Aged Care Organisations Research Articles

Generating and translating evidence for safe and effective medication management in aged care homes.

Generating and translating high-quality evidence is integral to providing safe and effective medication management for residents of aged care homes. Residents are often under-represented in trials of medication effectiveness and safety. This paper reviews opportunities and challenges for generating and translating evidence for safe and effective medication management in aged care homes. There are an increasing number of randomized controlled trials (RCTs) being conductedin aged care homes. Observational studies can also help address the evidence-practice gap arising from underrepresentation of residents in RCTs. Stepped-wedge and helix counterbalanced designs may help overcome limitations of traditional RCTs for evaluating medication management interventions in the aged care setting. Strategies for generating evidence include building effective partnerships with aged care homes and organizations, using novel trial designs, leveraging existing data and knowledge sharing through international platforms. Strategies for translating evidence include using quality indicators for audit and feedback, provision of education and training, engaging internal and external stakeholders, and development of local action plans and guideline implementation tools. There is an emerging interest in the role of knowledge brokers to facilitate knowledge translation. Future directions for generating and translating evidence include strengthening international research collaboration, industry partnerships, standardizing aged care home data to support national and international comparisons, and optimizing the use of technology. Initiatives may include improving access to routinely collected administrative health and medication data for conducting high-quality observational studies. Future studies should assess outcomes prioritized by residents to ensure that medication management strategies are tailored to their needs.

Do job demands and resources differ between permanent and temporary eldercare workers in Sweden?

Eldercare organizations face high sickness absence rates and staff turnover and rely heavily on temporary workers to fill staffing gaps. Temporary workers may experience differences in job demands and resources compared with permanent workers, but this has been largely understudied. To compare perceived job demands and resources between permanent and temporary Swedish eldercare workers. Permanent and temporary eldercare workers in a Swedish municipality were invited to answer a digital survey on work environment conditions. Differences between permanent and temporary workers in job demands and resources were analyzed using multivariate analysis of variance adjusted for age, sex, place of birth, and percent of full-time work and univariate analyses were conducted to consider differences in specific factors. A total of 1076 permanent and 675 temporary workers received the survey, and the final study sample included 451 permanent and 151 temporary workers. Multivariate analyses revealed that temporary workers reported statistically significant lower job demands compared to permanent workers, but no statistically significant differences in resources were found between the groups. Univariate analyses showed that temporary workers reported lower quantitative demands, perceived exertion, and time spent bending forward, than permanent workers. These data suggest comparable support across groups, but a higher workload among permanent workers. Our findings indicate that temporary workers experienced lower job demands than permanent workers, but that no notable difference was found in resources. Interventions aimed at distributing job demands more evenly among eldercare workers with different employment forms may be necessary.

Fostering an aged care organizational culture that supports innovation.

This study aimed to identify how aged care organizations can foster a culture that supports the implementation of innovation. The aged care sector must innovate to meet clients' evolving needs and increased regulatory requirements. Given the need to account for the values, beliefs, expectations, and assumptions held by a diverse range of stakeholders, implementing innovations within aged care can be exceptionally complex. Fostering a supportive organizational culture can facilitate the implementation of these critical innovations. Papers from a large scoping review that identified organizational culture as a barrier and/or enabler to implementing innovations in aged care were imported into NVivo. Data relating to how organizations fostered (or could foster) a culture that supported the implementation of innovations were then extracted, inductively coded, interpreted, and grouped into approaches. Of the 193 papers from the original scoping review, 109 were included in this secondary analysis. From these 109 papers, we identified six key approaches: cultivating collaboration; valuing contributions; ensuring alignment between the organizational vision, culture, and innovation; demonstrating organizational commitment; developing and communicating the implementation plan; and accounting for stability. Our study outlines effective approaches that can be used by aged care organizations to cultivate a culture that supports the implementation of innovations. However, these approaches should not be viewed in isolation; rather, they are interconnected and mutually reinforcing. Together, these insights offer practical guidance for aged care entities seeking to adapt and evolve through innovation implementation. http://links.lww.com/IJEBH/A264.

Implementing a gerontological nursing competencies programme in aged care: Participant experiences.

To explore the experience of registered nurses and their mentors in the implementation of the Gerontological Nursing Competencies in long-term aged care and the perceived effectiveness and suitability of the programme to support nurse development. The global population is ageing and needs a reliable aged-care nursing workforce. Opportunities for education and mentorship for newly qualified and experienced aged-care nurses warrant investigation. Qualitative evaluation using semi-structured focus groups was conducted following the implementation of the programme into five not-for-profit long-term aged-care organisations and analysed by a reflexive qualitative thematic approach and reported according to COREQ criteria. A total of 21 nurses (7 mentors and 14 mentees) participated in six focus groups. Five themes were generated: (1) nurses gained confidence and competence through the programme; (2) the facilitation of suitable mentoring activities and approaches was crucial to success; (3) the programme helps nurses recognise gerontology as a specialty; (4) the programme contributes to building a strategy of recruitment/retention/quality improvement in the sector; (5) barriers, challenges, changes and recommendations were identified. The Gerontological Nursing Competency model, which combined adaptive mentoring supported by reflective practice embedded in a gerontological nursing competencies framework, was perceived to improve nurse confidence and competence to lead and improve nursing standards of care. The evidence-based competencies are an acceptable and effective method for supporting gerontological nurse development. Expansion of, and accessibility to, the programme may aid global responses to aged-care reform, by building the recognition of gerontological nursing as a specialty and contributing towards recruitment, retention and quality care improvements.

The evaluation and enhancement strategies of core competencies for older adult caregivers in integrated medical and older adult care institutions.

The study aimed to understand the main skills of older adult caregivers and find ways to improve these skills. We selected participants using a method called random cluster sampling, where caregivers from 17 different medical and nursing care facilities across seven districts in Hangzhou were chosen. We collected 492 valid questionnaires and conducted interviews with 150 people. To analyze the data, we used T-tests and Analysis of Variance (ANOVA) to identify what factors affect caregivers' skills. We also performed multiple regression analysis to explore these factors in more depth. The analysis showed that age (p = 0.041), annual income (p < 0.001), and having a training certificate (p < 0.001) significantly influence the skills of older adult caregivers. Specifically, caregivers' age and whether they had a training certificate were linked to how competent they were, with income being a very strong factor. The study highlighted a gap between the caregivers' current skills and the skills needed for high-quality care. This gap shows the need for training programs that are specifically tailored to the caregivers' diverse needs and cultural backgrounds. Medical and eldercare facilities should adjust their work and educational programs accordingly. It's also important to look at how caregivers are paid to make sure their salary reflects their skills and the quality of care they provide. Finally, it's crucial to integrate a comprehensive training program that leads to certification within eldercare organizations.

Writing research-based theatre on aged care: the ethnodrama, After Aleppo

ABSTRACT This paper documents the visioning, crafting, and writing of an ethnodrama – a type of embodied writing that takes the form of a research-based play script – about one unusual experience within an aged care organization: what might happen when technology, specifically virtual reality, is implemented into this unique organizational setting? As well as reflecting on the artistic and scientific value of research-based theatre, the script of one of the monologue plays, After Aleppo, is shared. Play scripts are a uniquely creative form of embodied writing, helping people see, imagine, and better understand the experiences of others, with ethnodrama the translation and adaption of research into a written script. As well as generating empathy, this research-based theatre provides a novel form of knowledge translation to engage and educate the public and those working in aged care organizations, a diverse workforce dealing with issues of care relationships, ageing, technology, and death.

Adaptation and Implementation of a Volunteer-Delivered, Telephone-Based, Social Support Program HOW-R-U? During the COVID-19 Pandemic: A Pragmatic Study.

Public health concerns surrounding social isolation and loneliness heightened during the coronavirus disease 2019 (COVID-19) pandemic, as infection prevention measures led to increased feelings of loneliness and depression. Our objective was to evaluate the implementation of the HOW-R-U? program, during the pandemic (March 2020-December 2021). HOW-R-U? is a weekly volunteer-delivered telephone program designed to facilitate social connection and ease feelings of social isolation, loneliness, and depression in older people. This pragmatic study used the Implementation Framework for Aged Care to adapt and implement HOW-R-U? in an Australian aged and community care organization and a tertiary health service in Melbourne. The evaluation involved analysis of program data, semistructured interviews, and surveys with program recipients, volunteers, and referrers. A process evaluation was conducted alongside an assessment of outcomes including pre- and post-symptoms of isolation, depression, and loneliness. The implementation evaluation indicated that codesigned systems and processes effectively supported the ongoing implementation of HOW-R-U? with transition into business as usual across both organizations. Recipients reported that telephone calls had a positive impact on their lives, whereas volunteers reported enjoyment of supporting others. Several challenges were identified, namely in program reach and fidelity. HOW-R-U? was well regarded by all involved, and evaluation learnings have informed implementation into business as usual by both organizations.

Mental health outcomes of family carers after admission to aged care: A cross-sectional survey study.

This study investigated the predictors of poor mental health outcomes among family carers of residents after transitioning into residential aged care. Using a cross-sectional design, five groups of variables were evaluated as predictors: caregiver demographics; caregiving load; resident-related variables; loneliness and visiting frequency; and the impact of the COVID-19 context. A total of 309 primary family contacts of all residents of two residential aged care organisations in the state of Victoria (Australia) participated in the study (response rate 19%). The K-10 and the Burden Scale for Family Caregivers were used to measure the primary outcomes. We compared psychological distress and burden outcomes between carers whose relative was admitted within the last 12 months, or longer than 12 months ago. Time since admission (<12 months or >12 months) did not affect the level of psychological distress (t (238) = -.08, p = .94) or subjective burden (t (245) = -.89, p = .38). Being a woman, a spouse, speaking a language other than English at home, being less satisfied with the support offered by the facility, not feeling supported in the decision to admit their relative, being lonely and providing higher levels of care preadmission were predictors of poor mental health outcomes. Older women with low-English proficiency who were primary carers and are socially isolated, are more likely to experience poor mental health outcomes and need additional support. These findings may inform the development of screening tools and tailored interventions to support this population during and after the transition process.

Chinese-Australian carers' perceived needs and preferences in planning to embed an iSupport for Dementia program in aged care services.

To assess Chinese-Australian carers' needs and preferences through co-design strategies with stakeholders to embed an evidence-based iSupport for Dementia program into routine community aged care services in Chinese ethno-specific aged care organisations. A cross-sectional survey was conducted from July to August 2022 in three Chinese ethno-specific aged care organisations in Australia. We applied a univariate analysis to test variables associated with carers' needs and preferences when embedding the iSupport for Dementia program into routine practice among community aged care services. A total of 101 carers completed the survey. Most carers in our study preferred the iSupport program to be provided in their first language, have a program facilitator to lead the program and would like to interact with peers in the program. Most carers indicated that they are willing to pay for the iSupport program using the budget allocated to their home care package. Younger carers (younger than 65 years), and adult children's carers are more likely to use the web-based iSupport manual and invite their family members to the program compared to those older than 65 years. Other demographic characteristics had no significant association with their needs and preferences. Chinese-Australian carers' perceived needs and preferences in this study will inform the implementation of a culturally tailored iSupport program to be embedded in community aged care services provided by Chinese ethno-specific aged care organisations. Findings will also inform culturally and linguistically congruent iSupport programs for carers from other culturally and linguistically diverse communities in Australia.

Cross-sector learning collaboratives can improve post-diagnosis care integration for people with young onset dementia

Introduction:Post-diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, health care, and social care sectors. The aim of this project was to test the feasibility and effectiveness of a learning collaborative implementation strategy for improving the cross-sector integration of care for people with YOD.Methods:We conducted a longitudinal mixed-methods process evaluation, and recruited one representative from three Australian aged care organisations, three disability care organisations, and three organisations contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six-module online education package incorporating written resources, webinars, collaboration, and expert mentoring. Participants identified gaps in services in their region and barriers to care integration, and developed a shared plan to implement change. Normalisation Process Theory was applied to understand acceptability, penetration, and sustainability of the implementation strategy, as well as barriers and enabling factors.Results:Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (Mean = 39.67, standard deviation = 9.84) and did not change by the end (Mean=39.67, standard deviation = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action toward integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative.Discussion:Learning collaboratives hold promise as a strategy to improve cross-sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change.

Malnutrition and its contributing factors for older people living in residential aged care facilities: Insights from natural language processing of aged care records.

Malnutrition is a serious health risk facing older people living in residential aged care facilities. Aged care staff record observations and concerns about older people in electronic health records (EHR), including free-text progress notes. These insights are yet to be unleashed. This study explored the risk factors for malnutrition in structured and unstructured electronic health data. Data of weight loss and malnutrition were extracted from the de-identified EHR records of a large aged care organization in Australia. A literature review was conducted to identify causative factors for malnutrition. Natural language processing (NLP) techniques were applied to progress notes to extract these causative factors. The NLP performance was evaluated by the parameters of sensitivity, specificity and F1-Score. The NLP methods were highly accurate in extracting the key data, values for 46 causative variables, from the free-text client progress notes. Thirty three percent (1,469 out of 4,405) of the clients were malnourished. The structured, tabulated data only recorded 48% of these malnourished clients, far less than that (82%) identified from the progress notes, suggesting the importance of using NLP technology to uncover the information from nursing notes to fully understand the health status of the vulnerable older people in residential aged care. This study identified 33% of older people suffered from malnutrition, lower than those reported in the similar setting in previous studies. Our study demonstrates that NLP technology is important for uncovering the key information about health risks for older people in residential aged care. Future research can apply NLP to predict other health risks for older people in this setting.

Transforming aged care with virtual reality: How organisational culture impacts technology adoption and sustained uptake.

Virtual reality (VR) is not a common leisure activity in aged care, despite pilot studies demonstrating its value as a tool to combat inactivity and loneliness. This study investigated the organisational enablers and barriers to sustained uptake of VR among aged care staff and organisations, who may lack familiarity or confidence with the technology. Creative methods were adopted to co-design and develop a VR implementation toolkit tailored specifically for aged care staff. Three aged care homes in South-East Queensland participated, with 15 residents and seven staff engaging in up to four VR sessions facilitated by the research team. Participant observation of the VR sessions was complemented by interviews with aged care staff and residents. Guided by Normalisation Process Theory, a reflexive thematic analysis identified four key themes: (1) Positively Appreciating the VR Experience, (2) Staff VR Champions and the Importance of Personal Use and Experimentation with VR, (3) Management Support and (4) Technical Challenges. Our results indicate benefits and challenges of VR use in aged care, offering valuable insights into the factors that can lead to the long-term success of VR-based leisure activities for aged care. Providing time and resources for a VR champion to experiment and learn about the technology is critical. The development of an online implementation toolkit, based on our learning from this project, also provides aged care stakeholders with the evidence-based resources needed to ensure the successful implementation of VR-based leisure programs.

Nursing home geriatric rehabilitation care and interprofessional collaboration; a practice-based study

BackgroundFrailty and multimorbidity are common among patients in geriatric rehabilitation care (GRC). Proper care of these patients involves multiple professionals which requires optimal interprofessional collaboration to provide the best possible support. Interprofessional collaboration (IPC) goes beyond multi-professional collaboration. It requires professionals to think beyond the expertise of their own discipline and work on joint outcomes in which the patient is actively involved. This study describes the development of the GRC teams of an elderly care organization towards the IPC.MethodsMixed method pre-post study of 15 months. The interprofessional training program comprised team trainings, webinars, and online team sessions. Data was aggregated by administering the Extended Professional Identity Scale (EPIS) and QuickScan Interprofessional Collaboration (QS) measurements to GRC staff and by observations of the multi-professional team consultation (MPC) meetings of six GRC teams of an organization for elderly care in Drachten and Dokkum in the Netherlands. ADL independence (Barthel Index) and number of inpatient days were analyzed before and after the project.ResultsPretest healthcare professional response was 106, patients for analyses was 181; posttest response was 84, patients was 170. The EPIS shows improvement on “interprofessional belonging” (P = .001, 95%CI: 0.57–2.21), “interprofessional commitment” (P = .027, 95%CI: 0.12–1.90), and overall “interprofessional identity” (P = .013, 95%CI: 0.62 − 5.20). On the QS, all domains improved; “shared values” (P = .009, 95%CI: 0.07 − 0.47), “context” (P = .005, 95%CI: 0.08 − 0.44), “structure & organization” (P = .001, 95%CI: 0.14 − 0.56), “group dynamics & interaction” (P < .001, 95%CI: 0.18 − 0.58), and “entrepreneurship & management” (P = .039, 95%CI: 0.01 − 0.48). A qualitative analysis of the reflection responses and MPC observations indicate a shift from multi-professional to more IPC. Differences in ADL over time were not statistically significant. The mean number of inpatient days was reduced by 11.8 (P < .001, 95%CI: -17.34 - − 6.31) days.ConclusionsWithin the GRC teams, there was a shift observed to more IPC and better representation of the patient’s wishes and needs. ADL independence did not change, yet we found a statistically significant decrease in the number of inpatient days. The basis for IPC was well established, however, it remains necessary that the teams continue to develop and invest in the collaboration with each other and the patient to further improve it.

Exploring the role of a facilitator in supporting family carers when embedding the iSupport for Dementia programme in care services: A qualitative study.

To explore stakeholders' perceptions of a facilitator's role in supporting carers when embedding iSupport for Dementia psychoeducation program, in care services. A qualitative descriptive study design was applied. Data were collected from workshops and interviews with carers of people living with dementia (PLWD)and with health and social care professionals from two tertiary hospitals and two community aged care organisations across three Australian states between October 2021 and March 2022. A thematic analysis was used to analyse data. The COREQ guideline was followed to report our findings. A total of 30 family carers and 45 health and social care professionals participated in the study. Three main themes and seven subthemes were identified from the data. We described the main themes as (1) the facilitator's role at the time of dementia diagnosis, (2) the facilitator's role throughout the everyday dementia care journey and (3) the facilitator's role during transition moments. Caring for family members with dementia is demanding and stressful for carers. Embedding a facilitator-enabled iSupport for Dementia program in hospital and community aged care settings has the potential to mitigate sources of stress associated with care recipient factors, carer factors and care service factors, and improve the health and well-being of carers and those for whom they care. Our findings will inform the establishment of iSupport facilitators appointed by dementia care providers in hospital and community care settings and help determine their roles and responsibilities in delivering the iSupport program. Our findings relate to nurse-led and coordinated dementia care in hospital and community aged care settings. This study was co-designed with stakeholders from two aged care organisations and two tertiary hospitals. The study participants were staff employed by these organisations and carers of PLWD who were service users.

Euthanasia and faith-based aged-care organisations: The right not to kill?

In this paper we focus on an important specific issue which has not received serious attention in the scholarly literature on euthanasia, namely, that of the coercive imposition (by way of sanction-backed regulations) of the practice of voluntary active euthanasia (in particular) on faith-based, aged-care organizations. In Section 1 we outline the relevant conceptual background drawing on existing literature. In Section 2, we consider two conflicting ethical standpoints on voluntary active euthanasia. In Section 3 we outline the nature and extent of the push to impose the practice of voluntary active euthanasia on Catholic-run aged-care organizations. In Section 4 we argue that the argument for coercively imposing the practice of voluntary active euthanasia on faith-based, aged-care organizations, is not well-made, especially in the context of liberal democracies committed to pluralism.

The lived experience of frailty: what does it mean to be frail?

ABSTRACT With population ageing, frailty is an increasingly critical global health matter. Many studies have focused on physical aspects of frailty, but more recently on the psychosocial aspects of frailty. Within western societies frailty is often linked with fear and suffering. This paper outlines a previously understudied perspective; the spiritual dimension in frailty, bringing a holistic view to this complex condition. The paper presents the main findings of a mixed methods study that focused on the lived experience of older people, receiving high-level care living in residential care or at home. Participants (n = 25) were identified as being frail by staff of the residential aged care organisation, and confirmed by psychometric testing. The quantitative component of the study comprised a survey of psychometric measures of mental health, wellbeing and an index of activities of daily living. The qualitative component followed a phenomenological approach, using the Spiritual Tasks and Process of Ageing model (STPA) as a study framework. Analysis focused on the lived experience of participants and where they found meaning in their perceived vulnerability and through self-transcendence, with reports of things they found hardest in life, and inner strength forming the most important themes.

A profile of students in a university-based distance dementia education program: Implications for policy and practice.

The online program began in 2012 to support aged care workers without a tertiary education or vocational qualification. This paper documents changes in the student profile since initiation of the program, and how the program may support recommendations of the Royal Commission into Aged Care Quality and Safety and engage other educators, providers and policymakers. Four hundred and seventy-one commencing undergraduate students completed a 16-item online survey in 2017 to document demographics and reasons for study. Categorical associations were assessed with univariate logistic regression in R v3.6. Most students (71%; 336) were aged between 41 and 60 years but the program now included younger (<41 years) and older (>80 years) people. Unlike the 2012 students, about 41% had tertiary-level qualifications, and 56% were employed in professional positions, including registered nurse, general practitioner and allied health professional. Professional and practice development was the primary reason for study; significantly so for younger (<41 years) participants in aged and dementia care (χ2 (5) = 18.15, p = 0.003) and for those with previous university experience (χ2 (4) = 22.17, p = 0.001). Older (≥61 years) participants enrolled to gain greater knowledge about dementia (χ2 (4) = 17.60, p = 0.002). Understanding the changed student profile guided program refinement to ensure the provision of effective, evidence-based education in dementia understanding and care. Work now focusses on increasing partnerships with aged care organisations, community and postsecondary training institutions to support a continuum of workforce development options, guided by the recommendations of the Royal Commission.

The effects of a theory-informed intervention on physical activity behaviour, motivation and well-being of frontline aged care workers: A pilot study with 6-month follow-up.

Due to the nature of their jobs, frontline aged care workers may be a population at risk of poor health and lifestyle habits. Support of their well-being through the workplace is likely to be complex. The objective of this study was to assess the effectiveness of a need-supportive program for changing physical activity and psychological well-being via the motivational processes of behavioural regulations and perceived need satisfaction. Frontline aged care workers (n = 25) participated in a single cohort, pre-post pilot trial. The program included a Motivational Interviewing style appointment, education on goal setting and self-management, the use of affect, exertion and self-pacing for regulating physical activity intensity and practical support activities. Outcomes (7-day accelerometery, 6-min walk, K10 and AQoL-8D), and motivational processes (BREQ-3 and PNSE) were measured at baseline, 3 and 9 months, and analysed using linear mixed models for repeated measures. There were significant increases in perceived autonomy at 3 months (Δ .43 ± SE: .20; p = .03) and 6-min walk distance at 9 months (Δ 29.11 m ± SE: 13.75; p = .04), which appeared to be driven by the relative autonomy index (behavioural regulations in exercise questionnaire [BREQ-3]). Amotivation increased at 3 months (Δ .23 ± SE:.12; p = .05); which may have been due to low scores at baseline. No other changes were demonstrated at any timepoint. SO WHAT?: Participants demonstrated positive changes in motivational processes and physical function, however, due to the low levels of participation in the program, the program had a negligible impact at the organisational level. Future researchers and aged care organisations should aim to address factors impacting participation in well-being initiatives.

Optimizing aged care environments to promote resident functional mobility and reduce staff injury risk.

Introduction: This study aimed to evaluate the suitability and usability of the Pro-Mobility patient/person handling assessment tool (ProMob) within residential aged care. Physiological changes associated with ageing influence an older person's ability to perform functional mobility tasks such as transferring from furniture and walking. Strategies that improve capability and/or reduce the physical demands of the task have the potential to promote an older person's mobility, independence and wellbeing. Environment-related strategies in Manual Handling of People (MHP), such as optimum seated heights, in part address this challenge, as they can promote resident functional mobility while also protecting staff from injury. The ProMob tool was developed to address this issue through systematic evaluation of these environmental factors. Methods: The participants in this study were seven (7) residential aged care facilities (RACFs) operated by a not-for-profit aged care organization. A qualified assessor evaluated MHP risk management with the ProMob tool at each RACF through collection of data for a random sample of residents (n = 67) regarding their living environments and available mobility information. Data was transferred to an SPSS-22 statistical software database for analysis which involved descriptive statistics and cross tabulations. Results: Application of the ProMob tool provided effective quantification of the nature and extent of environment-related MHP interventions that may influence resident mobility. Areas for improvement with MHP risk management were identified, with variation evident across RACF's within the same organisation, which was not consistent with levels of care (e.g., lack of clear space to facilitate mobility). Low level care facilities were observed to have fewer adaptive environmental features that could potentially slow decline in independence. Discussion: Features of the aged care environment can be used to facilitate the functional mobility of aged care residents, and simultaneously reduce injury risk for staff in MHP interactions. The ProMob tool can be used for auditing care facilities, planning re-development, and continual improvement in provision of care and management of staff injury risk exposure.

Adaptation among aged care and disability service providers in response to the COVID-19 pandemic: Lessons for the future.

Aged care and disability service organizations are critical infrastructure. However, in 2020, restrictions were introduced to reduce the infection risk of the coronavirus disease 2019 (COVID-19), and these organizations needed to quickly devise COVID-safe ways of working to continue to meet the needs of their clients. To investigate how these organizations adapted their service delivery and which innovations they felt were worthwhile for sustaining beyond the COVID-19 pandemic, interviews were undertaken with representatives from 26 aged care and disability service organizations across three states in Australia (Western Australia, New South Wales, and Victoria). Findings revealed that organizations adapted their practices across three key innovation areas: (1) developing new approaches or expanding existing services, particularly around food provision, social connection, information dissemination, and technology support; (2) modifying the mode of service delivery, through safe in-person contact or offering alternative online services; and (3) reducing bureaucracy and introducing remote working. A common theme across all service innovations was the strong focus on providing clients and staff with choice and control. Moving forward, many organizations wanted to integrate and maintain these innovations, as they were associated with additional benefits such as increased client health and safety, service flexibility, and sufficient human resources to serve clients. However, continued maintenance of some initiatives require additional resourcing. The continuation of COVID-19 pandemic adaptations and, indeed, ongoing innovation, would therefore be facilitated by greater flexibility of funding to allow organizations and their clients to determine the service types and modes that best meet their needs. Further, these innovations have implications for sector-wide best practice.