully Inadequate Requirements and Sanctioned Quality Deficits For Private, Foreign, Property and Superannuation Investors to Act Like They Care Act 1997.

Four years ago, Wendy Lacey, Dean and Head of the University of South Australia’s Law School slammed the Aged Care Act, stating there is “a complete absence of any positive and mandatory legal obligation on the part of facilities to take proactive measures to promote mental health and wellbeing of their residents.”

For the most part, aged care facilities can’t even get the food right. Instances of malnourished aged care residents are accepted as between 22 and 50 percent – which is almost 30% in dispute. A rather unacceptable reckoning were it to do with money and profit.

So not only do these expensive facilities not get the food right, they can’t even get how not right their food is, right.
It’s no secret residential aged care homes are chronically understaffed by chronically underpaid staff. Almost all are women, and with an average age of 47. Despite the fact that the proper care of the elderly, demented, frail and incontinent is recognised as one of the most demanding and challenging work in the health care sector, it’s possible to do this job without any formal qualifications.

Instead of mandating ratios like the whole village did in raising a child (1:10), the beaurocratic excuse for refusing this was that there would never be sufficient staff for small country towns and Aboriginal communities.

The irony. It burns. Hot.

Staffing studies from the US, Canada, UK, Germany, Norway and Sweden all validate what common sense dictates: that the standard of care is relative the ratio of registered nurses-to-residents. It’s empirical evidence that completely fell on deaf ears, too filled with the white noise of the government’s own brilliance of solving the problem by simply merging a number of agencies instead.

Local government did the same thing in some ecstasy-fuelled, cost-cutting, power-protecting amalgamation in 2017. Services became limited. Rates increased.

It was like watching magic play a joke on itself.

Over two years from 2017, costly Australian Royal Commissions have exposed unethical behaviour in primary producers, bankers, and aged care providers. Stealing water from a fragile environment, making money from dead customers, and the wholesale abuse and neglect of the frail and vulnerable is a lot of empirical evidence of profits over people.

It’s endemic; it’s the COVID-19 of social integrity. We’ve let it infect and mutate since 1976 when Milton Friedman decided that businesses serve society best when they abandon talk of ‘social responsibilities’ and solely maximise returns for shareholders.

We gave the bastard a Nobel Prize for that. He should be known as the Father of Short-termism, Hostile Takeovers, Mind-Boggling Scales of Fraud and Savage Job Cuts.

My word. He could run a residential aged care facility.

So how will a Seniors Dental Benefit Scheme work?

There’s no easy way to say this: it probably won’t. It’ll just be more Centrelink forms for someone to tediously trawl through. Either personally, or on behalf of a loved one to maybe find out they’re not eligible.

Or it might end up like ACAT where they run out of resources for home care packages. Then you have to respectfully and vigilantly wait until someone dies, while secretly wishing they’d just hurry up already.

Somehow we like death and vigilance.

It’s a high price we pay for the social integrity we no longer value. It’s integrity that leads the soul of a person, the spirit of a country. It is the nuance of government. It’s a cybernetic loop with each the drive and influence of each.

For decades, governments have used the term ‘quality’ in the names of various licensing accreditation agencies for the aged care sector. In 2013, Aged Care Standards and Accreditation Agency was renamed the Australian Aged Care Quality Agency as the sole approval body for providers under the Aged Care Act 1997.

Its focus, apparently, is “the quality assurance of the aged care services that they deliver”. There’s also the Aged Care Quality Advisory Council, as well as the Aged Care Quality and Safety Commission.

That’s a regular load of quality and safety regulators to have never put reportable measures in place that guarantee true levels of quality care for those whose only crime is being old.
And here we are with yet another proposal about funding and mechanisms. This time, it’s to ensure that private dental practitioners can provide screening and treatment, so that the oral health of our most vulnerable population will not continue being neglected.

Oral health will always be neglected until the government puts mouths back into the body and dental is covered by Medicare for the whole of your life.
Submissions to the Royal Commission into aged care by the ADA outline the need for a Senior Dental Benefits Scheme. The model as proposed, has Commonwealth Seniors Card holders and Pensioner Concession Card holders over the age of 65 receiving an individual subsidised entitlement to capped public or private dental treatments every two years. 

It excitedly suggests it could be used by patients for dental examinations prior to, or upon entry to residential aged care, and regularly after that; as well as covering as any necessary treatment, and oral health care planning. It points out, importantly, that the scheme means older people will no longer languish in the public dental system, and have the choice of continuing as patients with their regular dentist. 

It’s an entitlement scheme that could only be dreamed up by the entitled. Those who’ve never had ongoing oral health issues that reach a critical point of gum, tooth and bone loss by age 65.
Those who have never been forced to neglect their teeth because they languished in the public dental system for the entirety of their childhood.

And again in their 20s. And then gave up after five years of waiting since they were 37.

As far as the choice of continuing with the dentist they’ve always had, try that when the residential care available, or the only one you can afford is 50km away.

There is genuine respect for the ADA, and its attempt to achieve something, and appreciation for the requirements of official documentation. However, the proposal fluffs itself up like a lone chook under a carport of mealworms and raisins. It has a Scotty from Marketing feel about it with “improving access to affordable and timely dental treatment for those aged 65 and above” and that the scheme ensures “a better foundation of oral health.”

At 65 it can’t be a foundation. It can only be a façade.

Naturally, this Seniors Dental Benefits Scheme has the support of aged care advocacy groups. They’re used to chicken feed, god bless ‘em. They’ve got to take anything they can get.

It’s uncertain where the brilliancy of this scheme bushels its blinding light when it seems reminiscent of the Child Dental Benefits Scheme only for taller people; albeit with not dissimilar cognitive function and emotional needs. It’s a kids’ model nobody’s ashamed to utilise, but not the staffing ratios one that is basic insurance for decent care and a general sense of safety and wellbeing.

It must be disrespectful somehow to equate children with the elderly. 

The ADA indicates that having a national scheme based on consistent eligibility criteria and treatment rules, can fund dental care for a high proportion of residents, and is equally important to aged care providers trying to navigate an already complex funding system. 

Italics and outrage mine. This ‘already complex funding system’ is around $AU17b a year by the government, with resident ‘contributions’ set by the government at 85% of the Age Pension.

Seems it’s a much more complex funding system when you’re old folk with $AU64.55 left in yer kick per week. How much that subsidises your much-needed dental work with your dental subsidy is anyone’s guess.

The spin seems to be the many perceived advantages this national scheme would bring for residents, aged care providers and governments with some banging on about ongoing assessments and general health and nutritional benefits.

It seems a moot point to have a full set of choppers when there’s never enough staff to cut up your food so you can eat.

Aged care doesn’t deal with nutrition – we already know that by the stats. We already know about the industry’s preponderance, nay policy, for sustained understaffing. We already know they’re an industry with shareholders.

And everybody knows about Milton Freidman’s pillow talk.

So the answer to the question is within the question: Seniors Dental Benefits Scheme – How Will It Work?

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