Permanent Care Research Articles

Factors associated with accessing aged care services in Australia after approval for services: Findings from the historical cohort of the Registry of Senior Australians.

ObjectiveTo evaluate the access of approved aged care services and factors associated with accessing these services.MethodsA retrospective cohort study was conducted (1/7/2003‐30/6/2013). The incidence of accessing permanent residential, home and respite care services within one year or transition care within 28 days of approval was evaluated. The association of participants’ socio‐demographic characteristics, limitations, health conditions and assessment characteristics with service use was evaluated.ResultsIn 799 750 older Australians, the incidence of accessing approved permanent residential care within one year was 70.9% (95% confidence interval [CI] 70.8%‐71.0%), home care 49.5% (95% CI 49.3%‐49.7%) and respite 41.8% (95% CI 41.7%‐41.9%). The incidence of accessing transition care at 28 days was 78.5% (95% CI 78.2%‐78.7%). Aged care seekers’, assessments’ and assessors’ characteristics are associated with service access.ConclusionMonitoring the use of aged care service approvals is necessary for the identification of service access barriers to support evidence‐based policy changes.

Using elastic nets to estimate frailty burden from routinely collected national aged care data.

To (1) use an elastic net (EN) algorithm to derive a frailty measure from a national aged care eligibility assessment program; (2) compare the ability of EN-based and a traditional cumulative deficit (CD) based frailty measures to predict mortality and entry into permanent residential care; (3) assess if the predictive ability can be improved by using weighted frailty measures. A Cox proportional hazard model based EN algorithm was applied to the 2003-2013 cohort of 903996 participants for selecting items to enter an EN based frailty measure. The out-of-sample predictive accuracy was measured by the area under the curve (AUC) from Cox models fitted to 80% training and validated on 20% testing samples. The EN approach resulted in a 178-item frailty measure including items excluded from the 44-item CD-based measure. The EN based measure was not statistically significantly different from the CD-based approach in terms of predicting mortality (AUC 0.641, 95% CI: 0.637-0.644 vs AUC 0.637, 95% CI: 0.634-0.641) and permanent care entry (AUC 0.626, 95% CI: 0.624-0.629 vs AUC 0.627, 95% CI: 0.625-0.63). However, the weighted EN based measure statistically outperforms the weighted CD measure for predicting mortality (AUC 0.774, 95% CI: 0.771-0.777 vs AUC 0.757, 95% CI: 0.754-0.760) and permanent care entry (AUC 0.676, 95% CI: 0.673-0.678 vs AUC 0.671, 95% CI: 0.668-0.674). The weighted EN and CD-based measures demonstrated similar prediction performance. The CD-based measure items are relevant to frailty measurement and easier to interpret. We recommend using the weighted and unweighted CD-based frailty measures.

Altered Fecal Microbiome Years after Traumatic Brain Injury.

Patients with chronic traumatic brain injury (TBI) requiring long-term, permanent care suffer a myriad of clinical symptoms (i.e., impaired cognition, fatigue, and other conditions) that persist for years beyond the acute brain injury. In addition to these comorbid clinical symptoms, chronic TBI patients exhibit altered amino acid and hormonal profiles with distinct cytokine patterns suggesting chronic inflammation. This metabolic link suggests a role of the gut-brain axis in chronic TBI. Thus, we utilized a two-site trial to investigate the role of the gut-brain axis in comorbidities of chronic TBI. The fecal microbiome profile of 22 moderate/severe TBI patients residing in permanent care facilities in Texas and California was compared to 18 healthy age-matched control subjects working within the participating facilities. Each fecal microbiome was characterized by 16S(V4) ribosomal RNA (rRNA) gene sequencing and metagenomic genome sequencing approaches followed by confirmatory full 16S rRNA gene sequencing or focused tuf gene speciation and specific quantitative polymerase chain reaction evaluation of selected genera or species. The average chronic TBI patient fecal microbiome structure was significantly different compared to the control cohort, and these differences persisted after group stratification analysis to identify any unexpected confounders. Notably, the fecal microbiome of the chronic TBI cohort had absent or reduced Prevotella spp. and Bacteroidies spp. Conversely, bacteria in the Ruminococcaceae family were higher in abundance in TBI compared to control profiles. Previously reported hypoaminoacidemia, including significantly reduced levels of l-tryptophan, l-sarcosine, ß-alanine, and alanine, positively correlated with the reduced levels of Prevotella spp. in the TBI cohort samples compared to controls. Although the sequelae of gut-brain axis disruption after TBI is not fully understood, characterizing TBI-related alterations in the fecal microbiome may provide biomarkers and therapeutic targets to address patient morbidity.

Pleural space infection bacteriology and clinical, laboratory, and physical outcomes

Introduction and Objectives: Even with the development of powerful medicines, bacterial pneumonia remains a leading cause of death and disability. The goal of this article is to discuss the bacteriology of pleural space infection and to identify the parameters that would predict infection outcome in different types of parapneumonic effusion.Materials and Methods: Observational study of patients diagnosed with simple, difficult, or complex parapneumonic effusion who were admitted at the Department of Respiratory Medicine, Mamata Medical College, Khammam, Telangana, India, between March 2019 to September 2019. Gram staining and culture growth of pleural fluid was examined to characterised the bacteria that cause pleural space infection. Multiple logistic regressions were used to statistically analyse the data and draw comparisons between the two outcomes.Results: Multiple logistic regression models and a univariate model were utilised. Comparable gram-positive and gram-negative bacterial growth was seen in this study of pleural space infections. pH, loculation, positive stain, culture, fever, and serum albumin were all statistically significant in independent analyses. Tube thoracostomy success or failure was significantly predicted by PH, loculation, and serum albumin in a multivariate analysis.Conclusion: Predictive indicators for the prognosis of difficult and complex parapneumonic effusion included pleural fluid pH, loculation, and serum albumin in a multivariate analysis. They may be put to use in sending patients on to more permanent care.

Gdańskie odznaki żebracze (XVI–XVIII w.)

Beggar badges of Gdańsk In Gdańsk of the 16th century, due to the failure of medieval forms of aiding the poor based on Church institutions, the growing number of people seeking support in a port town which was quickly getting rich and under the influence of ideas spread by Martin Luther, the policy concerning beggars and people seeking aid changed. It was demonstrated by passing the first beggar ordinance in 1525, which introduced the supervision of the city council over the system of social welfare based on the existing hospitals in town. Special badges with the crest of Gdańsk had been known since the middle of the 16th century, which entitled their wearers to beg in the vicinity of the city as well as to receive aid from public funds. Those artefacts were cast from lead and apart from the crest also had a depiction of a beggar and a date specifying the annual validity of the symbol. They would most often be sawn to clothes or worn around the neck. There are four beggar categories known to us: 1) for the inhabitants of Gdańsk unfit for work and their children thus entitled to basic education; 2) badges for the poorest group of citizens having trouble making a living, which included their personal data and address; 3) badges for city visitors who needed aid and had not been admitted to hospitals, which entitled them to beg temporarily; 4) badges for the patients of the City Hospital (the Lazaret), which since the 17th century had become the main centre of medical care for the poorest. Artefacts registering those entitled to permanent or temporary hospital care are known dating even from the middle of the 18th century. With the popularisation of written documentation in the hospital, at the end of the 18th century artefacts of that kind became obsolete.

Who uses residential aged care now, how has it changed and what does it mean for the future?

Objective This paper presents past trends in resident characteristics and usage patterns in residential aged care and explores implications for the future. Methods Time series analyses were undertaken of national aged care administrative datasets and the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers. Results Although the number of people in residential care has continued to increase, resident profiles have changed as a result of higher growth rates in the number of men and of people aged 65-74 years and 90 years and over, and a decline in the number of women aged 75-89 years. Relative to population size, usage rates are declining across all age groups, the average length of stay is shortening, and dependency levels appear to be rising. Conclusion Changing trends in residential aged care use, when combined with key trends in the broader population of older Australians, offer useful insights in planning for the future. What is known about the topic? Trends in the changing characteristics of permanent aged care residents and patterns of use of Australian residential aged care have received sparse attention in scholarly journals. Government reports and databases contain useful statistics, but they do not provide a coherent analysis and interpretation of the implications of these trends or situate them in broader population patterns. What does this paper add? The analyses in this paper demonstrate patterns of change and continuity in the use of residential care over the past decade, and locate those changes in the context of broader trends in the ageing population. Together, this provides useful insights into current and likely future trends, as well as a basis for imagining an improved residential aged care system in the future. What are the implications for practitioners? These analyses illustrate how data on aged care services, demographic trends and disease patterns can be used to consider the challenges that have affected our residential aged care system in the past and how that may be addressed in the future.

Corrigendum to: Who uses residential aged care now, how has it changed and what does it mean for the future?

ObjectiveThis paper presents past trends in resident characteristics and usage patterns in residential aged care and explores implications for the future.MethodsTime series analyses were undertaken of national aged care administrative datasets and the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers.ResultsAlthough the number of people in residential care has continued to increase, resident profiles have changed as a result of higher growth rates in the number of men and of people aged 65-74 years and 90 years and over, and a decline in the number of women aged 75-89 years. Relative to population size, usage rates are declining across all age groups, the average length of stay is shortening, and dependency levels appear to be rising.ConclusionChanging trends in residential aged care use, when combined with key trends in the broader population of older Australians, offer useful insights in planning for the future.What is known about the topic?Trends in the changing characteristics of permanent aged care residents and patterns of use of Australian residential aged care have received sparse attention in scholarly journals. Government reports and databases contain useful statistics, but they do not provide a coherent analysis and interpretation of the implications of these trends or situate them in broader population patterns.What does this paper add?The analyses in this paper demonstrate patterns of change and continuity in the use of residential care over the past decade, and locate those changes in the context of broader trends in the ageing population. Together, this provides useful insights into current and likely future trends, as well as a basis for imagining an improved residential aged care system in the future.What are the implications for practitioners?These analyses illustrate how data on aged care services, demographic trends and disease patterns can be used to consider the challenges that have affected our residential aged care system in the past and how that may be addressed in the future.

Patient-Related Barriers to Timely Dialysis Access Preparation: A Qualitative Study of the Perspectives of Patients, Family Members, and Health Care Providers

Rational & ObjectiveA key aspect of smooth transition to dialysis is the timely creation of a permanent access. Despite early referral to kidney care, initiation onto dialysis is still suboptimal for many patients, which has clinical and cost implications. This study aimed to explore perspectives of various stakeholders on barriers to timely access creation.Study DesignQualitative study.Setting & ParticipantsSemi-structured interviews with 96 participants (response rate, 67%), including patients with stage 4 chronic kidney disease (n = 30), new hemodialysis patients with (n = 18) and without (n = 20) permanent access (arteriovenous fistula), family members (n = 19), and kidney health care providers (n = 9).Analytical ApproachThematic analysis.ResultsPatients reported differential levels of behavioral activation toward access creation: avoidance/denial, wait and see, or active intention. 6 core themes were identified: (1) lack of symptoms, (2) dialysis fears and practical concerns (exaggerated fear, pain, cost, lifestyle disruptions, work-related concerns, burdening their families), (3) evaluating value against costs/risks of access creation (benefits, threat of operation, viability, prompt for early initiation), (4) preference for alternatives, (5) social influences (hearsay, family involvement, experiences of others), and (6) health care provider interactions (mistrust, interpersonal tension, lack of clarity in information). Themes were common to all groups, whereas nuanced perspectives of family members and health care providers were noted in some subthemes.LimitationsResponse bias.ConclusionsIndividual, interpersonal, and psychosocial factors compromise dialysis preparation and contribute to suboptimal dialysis initiation. Our findings support the need for interventions to improve patient and family engagement and address emotional concerns and misperceptions about preparing for dialysis.

Tumor re-growth, case outcome, and tumor scoring systems in rehabilitated green turtles with fibropapillomatosis.

Fibropapillomatosis (FP) is an infectious, neoplastic disease of major concern in sea turtle rehabilitation facilities. Rehabilitating sea turtles that undergo tumor removal surgery often have tumor regrowth and may experience mortality. We evaluated tumor score, removal, and regrowth in rehabilitating green sea turtles with FP in 4 rehabilitation facilities in the southeastern USA during 2009-2017. Of 756 cases, 312 (41%) underwent tumor removal surgery, 155 (50%) of those had tumor regrowth within an average of 46 ± 45 d, and 85 (27%) had multiple (>1) regrowth events. Of 756 turtles with FP, 563 (75%) did not survive after admission into a rehabilitation facility, including 283 (37%) that were euthanized and 280 that died without euthanasia (37%), and 193 survived, including 186 (25%) released and 7 (1%) placed in permanent captive care. Tumor removal surgery increased the odds of tumor regrowth but also enhanced survivorship, whereas tumor regrowth was not a significant predictor of case outcome. Three FP tumor scoring systems were used to assign tumor scores to 449 cases, and differing results emphasize that tumor scoring systems should be applied to the situations and/or location(s) for which they were intended. FP tumor score was not a significant predictor for the event or extent of FP tumor regrowth after surgical excision. Under current rehabilitation regimes, outcomes of rehabilitation for tumored turtles have a low probability of success. The results of this study may be used to help guide clinical decision-making and determine prognoses for rehabilitating sea turtles with FP.

Medicine at the border: resort to afghans health professionals in a humanitarian emergency context

Calais is a “border area” (Cuttitta, 2015). In 2014, the increase in the number of exiles forced the hospital to develop its medical team attached to the permanent health care access service (PASS), which provides free hospital medicine for vulnerable patients without social security coverage. The rapport of professionals towards precariousness has been the subject of several sociological studies that have shown that caregivers in hospitals can express disgust towards patients at the margins....

The effect of a purpose-built memory support unit on the transition to high level dementia care; Perspectives of multiple participants

BackgroundAustralia faces the challenge of an ageing population. The incidence of people with dementia unable to live in the community is expected to rise leading to demands on care facilities to provide specialised care. This paper reports on the effect a purpose-built Memory Support Unit has on multiple participants during the transition from home, or an aged care residence, to high level dementia care. AimThe aim of this research was to understand the effect of a purpose-built Memory Support Unit on the experiences of those with dementia who are transitioning into this environment, their family or carers and staff. MethodA qualitative descriptive methodology was adopted to frame the research. Face-to-face interviews were conducted with nine family members, two residents and three Registered Nurses. FindingsA purpose-built Memory Support Unit may have a positive effect on the older person, their families, carers and staff, thus improving the experience of all participants as the older person transitions into dementia care. Optimising design of the physical environment may foster a more person-centered orientation to care and positive outcomes for residents, family members or carers and staff. ConclusionsPurpose built environments may have a meaningful subjective effect on the wellbeing of older people during the transition from their residence to permanent dementia care, their family, carers and staff. It is recommended that architects, funding agencies and aged care providers engage with the growing body of evidence that purpose-built environments, such as the Memory Support Unit, to enhance the quality of the experience of those transitioning to high level dementia care, their family or carers and staff.

Children–plant interaction using therapeutic horticulture intervention in a Romanian school

Abstract Nature, childhood, and ecopsychology can to be connected in the landscape of a schoolyard. The landscape architecture of the natural environments serves as a wide-open green space for outdoor activities, creating imaginative and inventive urban environmental layouts and connecting natural elements. School-based green experience, either indoor or outdoor, can be a physical and mental activity for children. In the case of individuals, it makes` easy to access a natural, green environment and to be actively involved in a natural setting, developing either social and/or cognitive functions and improving concentration and creativity. Therapeutic horticulture activity, such as planting indoor plants, can be a good experience for developing team work, the proprioceptive (kinase) receptors, affectivity, socialization, permanent care, and responsibility. The potential benefits of ornamental plants for children involved in public education include spending time in outdoor spaces, fresh air and sunshine, experiencing a sense of control, and being exposed to sensory stimulations. Physical and psychological education based on therapeutic horticulture activities in Romanian schools, such as planting and green care, can provide important opportunities for children to develop their attachment to nature, offering sustainable education solutions to an active part of the natural environment.

Care preferences of the German population: the option of assisted residential groups

There has been asteadily growing trend for years towards assisted residential groups for seniors. Nevertheless, the proportion of persons living in such residential groups lags far behind that of traditional retirement homes, which are often viewed as undesirable. The preferences of the German population when it comes to living arrangements and nursing care in old age. Who is interested in living and being cared for in residential groups for seniors and why? Analysis of data obtained by the Allensbach Institute for Demoscopy (Institut für Demoskopie Allensbach) particularly from surveys conducted for the DAK-Pflegereport 2017-2019. If they were in need of permanent nursing care most Germans would prefer to be cared for by relatives and/or ahome care service in their own home. Only 5% would prefer aretirement home from the outset, while aconsiderably greater proportion would consider alternative types of nursing care and 20% would choose care that is provided in aresidential group setting; however, the desire for such alternative care has only been realized by amaximum of 2% of persons in need of care. Women express above average interest in assisted residential groups. Many feel that such residential groups are especially suitable for people with dementia. There are different reasons why people are interested in residential care arrangements, whereby avoiding loneliness and the mutual support residents can provide to one another are cited particularly often; however, practical factors also play arole. Given the widespread desire to live in assisted residential groups, the question arises as to why so few people have made use of this residential arrangement and how it might be possible to better meet the needs of those persons who are interested in residential group living.

EXPERIENCES OF OLDER PEOPLE AND INFORMAL CAREGIVERS WITH LIVE-IN MIGRANT CARE WORKERS IN BELGIUM

The increasing number of older people has a significant impact on the organization of care in European countries. Despite the availability of formal care services, adequate solutions are still missing and older people themselves search for alternative strategies to meet their care needs. For example, a recent tendency is to call upon help of migrant care workers. In Belgium, research concerning this often invisible care solution remains absent. Therefore, the study at hand explores the experiences of the older care users and their informal caregivers and examines how this care can increase their well-being. Eight in-depth interviews with older people who rely on live-in migrant care workers, five interviews with professionals and one focus group with experts have been conducted. This study found that live-in caregivers relieve the informal carers, guarantee the presence of permanent care 24/7 and enable older people to live longer at home.

Geographical accessibility to permanent care centers of family doctors from Bihor County, Romania

Abstract Accessibility (geographic or spatial) to health services is a component of health care services access that through measurement can assess inequities in health. Geographical accessibility can be measured using a geographic information system (GIS) where travel time is calculated from the patient’s home to the place where a service is delivered. Permanent care centers of family doctors (PCCs) are units providing family medicine services (consultations, injections, solving minor emergencies) outside the work schedule of family doctors (night and holiday), for overloading prevention of emergency hospitals services by direct addressing or by calling to the unique emergency number 112. Bihor County has 617118 inhabitants in the 101 administrative-territorial units (458 localities), 334 family medicine practices, and there were 34 PCCs. We intended to identify the number of localities in more than 10, 20 or 30 minutes of travel by car from the PCC (based on end-2018 data). A GIS was created using the QGIS application, which includes layers: the county border, the 454 localities and the georeferenced addresses of PCC. Using the ORS Tools plug-in, the appropriate isochrones were created. Then overlapping isochrones and localities (points), the number of localities for which the travel time to the nearest PCC is greater than 10, 20 and 30 minutes, respectively, was obtained. The time needed for the inhabitants to reach the PCC is: more than 10 minutes for 247 localities; more than 20 minutes for 81 localities and over 30 minutes for 10 localities. The results are presented in the form of maps and in tabular form (localities). Using GIS, accessibility to medical services in a territory (city, county, country) can be measured. The application of free GIS software, QGIS, requires hardware, staff training, procedures (for work and decision-making) to research and improve population access to health services. Key messages Access to health services can be assessed using geographic information systems. The use of appropriate maps facilitates decision making to optimize health services.

Older women’s patterns of home and community care use and transition to residential aged care: An Australian cohort study

ObjectiveTo examine whether patterns of home and community care (HACC) use and person-based characteristics were associated with time to enter permanent residential aged care (RAC). Study designA prospective cohort study. The sample consisted of 8062 participants of the Australian Longitudinal Study on Women’s Health who used HACC services between 2001 and 2014. Main outcome measuresTime from first HACC use to enter permanent RAC. The median follow-up time was 63 months. Factors associated with time to enter RAC were identified using competing risk regression models. ResultsOf the 8062 participants, 60% belonged to the ‘basic HACC’ group, who used few services minimally; 16% belonged to the ‘moderate HACC’ group, who predominantly used domestic assistance with moderate use of other services; and 24% belonged to the ‘complex HACC’ group, who used many services frequently. Being a member of the complex HACC group was associated with a lower cumulative incidence of RAC than basic or moderate HACC (chances 15% versus 30% by the median observation period, p < 0.01). Living in a remote/outer region (sub-distributional hazard ratio (sdHR) = 0.83, 95%CI: 0.74 – 0.93) was associated with delayed admission to RAC. Meanwhile, earlier admission was associated with living in an apartment (sdHR = 1.29, 95%CI: 1.20–1.40) or a retirement village (sdHR = 1.54, 95%CI = 1.38–1.72), having a physical functioning score <40 (sdHR = 1.16, 95%CI = 1.05–1.25), and falls with injury (sdHR = 1.15, 95%CI = 1.05–1.25). ConclusionsOur findings highlight the importance of providing more community care services, age-friendly housing, falls prevention and physical activity programs to reduce inappropriate admission to RAC.

Young people in aged care: trends in the use of aged care services by younger Australians, 2008–2016

Purpose : To determine incidence rate of aged care service use between 2008–2009 and 2015–2016 by younger Australians and the yearly rate of change. Material and methods A population-based epidemiological study was conducted using publicly available datasets from the Australian Institute of Health and Welfare and Australian Bureau of Statistics. The incidence of service utilization by younger people (<65 year) and per 10,000 citizens 0–49, 50–54, 55–59, and 60–64 years old per year was estimated. Negative binomial regression models were used to estimate incidence rate ratios. Results Between 2008–2009 and 2015–2016 the number of younger people accessing services increased for home care services by 103.2% and transition care by 131.9% but decreased for permanent residential care by 0.4%, and respite care by 2.4%. Permanent residential care incidence use decreased for the overall population (incidence rate ratio = 0.98, p < 0.001) and in those 55–59 years old (incidence rate ratio = 0.97, p < 0.001) and for respite care incidence use decreased in those 0–49 years old (incidence rate ratio = 0.93, p = 0.001). The incidence use of home care increased in the overall group (incidence rate ratio = 1.04, p < 0.001) and in those 50–54 (1.08, p < 0.001) and in those 55–59 years old (incidence rate ratio = 1.03, p < 0.001). The use of transition care services increased significantly in all age groups (overall incidence rate ratio = 1.09, p < 0.001). Conclusions The overall use of permanent residential care has decreased along with the use of respite in the youngest people, and the use of home and transition care services have increased. Efforts to keep young people out of residential aged care may have redirected them to home care services. Implications for rehabilitation The number of young people (<65 years old) with disability using aged cares services in Australia has increased significantly between 2008–2009 and 2015–2016. The overall use of permanent residential care has decreased along with the use of respite care, and the use of home and transition care services have increased, which should be encouraged. Development of targeted rehabilitation support programs to support young people with disability housed in residential aged care may help to better cater their care needs. Development of transition pathways to shift young people with disability to appropriate support programs may help to reduce the number of younger people with disability in aged care services.

Recusa de procedimentos em Hospital de Reabilitação: análise bioética

Do ponto de vista bioético é importante analisar as causas de conflitos na recusa da realização de procedimentos durante a internação de pacientes em Hospital de Reabilitação. Objetiva-se descrever a recusa dos procedimentos em Hospital de Reabilitação e analise à luz da bioética. Questionários foram aplicados a enfermeiros sobre o motivo da recusa de procedimentos e as consequências no atendimento. De 190 internações durante um mês, 20 recusaram procedimentos na enfermaria, 55% mulheres, 61 anos de idade, 75% com grau de escolaridade até o ensino médio, 75% apresentavam comorbidades, 65% com indicação cirúrgica. O tempo de internação foi em média de 27,5 dias, 10% recusaram procedimentos, entre estes de locomoção e de enfermagem, obteve-se consenso em 50%, houve consequências no atendimento em 55% destes. Os profissionais de saúde estão cientes de que não é possível realizar cuidados sem o consentimento do paciente, todavia isso pode gerar impacto nos cuidados ao paciente. É importante que o paciente entenda as informações que lhe foram prestadas e as repercussões das suas decisões sobre o seu atendimento e tratamento, especialmente em reabilitação, que exigem cuidados duradouros ou permanentes, a depender do grau de dependência física e psíquica.

How do I stand compared to agency workers? Justice perceptions and employees' counterproductive work behaviours.

To test the influence of comparative procedural justice on the counterproductive behaviours of permanent nurses and care attendants who work with agency workers, and explore whether the perceived climate of competition between permanent and agency workers alters this relationship. Despite steady reliance on agency workers in the health care sector, there is a dearth of research on the reactions of permanent employees who may respond negatively to the presence of this external workforce. Questionnaires were distributed to employees of three long-term care facilities and their supervisors. Hypotheses were tested using moderated mediation analyses on a sample of 232 employee-supervisor dyads. Comparative procedural justice was indirectly related to counterproductive behaviours via employees' organization-based self-esteem. This relationship was weaker when perceived climate of competition was high. Promoting high levels of comparative procedural justice among permanent employees, rather than status differences with agency employees, should avert behaviours that could harm organizational functioning and therefore patient care. We discuss the leadership challenges to support neutral treatment and avoid the development of a competitive climate between permanent and agency workers (e.g., politics based on respect and collaboration, positive leadership).

Trends in the utilisation of aged care services in Australia, 2008\u20132016

BackgroundAged care support services in Australia are delivered through home care packages, permanent residential care, respite care and transition care. This study aimed to determine age and gender specific incidence rates of aged care service utilisation in Australia between 2008-09 and 2015–16.MethodsThis is a population-based epidemiological study of people accessing aged care services in Australia. The trends and characteristics of people (over the age of 65 years old) accessing aged care services in Australia were evaluated, using data (2008–09 and 2015–16) from the Australian Institute of Health and Welfare and Australian Bureau of Statistics. The yearly utilisation incidence rates (per 1000 people) per service type were calculated and changes in incidence rate ratios (IRR) of service utilisation for the study period were estimated using Poisson regression models.ResultsThe proportion of older Australians aged ≥65 years who used aged care services remained similar between 2008-09 (5.4%, N = 208,247) and 2015–16 (5.6%, N = 248,669). However, the incidence use of specific services changed during the study period. Specifically, admissions into permanent residential care decreased (from 23.8/1000 people in 2008–09 to 19.6/1000 in 2015–16, at a IRR of 0.84/year, p < 0.001) but increased for transition care (from 4.3/1000 in 2008–09 to 6.6/1000 in 2015–16, at a IRR of 1.57/year, p < 0.001) and home care packages (from 8.04/1000 in 2008–09 to 12.0/1000 per 1000 in 2015–16, at a IRR of 1.52/year, p < 0.001). Between 2008-09 and 2015–16, the greatest changes in IRR were observed in males aged 80–89 years accessing transition care (IRR = 1.68/year, p < 0.001). A higher proportion of people aged between 80-89 years (≥45%), females (≥60%), Australia born (≥ 60%) and English speakers (≥80%) used all the service types.ConclusionsPatterns of service utilisation for aged care services changed over the study period with a decrease in incidence of individuals accessing permanent residential care but increased for other service types. This finding reflects changes in attitudes regarding ageing in place and policies. These findings are helpful to inform key stakeholders on service planning to further improve quality of the aged-care services in Australia.