Over the past two decades, Australia has seen the number of persons aged 85 years and over increase by 153% and the number of centenarians increase by 263%, compared with a total population growth of 32% over the same period. As these trends continue, this article discusses the potential impacts to Queensland’s kerbside collection services from an ageing population.
The Australian Bureau of Statistics surveys information from people with disability, carers and older people to determine not only how ageing impacts on a person’s life, but how the combination of age and other factors affect the quality of life a person experiences (see the Survey of Disability, Ageing and Carers). Within this survey, older people are defined as those aged 65 years or over. In 2015, there were around 3.5 million older Australians, representing one in every seven people or 15.1% of the population. This proportion has increased from 14.3% (from 3.3 million) in 2012, and 13.3% in 2009, making it increasingly important to understand the characteristics and needs of older Australians. Around half of Australia’s older population (1.7 million or 7.5% of Australians) have a disability and, as such, older people and those people with disability now form a growing part of the Australian population. However, while the proportion of older Australians has increased, the prevalence of disability amongst them has decreased. In 2015, 50.7% of older people were living with disability, down from 52.7% in 2012.
As people age their physical and mental functioning sometimes deteriorate, where they become more susceptible to age-related conditions and they are more likely to require assistance with everyday activities such as household chores and transport, regardless of whether they have a disability or not. The majority of older Australians are living in households (94.8%), with over one-quarter (26.8%) of all older people living alone.
In 2015, 1.2 million older people living in households needed assistance with everyday activities, Informal and formal assistance was most commonly needed for health care tasks (22.9%), through to property maintenance (20.2%). Formal assistance was most commonly received for health care (64.8%) and household chores (48.1%).
This aging population can impact waste collections in two ways, firstly through the number of ‘assisted collections’ required. It is known that with current kerbside collection methods, as the population ages the number of assisted collections required also correspondingly increases. This, in-turn, impacts the service provision and resource requirements for both the residual waste collections and any collections of recyclable materials. These ‘assisted services’ will be intensified for certain kerbside collection infrastructure choices, such as the adoption of recycling crates or bags which require manual lifting.
The second impact is on the composition (and characteristics) of the residual waste stream. There will always be a component of household waste that is not recoverable through kerbside collection due to its properties (hazardous), cost considerations, market failure or the availability of appropriate technology. Presently, these materials may include:
- Hazardous and/or hard to handle wastes;
- Offensive Wastes; and
- Clinical Wastes.
Offensive waste is non-infectious waste (and not clinical), which is unpleasant and may cause offence to those coming into contact with it. It includes outer dressings that are not contaminated with body fluids through to sanitary hygiene waste, including nappies, colostomy bags and incontinence pads.
There is a growing trend in ‘Hospital in the Home’ activities which involve the provision of acute care at a patient’s usual place of residence as a substitute for inpatient care at a hospital. The Queensland Government in their ‘Blueprint for better healthcare’ (February 2013) prioritised plans to support patients in their homes, (under the care of their treating clinician) with indications of reduced costs and improved outcomes. As such, the amount of clinical wastes generated by householders (and therefore ultimately ending up in the residual waste steam) will continue to increase subject to regional provision.
Data sourced by the Waste to Opportunity Enterprise indicates annual growth in hospital in home services over recent years of up to 35% and does not include sources of other clinical waste generated in home such as waste from diabetes treatments monitored by general practitioners, aged care services delivered via Commonwealth care packages, home treatments/visits by private health services (noting formal assistance received for health care services is currently at 64.8%). With the ageing population coupled with some regions increasing hospital in home care services, the growth of clinical and offensive wastes in the domestic waste stream is set to continue.
Clinical and offensive wastes generated domestically are not defined as regulated wastes within Queensland. According to the Department of Environment and Heritage Protection (see Guideline: Clinical and Related Wastes, 26 March 2015), the following rulings apply to clinical wastes generated within the home environment:
- In the home environment the only category of clinical and related wastes requiring special treatment is sharps or other devices (hypodermic needles) used to penetrate the skin of humans or animals. All other clinical and related wastes can be disposed of through the domestic waste stream.
- Sharps that are generated in the home must be disposed of into a rigid-walled, puncture resistant container. Containers full of sharps may also be placed into the household waste bin. However, people disposing of sharps in this manner should check with the local council, hospitals, pharmacies or home health care agencies to see whether they will ‘take back’ containerised sharps.
- Pharmaceutical waste does not include empty capsules, empty bottles (containing no liquid) or uncontaminated wrapping (packaging boxes and empty blister packs) and may be disposed of as general waste.
- Cytotoxic drugs are substances used predominantly in chemotherapy and are capable of impairing, injuring or killing cells. They are the most hazardous of the pharmaceutical substances and must be handled using special precautions. Tubing and dressings generated in the home as a result of treatment with cytotoxic drugs are not clinical or related waste and therefore do not have to be treated before disposal to landfill. They may be disposed of into the household waste bin. However, they should be bagged first so that the waste is confined to this bag and cannot spread throughout the bin.
Despite these guidelines, it would appear that many health authorities/ professionals are not checking with local councils on the best or preferred disposal route for clinical and related wastes. Most Queensland Councils have already reported growth in the receipt of clinical and related wastes, with some Materials Recycling Facilities (MRFs) experiencing dramatic increases in the number of containerised sharps boxes within the yellow-top bin recycling collection. Both of these trends increase risks to collection and sorting personnel as well as the associated treatment and disposal costs to local government and privately operated sorting facilities.
We must adopt a smarter approach to the way in which we manage the rising amount of clinical wastes arising from households, one that not only reduces risks and incidents of infection to those who collect and process these waste streams but also processes that do not leave anything to chance. This must start with the risk education of all stakeholders based on existing and future collection and treatment systems. We must be aware and take appropriate action to address the risks associated with the increasing volumes of clinical and offensive wastes in our household/general waste streams and identify how this impacts our collection and treatment strategies into the future.