Residential Aged Care Context Research Articles

Social participation in Australian residential aged care: A human rights perspective.

The Royal Commission into Aged Care Quality and Safety emphasised the critical need for a human rights-based approach to protect the rights of older people in the Australian aged care context, including 'the right to social participation'. This topic is important because of the widespread social isolation and loneliness in Australian residential aged care. This article demonstrates how a human rights-based framework can provide guidance to governments in approaching issues involving the protection of older people's need for social connection in aged care. In doing so, the article considers examples of how the Australian government can ensure choice of living arrangement, individualised support and access to community services and facilities in the residential aged care context to better protect the right to social participation.

A Scoping Review on Attitudes towards Sexuality in Residential Aged Care

Objectives. Sexuality in residential aged care is a complex and often overlooked aspect of aged care. The attitudes of both staff and residents significantly influence how sexuality is perceived and addressed in these settings. This scoping review aims to compile, analyse, and identify gaps in the existing research concerning the attitudes of residents and staff towards sexuality within the context of residential aged care. Methods. The scoping review involved a systematic search across eight databases, yielding 469 unique articles, with 29 included studies. Results. Thematic synthesis within the selected studies disclosed three themes: hollow attitudes, postsexual residents, and organizational setbacks. Discussion. The results emphasize the significance of treating sexuality as a fundamental right, emphasizing that it should be not only acknowledged in theory but also implemented in practice.

Face Validity of Four Preference-Weighted Quality-of-Life Measures in Residential Aged Care: A Think-Aloud Study.

There is an increased use of preference-weighted quality-of-life measures in residential aged care to guide resource allocation decisions or for quality-of-care assessments. However, little is known about their face validity (i.e., how understandable, appropriate and relevant the measures are 'on their face' when respondents complete them). The aim of this study was to assess the face validity of four preference-weighted measures (i.e., EQ-5D-5L, EQ-HWB, ASCOT, QOL-ACC) in older people living in residential aged care. Qualitative cognitive think-aloud interviews were conducted using both concurrent and retrospective think-aloud techniques. To reduce burden, each resident completed two measures, with the four measures randomised across participants. Audio recordings were transcribed and framework analysis was used for data analysis, based on an existing framework derived from the Tourangeau four-stage response model. In total, 24 interviews were conducted with residents living across three residential aged care facilities in Melbourne, Australia. Response issues were identified across all four measures, often related to comprehension and difficulty selecting a response level due to double-barrelled and ambiguous items that have different meanings in the residential aged care context. We also identified issues related to understanding instructions, non-adherence to the recall period, and noted positive responding that requires attention when interpreting the data. Our findings provide further evidence on the appropriateness of existing measures, indicating numerous response issues that require further research to guide the selection process for research and practice.

Communities of practice in residential aged care: A rapid review.

Communities of practice (CoPs) have the potential to help address the residential aged care system's need for continuing education and quality improvement. CoPs have been used in healthcare to improve clinical practice; however, little is known about their application to the unique residential aged care context. This rapid review of CoPs for residential aged care was conducted to summarise the features of CoPs, how they are developed and maintained, and assess their effectiveness. MEDLINE and CINAHL databases were searched for studies published from January 1991 to November 2022 about CoPs in residential aged care. Data were extracted regarding the CoPs' three key features of 'domain', 'community' and 'practice' as described by Wenger and colleagues. Kirkpatrick's four levels of evaluation (members' reactions, learning, behaviour and results) was used to examine studies on the effectiveness of CoPs. The Mixed Methods Appraisal Tool was used for quality appraisal. Nineteen articles reported on 13 residential aged care CoPs. Most CoPs aimed to improve care quality (n = 9, 69%) while others aimed to educate members (n = 3, 23%). Membership was often multidisciplinary (n = 8, 62%), and interactions were in-person (n = 6, 46%), online (n = 3, 23%) or both (n = 4, 31%). Some CoPs were developed with the aid of a planning group (n = 4, 31%) or as part of a larger collaborative (n = 4, 31%), and were maintained using a facilitator (n = 7, 54%) or adapted to member feedback (n = 2, 15%). Thirteen (81%) studies evaluated members' reactions, and three (24%) studies assessed members' behaviour. The heterogeneity of studies and levels of reporting made it difficult to synthesise findings. This review revealed the variation in why, and how, CoPs have been used in residential aged care, which is consistent with previous reviews of CoPs in healthcare. While these findings can inform the development of CoPs in this context, further research is needed to understand how CoPs, including the membership makeup, delivery mode, facilitator type and frequency of meetings, impact quality of care.

Māori realities, intimacies, and sexual expressions: reconceptualising consent to uphold kaumātua mana in aged residential care

Increasingly, kaumātua (Māori elders) in Aotearoa (New Zealand) live apart from whānau (Māori extended family) in residential care, where policies are shaped by post-colonial legislation and ethical principles that privilege individual rights over Indigenous priorities and rights. The communal context of residential care has created late-life opportunity for intimacy and sexual expression with new partners. These issues are addressed in the international literature, highlighting the benefits and complexities. Literature report there may be clashes between resident and family members’ wishes, and tensions around privacy and consent. This article considers survey data and semi-structured interviews with kaimahi (Māori care workers) and a kaumātua who were part of a larger study of staff, residents, and family in the residential aged care context. Post-colonial individualistic rights-based approaches do not necessarily fit with a Māori worldview. A Māori-led articulation of consent is essential to uphold the mana (authority, influence, power) of kaumātua and whānau.

Career mentoring in aged care: Not all it seems

Understanding the nature of career mentoring is important for improving the career experience of aged care workers. This study explores the career mentoring behaviours of sponsorship, coaching, advocacy, challenging assignments, exposure and visibility in the residential aged care context. Interviews were conducted with 32 aged workers from several occupations within the care context. It was found that career mentoring in the aged care context was limited. The mentor behaviours of coaching, sponsorship and advocacy were limited and there was no opportunity in aged care to provide challenging assignments or promote exposure and visibility. Organisations and managers can facilitate learning and personal development by providing inclusive training for all workers regardless of the need to meet professional registration requirements. Learning needs to be continuous as careers and clinical techniques evolve. Extension of existing mentoring programmes to include all care workers would improve overall quality of care in residential aged care facilities.

Provision of palliative and end-of-life care in New Zealand residential aged care facilities: general practitioners' perspectives

This exploratory study examined general practitioners' (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs' life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility's end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs.

Resident decision-making in the context of residential aged care

BackgroundWorldwide research confirms that older people value autonomy, want to remain independent and want control over their lives for as long as possible. Accordingly, the aged care system in Australia is undergoing major government-initiated reforms and is moving towards consumer directed care. AimTo explore the views of residents and care staff of resident decision-making, choice and control in the residential aged care context. MethodsResidents from across four residential aged care facilities in Adelaide were interviewed and staff focus groups were held. A thematic analysis of the data was conducted. FindingsResidents valued opportunities for privacy, communal engagement, productivity, negotiation with staff, and for opportunities to engage with systems of governance. How staff prioritise resident decision-making is influenced by the carer’s judgement of the resident’s characteristics and of the organisation’s rules and polices. DiscussionOlder people living in residential care are no longer living in their own home but instead are dealing with organisational rules and routines framed by others upon whom they are dependent. ConclusionThe day-to-day decision-making process for residents is likely to remain complex due to residents having to take into account rules, regulations and policies operationalized through organisational channels.

A systematic review of instruments for measuring outcomes in economic evaluation within aged care.

BackgroundThis paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector.MethodsOnline databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000.ResultsThe most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care.ConclusionIn the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0372-8) contains supplementary material, which is available to authorized users.

The role of government in influencing labour conditions through the procurement of services: Some political challenges

The increasing complexity of the employment relationship in supply chains poses challenges to the protection of labour standards internationally. While there is significant research on labour standards in international supply chains, there is much less on domestic supply chains and public procurement. Furthermore, the role of government in supply chain labour standards is under-researched. This article uses the context of residential aged care in Australia and New Zealand to highlight the inadequacy of the current role of government in promoting decent labour standards in domestic supply chains. We argue that the role of government in the employment relationship needs to be reconceptualised in order to recognise its agency as an indirect employer, and its consumer power, in public procurement.

Feeling Silly, but Feeling Good: : The Psychosocial Effects of Nintendo Wii Sports Games in Residential Aged Care Elders

Originally part of a mixed method, quasi experimental study, this paper focuses on the qualitative data obtained from the focus groups held with the residential aged-care (RAC) participants. The study examined whether the Nintendo Wii Sports (NWS) active video game (exergame) system could significantly improve the functional ability, physical activity levels and quality of life of 34 older adults (4 men and 30 women, 83 ± 8 yr) living in 2 residential aged care centres. Further qualitative data, supported the original themes of ‘feeling silly, feeling good’; ‘having fun’; and ‘something to look forward to’. This additional data provides more support for the utilisation of NWS exergames in the RAC context to enhancing sense of empowerment and personal achievement.

What carers and family said about music therapy on behaviours of older people with dementia in residential aged care.

This study sought to evaluate the effectiveness of group music therapy (MT) intervention on behaviours of older people with dementia. Reported here are qualitative data from five, semi-structured focus groups; two comprising a total of seven family members and three comprising a total of 23 staff members. A number of core themes emerged: temporality, effect and policy with a number of subthemes. The MT effect is tempered by the temporality of (i) the older person's dementia state, (ii) the session and (iii) the psychosomatic effect on the older person. Music therapy is perceived to (i) evoke memories and facilitate reminiscence, (ii) act as a diversion (has an instrumental value) and it is contentious to discount the (iii) dichotomy between music and therapist in terms of the overall effect. Finally, policymakers need to know that MT is (i) highly prized and more, not less, MT is recommended. Findings from this study illustrate that the timing of the MT session has consequences for the workflow in the residential aged care facility; MT has a psychosomatic effect and participants here evaluate this as temporal. Care providers and family members acknowledge the instrumental value of MT and its helping with cognition and exercise. They have mixed views about the effects of the music and the effect on the older person by the therapist but most definitely want policymakers to ensure more, not less, planned and better funded MT is part of ongoing care in the residential aged care context. Areas for future research and policy are also highlighted. These views on group MT in residential aged care can initiate critical reflection on current practices and systems. Research is needed exploring the timing and scheduling of MT sessions at different times in the day for older person with dementia exhibiting negative behaviours.

Physical and Psychosocial Function in Residential Aged-Care Elders: Effect of Nintendo Wii Sports Games

This mixed-methods, quasi-experimental pilot study examined whether the Nintendo Wii Sports (NWS) active video game (exergame) system could significantly improve the functional ability, physical activity levels, and quality of life of 34 older adults (4 men and 30 women, 83 ± 8 yr) living in 2 residential aged-care (RAC) centers. Change score analyses indicated the intervention group had significantly greater increases in bicep curl muscular endurance, physical activity levels, and psychological quality of life than the control group (p < .05). Analysis of the quotes underlying the 3 themes (feeling silly, feeling good; having fun; and something to look forward to) suggested that intervention group participants developed a sense of empowerment and achievement after some initial reluctance and anxiousness. They felt that the games were fun and provided an avenue for greater socialization. These results add some further support to the utilization of NWS exergames in the RAC context.

Applying workability in the Australian residential aged care context

The study is based on an innovative demonstration project which trialled the implementation of the Finnish 'workability' framework and research measures. It aimed, firstly, to test the applicability of the Workability Index (WAI) to the Australian residential aged care workforce, focusing on personal care assistants (PCAs), and secondly, to assess the effectiveness of actions aimed at improving workability. The facility manager implemented multidimensional 'actions' according to the workability framework. The Workability Survey (WAS) and WAI and intervention instruments were administered (n = 64). Completed responses to 'pre' and 'post' instruments formed matched pairs (n = 15). WAI scores increased significantly, by 3 points on average, after all 'actions' were implemented. The only significant 'action' was increasing the number of PCAs in high care. Workability provides a useful research workforce development instrument measuring interactions between aged care workers and organisational demands and the outcomes of 'actions'.

Literature review to identify factors that support implementation of evidence-based practice in residential aged care

The aim was to undertake a review of the literature on change management, quality improvement, evidence-based practice and diffusion of innovations to identify key factors that might influence the uptake and continued use of evidence in residential aged care. The key factors will be used to shape and inform the evaluation of the Encouraging Best Practice in Residential Aged Care Program which commenced in Australia in 2007. MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched using combinations of search terms. Searching focused on existing literature reviews, discussions of relevant conceptual and theoretical frameworks and primary studies that have examined the implementation of evidence-based practice in residential aged care. Keyword searching was supplemented with snowball searching (following up on the references cited in the papers identified by the search), searching by key authors in the field and hand searching of a small number of journals. In general, the period covered by the searches was from 2002 to 2008. The findings from the literature are often equivocal. Analysis and consolidation of factors derived from the literature that might influence the implementation of evidence-based practice resulted in the identification of eight factors: (i) a receptive context for change; (ii) having a model of change to guide implementation; (iii) adequate resources; (iv) staff with the necessary skills; (v) stakeholder engagement, participation and commitment; (vi) the nature of the change in practice; (vii) systems in place to support the use of evidence; and (viii) demonstrable benefits of the change. Most of the literature included in the review is from studies in healthcare and hence the generalisability to residential aged care is largely unknown. However, the focus of this research is on clinical care, within the context of residential aged care, hence the healthcare literature is relevant. The factors are relatively broad and cover the evidence itself, the process of implementation, the context within which evidence will be implemented and the systems and resources to support implementation. It is likely that the factors are not independent of each other. The set of factors will be refined over the course of the evaluation.

How is quality being monitored in Australian residential aged care facilities? A narrative review

'Quality of Care' is a difficult concept to measure, particularly within the context of residential aged care, which involves lifestyle issues as much as health issues. Recent years have seen an increased focus on quality within residential aged care. Yet, Australia does not have a structured and comprehensive quality monitoring system within this sector. While the Australian Accreditation Standards have been credited with contributing to improving care since their introduction in 1998, they are only considered to represent minimum (rather than optimal) standards of quality, and they do not sufficiently focus on clinical outcomes. Further, individual facilities might only be assessed against these standards every 3 years; within that time, there is much scope for quality variations to go unnoticed. This paper contends that collecting and analysing comprehensive clinical data from aged care facility residents constitutes an essential step in the process of monitoring quality in this environment. Such data can be used to formulate indicators of quality, that is, to create markers to highlight areas of clinical care that might be of questionable (or exceptional) quality, enabling more detailed investigations of care practices within a facility. The above processes could thus fill the current gap in quality monitoring that exists within the Australian residential aged care system, thus ensuring the provision of best-practice care to this vulnerable population.

Aggression in nursing: a time to look closely at aged care?

The nature and extent of aggression in the residential aged care context needs to be examined. Recognition of the unique challenges faced by nurses and carers working with people who have dementia must be addressed. (non-author abstract)

Quality of life measures for residents of aged care facilities: a literature review

AbstractWith increases in life expectancy and concomitant utilisation of residential aged care, there is a need to improve quality of long term care for older people. An essential outcome of such care is optimum quality of life (QoL), but it is difficult to define and measure, particularly within the context of residential aged care. The majority of QoL measures available either do not measure issues relevant to residents of aged care facilities or they measure areas that are not appropriate. Further, an over‐emphasis on health and physical function might produce a more negative picture of quality of life than actually experienced by this group of people. This paper explores available QoL measurement tools and argues for the utilisation of a standard instrument that can adequately measure QoL in residential aged care. Data from such a tool might assist policy makers in their decision‐making, if used on a national basis.