Covert Euthanasia – Australia’s System of Residential Aged Care

The Pope has stated that in today’s society, there is a system of covert euthanasia[1]. When I read this term, my mind immediately turned to the dire situation in Australia’s aged care system. In my recent work on the Government Scorecard, I became appalled at how little funding is provided for a sector that we rely on so heavily. The absence of government oversight of performance also indicates a complete lack of compassion for older Australians who rely on these facilities. Our elders are cast into aged care homes where they are overmedicated and undernourished – physically, mentally, and emotionally. They are devoid of dignity and lack the one thing that sustains us all – love. Could Australia’s Residential Aged Care Facilities (RACFs) actually deliver covert euthanasia of our elderly?

What Would Covert Euthanasia Look Like?

It does not take too much imagination to identify what an aged care system that delivers covert euthanasia would look like.  The clear indicators would be:

  1. Little financial support – signifying a lack of concern with the quality of care
  2. Minimal oversight including measuring and monitoring of key service criteria, – demonstrating a lack of regard for the resident’s quality of life.
  3. Lack of attention and love for the residents – indicating an inherent belief in their lack of worth.
  4. Lack of support for families to provide an alternative to isolation in institutional care
  5. No clear long-term plan to rectify systemic failures where they occur.

Let’s take a closer look and see if there is any evidence of these indicators in Australia’s delivery of RACFs.

1. Little Financial Support

The following graph was published in the Medical Journal of Australia[2] shows that Australia places the most reliance on long-term institutional care for both over 65- and 80-year age groups of the OECD nations.

In contrast to the high reliance, Australia has one of the lowest spendings on aged care (as a proportion of GDP) in the OECD.

The question then becomes, how can you expect quality care in a system that is so full and yet so minimally funded? Of course, the cynical response would be that you could not logically expect quality in this situation.

And data reported by the Australian Productivity Commission shows that quality was actually in decline. There was a  continued decrease in three-year accreditations from 96.9 in 2018 to 87.3 in 2021. This means that a smaller number of providers delivered a high level of service quality over this time.

Source: Productivity Commission, Report on Government Services. 2022. Part F, Section 14 Aged Care Services.

But then, if you are not expecting quality service, then what are you expecting? Why wouldn’t you provide the financial support necessary to enable residents to thrive? If not thrive, what do you want them to do? The case for covert euthanasia strengthens.

2. Minimal Oversight

Surely though, there would be oversight of the services to guarantee funding was used to deliver great outcomes for residents. After all, what you measure and monitor is a clear sign of what you care about.

Here’s the thing, though. It was not until 2019 (seven years after taking power and one year after the start of the Aged Care Royal Commission) that the government established the Aged Care Quality and Safety Commission and the National Mandatory Aged Care Quality Indicator Program (NMQIP). NMQIP reports on only three indicators: pressure injuries, physical restraints, and weight loss (each with several subcomponents). There is no data available on the quality of care or how the care meets the client’s needs.

“If you’re not measuring, you don’t care, and you don’t know” ~ Steve Howard.

As this quote suggests, the lack of government monitoring, measuring and reporting would indicate that they did not care about residents’ quality of life in aged care facilities. This seems to compound the case for covert euthanasia.

3. Lack of Attention and Love

In a report presented to the Royal Commission, it was revealed that more than half of all Australian aged care residents (57.6%) are in homes that have unacceptable levels of staffing. Another 27% have only acceptable levels of staffing.[3].

The result is a desperate lack of attention to the needs of the elderly in aged care. The Australian Nursing and Midwifery Federation (ANMF) research shows that people living in residential aged care need around 4.3 hours of care per day. They currently receive only 2.5 hours of care each day, just over half of their actual needs.

The Register of Senior Australians (ROSA) is a cross-sectoral partnership of researchers, clinicians, aged care providers and consumer advocacy groups. Their report for the Royal Commission identified several best-practice performance measures that could readily be reported given existing data in Australia. These measures in Australia paint a disturbing picture of the lack of love afforded to residents in aged care.

The ROSA research shows the rates of three or more psychotropic medications used in people aged 75 years and older were 3-4 times higher in Australia than in Sweden. This indicates that residents in aged care are bearing a significantly high sedative load. High sedation also increases the risk of falls and other accidents, leading to injury and rapid decline in health.

In addition, ROSA’s research shows the use of antidepressants in a year by people in residential aged care and home care in Australia is high. At a rate of 68.3% and 46.2%, it is higher than seven of the eight countries in the associated study. These results show that almost seven out of ten residents in aged care facilities are on antidepressants.

The other reality for residents is that around 40% never get visitors. They have no direct contact with loved ones, no personal touch from friends or relatives, and no reassurance about their worth.

So, unfortunately, without evidence to the contrary, these statistics present a picture of aged care institutions as a place of despair, sedation and depression. They appear to be places where one is put just to wait out their final days. There is no doubt that the staff would be doing their best to provide the utmost care. However, the systemic pressures they face mean that the residents would feel neglected, a burden, lonely and unloved.

“It’s lack of love we die from.” ~ Margaret Atwood

Again, the question must be asked – if you set up a system that is incapable of providing attention, dignity and love, how do you expect these things to be given. And again, the harsh answer is that perhaps you never expected the system to deliver these things in the first place. But if you allow the system to fail its residents, you are condemning them to a life of suffering, for which the only way out is to die. This appears to provide further evidence that Australia’s system of RACFs has been established as a centre of covert euthanasia.

4. Lack of Support For Family Care

While not always practical, care in-home provides so many advantages physically, socially and psychologically.  There is a much lower rate of older Australians on antidepressants in-home care than in RACFs.  Our elders can maintain their sense of identity, worth, and connections with meaningful activities and loved ones. They can contribute and feel valued for their wisdom and experience. They can continue to feel part of a tribe.

Maintaining these connections is recognised in several countries, and governments are establishing robust integrated care systems to bring support either within or close to their homes. Integrated care allows elders to remain at home or with family while being provided with the additional medical and mobility support they require. It also enables family members to uphold their duty of filial piety and care for their parents in old age while also continuing in employment and meeting their financial obligations.

In Australia, though, we are being converted to the new religion of materialism, openly endorsed by both sides of politics. Our representative’s decree is that continued economic growth, strong sales, high consumer confidence, and low unemployment are the keys to happiness. And so, we should all strive to work, spend and have more. There is no doubt that employment and financial self-sufficiency are important. However, the current policies drive us to care more about things than we do about people. Materialism makes us mean.

“The way we are living today, the only thing that matters is the success of our economic system, and what is least important is the wellbeing of mankind.” ~ Rabbi Abraham Skorka

In a materialistic society, everything becomes consumable, used for our superficial pleasure. This philosophy is evident in our approach to the environment – use and abuse for economic gain. The picture presented in the Royal Commission suggests the same approach to our elderly. They have done their bit for the economy, paid their taxes, and now they can be thrown away like the rest of our landfill.

If this was not the case, we would see substantial support for families to provide care for their parents and grandparents.  However, the current economic policy forces people to focus on their survival and success at the expense of those who ensured their survival and assisted their success. The policies have established a society with very little choice for those who want to provide sole care or share care for their elders. The reality is that many are struggling financially. They fear for their own lives after retirement and cannot afford to lessen their income to take on a more active carer role. The continued rising cost of living and household debt means it is almost impossible for one partner to opt-out of work and care for an elderly parent or relative. The existence of more single-parent families makes this situation even less feasible.

Ultimately, then, there is no viable alternative for many families.  They must submit their elders to institutional care, which has been shown in many cases to offer only neglect, despair and depression.  The lack of freedom for the elder and the family in this choice shows a dearth of compassion towards both parties, and their separation plants the seed for covert euthanasia.

5. No Long-Term Plan

It is recognised that volunteers have always played an important role in aged care facilities, filling the social gap created by a shortage of staff. During the pandemic, volunteer access to aged care was halted to protect vulnerable residents. This decision did not appear to deliver much value, with aged care residents being the hardest hit by the virus regardless of the volunteers’ exclusion and the residents suffering from even greater isolation and loneliness.

This year, the federal government has established a formal program called Re-engaging Volunteers into Residential Aged Care Facilities (RACF). With this program, RACFs are matched with volunteers who will provide social and wellbeing services and “provide relief to the RACF workforce”.

While any program that improves the lives of aged care residents is to be applauded, the materialistic nature of our society has me curious about how successful this program may be. Many people out there with tender hearts would love to connect with our older Australians and offer support to our incredible aged care staff. But will “the economy” let them? How many people can afford to take the time to volunteer? While the hearts and minds may be willing, the debts may be more demanding.

In addition, calling in volunteers is only a short-term Band-Aid for a broken system. It is also, in my mind, downright rude when not being supported with a longer-term plan. Where is the long-term plan to redress the distressing care imbalance and build a network of high-quality, sustainable services? Where is the plan to provide the staff with the resources they need to deliver the care they so deeply yearn to? Where is the plan to show those currently in or thinking about entering aged care that they are actually respected and will be cared for?

There is none.  So what does this tell you about the level of concern for our elderly?

The lack of vision, a clear plan, and the lack of accountability and leadership on this issue are more indicators of a government running a campaign of covert euthanasia.

The Care Contract As A Coup de Grace?

The findings of the Aged Care Royal Commission are nothing but heartbreaking. The way the government has underfunded and undermanaged the sector is criminal. All of the information provided has me convinced that aged care facilities have become centres of covert euthanasia.

There is no doubt that these facilities are where people go to live out their old age, and in reality, all are expected to die there. But one should be able to expect that they can die with dignity, respect and a sense of self-worth. However, the statistics show that the majority are drugged, deserted, and depressed. They are not supported during their dying years. Instead, the institutionalised neglect works to hasten their demise. 

However, there is one significant difference between our aged care system and euthanasia.  The definition of euthanasia suggests a painless death. I can only guess that dying with a broken heart and shattered spirit would be excruciating.

In conclusion, while I cannot attest to the level of consciousness brought by the policymakers in this area, I feel confident asserting that the way Australia’s systems of RACFs are governed creates covert euthanasia. RACFs are not established to deliver love, and if this report has shown anything, these facilities actively withdraw it. Not providing our elders with sufficient food or medical attention is criminal.  But not providing them with love and a sense of self-worth is downright depraved.

So yes, Bishop of Rome, I agree with your assessment. Covert euthanasia it is. Harsh but fair.


[1] Bergoglio, J. M. (2014). On Heaven and Earth – Pope Francis on Faith, Family and the Church in the 21st Century. Bloomsbury Publishing PLC.

[2] Gibson, D. M. (2021). Is Australia over‐reliant on residential aged care to support our older population? Medical Journal of Australia, 215(1), 45. https://doi.org/10.5694/mja2.51127

[3] AHS.0001.0001.0001.pdf (royalcommission.gov.au)

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