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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

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

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

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

Caring

What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Voluntary assisted dying is now lawful in <a href="https://theconversation.com/voluntary-assisted-dying-will-soon-be-legal-in-all-states-heres-whats-just-happened-in-nsw-and-what-it-means-for-you-183355">all Australian states</a>. There is also <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">widespread community support</a> for it. Yet some residential institutions, such as hospices and aged-care facilities, are obstructing access despite the law not specifying whether they have the legal right to do so. As voluntary assisted dying is implemented across the country, institutions blocking access to it will likely become more of an issue. So addressing this will help everyone – institutions, staff, families and, most importantly, people dying in institutions who wish to have control of their end. <h2>The many ways to block access</h2> While voluntary assisted dying legislation recognises the right of doctors to <a href="https://theconversation.com/was-take-on-assisted-dying-has-many-similarities-with-the-victorian-law-and-some-important-differences-121554">conscientiously object</a> to it, the law is generally silent on the rights of institutions to do so. While the institution where someone lives has no legislated role in voluntary assisted dying, it can refuse access in various ways, including: <ul> <li> restricting staff responding to a discussion a resident initiates about voluntary assisted dying </li> <li> refusing access to health professionals to facilitate it, and </li> <li> requiring people who wish to pursue the option to leave the facility. </li> </ul> <h2>Here’s what happened to ‘Mary’</h2> Here is a hypothetical example based on cases one of us (Charles Corke) has learned of via his role at Victoria’s <a href="https://www.safercare.vic.gov.au/about/vadrb">Voluntary Assisted Dying Review Board</a>. We have chosen to combine several different cases into one, to respect the confidentiality of the individuals and organisations involved. “Mary” was a 72-year-old widow who moved into a private aged-care facility when she could no longer manage independently in her own home due to advanced lung disease. While her intellect remained intact, she accepted she had reached a stage at which she needed significant assistance. She appreciated the help she received. She liked the staff and they liked her. After a year in the facility, during which time her lung disease got much worse, Mary decided she wanted access to voluntary assisted dying. Her children were supportive, particularly as this desire was consistent with Mary’s longstanding views. Mary was open about her wish with the nursing home staff she felt were her friends. The executive management of the nursing home heard of her intentions. This resulted in a visit at which Mary was told, in no uncertain terms, her wish to access voluntary assisted dying would not be allowed. She would be required to move out, unless she agreed to change her mind. Mary was upset. Her family was furious. She really didn’t want to move, but really wanted to continue with voluntary assisted dying “in her current home” (as she saw it). Mary decided to continue with her wish. Her family took her to see two doctors registered to provide assessments for voluntary assisted dying, who didn’t work at the facility. Mary was deemed eligible and the permit was granted. Two pharmacists visited Mary at the nursing home, gave her the medication and instructed her how to mix it and take it. These actions required no active participation from the nursing home or its staff. Family and friends arranged to visit at the time Mary indicated she planned to take the medication. She died peacefully, on her own terms, as she wished. The family informed the nursing home staff their mother had died. Neither family nor staff mentioned voluntary assisted dying. <h2>Staff are in a difficult position too</h2> There is widespread community support for voluntary assisted dying. In a 2021 survey by National Seniors Australia, <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">more than 85%</a> of seniors agreed it should be available. So it’s likely there will be staff who are supportive in most institutions. For instance, in a survey of attitudes to voluntary assisted dying in a large public tertiary hospital, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15285">88% of staff</a> supported it becoming lawful. So a blanket policy to refuse dying patients access to voluntary assisted dying is likely to place staff in a difficult position. An institution risks creating a toxic workplace culture, in which clandestine communication and fear become entrenched. <h2>What could we do better?</h2> 1. Institutions need to be up-front about their policies Institutions need to be completely open about their policies on voluntary assisted dying and whether they would obstruct any such request in the future. This is so patients and families can factor this into deciding on an institution in the first place. 2. Institutions need to consult their stakeholders Institutions should consult their stakeholders about their policy with a view to creating a “<a href="https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00891-3">safe</a>” environment for residents and staff – for those who want access to voluntary assisted dying or who wish to support it, and for those who don’t want it and find it confronting. 3. Laws need to change Future legislation should define the extent of an institution’s right to obstruct a resident’s right to access voluntary assisted dying. There should be safeguards in all states (as is already legislated <a href="https://documents.parliament.qld.gov.au/tp/2021/5721T707.pdf">in Queensland</a>), including the ability for individuals to be referred in sufficient time to another institution, should they wish to access voluntary assisted dying. Other states should consider whether it is reasonable to permit a resident, who does not wish to move, to be able to stay and proceed with their wish, without direct involvement of the institution. <hr /> The opinions expressed in this article are those of the authors and do not necessarily reflect the views of Victoria’s Voluntary Assisted Dying Review Board.<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/183364/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, Associate Professor in Law, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin 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/what-happens-if-you-want-access-to-voluntary-assisted-dying-but-your-nursing-home-wont-let-you-183364">original article</a>. </div>

Caring

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

Caring

How much sport will you be able to watch for free under proposed new Australian broadcast rules?

<a href="https://theconversation.com/profiles/hunter-fujak-290599">Hunter Fujak</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/david-rowe-16403">David Rowe</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Watching sport on television and other screens is integral to the <a href="https://researchdirect.westernsydney.edu.au/islandora/object/uws%3A57259">cultural lives of many Australians</a>. This is why, in 1995, the anti-siphoning scheme was introduced to ensure sport “<a href="http://www.tandfebooks.com/isbn/9780203758397">events of national importance and cultural significance</a>” would not be captured exclusively by pay TV at the expense of free-to-air coverage. There have been enormous <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9780429402265-5/television-tony-bennett-modesto-gayo-david-rowe-graeme-turner">changes in television</a> since and this analogue-era legislation is increasingly out of step with the modern digital media landscape. Critically, under current definitions, streaming services such as Netflix and Amazon fall outside a scheme restricting subscription broadcasters like Foxtel. The federal government <a href="https://anthonyalbanese.com.au/media-centre/labor-will-support-local-tv-free-sport-in-the-streaming-age">promised</a> before its election in 2022 to review the anti-siphoning scheme. Its subsequent <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r7132">Communications Legislation Amendment (Prominence and Anti-siphoning) Bill 2023</a> is designed to close the “<a href="https://theconversation.com/streaming-platforms-will-soon-be-required-to-invest-more-in-australian-tv-and-films-which-could-be-good-news-for-our-screen-sector-198757">regulatory gap</a>” that has emerged within media law since Netflix’s launch in Australia in 2015. The Senate referred the bill to its Environment and Communications Legislation Committee. Its report has just been released and will help shape Australians’ access to sport media content. <h2>The importance of prominence</h2> “Prominence” refers to the discoverability of individual media applications, such as Netflix or 9Now, on the user homepage of smart televisions. The federal government is troubled by overseas services like YouTube and Amazon being immediately visible on smart televisions through commercial licensing agreements, effectively “burying” Australian free-to-air TV. Public service broadcaster SBS, for example, <a href="https://www.9news.com.au/national/anti-siphoning-prominence-laws-australia-free-to-air-tv-channels/87bc8ddd-4120-4542-864e-2c84a781411e">claimed</a> during Senate hearings that one television manufacturer demanded both a placement fee and a 15% share of revenue to feature on the television’s homepage. Prominence is crucial in sport because anti-siphoning legislation is based on the principle that, although in <a href="https://www.thenewdaily.com.au/finance/finance-news/2023/03/06/tv-habits-australia">general decline</a>, free-to-air TV is still the most effective, <a href="https://accan.org.au/files/Reports/ACCAN%20Research%20Snapshot%20How%20Australians%20Watch%20TV.pdf">low-cost, readily-accessed</a> vehicle for delivering premium sport to a majority of Australian households. <h2>Anti-siphoning</h2> While often criticised by <a href="https://www.infrastructure.gov.au/have-your-say/anti-siphoning-scheme-review">subscription media companies and many sports</a> as anti-competitive, anti-siphoning legislation is significantly responsible for the continued abundance of free major sport on our televisions. In a portent of the risks ahead, <a href="https://www.cricket.com.au/news/3807634/amazon-prime-video-secures-icc-broadcast-rights-in-australia-t20-odi-world-cup-world-test-championship-2024-27">International Cricket Council</a> World Cups will disappear from free-to-air television between 2024 and 2027, after the world governing body signed an exclusive four-year deal with streaming platform Amazon. The <a href="https://www.theage.com.au/sport/afl/afl-boss-flies-to-us-for-talks-with-media-companies-20220425-p5ag16.html">AFL</a> also reportedly met Amazon in 2022 as part of its media rights negotiations. <a href="https://theconversation.com/regardless-of-the-rules-sport-is-fleeing-free-tv-for-pay-and-it-might-be-an-avalanche-154640">Loopholes</a> in the scheme are also being increasingly exploited. This problem was exposed in 2018 when <a href="https://www.cricket.com.au/news/3296093/tvs-antisiphon-list-and-cricket-explained">Australian one-day international cricket matches</a> went behind a paywall, despite being listed as free-to-air events. As <a href="https://www.news.com.au/entertainment/tv/streaming/nrl-calls-for-technologically-neutral-overhaul-to-sport-broadcasting/news-story/31fc06ab986e12c7e6f720df33d23ad1">Foxtel</a> told the Senate hearing, both Nine (Stan) and Ten (Paramount+) are now hybrid networks, able to move acquired sports from free-to-air broadcast to behind a streaming paywall. At present, free-to-air networks cannot be compelled to acquire the rights to any sport, broadcast them if they do, or refrain from on-selling them to a pay platform. <h2>What are the implications for sport and other viewers?</h2> The majority Senate report broadly supported the federal government’s existing <a href="https://minister.infrastructure.gov.au/rowland/media-release/exposure-draft-prominence-regulations-released">exposure draft</a>. Regarding prominence, this means free-to-air channel “tiles” will be highly visible when you turn on a new smart TV. A 12-month phased implementation of a prominence framework was recommended by the committee – and would only apply to new televisions. The committee also broadly accepted the draft bill’s anti-siphoning provisions, which will affect what and where sport is viewed by fans. First, the listed events will be expanded by 30% and incorporate more women’s and parasports. They include the AFLW and NRLW finals, NRLW State of Origin, and the Summer Paralympic Games. To provide counterbalancing benefits to subscription broadcasters, sport events not acquired by a free-to-air broadcaster will become more quickly available to subscription platforms (12 months before an event starts, rather than six months before). This provides subscription platforms with greater lead-in times to plan, organise and promote their content schedules. The most controversial recommendation related to the scope of anti-siphoning laws, affecting how Australian viewers can access sport in the medium term. It supported the government’s position, on grounds of excessive competitive advantage, that anti-siphoning should only apply to terrestrial broadcasting. This excludes digital rights for live streaming through broadcast video on demand apps such as 9Now, Seven+, iView and SBS On Demand. Commercial free-to-air broadcasters called this a “<a href="https://www.mediaweek.com.au/industry-reacts-to-prominence-and-anti-siphoning-findings/">nightmare scenario</a>”, as they <a href="https://www.freetv.com.au/access-to-local-tv-services-and-free-sport-under-threat-unless-laws-are-strengthened/">estimate</a> 50% of households will be watching TV online by 2027. For viewers without televisions connected to aerials, this could make major sport events on free-to-air TV unavailable. Although terrestrial TV is still the most <a href="https://intellectdiscover.com/content/journals/10.1386/jdmp_00098_1">universally available screen sport vehicle</a>, aerials are no longer routinely installed in new housing developments. Research by the <a href="https://www.acma.gov.au/television-research">Australian Communications and Media Authority</a>, though, indicates that free-to-air network claims about disappearing TV aerials are somewhat exaggerated. Nonetheless, as modernisation was a central justification for the anti-siphoning reforms, the strategic compromise over broadcast video on demand apps will inevitably be scrutinised. Notably, in a dissenting minority report, the Greens were unhappy the bill did not go far enough in either prominence or anti-siphoning. They reserved their right to reject it unless suitably amended to guarantee global corporations could not capture Australian sports rights. <h2>What happens next?</h2> The amended bill must pass through Parliament to become law, and its final shape and the fate of any amendments are as yet unknown. While it is widely, though not universally, acknowledged action is needed to protect free screen sport viewing, intense disagreement remains among competing interest groups over what is to be done now and in the future. To safeguard their viewing interests, Australian sport fans will need to watch these formidably technical debates as closely as their favourite sport contests.<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/226499/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hunter-fujak-290599">Hunter Fujak</a>, Senior Lecturer in Sport Management, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/david-rowe-16403">David Rowe</a>, Emeritus Professor of Cultural Research, Institute for Culture and Society, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Image credits: Getty Images 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-much-sport-will-you-be-able-to-watch-for-free-under-proposed-new-australian-broadcast-rules-226499">original article</a>.

Hospice nurse explains why we shouldn't be afraid to die

A hospice nurse has shared why we shouldn't be afraid to die, explaining all the ways in which our bodies "shut off" to make for a "peaceful" death. Julie McFadden, a nurse based in Los Angeles, has long been sharing videos and explanations about end of life care in an attempt to destigmatise the conversations and fear around death and dying. In her latest YouTube video, McFadden got candid with her followers as she confessed she isn't afraid to die and why no one else should be either. She went on to explain all the ways in which our bodies are supposed to "shut off" in our final moments, making for a "peaceful" and "natural" death. " "I'm not afraid of death and here's the science behind it, our body biologically helps us die, so here is what I've seen and learned as a hospice nurse over the years - our body is literally built to die," she said. The hospice nurse revealed that bodies began to slowly shut down in the six months leading up to death, explaining that a person nearing the end of their life would start "eating less, drinking less, and sleeping more." "Why is that happening? Because calcium levels in the body are going up and because calcium levels are going up the person is getting sleepier," Julie said. "Our brains have built in mechanisms to make us hungry and thirsty. Biologically, when the body knows it's getting towards the end of life those mechanisms shut off, so the person does not usually feel hungry and does not usually feel thirsty, which is helping the body slowly shut down." <iframe title="YouTube video player" src="https://www.youtube.com/embed/CJEkzA0gt6s?si=CIzcf3xchddKtf1D" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> She put minds at ease by debunking a common concern, saying that while certain diseases could make death more uncomfortable, dying in itself wasn't painful. "There are times when the disease that the person is experiencing can cause symptoms and it's more difficult because they're dying from a certain disease, but the actual process that the body is going through to help it die is actually helping that person," Julie added. "There have been many times as a hospice nurse that I have watched someone slowly die on hospice and I have not needed to give them any medication because their disease was not causing any symptoms - no pain, no shortness of breath, they were just more tired and weren't eating or drinking." "They still did all of the things any other person on hospice would be doing, like they slowly go unconscious, they slowly stop eating and drinking. I didn't have to give them any medications. They were perfectly comfortable and died a very peaceful death." Julie explained that death was even "comforting" in a way because when you're about to take your last breath, your body released endorphins, making you feel euphoric in your final moments. "The body slowly goes into something called ketosis, which releases endorphins. In that person's body those endorphins dull pain, dull nerves, and they also give that person a euphoric sense, so they feel good," she said. "There are many reasons why I don't fear death. Yes, I have had some pretty crazy spiritual experiences as a hospice nurse that led me to not fear death, but there are also biological, metabolical, and physiological things that happen in the body that truly, truly comforted me." She concluded, "Our bodies are built to die. The less we mess with that, the more peaceful it will be." Image credits: YouTube / Instagram

Caring

From this week, you’ll be able to look up individual companies’ gender pay gaps

<a href="https://theconversation.com/profiles/natasha-bradshaw-1358801">Natasha Bradshaw</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> There will be nervous executives all over Australia this week. Come Tuesday, large private sector organisations will have their company’s gender pay gaps published for the first time for all to see, name, and shame. As they brace for the fallout, let’s look at how what we will be told is changing, and what it will mean for you. <h2>What is changing?</h2> Every year, the Workplace Gender Equality Agency (<a href="https://www.wgea.gov.au/">WGEA</a>) collects information from every employer with more than 100 employees. Until now it has published only a summary of the findings on its website, including Australia’s overall gender pay gap, and the gap by industry and employment arrangement. But for the first time legislation enacted last year also allows WGEA to publish the gender pay gaps of individual employers. <figure class="align-right zoomable"><figcaption></figcaption></figure> Tuesday’s release will include each large company’s median gender pay gap, and the share of women it employs in lower- and higher-paid jobs. Employers will have the chance to publish a <a href="https://www.wgea.gov.au/data-statistics/data-explorer">statement</a> alongside their results to provide context. That means from Tuesday you will be able to look on the <a href="https://www.wgea.gov.au/">WGEA website</a> and find the median gender pay gap of your large private sector organisation, or of an organisation you are thinking of joining, and how it stacks up against its competitors. <h2>Why the change?</h2> Australian women, like women elsewhere, have made astounding progress in the workforce in recent decades. Women are both working and earning more than ever before. But progress has stalled, and the gender pay gap remains stubbornly persistent. The Albanese government has shown its commitment to gender equity by increasing the <a href="https://www.servicesaustralia.gov.au/child-care-subsidy">childcare subsidy</a> and extending <a href="https://www.servicesaustralia.gov.au/parental-leave-pay">paid parental leave</a>. But beyond this, the options for governments are limited. Most of the barriers to women getting better-paid jobs can only be broken by employers. The public naming and shaming that will begin on Tuesday will push accountability onto employers, holding them responsible for the conditions in their workplaces. Workers and bosses are going to take notice: when employer gender pay gaps were released in the UK in 2018 it was the <a href="https://www.genderpay.co.uk/wp-downloads/moving-forward-may-2018/presentations/Gender_Pay_Gap_Moving_Forward_May_2018_Studio_2_5_Nick_Bishop.pdf">biggest business news story of the year</a>, with coverage rivalling the wedding of Prince Harry and Meghan Markle. At a time when companies are fighting for top talent, it is going to make it more difficult for employers with large pay gaps to hire talented women. Research shows that on average women are willing to accept a <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3584259">5% lower salary</a> in order to avoid working for the employers with the biggest gender pay gaps. <figure><iframe src="https://www.youtube.com/embed/vAr1Lhaw0Ao?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Workplace Gender Equality Agency.</figcaption></figure> <h2>Let’s not rush to judge</h2> While <a href="https://www.wgea.gov.au/about/our-legislation/publishing-employer-gender-pay-gaps">naming and shaming</a> will help make this policy effective, we should be careful about rushing to judgement. It is possible for an employer to be making serious efforts to improve while its gap remains large. And some actions aimed at improving things, such as implementing a gender quota on entry-level positions, can worsen a company’s apparent gender pay gap in the short term by temporarily increasing the number of lowly-paid women. Also, there will be firms that have a low gender pay gap because they pay both men and women poorly. On Tuesday, we should instead look closely at whether the organisation has outlined clear steps it will take to improve, and how it compares to its competitors. In future years, we will be able to see how things have changed. <h2>What will matter is what employers do next</h2> Since the UK reforms were introduced in 2018, the gender pay gap has narrowed by <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3584259">one-fifth</a>, with the biggest improvements coming from the worst offenders. UK companies have also become more likely to include wage information in their job ads, equalising the starting point of wage negotiations for all applicants. But for existing employees, the narrowing of the gap has been caused more by slower growth in men’s wages than faster growth in women’s wages, which isn’t good news for anyone looking for a pay rise. The full effects of the Australian reforms won’t be seen for some time. It is likely that making high-paid jobs more accessible to women will allow employers to tap into a new talent pool and encourage more highly credentialed women into the workforce, adding to productivity growth. What is clear now is that if we want to narrow the gender pay gap, we need to know what’s happening. The avalanche of data due on Tuesday will be a start.<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/224167/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-bradshaw-1358801">Natasha Bradshaw</a>, Senior Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Getty Images 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/from-this-week-youll-be-able-to-look-up-individual-companies-gender-pay-gaps-224167">original article</a>.

Money & Banking

Life behind bars for serial killer nurse

British nurse Lucy Letby has been handed a life sentence for the murder of seven infants and the attempted murder of six others in a neonatal ward located in Chester, England. Justice James Goss, adhering to the strictest punishment allowed by British law, issued a whole-life order, ensuring that 33-year-old Letby would spend the remainder of her life incarcerated, as capital punishment is not applicable in the UK. In a trial that spanned ten months, Letby was found guilty of killing five male and two female infants and causing harm to other newborns within the neonatal unit of the Countess of Chester Hospital between June 2015 and June 2016. This conviction ranks her among the most prolific child serial killers in the UK's history. Despite her absence from the sentencing proceedings, Justice Goss emphasised the calculated nature of Letby's actions, stating, "There was premeditation, calculation and cunning." He further highlighted the malevolence and absence of remorse in her demeanour, emphasising that no mitigating factors were present. Prosecutors detailed Letby's disturbing actions during her tenure in the neonatal unit. As the hospital witnessed an alarming increase in unexplained infant deaths and health deteriorations, Letby was consistently on duty during these incidents. Prosecutors painted her as a constant, ominous presence when these infants experienced collapses or fatalities, using tactics that were difficult to detect. She even deceived colleagues into believing these incidents were normal. The anguish and outrage from the victims' families were palpable during the sentencing, compounded by Letby's absence from the proceedings, which is permitted under British legal protocol. The mother of a girl identified as Child I said in a statement read in court: "I don’t think we will ever get over the fact that our daughter was tortured till she had no fight left in her and everything she went through over her short life was deliberately done by someone who was supposed to protect her and help her come home where she belonged." Because of Letby's absence at the sentencing, calls for legal reform quickly emerged, urging that prisoners should be compelled to attend their sentencings. UK Prime Minister Rishi Sunak expressed his government's intention to address this matter. Medical professionals raised concerns about Letby's behaviour as early as 2015, but their apprehensions were not heeded by management. Some argue that had these concerns been acted upon promptly, lives could have been saved. An independent inquiry will delve into the hospital's response to the alarming rise in deaths and the actions of the staff and management. In conclusion, British nurse Lucy Letby's life sentence for the murder of seven babies and the attempted murder of six others has sent shockwaves through the nation. Her calculated actions, lack of remorse, and absence from the sentencing have ignited discussions about legal reforms and the responsibility of institutions to heed early warning signs. Images: Cheshire Constabulary

Legal

Lump sum, daily payments or a combination? What to consider when paying for nursing home accommodation

<a href="https://theconversation.com/profiles/anam-bilgrami-1179543">Anam Bilgrami</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Moving yourself or a loved one to a nursing home can be <a href="https://theconversation.com/should-we-move-our-loved-one-with-dementia-into-a-nursing-home-6-things-to-consider-when-making-this-tough-decision-189770">emotional and difficult</a>. While some have their nursing home accommodation costs fully covered by the government (based on a <a href="https://www.myagedcare.gov.au/how-much-will-i-pay">means test</a>), most will have to pay their own way. The average lump sum room value is <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">A$334,000</a>. Choosing how to pay can make this time even more challenging, particularly for those with <a href="https://theconversation.com/would-you-pass-this-financial-literacy-quiz-many-wont-and-its-affecting-expensive-aged-care-decisions-175063">low financial literacy</a>. This is an important and complex decision. It can affect your income, wealth, means-tested aged care fee, and bequests. Here are some things to consider before you decide. <h2>3 ways to pay</h2> You can <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs">pay</a> for a nursing home room in three ways. You can pay the entire room price as a one-off, refundable lump sum (a “refundable accommodation deposit”, sometimes shortened to RAD). This lump sum is refunded to the resident or their estate when the person leaves the nursing home (if they move or pass away). The refund is <a href="https://www.myagedcare.gov.au/aged-care-home-accommodation-refunds">guaranteed by the government</a>, even if a provider goes bankrupt. People who don’t want to pay a lump sum can instead choose rent-style, “daily accommodation payments” (sometimes shortened to DAP). These are fixed, daily interest-only payments calculated on the total room price. The rate at which they are calculated is known as the “maximum permissible interest rate” or MPIR. The maximum permissible interest rate is set by the government and is currently <a href="https://www.health.gov.au/sites/default/files/2023-06/base-interest-rate-bir-and-maximum-permissible-interest-rate-mpir-for-residential-aged-care_0.pdf">7.9%</a> per annum. The <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">formula</a> for a daily accommodation payment is (RAD × MPIR) ÷ 365. Unlike lump sums, daily accommodation payments are not refunded. The third option is a <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">combination payment</a>. This means paying part of the room price as a lump sum, with daily payments calculated on the remaining room amount. On leaving the home, the part lump sum is refunded to the resident or their estate. With a combination payment, the consumer can choose to pay whatever amount they like for the lump sum. The table below shows three different ways someone could pay for a room priced at $400,000. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&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/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" alt="" /></a><figcaption><a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></figcaption></figure> So which is best? It’s impossible to say. It depends on a person’s circumstances, family situation, finances, preferences and expected length of stay. <h2>Why do some people choose a lump sum?</h2> One downside of a lump sum (or part lump sum) is that choosing this option means this money is not invested elsewhere. By handing over the lump sum, for example, you forgo returns you could have made by investing this same money into property or stocks over the period of your nursing home stay. On the other hand, paying lump sum means you get to avoid the daily interest payments (the 7.9% in the table above). So you could potentially be better off paying a lump sum if you think there’s no way you could make investment returns on that money that are substantially higher than the interest you’d be charged through daily payments. One advantage of choosing a lump sum is it’s considered an <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">exempt asset</a> for pension purposes; some people may get more <a href="https://www.afr.com/wealth/personal-finance/five-things-you-need-to-know-about-aged-care-deposits-20200302-p54606">pension</a> if they pay the lump sum. The lump sum, however, does count as an asset in determining the <a href="https://www.health.gov.au/our-work/residential-aged-care/charging-for-residential-aged-care-services/residential-aged-care-fee-scenarios-for-people-entering-care-from-1-july-2014">means-tested care fee</a>. And if you sell your house, remember any money leftover after you pay the lump sum will be counted as assets when you’re means-tested for the pension and means-tested care fee. <h2>Why might some people prefer daily payments?</h2> Not everyone can can afford a lump sum. Some may not want to <a href="https://theconversation.com/is-it-worth-selling-my-house-if-im-going-into-aged-care-161674">sell their home</a> to pay one. Some may want to hold onto their house if they think property prices may increase in the future. Daily payments have recently overtaken lump sums as the most <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">popular payment option</a>, with 43% of people paying this way. However, recent <a href="https://amp-smh-com-au.cdn.ampproject.org/c/s/amp.smh.com.au/money/super-and-retirement/aged-care-interest-rate-increase-sees-daily-payments-almost-double-20230324-p5cuz2.html">interest rate rises</a> may slow or reverse this trend. And if a spouse or “<a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/residential-aged-care/aged-care-costs">protected person</a>” – such as a dependant or relative that meets certain criteria – is still living in the house, it’s also exempt from assets tests for the pension and other aged care fees. If the home is vacated by a protected person, its value is still excluded from the pension means test for <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">two years</a> (although rental income is still assessed). If you do not anticipate a lengthy nursing home stay, daily payments may potentially be the easiest option. But it’s best to consult a financial adviser. <h2>What does the research say?</h2> My <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">research</a> with colleagues found many people choose the lump sum option simply because they can afford to. Those <a href="https://ahes.org.au/portfolio-items/entering-aged-care/">owning residential property</a> are more likely to pay a lump sum, mostly because they can sell a house to get the money. People who consult financial advisers are also more likely to choose lump sums. This may be due to <a href="https://www.afr.com/wealth/aged-care-costs-most-opt-for-pay-as-you-go-20181023-h170g4">financial advice</a> suggesting it’s tough to earn investment returns higher than what you’d save by avoiding the interest charged in the daily payment option. Some aged care providers <a href="https://www.mq.edu.au/__data/assets/pdf_file/0003/1164243/the-role-of-refundable-accommodation-deposits-FINAL.pdf">prefer</a> lump sum payment since they <a href="https://www.agedcarequality.gov.au/providers/prudential-standards/permitted-use-refundable-deposits">use</a> these to renovate or refurbish their facilities. But providers are not allowed to influence or control your decision on how to pay. The recent Royal Commission into Aged Care recommended <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf">phasing out</a> lump sums as a payment option, leaving only daily payments. While that would reduce the complexity of the payment decision and remove the incentive for providers to sway decisions, it would also reduce consumer choice. <h2>Is there anything else I should know?</h2> Some 60% of people we <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">surveyed</a> found the decision complex, while 54% said it was stressful. It is best to seek professional <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs#financial-advice">financial advice</a> before you decide. Services Australia also runs a free <a href="https://www.servicesaustralia.gov.au/what-financial-information-service?context=21836">Financial Information Service</a> that can help you better understand your finances and the payment decision. But it does not give <a href="https://www.servicesaustralia.gov.au/financial-information-service-officers?context=21836#a2">financial advice or prepare plans</a>. You have <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">28 days to choose a payment method</a> after admission, and six months to pay if you <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">choose a lump-sum payment</a>. In the interim, you will be charged daily interest payments on the room price.<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/207405/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/anam-bilgrami-1179543">Anam Bilgrami</a>, Research Fellow, Macquarie University Centre for the Health Economy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images 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/lump-sum-daily-payments-or-a-combination-what-to-consider-when-paying-for-nursing-home-accommodation-207405">original article</a>.

Retirement Life

People thinking of voluntary assisted dying may be able to donate their organs. We need to start talking about this

<a href="https://theconversation.com/profiles/robert-ray-1441988">Robert Ray</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> The number of people needing an organ transplant vastly outweighs the number of organs available. <a href="https://www.donatelife.gov.au/sites/default/files/2023-02/OTA%202022%20Donation%20and%20Transplantation%20Activity%20Report.pdf">In 2022</a> there were about 1,800 Australians waiting for an organ but only about 1,200 people received an organ transplant. But in <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.16085">a recent paper</a>, I outline one unexplored option for increasing the number of potential organ donors in Australia – transplanting organs from people undergoing voluntary assisted dying. This would involve transplanting organs only after someone had died. It’s estimated <a href="https://jamanetwork.com/journals/jama/article-abstract/2616383">about 10%</a> of people eligible for voluntary assisted dying are likely to be medically suitable to donate their organs. Based on <a href="https://www.safercare.vic.gov.au/sites/default/files/2022-09/Voluntary%20Assisted%20Dying%20Review%20Board%20Report%20of%20Operations%20July%202021-June%2022_FINAL.pdf">Victorian figures</a> alone, this could lead to about an extra 40 potential organ donors each year. This type of organ donation has taken place <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297969/">for more than 20 years</a> in Europe, and more recently in Canada. Organs transplanted from donors undergoing voluntary assisted dying <a href="https://jamanetwork.com/journals/jamasurgery/article-abstract/2769118">have</a> <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.16267">similar</a> <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.16971">success rates</a> to more traditional donations. Yet, this is a discussion we’ve yet to have in Australia. Here are some of the ethical and practical issues we need to start talking about. <h2>Is this ethical? It’s tricky</h2> The main ethical challenge is ensuring a person isn’t motivated to end their life prematurely so they can donate their organs. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.13746">Internationally</a>, <a href="https://jme.bmj.com/content/42/8/486.short">this challenge</a> is mainly addressed by having <a href="https://www.sciencedirect.com/science/article/pii/S1600613523000291">independent assessments</a> by multiple doctors. This is to ensure the motivation is genuine and honest, much like assessing someone before voluntary assisted dying. Similarly, it is important the doctor of someone undergoing voluntary assisted dying isn’t persuading them to donate an organ. This means any doctor overseeing voluntary assisted dying may be limited in how much they can discuss organ donation with their patient. Again, this <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.13746">has been managed internationally</a> by having separate, independent doctors overseeing organ donation and voluntary assisted dying, <a href="https://www.cmaj.ca/content/190/44/E1305.short">without one influencing</a> the other. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&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/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=437&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=437&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=437&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=549&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=549&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528192/original/file-20230525-27-sjwdaa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=549&fit=crop&dpr=3 2262w" alt="Elderly woman in bed hand on covers" /></a><figcaption>Is this what people really want, with so little time left? <a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-laying-on-bed-hospital-1054837748">Shutterstock</a></figcaption></figure> Organ donation may also affect the way voluntary assisted dying is conducted, which <a href="https://www.sciencedirect.com/science/article/pii/S1600613523000291">may impact</a> participants’ very limited quality of life. That’s because determining if someone is eligible to donate an organ involves a number of <a href="https://jme.bmj.com/content/43/9/601.short">investigations</a>. These may include blood tests, radiology (imaging) and numerous clinical encounters to exclude diseases such as cancer, which would prevent someone donating their organs. These investigations may be exhausting but necessary. This burden must be weighed against the participant’s wishes and motivation to donate their organs. So people must also be informed of the impact organ donation will have on their limited life left. The choices of people considering this option must be respected and they must be given multiple opportunities to review their decision, without undue influence or bias. <h2>Practical issues: coordination, location, regulation</h2> Practically, combining organ donation and voluntary assisted dying is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.13746">challenging</a>. This includes the difficulty organising and coordinating specialists in organ donation, voluntary assisted dying and transplantation. This is why, internationally, organ donation of this nature mostly occurs in large hospitals, where it’s easier to coordinate. So if people want to donate an organ this way, they may spend their last moments in an unfamiliar environment. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&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/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528195/original/file-20230525-15-irsqg9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Patient being wheeled on stretcher through hospital corridors" /></a><figcaption>People may have to be moved to a large hospital with the facilities and staff on hand. <a class="source" href="https://www.shutterstock.com/image-photo/surgeon-assistant-team-transport-move-stretcher-2062330820">Shutterstock</a></figcaption></figure> Efforts have been made <a href="https://jamanetwork.com/journals/jamasurgery/article-abstract/2776765">internationally</a> to prioritise these valuable last moments by giving people the choice of where voluntary assisted dying occurs (<a href="https://www.cmaj.ca/content/190/44/E1305.short">such as their home</a>). But this currently only occurs in a minority of cases and increases the complexity of organ donation. Regulating the process is also essential to developing a safe, trustworthy and effective program. Ideally a centralised organisation such as Australia’s national <a href="https://www.donatelife.gov.au">Organ and Tissue Authority</a> would organise, undertake and regulate this. However, this may be challenging given voluntary assisted dying practices are specific to each state. <h2>The challenges ahead</h2> If someone considering voluntary assisted dying wants to donate their organs and is deemed eligible, there is currently <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.16085">no legal barrier in Australia</a> to stop them. What might prevent them is how their doctor responds, and whether there are the services and organisations willing to fulfil this request ethically and practically. The next step in considering this form of organ donation is to discuss the prospect publicly. Every extra donated organ is potentially lifesaving. So we should make every effort to consider potential safe and ethical ways to increase donation and transplantation rates.<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/206298/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/robert-ray-1441988">Robert Ray</a>, Affiliate Associate Lecturer, School of Medicine, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credit: 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/people-thinking-of-voluntary-assisted-dying-may-be-able-to-donate-their-organs-we-need-to-start-talking-about-this-206298">original article</a>.

Body

Hospice nurse shares the specific things people see before they die

A hospice nurse has revealed the very specific things people often see before they die. Julie McFadden, a 39-year-old end of care nurse from Los Angeles, shared a now-viral TikTok about what people see in the moments before they pass away. Julie cares for terminally-ill patients near their end-of-life, keeping them comfortable in the months leading up to their death. In the final weeks of someone's life, people are often visited by lost loved ones and pets that give them the encouragement to cross over. The 39-year-old said most of her patients report apparitions of relatives who offer them comforting words such as, "We're coming to get you soon," or, "Don't worry, we'll help you". After working in hospice care for over five years, McFadden has learnt a lot about death and dying, and how people handle the last days of their life. She revealed that dying patients see family, friends and pets who have passed away so often it is noted in educational packets given to the patient and their relatives, "so they understand what's going on". McFadden also added that medical professionals don't know why these apparitions happen, and don't know how to explain it in a logical sense. These apparitions usually appear a month before the patient dies, she claims, and can either present in dreams or the person being able to physically see them. The nurse said patients will often ask, "Do you see what I'm seeing?" Rather than being scared of what they're seeing, Ms McFadden claims patients often find the visits "comforting". Julie went on to say that she doesn't believe these "visits" are hallucinations, as she says the patients are normally "pretty alert and oriented, they're usually lucid". "It's not like they're saying a bunch of crazy things that don't make any sense," Ms McFadden added. "They're usually functional and logical and questioning me, 'Why am I seeing my dead mom, do you see her?'" Ms McFadden ended her video by saying that for many people in their final days, these visits from loved ones can help a person feel a sense of calm and contentment around dying, rather than a sense of fear of the unknown. Image credits: Shutterstock / Instagram

Caring

MAS*H star passes away

M*A*S*H star Judy Farrell has passed away at the age of 84, her son has confirmed to TNZ. The actress, who is best known around the world for her portrayal of Nurse Able, died in hospital nine days after suffering a stroke which left her unable to communicate. However, TNZ have reported that Judy was conscious still and able to squeeze the hands of her loved ones. While Judy’s son Michael - whom she shared with fellow M*A*S*H actor Mike Farrell - has not yet spoken publicly about her mother’s passing, her former co-star Loretta Swift spoke to Fox News Digital about losing “family”. “Judy was a most beautiful woman - inside and out. We grew up together," the actress behind Major Margaret ‘Hot Lips’ Houlihan said. "She was family. This has been a painful loss, but we will always have the beauty of her memory. “Rest in peace, Nurse Able." Farrell starred as Nurse Able in eight episodes of the hit series, and was the only actress to ever be credited as the character. Initially, Nurse Able was a minor role - often just a placeholder for the instances where a background nurse had a line - and from Seasons 2-11 she was played by no fewer than 11 different people. By the fourth season, the role progressed so that she became involved in the show’s plot. It was in the sixth season that Judy Farrell secured her place in television history as Nurse Able, taking over for the character’s final appearances on screen in Seasons 6-11 for eight episodes. During her time on the show, Farrell starred alongside the likes of Loretta Swift, Alan Alda, and ex-husband Mike Farrell. The latter joined M*A*S*H’s cast in 1975, replacing Wayne Rogers, and remained until the 1983 finale. The couple had married in 1963, but went on to divorce 20 years later, in the same year that M*A*S*H bid farewell to its audience. Their split was reportedly amicable, with the two going on to remarry and co-parent their children, son Michael and daughter Erin. And as Farrell’s loved ones mourn her loss, fans and followers of the actress have taken to social media to share their grief, and to honour her work, sharing some of their fondest memories of her time bringing their beloved Nurse Able to life. “RIP Nurse Able. I was so thrilled to have known you, Judy Farrell,” wrote comedian Murray Valeriano. “Condolences to the Farrell and MASH families,” one fan said. And for another, it came as a tragic opportunity to share a clip of Farrell’s work, showcasing the actress alongside some of her former co-stars, with Classic MASH writing “Sad news today.” <blockquote class="twitter-tweet"> Sad news today. Judy Farrell has passed away. <a href="https://twitter.com/hashtag/ClassicMASH?src=hash&ref_src=twsrc%5Etfw">#ClassicMASH</a> <a href="https://t.co/hCfSpL7c0W">pic.twitter.com/hCfSpL7c0W</a> — Classic MASH 🍸 (@ClassicMASH) <a href="https://twitter.com/ClassicMASH/status/1643275688017903616?ref_src=twsrc%5Etfw">April 4, 2023</a></blockquote> Images: Getty, Twitter, MASHFandom.com

“I haven’t been able to move": Home and Away star's debilitating condition

Former Home and Away actress Sophie Dillman has opened up about the debilitating pain she suffers as she battles with endometriosis. The star took to Instagram to share the realities of her condition with two drastically different photos. “Endometriosis can look like this or this depending on the day,” her caption began. In one photo, the actress can be seen smiling and posing for photos at an event. In the second photo, Dillman is pictured lying on the floor with a hot water bottle on her stomach. “I haven’t been able to move from the floor this morning because it’s too painful to even walk around the house,” she said. “But then some days it doesn’t affect me at all. I don’t know when the pain or swelling or nausea will start or end,” she wrote. She then goes on to share that “the unknown is heartbreaking,” and gives a shout out to those who support their loved ones on the days they can’t get up. “We need more research, funding and answers. F***. Endo,” she ended her caption tagging <a href="https://www.endometriosisaustralia.org/" target="_blank" rel="noopener">Endometriosis Australia</a>. <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-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CqP_7wyIqYn/?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/p/CqP_7wyIqYn/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Sophie Dillman (@sophiedillman)</a> </div> </blockquote> Dillman is one of nine women who suffer from endometriosis, which is when tissue similar to the lining of the uterus grows outside the womb, and it’s a chronic disease without a known cure. One option to reduce the pain is a laparoscopy- where a tiny camera is sent into the pelvic region to investigate and “remove any of the tissue that’s causing pain”. Dillman has said that she’s undergone three of these surgeries and said that she has “a lot of tissue that they can’t remove because it’s in the lining of my various organs”. “It’s exhausting and painful and ... sometimes awkward and it sucks,” she said, adding that the surgery does not address her situation. “So it seems that it will be something I will have to continuously do throughout my life,” she added. Bindi Irwin is another woman who suffered from endometriosis, and just this month she opened up about <a href="https://www.oversixty.com.au/health/caring/how-did-you-live-with-this-much-pain-bindi-irwin-hospitalised" target="_blank" rel="noopener">her experience and the surgery</a> she undertook. Dillman hopes to raise awareness around the stigmas surrounding the condition that stops women talking about it or seeking help. The actress hopes that she can use her platform with almost 300,000 followers, and her role as an ambassador for Endometriosis Australia to continue educating others. Image: Getty

Body

Should we move our loved one with dementia into a nursing home? 6 things to consider when making this tough decision

Almost <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/summary">400,000</a> Australians are living with dementia. A million or more family members and friends care for and support them. About two-thirds of people with dementia live in the community. Deciding to move a loved one into a nursing home is an incredibly difficult one. I found it difficult and stressful considering this move for my own loved one, even with 20 years of experience in dementia and aged care. Sometimes the decision has to be made quickly, such as when the person is in hospital. Sometimes the decision takes much longer and is made over months, or even years. There are some important things you should consider when trying to decide the best option for you and your loved one. I’ve outlined six here. <h2>1. Your loved ones’ views around going into care</h2> We don’t want to force our loved one to do something against their wishes. It’s unusual for someone to want to go into a nursing home. It may take many conversations and a decent amount of time before your loved one accepts they might need more care and that a nursing home is the right place to get that care. <h2>2. Your loved one’s current quality of life</h2> If you think your loved one has an overall good quality of life, and that their quality of life may decrease when they go into a nursing home, this could be a sign you should keep trying to support the person to live at home. However, if their quality of life is currently poor, particularly if this is due to not having enough day-to-day physical care, health care or emotional support, then moving into a nursing home might help meet their daily needs. Spend some time observing to figure out <a href="https://theconversation.com/home-for-the-holidays-and-worried-about-an-older-relative-make-observations-not-assumptions-173782">how your loved one is doing at home</a>. You could perhaps make a list of the things they need to lead a good life (company, three square meals, help taking medicines, going out into the community) and see if these are currently being met. <h2>3. Risks if your loved one stays at home</h2> People often <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-7-13">go into a nursing home</a> because we think they are no longer safe living at home. It might be possible to reduce some of the risks of them being at home through <a href="https://www.enablingenvironments.com.au/home.html">modifying the home</a> and <a href="https://www.alzheimerswa.org.au/about-dementia/living-well-dementia/assistive-technology-help-sheets/">using technology</a>(personal emergency alarms, GPS trackers, stove timers) or services (meals on wheels, community care, physiotherapy for mobility). <h2>4. Capacity of your loved one’s family and friends to keep supporting them</h2> The availability and capacity of family carers is probably the most crucial part in supporting someone with dementia to keep living well at home. Carers often have other responsibilities such as work and children, which means they can’t support their loved one as much as they would like. Being a carer is physically and emotionally demanding, and over time caring can take its toll. Carers should seek help and support from other family and friends, learn more about <a href="https://forwardwithdementia.au/">dementia</a>, use services including <a href="https://theconversation.com/respite-care-can-give-carers-a-much-needed-break-but-many-find-accessing-it-difficult-183976">respite care</a> and <a href="https://www.dementia.org.au/support">Dementia Australia</a>. Carers often face a difficult choice between their own health and wellbeing, and supporting their loved one to remain at home. If carers are caring as much as their time, energy and physical and mental wellbeing will allow, and that care is not enough for their loved one’s needs, then more help is needed – and residential care is one way of getting that help. <h2>5. Alternatives to nursing home care</h2> Community care services are government-subsidised services to support older people to keep living at home. You can get up to 14 hours of care a week depending on need, though there is an assessment process and often a waiting time for services. You can pay for community care privately as well, although this can be very expensive. An <a href="https://www.cota.org.au/information/aged-care-navigators/who-can-use-aged-care-navigator-services/">Aged Care Navigator</a> (or from 2023 an “aged care finder”) can help you search for suitable available home care services. Some families choose to move in with the person with dementia, or have them move in with family. This may be an option if there is suitable accommodation, and they are able to live together comfortably. <h2>6. Availability of quality nursing home care</h2> It’s emotionally easier to place a loved one in a nursing home if carers are confident the home will provide suitable care. Often, family want a nursing home that is geographically close so they can visit, has a suitable room (such as a single room with an ensuite), sufficient and kind staff with training in supporting people with dementia, a pleasant environment, nutritious appealing food, and quality clinical care. It takes time to visit and pick a <a href="https://theconversation.com/when-choosing-a-nursing-home-check-the-clothing-and-laundry-100727">suitable nursing home</a>, check it’s appropriately <a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">accredited</a>, and understand how much it will <a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">cost</a>. You might have to wait for a bed in a quality home. You can often trial the nursing home by having your loved one stay for two weeks of respite care. When your loved one enters nursing home care, you’ll still be caring for them. You want to ensure you can continue to support your loved one emotionally and practically in partnership with the nursing home. <h2>Getting help</h2> Usually there is no “right” or “wrong” decision. You might struggle and there might be family conflict around what the “right” decision is. Speaking to a counsellor at <a href="https://www.dementia.org.au/support/counselling">Dementia Australia</a> might help work through the options and your feelings, you can talk to them as an individual or attend as a family. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/should-we-move-our-loved-one-with-dementia-into-a-nursing-home-6-things-to-consider-when-making-this-tough-decision-189770" target="_blank" rel="noopener">The Conversation</a>.

Caring

Will you be able to afford to retire?

It was once likely that you’d die before retiring; it’s now highly probable that there will be a gap of several (or even many) years between when you permanently leave the workforce and when you die. How are you going to survive when you’re no longer willing or able to swap your time for money? A friend recently remarked to me that his work made him feel like a consumable part in a big machine. That sounds brutal, but there is a truth in it, and a revelation that we have to use our productive time to set ourselves up for life after we’ve ‘worn out’. So how do you plan to survive once you’ve retired? Here are four possible sources of income to pay your lifestyle expenses: Welfare The age pension is a subsistence payment that’s barely enough to survive on. It isn’t an option you’ll want to rely upon solely in your retirement years. Even when used as a supplement to other income, the age pension is still welfare—it’s not an entitlement nor a return of taxes paid. And don’t forget, the age pension is only available to those with insufficient income or assets to look after themselves. Any financial plan that causes you to rely on a subsistence payment in retirement is surely a poor one, leading to a poor outcome. Compulsory super Do you know that superannuation has a two-fold meaning? The more well-known one is your retirement savings available for survival once you retire. However less well-known is this: a stage in life when you become obsolete for full-time work. The superannuation (aka super) that employers deduct from your pay is sent directly to your nominated superannuation fund. The money invested in superannuation is usually locked away until after retirement and can’t be easily accessed. The profits made are concessionally taxed and reinvested to boost your super balance. A burning question many people wonder is ‘will I have enough super to survive in retirement?’ Sadly, the answer for many is no. The gap might be able to be closed if you qualify for the age pension or draw down on your superannuation balance or other assets, but the reality is more likely that you will have to downsize your living standards to lower your living expenses. Voluntary super What about occasionally topping up your superannuation account voluntarily by making some extra contributions? Well, that may be a good idea if you’re not too far off retirement (10 years or less). However, for others, locking away inaccessible money for decades may result in a severe loss of flexibility, which makes this option quite unattractive. There are also limits on how much can be voluntarily contributed on tax-effective terms. Super sufficient You can, of course, save and invest outside the superannuation regime, in your own name or using an entity such as a company or a trust (e.g. family trust, unit trust). These are non-superannuation assets, and they generate non-superannuation investment income. Such income can be used to pay for your lifestyle expenses at any time, not just after you’ve retired, or better yet, used to purchase other non-superannuation assets or to make voluntary contributions into your superannuation fund. While investing profits outside superannuation may be taxed at higher rates, the money is not locked away until retirement, and so you can use it to fund your financial freedom and avoid having to work until you are at least 60 years old. The ideal goal to aim for is to be what I call ‘super sufficient’ - an outcome where your investment income exceeds your tax and living expenses, so you can live independently without the fear of running out of money because you’ll never have to eat into your capital. So, which option is best? Well, the answer depends on your circumstances, choices and chances. Time is the biggest consideration. The less of it you have, the fewer options are available. If you’re in your 60s or older and don’t have much investment income or capital, then your choices are limited, and you’ll likely have to reign in your living expenses and perhaps rely on the age pension. Younger people need to make the most of the time they have left until retirement, because the longer your investing horizon, the greater your ability to benefit from compounding. Don’t limit yourself to one option; be smart and keep your options open. Consider all the options in some sort of combination: the age pension (to the extent you qualify for it), money inside superannuation (topped up when your circumstances say it is sensible to do so) and wealth outside of superannuation that you can access as needed before you retire. You might be lucky some of the time, but you can’t be lucky all of the time. I’ve found that while luck does have a role to play, investing skill is a far bigger determinant of an investor’s long-term success. If you want to improve your chances, your choices, or your circumstances, then invest inwards by improving your financial knowledge and ability before investing outwards and acquiring investments. Edited extract from Steve McKnight’s Money Magnet: How to Attract and Keep a Fortune that Counts (Wiley $32.95), now available at all leading retailers. Visit www.moneymagnet.au Image: Getty Images

Money & Banking

Hospice nurse explains the “very comforting” thing that happens just before death

A hospice nurse has shared the “very comforting” thing that happens to a lot of people in the last moments of their life. Julie McFadden, a 39-year-old healthcare professional from the US, supports people who are coming to the end of their lives, going into specialised homes to make sure they remain as comfortable as possible in their final days. Throughout her career, she said more than half of those she has looked after experienced “visioning”, which is when people who are often fully lucid see deceased friends, family and pets in the moments leading up to death. “It happens most of the time at the end of their life, but they aren’t delusional,” the former intensive care nurse said on TikTok. “It’s often very comforting for the person. It’s never scary - if they’re scared, it’s likely they’re experiencing delirium or paranoia, not visioning.” “People don’t talk about it much but it’s really common and more than half of people I have looked after have experienced it.” “It’s so normal to fear death and I’ve had several patients who have expressed their fear - but then a family member came to them and they were no longer scared.” Julie went on to share a further explanation as to why people experience “visioning”, and the other-worldly power behind it. “We have no idea why this (visioning) happens and we are not claiming that they really are seeing these people,” she explained in one video. “We have no idea. But all I can tell you, as a healthcare professional who’s worked in this line of work for a very long time, (is that) it happens all the time.” “It happens so much that we actually have to educate the family and the patient about this topic before it happens so they’re not incredibly alarmed,” she added. “Usually it’s a good indicator that the person’s getting close to death - usually about a month or a few weeks before they die.” “It brings me comfort. I hope it brings you some comfort,” she concluded in her video, which quickly amassed more than 400,000 views. Image credits: TikTok

Caring

Oscar-winning actress dead at 88

Oscar-winning actress Louise Fletcher has died from natural causes at the age of 88. The star’s representative confirmed that she died at her home in France, after surviving two bouts of breast cancer. Best known for her role as Nurse Ratched in the film One Flew Over the Cuckoo’s Nest, Louise rose to fame thanks to her incredible performance. The film was the second in Oscar award winning history to have won all five major academy awards. “Well, it looks like you all hated me so much that you’ve given me this award for it, and I’m loving every minute of it,” Louise said when she accepted the Oscar awards. “And all I can say is, I’ve loved being hated by you.” Louise also appeared in Exorcist II: The Heretic and The Cheap Detective. She was encouraged to act by her Aunty and undertook acting classes at night. However, Louise was deemed too tall to act across from Hollywood’s leading men actors. This however did not stop her from landing TV roles before she eventually met her husband and started a family in 1961. From 1973, she returned to the industry before accepting the role as Nurse Ratchet. Image: Getty

Caring

Could ‘virtual nurses’ be the answer to aged care staffing woes?

Former Health Department Chief Martin Bowles has <a href="https://www.theguardian.com/australia-news/2022/aug/03/virtual-nurses-may-be-needed-to-meet-247-aged-care-staff-mandate-top-health-executive-says" target="_blank" rel="noopener">reportedly proposed</a> “virtual nurses” could help address the shortage of nurses in aged care. This might involve remote, possibly artificial intelligence-assisted, virtual care, rather than physical nurse presence, to assist nursing homes to meet new legislative requirements to have a registered nurse present 24/7. There are clear opportunities for technological innovations to improve the care, health, and wellbeing of older people. However, substitution of face-to-face nursing and human interaction with remote care is not the answer. This seriously risks perpetuating the status quo where <a href="https://www.hrw.org/news/2021/03/03/australia-urgently-address-aged-care-abuse#:%7E:text=%E2%80%9CMultiple%20investigations%20and%20reports%20have,human%20rights%20of%20older%20people.%E2%80%9D" target="_blank" rel="noopener">many older people suffer</a> from isolation, neglect and lack of human engagement. Eroding requirements to properly staff nursing homes with registered nurses could make it even harder to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685779/" target="_blank" rel="noopener">attract and keep</a> staff. <h2>What are ‘virtual nurses’?</h2> “<a href="https://www.nature.com/articles/d41586-022-00072-z" target="_blank" rel="noopener">Robot nurses</a>” already exist in some contexts, helping to move patients, take vital signs (such as blood pressure), carry medicines and laundry, and even engage with patients. <blockquote class="twitter-tweet"> How Paro the robot seal is being used to help people w/<a href="https://twitter.com/hashtag/dementia?src=hash&ref_src=twsrc%5Etfw">#dementia</a> <a href="http://t.co/65GZPQdjb2">http://t.co/65GZPQdjb2</a> <a href="https://twitter.com/hashtag/caregiving?src=hash&ref_src=twsrc%5Etfw">#caregiving</a> <a href="https://twitter.com/hashtag/Alzheimers?src=hash&ref_src=twsrc%5Etfw">#Alzheimers</a> <a href="http://t.co/gXYztkNAJo">pic.twitter.com/gXYztkNAJo</a> — Ian Kremer (@LEAD_Coalition) <a href="https://twitter.com/LEAD_Coalition/status/602223483687317504?ref_src=twsrc%5Etfw">May 23, 2015</a></blockquote> However, “virtual nursing” likely refers to more familiar technology where a real nurse provides a limited range of care via <a href="https://www.sciencedirect.com/science/article/pii/S1541461219303866?casa_token=4QuZ-seF5i4AAAAA:0QtENxksLvBDzKsrvWXuPNcgrPcKf6XhaVTbOVJfsnE8nL-XVQypjCq9XZGXp_KJ51ekYUQn" target="_blank" rel="noopener">telehealth</a> (by phone and/or video). While some might appreciate when robots can assist with <a href="https://www.nursingworld.org/~494055/globalassets/innovation/robotics-and-the-impact-on-nursing-practice_print_12-2-2020-pdf-1.pdf" target="_blank" rel="noopener">certain tasks</a>, much of what nurses do cannot and should not be performed remotely (or by robots). Indeed, older people, their loved ones, and staff are <a href="https://www.theguardian.com/australia-news/2022/feb/05/yelling-out-for-help-the-atrocious-conditions-inside-australias-aged-care-homes" target="_blank" rel="noopener">calling out for</a> more physically present staff and more time to care and interact, not virtual interfaces and remote consultations. The benefits of technology in health care are unquestionable and many innovations have improved care for older people. Artificial intelligence shows promise in helping <a href="https://www.nature.com/articles/s41598-021-81115-9" target="_blank" rel="noopener">prevent and detect falls</a>, and socially assistive robots such as <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1244-6" target="_blank" rel="noopener">PARO</a> (a baby harp seal), have been shown to reduce stress, anxiety and antipsychotic use in people with dementia. Technology should not, however, be introduced at the <a href="https://www.sciencedirect.com/science/article/pii/S1322769620301438?via%3Dihub" target="_blank" rel="noopener">expense of care quality</a> or supporting and sustaining a suitably sized and skilled aged care workforce. We still need to adequately staff nursing homes to provide <a href="https://www.sciencedirect.com/science/article/pii/S0020748921000869?via%3Dihub" target="_blank" rel="noopener">safe, dignified care</a>. <h2>We need adequate staffing</h2> The <a href="https://agedcare.royalcommission.gov.au/publications/final-report" target="_blank" rel="noopener">Royal Commission into Aged Care Quality and Safety</a> heard a vast quantity of evidence regarding insufficient staffing, particularly of nurses who have the education and skills to deliver high quality clinical and personal care. This expertise is why nurses cannot be replaced with remote care, and why the Commission recommended 24/7 registered nurse presence; this has now been <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r6874" target="_blank" rel="noopener">legislated</a>. More than half of Australian aged care residents live in nursing homes with <a href="https://ro.uow.edu.au/ahsri/1073/" target="_blank" rel="noopener">unacceptably low levels of staffing</a> and <a href="https://www.health.gov.au/resources/publications/2020-aged-care-workforce-census" target="_blank" rel="noopener">around 20%</a> do not have a registered nurse onsite overnight. Insufficient staffing results in workers <a href="https://www.anmfsa.org.au/Web/News/2022/The_grim_reality_of_what_happens_in_a_nursing_home_that_doesn_t_have_registered_nurses_24_7.aspx" target="_blank" rel="noopener">not having time to interact</a> with residents meaningfully and compassionately and also contributes to avoidable hospitalisations, worse quality care and outcomes, and poor working conditions for staff. As social beings, human interaction is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150158/" target="_blank" rel="noopener">fundamental to health</a>, wellbeing, and best practice care. This is particularly true for <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12173?casa_token=l5Y_-r6rvt8AAAAA%3Awpp7P9Q9CUncyK60XOUPgv5ORx_Pi0jyMJ-Yp_kvdL7b5sTYih66Htp7l05J_I0vafKubec91hRL4Q" target="_blank" rel="noopener">older people in nursing homes</a> who are less able to engage with others and is especially vital for those living with <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12765" target="_blank" rel="noopener">mobility challenges</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28332405/" target="_blank" rel="noopener">dementia</a>. Partly due to nurse low staffing levels, <a href="https://link.springer.com/article/10.1186/s12889-020-8251-6" target="_blank" rel="noopener">loneliness, isolation</a> and <a href="https://www.racgp.org.au/getattachment/86cf2c46-46f2-4177-a17b-700bb7cfa3ac/20030705lie.pdf" target="_blank" rel="noopener">mental ill health</a> are widespread in aged care and have become more common due to <a href="https://www.apa.org/topics/covid-19/nursing-home-residents" target="_blank" rel="noopener">pandemic related restrictions</a> on visitors and staff. Care experiences are shaped by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382052/" target="_blank" rel="noopener">human interaction and contact</a>; the touch of a hand, a smile, eye contact, and being able to take the time to genuinely listen. These actions are central to how nurses and other staff build effective and <a href="https://onlinelibrary.wiley.com/doi/10.1111/jan.12862" target="_blank" rel="noopener">meaningful relationships</a> with residents. Seeking to replace human contact with virtual interfaces seems both inconsistent with the Royal Commission’s findings and possibly cruel. Personal interactions also help staff, as the <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1_0.pdf" target="_blank" rel="noopener">Royal Commission</a> highlighted: <blockquote> Knowing those they care for helps care staff to understand how someone would like to be cared for and what is important to them. It helps staff to care – and to care in a way that reinforces that person’s sense of self and maintains their dignity. This type of person-centred care takes time. </blockquote> Rather than circumventing reforms to ensure more nurses provide face-to-face care in nursing homes, we need to address the range of challenges contributing to widespread and tenacious <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-8462.12427" target="_blank" rel="noopener">workforce shortages</a>. There are clear challenges for growing and retaining a sufficiently sized and skilled aged care workforce. However, government reforms, such as better pay, mandated care time, and greater accountability and transparency regarding the use of funds all work together to make aged care a feasible and attractive sector to work in. This is one where staff are supported to provide the high quality and safe aged care all Australians deserve and where older people receive best practice, human care. This article originally appeared in <a href="https://theconversation.com/could-virtual-nurses-be-the-answer-to-aged-care-staffing-woes-dream-on-188215" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

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