Residential Aged Care In Australia Research Articles

Reform and reverberation: Australian aged care policy changes and the unintended consequences for allied health.

Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care. Data from the four available Quarterly Financial Reports from the 2022-2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy. The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6minutes per person per day in the first quarter, reported allied health minutes fell to 4.6minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3minutes per person per day. This is just over half the Australian average of 8minutes reported to the RCACQS in 2019. Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced.

Assessing infection prevention and control programs in residential aged care in Australia: A multi-methods cross-sectional study.

To assess infection prevention and control programs in residential aged care facilities. A cross-sectional survey and structured interviews from 10 residential aged care facilities in Victoria, Australia, were used. Infection prevention and control nurse leads from each facility completed a purpose-built survey based on best practice infection prevention control program core components, including staff training, policies and procedures, governance, and surveillance. Follow-up interviews with residential aged care staff, residents and family visitors were carried out to elaborate and verify survey data. Surveys from all 10 facilities were received and 75 interviews carried out. All facilities had an infection prevention and control lead nurse who had undergone additional training, and 60% of facilities had an infection prevention and control lead position description. All facilities had a committee to oversee their infection prevention and control program, and all had policies and procedures for standard and transmission-based precautions. One facility did not have a policy on healthcare-associated infection surveillance, and two facilities did not have an antimicrobial stewardship policy. All facilities provided staff training in hand hygiene and personal protective equipment use, but not all routinely assessed competency in these. The residential aged care facilities' infection prevention and control programs were generally in a strong position, although there were some areas that require improvement. Further assessment of the quality of infection prevention and control program components, such as content of education and training, and policies and procedures, and ongoing evaluation of programs is recommended. Geriatr Gerontol Int 2024; 24: 358-363.

P163: Closing the gap: Funded psychology in residential aged care in Australia.

Objective:Historically, older adults in residential aged care facilities (RACF) in Australia had no access to government funded psychology services despite high rates of anxiety and depression. Change Futures is a registered charity that provides funded psychology to more than 220 RACFs in south-east Queensland and northern New South Wales, Australia, and since 2015 has been providing free psychology services to older adults living in aged care, using a predominately provisional psychologist workforce. This presentation will discuss the model of service that is provided, and the findings of a recent outcomes report.Method:Data was collected via clinician entered eHealth records in the 2021/2022 financial year from 01/07/2021 to 30/06/2022. Outcome measures were analysed using six repeated measure t-tests to compare clinical change from first and last assessments.Results:A total of 2865 residents were seen in 17,754 individual sessions and 298 group sessions. Staff education was provided in 94 sessions with 838 participants, who worked in RACFs. The most common presenting issue was difficulties with adjustment (70%), comorbid anxiety and depression (28%), depression (27%), loneliness (18%), and anxiety (17%). Outcomes of the psychology program showed statistically significant improvements on all measures, including the Kessler 5 psychological distress scale, Geriatric anxiety scale, Patient health Questionaire-9, De Jong Gierveld Loneliness Scale, and Brief Adjustment Scale.Conclusion:The described service model resulted in significant improvements to the psychological wellbeing of older adults, and represents an effective and sustainable training approach for provisional psychologists.

The challenges facing residential aged care homes to participate in quality food and nutrition research.

There is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens. Qualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in-depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches. Four themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples. Several challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions.

“If There Isn’t Love, It Isn’t Home”: An Exploration of Relationship Qualities and the Meaning of Home for Residents in Aged Care

Exploring the meaning of home is essential for the quality of life and well-being of older people in residential aged care. ‘Home’ is a spiritual concept that is deeply personal and important for older people. Using a qualitative, phenomenologically-based methodology, the meaning of home for ten older people living in residential aged care in Australia was examined using in-depth interviews to draw out the depth of meaning around the home. A key finding of the study showed that ‘home’ means connection through meaningful relationships and meaningful connection to place. The current paper focuses on meaningful relationships required for an older person to feel ‘at home’ in residential aged care. Drawing on residents’ personal narratives, fresh insights are provided into essential relationship qualities, and suggestions are made on how quality relationships can be facilitated and maintained, both for and by residents, to increase a sense of homeliness in residential aged care.

Progressing Towards a Freer Market in Australian Residential Aged Care

The Royal Commission into Aged Care Quality and Safety has again focussed attention on the failings of the Australian aged care system. Residential aged care in Australia has become increasingly market-driven since the major reforms of 1997. The aims of increased marketisation include providing residents with greater choice, higher quality services, and increasing providers’ efficiency and innovation. However, marketisation is not meeting these aims, predominantly due to asymmetries of knowledge and power between residents and aged care providers. These asymmetries arise from inadequate provision of information, geographic disparities, urgency for care as needs arise acutely, and issues surrounding safety, including cultural safety. We propose a human rights framework, supported by responsive regulation, to overcome the failings of the current system and deliver an improved aged care system which is fit for purpose.

The dementia policies in Australia relating to the COVID‐19 pandemic

BackgroundAustralia has a population of 26 million, and on January 28th 2021, 28,794 COVID‐19 infections and 909 deaths. 685 deaths were at residential aged care facilities, and data from the Australian Bureau of Statistics revealed that 72.7% of the people who died of the coronavirus in Australia (up to 31 August 2020) had at least one pre‐existing chronic condition listed on their death certificate, with dementia the most common (noted on 41% of death certificates). This presentation will present and discuss the key Australian dementia policy interventions implemented during the pandemic.MethodA scoping review of published academic, media, policy papers, white papers, and grey literature was conducted. We extracted relevant information pertaining to policies relating to dementia care during the COVID‐19 pandemic.ResultThe Australian government is managing the COVID‐19 outbreak as a health emergency, and have developed and funded a comprehensive response. For the older population and those with ADRD, the key policies include the National Health Plans, specific plans for people with disabilities, telehealth expansions, mental health and wellbeing pandemic response plans, home delivery of prescriptions, the establishment of an Aged Care Health Emergency Response Operations Centre, and a National COVID‐19 Aged Care Plan. In Victoria, the Victorian Aged Care Response Centre was established. The Pfizer/BioNTech vaccine will be given to priority groups from February 2021, which include aged care and disability care residents and workers (people with dementia account for 52% of all residents in aged care facilities). Strict policies were put in place for aged care facility visitations, and for the aged care workforce, such as the use of personal protective equipment and limiting staff to work in only one facility. Advocacy bodies were also key, and Dementia Australia and Dementia Support Australia, for example, developed advice to support people experiencing behavioural and psychological symptoms of dementia during the pandemic.ConclusionThere are currently no active cases in residential aged care in Australia, zero locally acquired cases for several weeks, with the (minimal) new cases emerging from the hotel quarantine system. Health policies have managed to limit the spread of COVID‐19 infection in Australia.

How does antibiotic use in Australian residential aged care compare globally?: A systematic review and meta-analysis

Introduction: Inappropriate antibiotic use in residential aged care (RAC) is a concern globally. The World Health Organization recommends surveillance of antibiotic use as part of its strategy to curb antimicrobial resistance. A number of recent programs have been initiated to monitor antibiotic use in RAC; however, a global comparison of estimates from these is not available. We aimed to analyse the international literature to summarise antibiotic use in RAC by region, including for Australia.Methods: We conducted a systematic review, meta-analysis and meta-regression of key indicators of antibiotic use in RAC. Random effects meta-analyses with subgroups by region were conducted. Meta-regression compared use in regions (providing odds ratios [OR]), while adjusting for year of data.Results: Ninety articles reporting antibiotic use across 38 countries were included. Meta-analyses and meta-regression were conducted for point prevalence (n=123 estimates) and 12-month period prevalence (n=19 estimates) of antibiotic use. Data reported for other measures of antibiotic use (e.g. days of therapy/1000 resident days; defined daily doses/1000 resident days) precluded meta-analysis and were summarised narratively. People living in RAC in Australia had higher odds of using an antibiotic on a single day and over 12-months compared to other regions (e.g. Eastern Europe, Western Europe, Asia and the British Isles). Point estimates and odds ratios with 95% confidence intervals will be presented.Conclusion: Antibiotic use in RAC in Australia is higher compared to some regions. There is a need for targeted antimicrobial stewardship programs in RAC to reduce unnecessary antibiotic use in this population. Introduction: Inappropriate antibiotic use in residential aged care (RAC) is a concern globally. The World Health Organization recommends surveillance of antibiotic use as part of its strategy to curb antimicrobial resistance. A number of recent programs have been initiated to monitor antibiotic use in RAC; however, a global comparison of estimates from these is not available. We aimed to analyse the international literature to summarise antibiotic use in RAC by region, including for Australia. Methods: We conducted a systematic review, meta-analysis and meta-regression of key indicators of antibiotic use in RAC. Random effects meta-analyses with subgroups by region were conducted. Meta-regression compared use in regions (providing odds ratios [OR]), while adjusting for year of data. Results: Ninety articles reporting antibiotic use across 38 countries were included. Meta-analyses and meta-regression were conducted for point prevalence (n=123 estimates) and 12-month period prevalence (n=19 estimates) of antibiotic use. Data reported for other measures of antibiotic use (e.g. days of therapy/1000 resident days; defined daily doses/1000 resident days) precluded meta-analysis and were summarised narratively. People living in RAC in Australia had higher odds of using an antibiotic on a single day and over 12-months compared to other regions (e.g. Eastern Europe, Western Europe, Asia and the British Isles). Point estimates and odds ratios with 95% confidence intervals will be presented. Conclusion: Antibiotic use in RAC in Australia is higher compared to some regions. There is a need for targeted antimicrobial stewardship programs in RAC to reduce unnecessary antibiotic use in this population.

Impact of musculoskeletal conditions among those in residential aged care in Australia.

To determine the prevalence of musculoskeletal conditions, co-morbidity and functional limitations in older people in residential aged care in Australia and the association of musculoskeletal conditions with mortality. A retrospective cohort study using data from 490325 people in the Registry of Senior Australians was conducted between 2004 and 2014. The association of co-morbidity, health risk factors and functional limitations with musculoskeletal conditions was evaluated using logistic regression. Cox regression was used to examine the association with mortality. Overall, 40.2% [95% CI 40.1-40.4]) of residents had a musculoskeletal condition, which was associated with limited social (OR 1.16 [95% CI 1.14-1.19]) and domestic activities (OR 1.44 [95% CI 1.39-1.49]). Residents with musculoskeletal conditions had a 15% lower risk of mortality (aHR 0.85 [95% CI 0.85-0.86], P<0.001) compared to residents without. The presence of musculoskeletal conditions in older people in residential aged care negatively impacts activities of daily living and quality of life rather than mortality.

Transforming routinely collected residential aged care provider data into timely information: Current and future directions.

Electronic information systems are becoming increasingly common in residential aged care in Australia. These systems contain valuable data generated during day-to-day care delivery for older adults. These data (termed 'routinely collected residential aged care provider data') are currently underutilised, however have potential significant benefits for both care delivery and research purposes. Routinely collected residential aged care provider data are more readily accessible, contain up-to-date information and can be linked to existing national or state-based administrative data sets, while providing more granular details about care delivered at the coalface. The aim of this paper is to provide clinicians, researchers, policymakers and providers with an understanding of the strengths of these types of data, as well as identifying areas that require future development to maximise their potential to drive improvements in resident care and outcomes. These considerations include data quality, data standardisation and models for data governance, consent and consumer involvement.

Contextual factors influencing talk in Australian residential aged care

PurposeThis paper offers an exploration of contextual factors that influence carer-to-resident talk in Australian residential aged care.Design/methodology/approachA qualitative exploratory multiple case study methodology and a theoretical framework of service language were applied to explore the perspectives of 21 registered nurses, assistants in nursing, leisure and lifestyle officers, general managers and care managers at three residential aged care homes in Australia.FindingsThe findings demonstrate contextual factors related to the care home environment, the carer and the relationship between carers and residents that impede or enable carer-to-resident talk in residential aged care. Multiple factors related to the care home environment were found to impede carer-to-resident talk, including time pressures, staffing levels, team culture and the prioritisation of tasks. Factors related to carers had potential to either impede or enable talk, including carers' awareness of the importance of communication, level of experience and individual characteristics, values and attitudes. A strong relationship between a carer and resident built on knowledge of individuals was a key enabling factor.Originality/valueThe paper advances an understanding of factors that influence talk and interaction in residential aged care in Australia from carers' and care home leaders' perspectives. The findings can be used to support verbal communication management strategies aligned with a person-centred care approach, including training and development of staff, cultural change interventions and a review of care delivery procedures.

The new dynamics of residential aged care in Australia: continuity and change.

Objective This paper tests the hypothesis that increases in recorded dependency levels of permanent residential aged care clients are associated with reduced length of stay and higher turnover. A secondary objective is to compare the Aged Care Funding Instrument with its predecessor, the Resident Classification Scale, on a common schema. Methods Administrative data for all Commonwealth-subsidised residential aged care services in Australia from 2008-09 to 2018-19 were obtained from the National Aged Care Data Clearinghouse. More than 750000 episodes of permanent residential aged care were analysed. The categories from the two rating systems were mapped to a six-level schema, primarily based on the dollar value of the categories at the time of transition. Results There was a strong trend towards higher dependency ratings across admissions, residents, and separations. However, contrary to expectation, measures of system activity showed a slowing of the system: length of stay increased and turnover decreased. Conclusions The mapping of dependency rating schemes to a common rating enables the analysis of long-term trends in residential care dynamics. There is no evidence that the marked increases in reported dependency ratings led to accelerated system activity, consistent with an earlier study. This analysis forms a solid base for ongoing analysis of care appraisals in the context of a possible new rating scheme. It highlights the interplay between policy changes and provider behaviour, and the need for robust data to monitor care appraisals and system dynamics. What is known about the topic? Residential aged care subsidies are determined by care needs in relation to assessed dependency levels, using the Aged Care Funding Instrument since 2008, and before that, the Resident Classification Scale. Between 2008-09 and 2018-19, there was considerable growth in residents classified at more dependent levels, and this would be expected to result in greater turnover in the system. What does this paper add? This paper maps the rating schemes to a simplified, common rating that enables the analysis of long-term trends in residential care dynamics. It shows that the system is slowing, contrary to the trends expected if residents were more frail as the reported ratings imply. The paper examines possible explanations of these trends, and addresses policy implications. What are the implications for practitioners? In the context of a potential new client-dependency classification, this study shows the importance of robust measures of the dynamics of the system-and the underlying data-vis -à -vis the means by which client dependency is assessed.

Competition, prices and quality of residential aged care in Australia

We quantify competition in Australia's residential aged care sector and study how competition is associated with quality of care and prices in the sector. Competition is defined three ways: the number of competitors within a 10 km radius of a facility; the distance (in km) to the third closest competing facility; and Herfindahl-Hirschman index based on market share of facilities within 10 km. We further examine whether quality and price differ by ownership types (government owned, for profit, and not for profit), after controlling for competition. We find that more competition is not associated with better quality or lower prices. Governmentowned facilities, in comparison to for-profit and not-for-profit facilities, are found to provide higher quality in some domains but not in others, yet tend to charge lower prices than other ownership types. The results indicate the possibility of market failures in aged care. Two key sources of market failures, the lack of public reporting of quality of care and price transparency, should be addressed as policy priorities before competition can work in residential aged care markets.

Considering the new minimum staffing standards for Australian residential aged care.

Objective To compare the historical staffing patterns and organisational characteristics of Australian residential aged care facilities (RACFs) against the new minimum staffing standards recommended by the Royal Commission into Aged Care Quality and Safety (RCACQS). Method Retrospective data analysis was used to compare the staffing levels and characteristics of 1705 RACFs (for 4 years, 2016-19) with the three new mandatory staffing requirements. De-identified datasets were provided by the RCACQS, obtained under its legal authority. Results Only 3.8% of RACFs have staffing levels at or above all three requirements. Although many (79.7%) already meet the requirement to have a registered nurse (RN) on-site for morning and afternoon shifts, few have staffing levels above requirements for total direct care per resident per day (10.4%) or care provided by an RN per resident per day (11.1%). Historical levels of on-site RNs, total direct care, and RN care vary significantly across facilities of different size, location and provider scale. Conclusion The new staffing standards, to be mandatory by 2023, prescribe minimum requirements significantly higher than existing levels, particularly in care per resident per day. Each of the three requirements will likely have a differential effect for different types of RACFs. What is known about the topic? International evidence suggests that introducing mandatory minimum staffing standards tends to increase the amount of care provided by staff in residential aged care facilities (RACFs). However, the impact of staffing standards is influenced by the stringency of the minimum threshold relative to existing staffing levels, the capacity of organisations to increase their staffing levels, and the specific way the regulation is formulated. What does this paper add? This paper explores the potential implications of the three national minimum staffing standards, to be in force by October 2023, specifying total direct care, care received by a registered nurse (RN), and an RN on-site. By examining the existing staffing levels of Australian RACFs, it identifies the extent to which facilities already meet the new standards and the characteristics of facilities with staffing levels above and below the three requirements (individually and in combination). What are the implications for practitioners? The study informs both policy and practice in relation to the likely effects of implementing the national minimum staffing standards for residential aged care in Australia. It demonstrates that the new minimum thresholds are likely to require substantial increases in staffing across the sector, both in terms of all direct care workers and RNs. It also shows that the three requirements are likely to have a differential effect for RACFs of different size, location and chain affiliation, thereby guiding policy about the future needs for Australia's aged care workforce.

Variation in Provision of Collaborative Medication Reviews on Entry to Long-Term Care Facilities

ObjectivesResidential medication management reviews (RMMRs) are comprehensive medication reviews conducted by clinical pharmacists and general medical practitioners. RMMRs are the primary government-funded service to optimize medication management in Australian residential aged care facilities (RACFs) and are recommended for all new residents. This study investigated resident characteristics associated with timely RMMR provision within 90 days of RACF entry and national intrafacility variation in timely RMMR provision. DesignNational retrospective cohort study. Setting and ParticipantsIndividuals aged ≥65 years who first entered permanent residential aged care in Australia between January 1, 2012, and December 31, 2015, received at least 1 medication in the previous year, and were alive at 90 days post-RACF entry. MethodsResident characteristics associated with timely RMMR provision were determined using multivariate logistic regression. Crude and risk-adjusted funnel plots were used to examine intrafacility variation in timely RMMR provision. ResultsOf the 143,676 residents from 2799 RACFs included, 30,883 (21.5%) received an RMMR within 90 days. Resident characteristics associated with timely provision included dementia (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.02–1.08), primary language other than English (aOR 1.04, 95% CI 1.01–1.09), number of unique prescriptions dispensed in the previous year (aOR [per additional 5 prescriptions] 1.02, 95% CI 1.01–1.03), need for medication administration assistance (aORs ranged from 1.35 to 1.42, compared with residents self-managing) and facility remoteness (aORs ranged from 0.67 to 0.75 for residents outside major cities). The proportion of new residents receiving a timely RMMR ranged from 0% (n = 303 RACFs) to 100% (n = 4 RACFs). There were 174 RACFs (6.2%) in which ≥50% of new residents received a timely RMMR. Conclusions and ImplicationsAlthough there was some evidence that RMMRs are targeted to individuals with a greater burden of medication use and those living with dementia, considerable variation in provision exists nationally. This flagship medication review service is generally underutilized among residents of Australian RACFs.

COVID-19 and residential aged care in Australia

The aged care sector requires transformation. The havoc wreaked by the COVID-19 pandemic globally and nationally may create an environment where the required changes are lost to other priorities. Australia’s success with the emergency response and management of COVID-19 pandemic are in a large part due to inherent underlying geographic and population factors. When reflecting on this pandemic we must objectively examine the domains of governance, workforce, models of care, evaluation and finally, resources and infrastructure. The COVID-19 pandemic highlighted major gaps in each domain. A prudent approach is required if we are to guard against the high COVID-19 case fatality rate of residents in aged care homes and to progress with much needed long-term changes.

Meeting the needs of older people living in Australian residential aged care: A new conceptual model.

To report on the conceptualisation of a model for residential aged care in Australia. Three-stage approach involving initial model conceptualisation; extensive consultation with stakeholders to test and develop the model for feasibility and acceptability; and examination of whether the model addresses circumstances that arise in scenarios of organisational failure. A model consisting of five domains relevant to the experience of older adults living in residential aged care-health care; social inclusion; rights; personal care and re-ablement; and dementia management. This proposed model of residential aged care takes as its purpose the provision of person-centred care to older people with complex health issues, requiring end-of-life care, and/or living with dementia. This includes supporting dignity of risk and quality of life and enabling older adults to thrive.

Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life.

To compare the outcomes and costs of clustered domestic and standard Australian models of residential aged care. Cross-sectional retrospective analysis of linked health service data, January 2015 - February 2016. 17 aged care facilities in four Australian states providing clustered (four) or standard Australian (13) models of residential aged care. People with or without cognitive impairment residing in a residential aged care facility (RACF) for at least 12 months, not in palliative care, with a family member willing to participate on their behalf if required. 901 residents were eligible; 541 consented to participation (24% self-consent, 76% proxy consent). Quality of life (measured with EQ-5D-5L); medical service use; health and residential care costs. After adjusting for patient- and facility-level factors, individuals residing in clustered models of care had better quality of life (adjusted mean EQ-5D-5L score difference, 0.107; 95% CI, 0.028-0.186; P = 0.008), lower hospitalisation rates (adjusted rate ratio, 0.32; 95% CI, 0.13-0.79; P = 0.010), and lower emergency department presentation rates (adjusted rate ratio, 0.27; 95% CI, 0.14-0.53; P < 0.001) than residents of standard care facilities. Unadjusted facility running costs were similar for the two models, but, after adjusting for resident- and facility-related factors, it was estimated that overall there is a saving of $12 962 (2016 values; 95% CI, $11 092-14 831) per person per year in residential care costs. Clustered domestic models of residential care are associated with better quality of life and fewer hospitalisations for residents, without increasing whole of system costs.

Direct health and residential care costs of people living with dementia in Australian residential aged care.

ObjectivesThis analysis estimates the whole‐of‐system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.MethodsData were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.ResultsThe average annual whole‐of‐system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out‐of‐hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.ConclusionThis study provides the first estimate of the whole‐of‐system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom‐up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top‐down, population costing approaches are taken.

Missed care in residential aged care in Australia: An exploratory study

BackgroundThe phenomena of missed nursing care is usually measured through quantitative surveys that detail the specific tasks that are rationed or delayed, and the reasons why this is so. These studies report high levels of agreement within and across countries between the two major measures employed; the Kalisch’s MISSCARE tool and the RN4Cast Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Most of these studies have been conducted in acute care settings and demonstrate the impact of lack of human and other resources upon decisions to omit care. Less in known about missed care in residential aged care AimTo explore the frequency and causes of missed care in residential aged care in three Australian states: New South Wales, Victoria and South Australia. MethodsQuantitative and qualitative data from 922 respondents working in residential aged care to the MISSCARE survey were bought together to identify the tasks missed in aged care and reasons for this. FindingsRespondents report the omission of unplanned care (toileting and answering bells) and rehabilitative care. The primary reasons for missed care are staffing shortages and difficulties in meeting residents’ complex health care needs due to demands arising from increased resident acuity and fewer skilled nurses to meet this demand. ConclusionResident care is missed in residential aged care with staffing numbers identified as a key cause.