The paradox of the Aged Care Act 1997: the marginalisation of nursing discourse^*

Abstract

This paper examines the marginalisation of nursing discourse, which followed the enactment of the Aged Care Act 1997. This neo-reform period in aged care, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision of care at the cheapest possible price. This paper exposes some of the gaps in the neo-reform period and challenges the assertion that the amalgamation of nursing homes and hostels in such an environment can provide better quality of care and life for residents. It argues that this amalgamation entails a transformation towards a social model of care and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision of aged care services. The paper proceeds to present strategies where the future for nursing practice in aged care necessarily involves a judicious balancing of individual cases alongside economic prescriptions of care and ever-changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field of aged care. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault.

Decrepit death as a discourse of death in older age: implications for policy

“…Unfortunately, observable unjust discrepancies in practice still remain depend on the setting in which a person receives their care. In residential aged care, the older dying person and their family seem to not warrant the expert medical and nursing care, holistic counselling and bereavement support, that are integral to what is offered to a dying person in other care settings (Angus & Nay, 2003).…”

Opinion Piece

“…Nursing discourses can act as a catalyst in addressing the importance of economic rationalisation and quality health care and the tensions created between the two in the form of governance, the system, resources and support (Angus & Nay, 2003;Chou, Boldy, & Lee, 2002). Organisational and structural reform in aged care organisations could be achieved if participatory processes included fl attened hierarchical structures and 'true' support and transparency on the part of management and the government (Chenoweth, Jeon, Goff, & Burke, 2006;Chenoweth & Kilstoff, 2002).…”

“…This has been recommended if the ongoing documentation situation is to be cleared and allow nurses to nurse and document that nursing (ACEMA, 2002;Angus & Nay, 2003;Cheek, Ballantyne, Jones, Roder-Allen, & Kitto, 2003;CofA, 2003aCofA, , 2003bPelletier, Duffi eld, Gietzelt, Larkin, & Franks, 2002;Tonuma & Winbolt, 2000). Nursing documentation is indispensable for quality nursing care and it requires a return to the nursing domain of responsibility and accountability and untied from funding.…”

Agents of care and agents of the state: bio‐power and nursing practice

“…The power of health care, through its directing and normalizing nature, serves as an instrument of social control. Angus and Nay (2003) corroborate this, and believe that surveillance and discipline regulations and procedures characterize the discourse surrounding the care of individuals. Nursing practice, whether preventive or curative, thus becomes the vehicle of disciplinary technologies.…”