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Some problems are common to both private residential and private nursing homes so a lot of thought and guidance is needed before any decisions are made. The first problem is funding. For most elderly people the cost is now borne by their local social services department. Their care manager will obviously be looking for value for money and is only allowed to use a certain number of known and registered homes, which keep their prices reasonable.

If the client has assets, they will be expected to pay the full rate themselves until their capital falls to such a level that the social services will step in. Some carers are so desperate to find a home that they will meet the difference themselves, only to find that as the rates go up, as they invariably do, they can no longer meet the difference, and their relative has to leave. All these financial considerations have to be sorted out before the person moves in, especially if help is needed from the local authority. Many homes require a month’s money in advance and some do not refund any should the client leave or die in this time.

The location of the home can be another problem. Many carers choose the private sector partly for the convenience of having a family member nearer to make visiting easier. Many old people still live in inner cities whilst their children have moved out to the suburbs or the country. For most old people the move out of their home is traumatic enough, but for many they have to move considerable distances either to be nearer relatives or simply to an area where the weekly costs are affordable. Circumstances change and sometimes carers have to move because of business commitments, leaving the person stranded in a totally new environment.

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As the march of medical science advanced into the realms of high technology, pills, potions and prevention – general surgeons got left behind. The appearance of the operating endoscope is just the golden technological opportunity that this hard pressed group of medical specialists was waiting for. Once more in the spotlight each day, they redefine the role of all the traditional intra abdominal procedures. Each passing week sees an old technique succumb to the advancing tide of endoscopic innovation. Gall bladders, hernias, appendixes and even the resection of cancerous lengths of large bowel are all attempted by the general surgeon’s latest technological toy.

Whilst it is fair to say that these general surgical techniques are indeed an advance on the abdominal search and destroy operations of old, there is still a fly in the surgeons’ philosophical ointment. The removal of a gall bladder may be beneficial for the patient; but it does nothing for the gall bladder. The same can be said about appendixes and uteruses which Australian surgeons remove at rates almost unmatched by any other corresponding group of health professionals any where in the world. If today, surgery is still a necessary evil, let us not forget that in terms of treatment resorting to the knife means that health promotion still has a long way to go.

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